How we use evidence-based design to improve patient outcomes

July 31, 2013 Stuart Elgie

It’s only when we examine what we have done that we can learn how something can be improved, changed or reinvented. 


What does research mean when we talk about architecture? Up until quite recently, it has most often been associated with the technical performance of a building. With the fossil fuel crisis in the early 1970s, the environmental performance of buildings was the focus of research endeavours. It involved looking at such things as insulation performance, heat loss calculations, energy used per square foot. The focus was on quantifiable, measurable things.

Over the last 15 to 20 years, however, researchers have looked at other aspects of design. And healthcare design has led the way. But this area of inquiry isn’t as easily measurable with scientific means.

Rouge Valley Health System - Ajax/Pickering Redevelopment

Patient fall prevention, for example, is a common focus of healthcare design research.  The question, “What causes a fall to occur?” is a more challenging subject to measure and quantify than, say, reducing heat loss in a building wall assembly.

Immediately, the environment, the space itself becomes a primary target for investigation and study. Did the design of the space in some way contribute to a fall occurring? More importantly, could the space have been designed in such a way to help avoid the fall from occurring?

The questions of inquiry flow pretty easily: Where are patient falls occurring? Was a fall the result of a patient moving from bed to washroom? Did it happen in the inpatient unit corridors? Was equipment in the way? Did the lighting have an impact? Was there glare from direct sunlight at a particular time of day? How was the patient feeling at the time? Were they sedated? Did they have specific sensitivities or impairments?

Tracking the answers to these questions is less ‘hard science’ and more of a ‘soft science.’ It is incredibly nuanced study. And, because of this, it requires different eyes – eyes which are sensitive enough to appreciate the varied impact that space has on us, yet still able define specific cause and effect.  

This type of research has led to the development of evidence-based design, most significantly, in design for health. The over-arching goal of evidence-based design is to improve health outcomes. It uses rigorously-developed study to do one or more of a few things:

  • To confirm an understanding based on intuition; 
  • To improve an existing condition; or 
  • To create an innovative new approach. 

For example, evidence-based design has confirmed something that a number of architects have intuitively known: Patients experience less stress when they have access to daylight and outside views. And, generally, when the patient experiences less stress, their chances for a positive health outcome are enhanced. Is this innovative? Not necessarily. But it’s really important to have that scientific backing so that, when windows and glazing are being configured, a patient’s perspective, and how they may be sitting, standing or lying down, is at the forefront of the designer’s concern. Because we know that a patient’s perspective affects their sense of wellbeing and supports their rehabilitation.

In these times of economic restraint, everything is questioned. So we as designers need to make sure that we take the long view and ensure that what we are doing is right for the ongoing improvement of healthcare delivery. For the recently opened Bridgepoint Health building in Toronto, the design team (Stantec, KPMB, HDR, and Diamond Schmitt), understood the importance of education and research in achieving Bridgepoint’s vision of a space that seemed less like a hospital and more of a community hub right from the beginning. We know that how we care for one another is a reflection of our culture and wanted to ensure those values were reflected in the building’s design. Bridgepoint operates under the same philosophy and is now carrying it forward with the Bridgepoint Collaboratory for Research and Innovation to help answer some of the questions of chronic disease, sharing that information back with the larger community that we’re all a part of.

This is not an easy undertaking. It takes time and hard work. It’s about understanding the nuances. Innovation rarely comes from the proverbial lightning bolt of inspiration.

Rather, innovation is about identifying a problem or issue, understanding a context, recording, measuring, analyzing, and trying to make sense of it all. Then, with that background, you project the future (one that creates a new or improved present), then test the hypothesis, measure and record again. Did the hypothesis come true? Finally, we need to share these efforts.

We need to spread the word about what we find so that others can have the benefit of our efforts. Even if you didn’t create something new, perhaps someone else will do so because of what you did. And, as a researcher, you may be the beneficiary of others’ investigations.

And that is the real benefit, proactively working together to create true environments of wellness, so amazingly consistent with the Bridgepoint vision.

While I don’t hold Winston Churchill out as a great architectural thinker or critic, he was an astute observer of people and culture, and he said, “We shape our buildings and, afterwards, our buildings shape us.” 

He’s right. When we create architecture in the built form, we live with its legacy for a long time. In the old Bridgepoint building, the staff developed habits in their delivery of care specific to its physical configuration and constraints. Now, Bridgepoint staff and patients are un-bending themselves to these old habits and developing new ones – our hope as designers is that the space has become more of an enabler for care than a constraint.

If we can be smarter and more enlightened when we design buildings, then it is not only Bridgepoint that will benefit, but our entire healthcare system.

About the Author

Stuart Elgie

Stuart is an architect and principal based in Toronto. His professional career includes the development of major projects spanning the healthcare, education, and mixed use sectors.

More Content by Stuart Elgie
Previous Article
What happens to your luggage when it goes behind the counter?
What happens to your luggage when it goes behind the counter?

Do you know what happens to your bag after you check it in at the airport? As a baggage system designer, I ...

Next Article
Why our brand refresh is all about "Design with community in mind"
Why our brand refresh is all about "Design with community in mind"

What an amazing impact our people have upon their communities and how passionately they work to make them b...