Evidence-based design is a process that bases decisions about the built environment on credible research to achieve the best possible outcomes. The Pebble Project is researching how design features in healthcare settings can affect patient safety, clinical outcomes, psychosocial outcomes, staff effectiveness, and physiological outcomes. Research has shown that factors like access to natural light and views can positively influence health outcomes like recovery from surgery and reducing length of stay, medication use, and need for stronger pain medications. The Center for Health Design and the Pebble Project are conducting research on how different design elements in various healthcare facility types like cancer centers, elderly care facilities, and clinics can impact outcomes. While upfront capital costs may be higher for evidence-based design, research

1. Improving Healthcare Outcomes by Design Evidence-based Design, the Pebble Project, and Home-based Care Ellen Taylor, AIA, MBA, EDAC

2. The Center for Health Design transforming healthcare environments for a healthier, safer world through design research, education, and advocacy The Center for Health Design is a non-profit 501C3 2

3. Thoughts for the day 3 QUESTION #2: Why does this matter? QUESTION #1: QUESTION #3: Can design really affect outcomes? What is evidence-based design? (and what is a Pebble?) QUESTION #4: What Research Is Being Done? QUESTION #5: What about cost?

4. THE PROCESS OF BASING DECISIONS ABOUT THE BUILT ENVIRONMENT ON CREDIBLE RESEARCH TO ACHIEVE THE BEST POSSIBLE OUTCOMES The Center for Health Design (www.healthdesign.org/aboutus/mission/EBD_definition.php) Q1: Evidence based design (EBD) Defined 4

5. The Pebble Project 5

6. The Pebble Project: a growing international context 6

7. Q2: why does this matter? 7 Patient Safety Clinical Outcomes Psychosocial Outcomes Staff effectiveness Physiological Outcomes

8. 8 Based on Henriksen, et al, The Human Factors of Home Health Care: A Conceptual Model for Examining Safety and Quality Concerns, December2009

9. Q3: Can Design Really Affect Outcomes? 9 Review of of Medical Records following surgery 10 years Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420-421.

10. 10 Brick Wall dayLOS +1 (p=0.025) Negative Comments +3 More (p=<0.001) medication doses Strongermeds (p<0.01)

11. Summary of Strategies and Outcomes 11

12. Q4:what research is being done? 12

13. Phase 1: Becker & Douglass, 2006 Aesthetics: Weill Greenberg Center - New York, NY, USA 13 Phase 2: Becker et al, 2008 Architects: Polshek Partnership, Ballinger

14. Technology access: Weill Greenberg Center - New York, NY, USA 14

15. Elderly & Disabled: Laguna Honda Hospital - San Francisco, California, USA 15 Architects: Anshen + Allen, Photos: © David Wakely

16. Elderly & Disabled: Laguna Honda Hospital - San Francisco, California, USA 16 Architects: Anshen + Allen, Photos: © David Wakely

17. Chronic Conditions: Froedtert Cancer Center, Milwaukee, Wisconsin, USA 17 Architects: OWP/P Cannon Design Photos: © Craig Dugan- Hedrich Blessing

18. Health through respite: Gardens & Nature 18 St. Alphonsus Regional Medical Center, Idaho MD Anderson Cancer Center, Texas Lake TriPoint Medical Center, Ohio Dublin Methodist Hospital, Ohio

19. Health like Home: Patient Room Design 19 Lake TriPoint Medical Center, Ohio Laguna Honda Hospital, California Lakeland Health and Healing, Michigan Dublin Methodist Hospital, Ohio Princeton University Medical Center, New Jersey

20. Healthcare Transitions: Clinics and ambulatory care 20 Planned Open Door Clinic, California Grace Hill Water Tower Health Center, Missouri Garfield Innovation Center, California La Clinica de la Raza: Fruitvale Transit Village, California

22. Wireless monitoring

23. Shared decision making

24. Self care

25. Health portals/ Health literacy

27. Technology Enabling design: Dublin Methodist Hospital - Dublin, Ohio, USA 23 Architects: Karlsberger

28. Technology Enabling design: Dublin Methodist Hospital - Dublin, Ohio, USA Architects: Karlsberger

29. $ THE TWO BOTTOM LINES ANNUAL OPERATING BUDGET ANNUAL CAPITALBUDGET Q5: Doesn’t it cost more? 25

30. 26

31. Ellen Taylor etaylor@healthdesign.org www.healthdesign.org http://clinicdesign.healthdesign.org/