Academic journal article HERD : Health Environments Research & Design Journal

A Review of the Research Literature on Evidence-Based Healthcare Design

Academic journal article HERD : Health Environments Research & Design Journal

A Review of the Research Literature on Evidence-Based Healthcare Design

Article excerpt



A visit to a U.S. hospital is dangerous and stressful for patients, families, and staff. Hospital-acquired infections and medical errors are among the leading causes of death in the United States, each killing more people than automobile accidents, breast cancer, or acquired immune deficiency syndrome (AIDS) (Institute of Medicine [IOM], 2001; Klevens, et al., 2007a). The resulting yearly cost for U.S. hospitals is estimated to be $5 billion for hospital-acquired infections (Centers for Disease Control and Prevention [CDC], 2000) and $17- to $29 billion for medical errors (Kohn, Corrigan, & Donaldson, 1999). According to the IOM (2001) in its landmark Crossing the Quality Chasm report: "The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits" (p. 1). Problems with U.S. healthcare not only negatively influence patients; they affect staff. Registered nurses have a turnover rate averaging 20% (Joint Commission, 2002).

At the same time, a major boom in hospital construction is occurring in the United States and several other countries. The U.S. healthcare system is facing the confluence of the need to replace aging 1970s' hospitals, population shifts, the graying of the Baby Boom generation, and the introduction of new medical technologies. As a result, the United States will spend more than $180 billion for new hospitals in the next 5 years alone, and healthcare construction is projected to exceed $70 billion per year by 2011 (Jones, 2007). These new hospitals will remain in place for decades.

This once-in-a-lifetime construction program provides an opportunity to rethink hospital design and especially to consider how better design can improve patient and staff outcomes. Just as medicine has increasingly moved toward evidence-based medicine where clinical choices are informed by research, healthcare design is increasingly guided by rigorous research linking hospitals' physical environments to healthcare outcomes, and it is moving toward evidence-based design (EBD) (Hamilton, 2003). For example, the Center for Health Design Pebble Project includes approximately 50 healthcare providers and manufacturers committed to using EBD for their construction projects. The Military Health System has adopted EBD for a $6 billion capital construction program for its 70 hospitals, which serve more than 9.2 million people worldwide. Kaiser Permanente and its partners in the Global Health and Safety Initiative are using EBD as a strategy to increase triple safety for patients, staff, and the environment. The Global Health and Safety Initiative comprises partners that provide over 100,000 hospital beds.

This report is an updated and expanded version of a 2004 report, "The Role of the Physical Environment in the Hospital of the 21st Century" (Ulrich, Zimring, Quan, Joseph, & Choudhary, 2004). Research teams from Texas A&M University and the Georgia Institute of Technology conducted a new and more extensive search for empirical studies linking the design of the physical environments of hospitals with healthcare outcomes. The following questions are explored in this study: (1) What can rigorous research tell us about "good" and "bad" hospital design? (2) Can improved design make hospitals less risky and stressful and promote more healing for patients, their families, and staff? (3) Is there scientifically credible evidence that design affects clinical outcomes and staff effectiveness in delivering care?


This review followed a two-step process. First, we conducted key word searches to identify potentially relevant studies published in English. Thirty-two key words were used, referring to patient and staff outcomes (such as infection, medical error, pain, sleep, depression, stress, and privacy), physical environmental factors (hospital, hospital units, healthcare facility, etc. …

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