2010 Survey of Design Research in Healthcare Settings; The Use and Impact of Evidence-based Design

by Ellen M. Taylor, AIA, MBA, EDAC

Published by The Center for Health Design, 2010

1.0 INTRODUCTION

1.1 Context

An unprecedented $194.5 billion in current dollars was spent on healthcare construction between 2004 and 2008 (Jones, 2009) . However, 2009-2010 marked a new economy—the Great Recession. Markets experienced financial losses throughout 2009, and December marked the second year of revenue declines of US architecture firms (Baker, 2010) . Based on survey results from October and November 2009, the 2010 Hospital Building Report (Carpenter & Hoppszallern, 2010) stated that respondents from one of every six hospitals indicated stopping a construction project in progress in 2009. Another 36 percent indicated projects had been scaled back, while 32 percent were not moving forward with new projects. Moving into 2010, columnist Robert J. Samuelson led his January 4 Washington Post/Newsweek article with the following: “One insistent question at the start of a new decade involves the lingering effects of the old: What scars will the Great Recession leave?”

As a result of the downward spiraling economy, several new considerations evolved while developing the 2010 Survey of Design Research in Healthcare Settings (Year 2). What effect would the economy have on the use of evidence-based design? Did people see the economy as a threat or barrier to the process? Were features being removed from projects?

According to the ASHE/HFM 2010 Hospital Building Report published in February 2010, the weak economy may be presenting a setback for the steady progress in the use of evidence-based design. While 51 percent of the survey’s respondents reported “Always” or “Mostly” using evidence-based design, some facility managers suggest the use of evidence-based approaches is not playing a large role in their projects.

With a focus solely on the use of design research in healthcare settings, results from this year’s survey can provide insight on these questions.

1.2 Survey Background

While use and acceptance of evidence-based design (EBD) has grown over recent years, we are still just beginning to learn how this knowledge is being translated into the design of new healthcare facilities. Working with Herman Miller Healthcare as a corporate partner, the Center for Health Design has completed the Second Annual Survey of Design Research in Healthcare Settings. A primary goal of the survey is to understand how research is being generated and applied to healthcare design. With participation from a diverse group of stakeholders involved in the healthcare design process, the survey results provide insight into many questions surrounding the use of research in healthcare design and set the stage for analysis of industry trends over time.

To measure these trends, the survey questions were structured around general categories including:

• awareness (design research and evidence-based design)
• information sources (design strategies and healthcare design trends)
• acceptance (definition and personal and industry opinions)
• applications of EBD features (use of specific design features and interventions)
• data collection (formal research, methods, analysis, and barriers)
• dissemination (how is information shared)

This report of survey results is organized into the same topics.

This year’s survey was conducted in the first quarter of 2010. The economy was still posting declines, but at a slightly slower pace than 2009. 

With more than 1,000 responses resulting in a 65.9 percent increase in participation, the results indicate only a few areas of statistically significant change. Results and significant shifts, some of which may be influenced by the current market conditions, are highlighted in the report.

1.3 Methodology

The 15-20 minute survey was conducted during the first quarter of 2010 and was developed in conjunction with an Advisory Council (AC) that reviewed the framework, respondent categories, topic areas, and questions.

The survey was announced through several e-mail lists, including a posting through the Vendome Publishing email list, and weekly e-newsletters through The Center for Health Design e-newsletter, the Pebble Project list, and the EDAC (Evidence-Based design Certification and Accreditation) news flash. The survey URL was also posted on several LinkedIn Group news announcements. The combined lists provide an audience of approximately 20-22,000 potential respondents. More than 1,000 took the survey for a response rate of approximately 5 percent. The completion rate of the survey was more than 83 percent.

Based on the respondents’ role (ie architect, vendor, academic researcher, etc), questions were posed about participation in healthcare design projects. Those involved in recent projects were asked a series of questions about activities during the planning, design, and completion of a project. Certain responses triggered skip logic to applicable areas of the survey. Those not involved in a recent project were asked several generic questions related to topics of public awareness and interest. Based on the responses and associated skip logic, participants were provided with percentage-completed information at selected points throughout the survey.

Questions with more response choices required a minimum number of responses to the lists (ie choose a minimum of five out of ten to fifteen selections). Some questions provided areas for open-ended responses.

To avoid participant fatigue and potential drop-out, two longer questions pertaining to the use of specific design features were incorporated as the last questions of the survey. Included features were limited to those with available evidence to support an improved outcome. Respondents could “write-in” features felt to be important but not part of the multiple choice selections.

An incentive of the chance to win a Herman Miller Leaf Light was offered to all of those completing the survey. The recipient was randomly selected from the interested respondents using a random number generator.

Data was exported from Survey Monkey into a Microsoft Excel-compatible file and subsequently imported into SPSS. A combination of Survey Monkey, Excel, and SPSS were used to complete data analysis that included descriptive statistics, cross tabulations, comparison of means and proportions, and non-parametric testing. All tests were conducted at a 95 percent confidence interval. Statistical review of the analysis was provided by Joseph Szmerekovsky, Ph.D., North Dakota State University College of Business.

1.4 Respondent Demographics

Respondents to the survey included: architects, interior designers, researchers, hospital facility-related staff, healthcare consultants, medical planners, hospital administrators (including C-Suite and non-facilities–related leadership), clinicians, and people in other relevant work categories. (see Figure 1 in PDF version). No significant changes were recorded in the percentage of respondents for the major categories. When grouped as Consultant Design Team, Provider Team, or Researcher (combining three research areas), the only significant change was a reduced number of respondents (from 12.9 percent to 4.5 percent) in the Researcher category (z = 2.73, p = 0.006).

As in Year 1, most respondents indicated more than 15 years in the healthcare industry (58.5 percent) with 39.0 percent indicating more than 15 years in their current role (see Figure 2 in PDF version). Nearly a third of respondents (29.7 percent) hold an executive leadership role within their organization, while 39.3 percent manage and direct others.

1.5 Respondent Projects

This year’s survey also captured information about the location of projects to determine the international scope of design research (see Figure 3 in PDF version). Results indicate that while respondents were primarily engaged in projects in the United States, 21.9 percent of related projects were based internationally.

Of the respondents, 93 percent indicated recent involvement with one or more healthcare design projects. Of those who were not involved in projects, nearly 80 percent expressed an interest in learning more about how design research could impact healthcare-related outcomes.