Does Evidence-based Design mean Paint-by-Number?

Enthusiasm for Evidence-based Design may have gone too far and that might stifle creativity and lead to prescriptive design. At least that is what one Designer said to me on the phone today.

Just because evidence-based design is a great idea (and it is!) does not mean that we have all the evidence yet. In fact, the scientists doing this type of research tell me that less than 5% of design decisions have solid evidence behind them.

Designers may assume that just because a few studies have been done on a given topic that there is a "right answer" on how to do something and they should not question it; after all, it has science behind it. But the research may be flawed, or it might not apply to their given situation. Furthermore, some kinds of questions can't be answered with numbers and therefore can't be reliably researched.

Until we have definitive evidence on a certain situation, what should we do? The Designer I was speaking with (who shall go unnamed) suggests that Designers should consider evidence-based design as only one of many tools that can be used in on a project. She urges:

• Using creativity to seek a "vision"
• Beware of making decisions that are too safe
• Take a more holistic view
• Consider meaning, consider the sacred
• Avoid "Painting by numbers"

Note: this all applies to Evidence-based Art too.

Comments

[anonymous]

There is a lack of understanding of what 'evidence-based design' is & its purpose. First, in the professional design world, we seek to find solid justifications that guide our decisions - thus 'evidence.'

Otherwise there would not be any guidelines for decision makers, and design would not build upon what has already been done effectively and purposefully. Why would we as designers not want to be informed and use this information to base their design decisions.? We learn from those that went before & build upon that. Isn't it the same in medicine, making decisions based upon those that came before? And the research provides grounded evidence as to what works best.

We cannot design purely on intuition, without decisions grounded in informed knowledge, particularly when we are designing for a vulnerable population. Yes, there are so many unanswered questions - researchers in healthcare have just begun to tap into the most surface layer of interior environmental issues that affect patients, family & staff. I find that those that question 'evidence-based design decisions' are typically those that don't want their opinions challenged & don't really want to grow in knowledge, thus to become better in their given field.

Please do not quote me - but I enjoyed responding!

[Debra Levin, President and CEO, The Center for Health Design]

EBD is not meant to be a roadmap. I'm in complete agreement that what we don't want to get to is a cookie cutter approach to healthcare design, but to me, the evidence has only ever been a guideline that needs creativity added to it in order to create the appropriate solution for that client in that community.

We do have a long way to go in the area of research, and that to me is the exciting part. Every year it seems like we grow by light years in what we have learned and yet we still have so much more to uncover and learn.

[John P. Eberhard]

Henry:

There is a general misunderstanding of how evidenced based design might integrate with the architectural design process. There is not presently a "body" of knowledge from neuroscience that could be used for evidenced-based design. It will take ten to twenty years for that to happen.
When it is large enough this "body" of knowledge will be like the ones used for acoustical, lighting or structural design in present practice. I don't think architects feel constrainted by having these engineering tools for designing, and they are not likely to be anymore constrained by Evidenced-based-design from neuroscience.

[Rosalyn Cama]

Henry:

EBD is hardly prescriptive it is intended to spark innovation by building upon the foundation of known outcomes. If we do not measure and report our successes and failures then we, like Lemmings, follow the most current trend which may be wrong. If all projects followed an evidence-based approach, then we would look to the existing body of knowledge, build upon it, hypothesize a new or different outcome and then measure and report our findings for better or worst. It is here where we will advance the understanding of how to truly build healing environments. We have a long way to go and need more designers willing to take this approach.

Best!

[Xiaobo Quan]

No science can claim to have all the evidence. EBD is at its early developing stage. That’s exactly why more rigorous research is needed. However, we can do better if we make our decisions based on the available research evidence. We’ve already seen reports that EBD results in better outcomes. EBD has raised the bar for healthcare architecture. It challenges designers to be able to critically evaluate the evidence and creatively incorporate the evidence into design. At the same time, it provides new opportunities of artistic design.

[Riprap]

The term itself "evidence-based design" reeks of hubris. It is not design based on evidence, it is design justified by subjective studies.

[barbara crisp]

First, I will preface by saying that healthcare has transformed in wonderful ways over the last 20 years and I have high hopes for it's future vision. I want to remind that the education and training of architects and designers is one of problem solving and in so, seeking out and using the available tools that assist in reaching successful and meaningful design conclusions is a significant part of that. In my mind, EBD is a tool, and if understood as that, is another filter through which design energy can and should be channeled for best outcomes. As John Eberhard and Henry indicate, there is not a body of knowledge to date, nor do many employ the use of what is available. Until there is more documented knowledge and the filtered use of that knowledge, there must be a more precise use of the term EBD because a loose use does not necessarily result in best outcomes. As with all tools, they reflect the user. My concern is that much can be lost in coining a term such as this and allowing it to drive a building type, much the way I have perceived loss, misunderstanding, and not best outcomes with the term "healing environment" over time. I suggest that there are more applicable and useful terms to depict an environment that assists in the healing process. That aside, with loose terminology can come what I call prescriptive design - if you do xyz, you have a "healing environment" or you have properly used an EBD process. Based on the fact that many people with diverse knowledge and expertise have impact on design decisions, and many without a design background, it is critical to have the term understood, as well as the fact that it is one of many tools by which decisions are made in the design process, as part much bigger picture that encompasses vision, meaning, and aspects of the sacred.

[Jeni]

From my view EBD, although a laudable concept, currently lacks the rigor to call itself a science. For example, consider the private patient room that incorporates same-handedness, electronic medication administration, and decentralized nurse work areas with electronic medical record access. If this room is considered a prototype for a safer room, should we incorporate all these principles in our future designs? Or have just one or two design aspects actually contributed heavily to a safer room and the rest of the design features are neutral in terms of safety?
I appreciate the desire of our healthcare design industry to become more disciplined in our understanding of the impact of our designed environments and EBD holds promise. In these early days, though, we should consider some of the EBD results more informational and anecdotal, rather than hard science.

[Susan Mazer]

Coming from a non-designer, researcher point of view, Evidence-based Design is "Participatory Action Research." Introduced by Kurt Lewin as an outgrowth of ethnography, an action research design involves all the components described originally by Kirk Hamilton: Assessment of the standing situation (baseline), involvement with the organization; develop measurable objectives based on specific interventions. Adjust as you go along...and document, document, document. What the studies have shown are specific events (studies) from which generalizations can be derived. The implementation of a concept into a new situation, however, will demand variations of the original design, objectives, and measures. Eventually, what we have is a collection of similar studies pointing to concepts, practices, and related outcomes...

In review of what the scientific method calls for, double-blind studies, etc. an objectification of what can hardly be objective, which are experiential environmental outcomes...I think that the framework of Evidence-based design offers equally valid data. Remember, all studies do, for example in drug studies, is offer a statistical analysis of what happened when specific patient populations did specific things. And, the exceptions out number the rule.

The cookie cutter fear is a myth. There is no way, for example, one can write a healing song based on an analysis of a Mozart Sonata. Only one Mozart and one may be enough...

The concern I have, however, is that EBD will provide a good excuse to do nothing...a way for a hospital to resist changes needed because the data has not yet been collected in the form that will push them into doing something (anything).

A great discussion!!

[hdomke]

Susan,
"In review of what the scientific method calls for, double-blind studies, etc. an objectification of what can hardly be objective, which are experiential environmental outcomes...I think that the framework of Evidence-based design offers equally valid data."
Could you explain this further. I don't understand. Are you saying that EBD research can't be done with randomized double-blind studies?

"The concern I have, however, is that EBD will provide a good excuse to do nothing...a way for a hospital to resist changes needed because the data has not yet been collected in the form that will push them into doing something (anything)."
Interesting. That is the opposite of my concern. I'm worried that designers will jump too quickly to embrace tentative studies and use them to support prescriptive design, i.e. "Paint by number".