"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

Successful designers often find themselves remarking how project decisions had a tremendous effect on occupants’ satisfaction, client relations, and future projects. However, this information may go unshared, and the expertise gained in the process has limited utility beyond the project group and the advancement of individual knowledge. What if there was a systematic method of documenting the effect of design decisions on building occupants that also further informed individual and group-level work across your firm?

In spring 2010, a group of professionals from design, healthcare management, and public health came together to critically examine how research could be integrated into the healthcare interior design process. The goal of the group was to document steps in the design process in which research would benefit three user groups: designers, clients, and the firm. Findings were presented at a nationwide conference forum for interior designers, and a group of designers and executive-level management integrated the information into a tool for design professionals. The purpose of this article is to summarize the findings as a case study and begin a dialogue on interdisciplinary work inside the design and healthcare to benefit the future of healthcare design and firm wide success in applying research to the design process.

Early on, team members discovered the need to visually display how research could be integrated into the design process. A learning tool was created entitled the Design Research Diagram. The purpose of the tool is to clearly illustrate the timeline and opportunities to conduct research at every stage of the design process. To create an appropriate tool applicable to various projects, needs, timelines, and resources, the working group faced several challenges. The largest obstacle was how to define research in different contexts. Designers, researchers, and healthcare experts think differently about research. Stephen Hurst, an academic partner and former director of the Georgetown Simulation Center, said, “One of the biggest challenges in working with an interdisciplinary group is communication. Each specific group has a specific language, and the challenge is to translate that language into a common goal. At the same time, the potential for idea generation is exponential because you generate new ideas from several perspectives and you are not blinded by your own bias.” In creating the Research Design Diagram, group members discussed different types of research projects, challenges, and methods used to conduct the research. Below are two examples of research projects used to inform the tool:

Arlington Free Clinic
Type of Research: Pre and Post Occupancy Evaluation
Design Stage: Programming, Move-in, Post Occupancy

The design team, in conjunction with Texas A&M University, conducted pre- and post-occupancy evaluations in an effort to confirm or contradict realization of design goals, such as community appropriateness, wayfinding, sufficient lighting, and overall comfort within the new space, The unique features of the project made for an excellent case study and could contribute to the body of evidence based literature. Timely contact with a research expert was made during the pre-design phase. Design intent and user comments about the space were measured after the new building was completed. A comprehensive report on staff and patient perceptions on the various aspects of the space were captured and used to inform designers about the success of their approach. Feedback from staff, volunteers and patients indicated the new space was appropriate for the community, supported the needs of patients and feels bright, especially lighting levels at the entrance, reception, and waiting.

Georgetown Clinical Simulation Center
Type of Research: Quasi-Experimental Prospective Cohort Design
Design Stage: Pre-Design

An industry-academic partnership was formed, and there was an opportunity to conduct research on healthcare workers at the Georgetown University O’Neill Family Foundation Clinical Simulation Center. Recognizing the potential of a formal research study to inform evidence based design, a healthcare research specialist was brought in to design and execute the study using scientific approaches to document the connections between the design changes and workers’ responses. Two design changes were made to an operating room suite at the simulation center—lighting improvements and painted line segmentation to improve the visual reference points for tools. Next door, an identical room remained unchanged. As healthcare workers used both rooms to stimulate real patient scenarios using mannequins, research was conducted on the healthcare workers’ stress and alertness in both settings and then compared. Results are used to inform design decisions in hospital operating rooms.

These examples highlight the use of a multidisciplinary team approach and well-thought-out research plans. In both situations, interdisciplinary resources inside and outside the firm were used to guide the research initiatives. For designers interested in integrating research into their design process, the Design Research Diagram may be a valuable tool to start discussions and may lead to new perspectives and ideas about how to systematically document the effect of design decisions on building. In this case study, one of the most challenging steps was working interdisciplinary. However, through several sessions of knowledge sharing, the results helped to further each team member’s unique perspective on how to move the field of design research forward.

Whitney Austin Gray, LEED AP, completed a healthcare research specialist internship with Perkins+ Will's Washington, D.C., office. She is currently a Ph.D. candidate at the Johns Hopkins Bloomberg School of Public Health and the Department of Health Policy and Management. Her primary research is on the impact of LEED certified green building design on occupant health, safety, and stress in healthcare centers. She can be reached at waustin@jhsph.edu.

Past installments of "Designing for Health" include (click on title to access the full article):
• Altruism in the Profession—The Implementation of Social Responsibility
• How Green is Your Furniture
• Workspaces for Well-being
• The Cultural Differences of Latin American Countries and Their Desire for American Influence
• Light and Its Role in Patient Safety
• Research-Based Client Communication
• An Urban Clinic—Connecting with the Community
• Patient and Staff Safety in Behavioral Health Facilities
• A Harmonious Companionship—Rejuvenating State-of-the-Art