This is a very interesting topic and it illustrates some difficulties in the healthcare design industry with using an evidence-based design (EBD) approach to projects. EBD uses all types of evidence - published research study findings, expert opinion, previous experiences, vendor opinions, etc. HERD has published several articles now on how to evaluate the level of evidence, but EBD uses all forms of evidence and balances that with the owners own values, beliefs and preferences. EBD uses measurement to compare before states with after the design implementation state, so in this sense it is like comparative research.

Research informed design or research based design is NOT the same as EBD and the terms should not be used interchangeably. Research informed or based design is limited to using ONLY research findings to inform design and negates all other forms of evidence. Therein lies a problem - what if there isn't any research on a particular design feature or issue? Then what do you do? In EBD, you could use a different form of evidence other than research to guide your design decisions.

I feel that research informed design was a new term introduced to a field that was trying desperately to understand what EBD was/is and how to actually implement EBD in practice. Unfortunately, introducing the new term has complicated matters all the more. There is a place for research informed design, but when research findings are not available, we need to use any form of evidence available to guide design decisions and then measure the results, disseminate/share the findings (hopefully in HERD), so we have evidence again for the future.

Thanks for letting me comment on this.

Jan Stichler, DNS, RN, EDAC, FACHE, FAAN
Co-Editor of HERD Journal

My biggest concern about the use of the term Evidence Based Design (or EBD) is that it tends to negate the whole issue of who decides what evidence is relevant or indeed reliable. This is part of the issue that Marc Sansom refers to in that US-based research evidence may not be relevant to other health systems such as developing countries or those with a predominately publically funded health system (so-called 'socialised medicine')

It also tends to negate the importance of the input resulting from the tacit knowledge and experience of a good health architect which is more than simply ticking off EBD items on a kind of tactical or strategic list. As an aside, I note that most health architects now claim to use EBD in order to win contracts (and clients often ask for it). I suggest that often they don't really know what they are offering (or asking for?) All this tends to detract from the credibility of EBD or Evidence Informed design or whatever the correct term is (I am not buying into that debate) - clinicians often won't accept it unless it is directly relevant to the issue being discussed.

An example: when surgeons wanted to put scrub bays in the corner of an OR without any doors between the bays and the OR, we argued the case that this was a really bad idea from an infection control point of view and quoted standards, guidelines, informed opinion, precedents, etc, etc. Their trump card (which meant that they did what they wanted) was that there are no specific research studies (EBD) that looked at scrub bays in this situation - I noted that there are also no studies suggesting toilets or washing machines in ORs either and who would do that? (but that's another matter...just joking!)

So EBD has not got the credibility to be used in the same way that EBM does and probably will never do so. It is only part of a health architect's repertoire and needs to be used appropriately and rigorously but in my opinion, it will never be all that we need.

As designers, we offer more than that, our skills are not and should not be substituted with a check list of EBD type measures in the same way that a doctor's diagnostic skills are more than a checklist derived from EBM. Design quality derives from more than using EBD to design a hospital.

My current research as a doctoral student has started looking at definitions of 'design quality' and 'project success' from the point of view of various user group participants - and I suspect that EBD will only be a part of these definitions and perhaps not even a particularly large part...time will tell!