What is the Value Proposition driving Eveidence-based Design?

A Ray Pentecost III, DrPH, AIA, ACHA
Vice President, Director of Healthcare Architecture,
Clark Nexsen
(Click to download full paper)

The popularity of an evidence-based design model or at least a research-influenced design approach in healthcare facility development has soared in recent years, but in the wake of what some might describe as an enlistment frenzy in this cause ce´le`bre two questions emerge: “What value is being created by all of this carefully empowered design?” and “How does the healthcare system prioritise the values created by the design community?”

The first question seeks to differentiate between the impact of design and the value of design. There is growing understanding of what design features help in the retention of key medical and nursing staff. The value proposition question asks, “At what cost are we creating an attractive workplace, and is it worth it?” Or consider the growing understanding among researchers of the relationship between lighting, noise and distraction and medication errors.

The value proposition question asks, “At what cost are we willing to try to reduce medication errors through design, and is it worth it?” While design research professionals wrestle with the value determination of individual design features, or design feature “bundles” as some are calling them, healthcare administrative and financial leadership is asking the second value question, “If I cannot afford to do everything that the evidence is suggesting that I do, how do I decide which of these design bundles offers the greatest relative value and which ones can I afford to include on my project?”

Cost constraints suggest clearly that the goal of evidence-based design cannot be the “perfect” healthcare environment, because one quickly senses that the cost of that eventuality would be impractical. Nor would it be fair to limit a discussion of “value” to monetary value alone, but in a world of limited resources one has to move past the question of “What can we accomplish?” to the questions “What can we afford to accomplish?” and “What priorities will we choose to accomplish from among the world of possibilities?”

While there are a growing number of researchers looking at design, there are relatively few looking at the value of evidence-based design. This presentation will highlight the work of several who have begun the process and will offer for consideration the challenges of defining the value equation, the value currency, the applicability of cost benefit and cost effectiveness analysis to healthcare design, as well as the frontier of establishing a value vocabulary for healthcare design research.