An ethnographic study of the role of evidence in problem-solving practices of healthcare facilities design teams

Progressive efforts within the healthcare design community have led to a call for architects to use relevant scientific research in design decision making in order to provide facilities that are safe, efficient, and flexible enough to accommodate evolving care processes. Interdisciplinary design project teams comprising architects, interior designers, engineers, and a variety of consultants struggle to find ways to deal with the challenge of incorporating the evidence base into the projects at hand. To date there has been little research into how these interdisciplinary teams operate in the real world and especially how they communicate and attempt to integrate evidence coming from different sources into the architectural design that is delivered. This study presents an investigation of a healthcare design project in situ by using methods of ethnographic inquiry, with the aim of developing an enhanced understanding of actual collaborative healthcare design practices. A major finding is that ‘evidence’, as used in practice is a richly textured notion extending beyond just the scientific research base. The description and analysis of the observed practices is presented around two core chapters involving the design process of 1) the emergency department and 2) the inpatient unit. Each design episode, which depicts the complex socio-cognitive landscape of architectural practice, introduces how evidence, with its various types and representational forms, was generated, represented, evaluated, and translated within the interdisciplinary design team. Strategically utilizing various design media, including layout drawings and mock-ups, the architects represented and negotiated a set of physical design attributes which were supported by differing levels of scientific research findings, anecdotes, successful precedents, in-house experimental findings, and intuition, each having different affordances and constraints in solving design problems over time. Individually, or combined into larger “stories” which were collectively generated, the set of relevant evidence provided a basis for decision making at various scales, ranging from minor details within rooms to broader principles to guide design work over the course of the project. Emphasizing the role of the architects in translation of evidence, the design episodes provide vivid examples of how various forms of evidence shape the design of healthcare environments. The case observed in this research demonstrated that the participants formulated and explained their design ideas in terms of mechanistic arguments where scientific research, best practices, and anecdotal evidence were integrated into segments that formed causal links. These mechanistic models, as repositories of trans-disciplinary knowledge involving design, medicine, epidemiology, nursing, and engineering, expand the scope of traditional understanding of evidence in healthcare design. In facilitating design processes architects are required not only to become knowledgeable about the available evidence on healthcare, but also to use their meta-expertise to interpret, translate (re-present), and produce evidence in order to meaningfully engage in interdisciplinary exchanges. In re-presenting causal models through layouts or mock-ups, architects play a critical role in evidence-based design processes through creating a platform that displays shortcomings of available evidence and shows where evidence needs to be created in situ.Ph.D

El diseño basado en la evidencia : un análisis temático

This paper presents an observational study of the activities of an interdisciplinary design team tasked with designing a healthcare facility in a developing country. The intent of the team was to implement «evidence-based design». Tracking the disciplinary interactions of the participants, we investigate emerging issues concerning integration of evidence coming from different sources into the architectural design delivered. The study adopts a data-driven thematic approach in the analysis of the qualitative data datacollected. We discuss three themes –textures of evidence, operationalizing evidence and tools of integration– that emerge out of our qualitative analysis of evidence-based design practice.En este artículo se presenta un estudio de observación de las actividades de un equipo de diseño interdisciplinario encargado de diseñar un centro de salud en un país en desarrollo. La intención del equipo fue la implementación de «diseño basado en la evidencia». Se realizó un seguimiento de las interacciones disciplinarias de los participantes, investigando las nuevas cuestiones relativas a la integración de la evidencia proveniente de diferentes fuentes en el diseño arquitectónico. El estudio adopta un enfoque temático basado en el análisis de los datos cualitativos recogidos. Se discuten tres temas –evidencia de textura, evidencias operacionales y herramientas de integración– que surgen de nuestro análisis cualitativo de la práctica del diseño basada en la evidencia