This paper explores the history of evidence-based medicine (EBM) in comparison to the relatively short history of evidencebased design (EBD). Throughout its development, EBM has encountered a number of challenges, including dealing with initial objections to the concept, creating safeguards to ensure rigor in research, supporting practitioners in their efforts to stay current with a growing body of research data, applying the literature to real-life situations, making decisions when literature to inform decision making is absent, and educating students and professionals to become EBM practitioners. The ways in which the field of EBM has handled these challenges provides a number of lessons for the relatively young field of EBD.
Key Words: Evidence-based medicine, evidence-based design, healthcare design, evidence-based practice
It may come as no surprise to architects who consider themselves evidence-based designers that evidence-based practices (EBPs) are not limited to the field of design. In fact, such practices are used in a number of industries. The fields of medicine, public health, nursing, social work, crime prevention, and education are a few of the many disciplines that employ an evidencebased approach to problem solving. Although each emphasizes the importance of basing decisions and actions on research literature, there are important differences in each field's approach to gathering, interpreting, and implementing evidence. To evidence-based healthcare architects, the fields of public health, nursing, and medicine are of particular relevance to the implementation of evidence-based design (EBD). Because many healthcare architects interact on a regular basis with clients who use an evidence-based approach to healthcare, it is important for designers to understand the similarities and differences between evidence-based healthcare fields and EBD. Architects will benefit from a comparison of these disciplines by learning techniques and theories of evidence-based medicine (EBM) that can be applied to improve the practice of EBD in healthcare.
A Brief History and Definition of EBD
The concept of EBD first gained formal recognition in 2003 in an article in Healthcare Design Magazine that described a four-level evidencebased process in which "An evidence-based designer, together with an informed client, makes decisions based on the best information available from research and project evaluations. Critical thinking is required to develop an appropriate solution to the design problem" (Hamilton, 2003, p. 20). This design process should lead to improvements in many areas, including "demonstrated improvements in the organization's clinical outcomes, economic performance, productivity, customer satisfaction, and cultural measures" (p. 20). The first step of the EBD process involves interpreting evidence from scientific literature and, accordingly, there is a growing body of evidence available to designers today. In fact, a 2004 study showed that there were more than 600 pieces of scientific literature relating specifi- cally to the effect of the environment on health outcomes (Ulrich, Zimring, Quan, Joseph, & Choudhary, 2004). A follow-up study, published in 2008, references additional research studies, further contributing to the body of healthcare design research literature (Ulrich et al., 2008). Once a designer has read and interpreted this literature, the EBD process continues with the formulation of a hypothesis based on the evidence, measurement of the results of the design innovation, publicly sharing the results, and ultimately meeting the highest academic standards by publishing peer-reviewed results.
Although this new EBD process was formally introduced in 2003, research on the relationship between the built environment and human behavior had been occurring for decades at some universities. Today, as designers have become increasingly aware of the relationship between research and design, the term "evidence-based design" has become a well-known and commonly used term in architectural practice-so common that some would argue that EBD has become a buzzword. …