Improvement opportunities for evidence-based design: an application of a critical realist's perspective

Both industry and academia consider Evidence Based Design (EBD) to be a positive way forward to improve the quality of the health service through better utilisation of rigorous evidence during the design process. The use of rigorous evidence is not a distinct activity of the design process; it materialises on different routes and activities scattered throughout the design process and which presents many prospects for improvement. The aim of the reported research is to identify how the evidence based design process could be improved. The research takes a critical realist's perspective. An overview of evidence based design, and critical realism are discussed in the back ground literature. Twelve semi-structured interviews with professionals working on healthcare built environment projects were used to gather data pertinent to their choice and application of different sources of evidence. Results validated a conceptually derived model of current practice of EBD and highlighted prospects for improvement. Interviews were thematically analysed to identify the rationale behind current practices and such themes were then used in deriving mechanisms and contingent conditions of the EBD. Six mechanisms that are causally efficacious prospects for improvement and four contingent conditions that flourish or suffocate these prospects were derived. Several suggestions are proposed several to improve EBD in the UK together with a discussion of the experience of adopting a critical realist's approach

Construction project change: Investigating cost and benefits

Cost overrun of projects is common in the construction industry. Changes to the original design and to the scope of works during the design development and construction phases contribute significantly to overall cost overrun of construction projects. However, scholars argue that change is inevitable, and some changes add value to the project. Therefore, it can be argued that the overrun of the initial construction cost through the changes made to the project may be insignificant compared to the reductions in life-cycle cost and whole life value of resultant built environments. Early research is presented here of a wider project seeking to evaluate the costs and value of proactive changes made during the construction phase with the intention to add value to the whole life of the project. Change control accounts and other related documentary evidence of two construction projects were investigated to identify changes made to the projects during the construction phase, and cost of those changes. Semi-structured interviews with quantity surveyors and project managers involved in those projects were conducted to enrich this documentary data. Analysis explored the contribution of proactive changes made with the intention to increase whole-life value to the overall cost overrun of construction projects, and clients’ understanding and willingness to pay for such changes. The next phase of this research will investigate the whole life value gained by the clients from these changes. Ultimately, this research aims to increase both clients and project managers understanding of cost and value of changes during the construction phase, with due consideration of the whole life cycle of construction projects

Building information modelling to support maintenance management of healthcare built assets

Purpose: This research investigated how digital capabilities associated with Building Information Modelling can integrate a wide range of information to improve built asset management decision making during the in-use phase of hospital buildings. Research methodology: A comprehensive document analysis and a participatory case study was undertaken with a regional NHS hospital to: review the type of information that can be used to better inform BAM decision making; to develop a conceptual framework to improve information use during the healthcare built asset management process; to test how the conceptual framework can be applied within a BAM division of a healthcare organisation; and to develop a cloud-based BIM application. Findings: BIM has the potential to facilitate better informed built asset management decision making by integrating: a wide range of information related to the physical condition of built assets; resources available for built asset management; and the built asset’s contribution to healthcare provision within an organisation. However, interdepartmental information sharing requires: a significant level of time and cost investment; and changes to information gathering and storing practices within the whole organisation. Originality/value: This research demonstrated that the implementation of BIM during the in-use phase of hospital buildings is different to that in the design and construction phases. At the in-use phase BIM needs to integrate and communicate information within and between the estates, facilities division and other departments of the organisation. This poses a significant change management task for the organisation’s information management systems. Thus, a strategically driven top-down organisational approach is needed to implement BIM for the in-use phase of hospital buildings

Macro level insurance for financing post disaster recovery: The case of National Disaster Insurance Policy in Sri Lanka

This paper evaluates the use of macro-level insurance to finance post-disaster recovery and reinstatement by investigating the case of the National Disaster Insurance policy implemented by Sri Lanka. The national scheme provided cover for all properties in the country against hazards such as flooding and provided compensation for those affected. Analysis of secondary data obtained from the organisations that managed the scheme showed that the scheme has delivered a much higher return compared to the total insurance premium paid, suggesting that the scheme has delivered a net positive benefit compared to the cost of the premium and can be considered a viable option. However, the existing secondary data did not reveal the values of other costs and indirect benefits associated with the scheme to compute a meaningful benefit-to-cost ratio. Further rigorous, evidence-based cost-benefit analysis is required to assess the cost-effectiveness of a scheme of this nature. A cost-benefit analysis approach based on an analytical hierarchy process is proposed as a possible solution to assess the cost-effectiveness of the scheme, which could be used by government organisations as an alternative, where analytical and research resources may be limited, to evaluate a range of disaster recovery financing options using stakeholder opinion

Offsite Construction Methods—What We Learned from the UK Housing Sector

Offsite construction has become popular in recent times due to the numerous benefits it offers compared to traditional construction methods. This paper explores the different offsite construction methods, the motivations for adopting these approaches, and the cost-effectiveness of these methods in the UK housing sector using multiple case studies. Firstly, the literature and data were obtained from various sources including professional body reports, industry reports, government websites, and journal articles. Following the review, twelve completed housing projects from the UK which used offsite construction approaches were analyzed. The review of these projects showed that different offsite methods were used in these projects. These include Structural Insulated Panels (SIPs), Timber Frames, Precast Concrete, Steel Frames, Volumetric Construction, Gyproc Habito Plasterboards, and Light Gauge Steel (LGS) technology. The key motivations for adopting offsite construction in these projects include the speed of construction, durability of the products, aesthetic considerations, thermal quality, low air leakage requirements, and quality of construction. Of the 12 cases, only two recorded a higher cost for the offsite construction method compared with the alternative using traditional approaches. The outputs of this paper provide evidence-based strategies which would inform practitioners on the best practices for adopting offsite construction methods and what to expect

Cost Benefit Analysis to Appraise Technical Mitigation Options for Earthquake Induced Liquefaction Disaster Events

Purpose- Recent earthquake-induced liquefaction events and associated losses have increased researchers’ interest into liquefaction risk reduction interventions. To the best of the authors’ knowledge, there was no scholarly literature related to an economic appraisal of these risk reduction interventions. The purpose of this paper is to investigate the issues in applying cost–benefit analysis (CBA) principles to the evaluation of technical mitigations to reduce earthquake-induced liquefaction risk. Design/methodology/approach- CBA has been substantially used for risk mitigation option appraisal for a number of hazard threats. Previous literature in the form of systematic reviews, individual research and case studies, together with liquefaction risk and loss modelling literature, was used to develop a theoretical model of CBA for earthquake-induced liquefaction mitigation interventions. The model was tested using a scenario in a two-day workshop. Findings- Because liquefaction risk reduction techniques are relatively new, there is limited damage modelling and cost data available for use within CBAs. As such end users need to make significant assumptions when linking the results of technical investigations of damage to built-asset performance and probabilistic loss modelling resulting in many potential interventions being not cost-effective for low-impact disasters. This study questions whether a probabilistic approach should really be applied to localised rapid onset events like liquefaction, arguing that a deterministic approach for localised knowledge and context would be a better base for the cost-effectiveness mitigation interventions. Originality/value- This paper makes an original contribution to literature through a critical review of CBA approaches applied to disaster mitigation interventions. Further, this paper identifies challenges and limitations of applying probabilistic based CBA models to localised rapid onset disaster events where human losses are minimal and historic data is sparse; challenging researchers to develop new deterministic based approaches that use localised knowledge and context to evaluate the cost-effectiveness of mitigation interventions

Does evidence based design for healthcare built environments limit creativity?

Research into therapeutic built environments and Evidence Based Design (EBD) has increased during the past three decades and the concept more readily adopted in practice. However, some practitioners believe that, as with any approach that builds on previous experiences to develop standards and guidelines, EBD could limit creativity. Given that creativity is often regarded as a major source of competitive advantage for a design, if EBD is seen as a barrier to creativity this may hinder its acceptance and application. The extent to which EBD could limit creativity during the design process is explored through a literature review. The findings suggest that only a smaller segment of evidence-based information, which relates to concept development, would affect creativity. Such information could foster information-driven design strategy and result in a lower level of creativity. However, properly implemented EBD strategies should not limit creativity since expert designers in EBD would use their knowledge (of therapeutic evidence) and expertness in the design process and need not follow and information driven strategy

Improving the resilience of existing built assets to earthquake induced liquefaction disaster events

LIQUEFACT was a EU H2020 funded project to investigate earthquake induced liquefaction potential across Europe and develop a series of tools to understand better the impacts that earthquake induced liquefaction disaster events have on the resilience of built assets and communities. A Resilience Assessment and Improvement Framework was developed to provide the theoretical underpinning for the LIQUEFACT project and to provide practical guidance on the assessment of built assets to Earthquake Induced Liquefaction Disaster events through the LIQUEFACT software tool and built asset management planning framework. This paper outlines the theoretical basis to the Resilience Assessment and Improvement Framework and built asset management planning framework and presents the results from a validation exercise through their application to a hypothetical healthcare scenario. The paper also describes the different stages of the research that led to the definition of the Resilience Assessment and Improvement Framework and built asset management planning framework. To this end the paper concludes that the Resilience Assessment and Improvement Framework and built asset management framework provide a longitudinal, holistic view of disaster vulnerability and resilience that can inform the selection of ground improvement mitigation actions to improve business continuity and resilience planning

Facilities management and earthquake risk reduction: The TURNkey project

Reducing vulnerability and improving resilience of the existing built environment to disaster events is a complex multidisciplinary challenge in which facilities managers need to contribute an understanding of the impact that a disaster event could have on both their hard and soft facilities. Facilities managers also need to identify potential operational, physical and corporate adaptations/mitigations that can support continued business function during and after a disaster event. This paper describes work in progress to develop an earthquake forecasting, early warning and rapid response system that business and critical infrastructure organisations can use as part disaster risk reduction and business continuity planning. Focusing on theory and methods, the paper considers the different aspects of resilience from a facilities management perspective and presents findings from a participatory action research programme that developed a series of use-cases to explore the potential impact of earthquake forecasting, early warning and rapid response on an organisation's vulnerability and resilience to an earthquake; and identifying physical, operational and organisational mitigation interventions that can reduce an organisation's disaster risk. The paper concludes the need for facilities managers to understand the different aspects of resilience and to apply the most appropriate to their hard and soft facilities management system