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.

 

2.0 FINDINGS

 

2.1 Awareness

Nearly all of those surveyed were aware of research that indicated improved healthcare-related outcomes (see Figure 4 in PDF version). Consistent with the results from last year, more than 80 percent of respondents stated they ”Regularly” or “Sometimes” used design research to make their decisions. No statistically significant changes in awareness of design research to improve healthcare outcomes were noted.

 

Of those who are not participating in healthcare building projects, awareness is also high, with 40.8 percent reporting “Always” or “Sometimes” using available design-related research to make personal healthcare decisions(see Figure 5 in PDF version).

 

Those participating in design teams were also asked about the awareness of the term evidence-based design (see Figure 6 in PDF version). Similar to the results for Awareness of Design Research (Figure 4), a majority of respondents (71.1 percent) indicated sometimes or regularly using evidence-based design.

 

Comparing Years 1 and 2, there was a statistically significant change in the responses for awareness of the terminology (χ² (4, N = 1,240) = 9.79, p = 0.04). Fewer respondents indicated using EBD “Sometimes,” and more indicated hearing about EBD but “not trying to use it yet.” As shown in Figure 7, the statistically significant change within the responses was an increase in those that have heard about EBD, but do not know much (z = -2.24, p = 0.025).

 

2.2 Gathering and Using Information

Figure 8 (see PDF version) shows sources used to gather information. The top two methods of “Always” gathering information continue to include past projects and Internet Searches. Although the order has switched in Year 2, the changes were not statistically significant. Despite increased use of webinars and blogs, respondent use of these methods to learn about healthcare design strategies is low.

 

The most number of significant changes were reflected in how information is gathered and collected (see Figure 9 in PDF version).

 

Significant changes included “Never” were as follows:

 

• conducting site visits (z = -1.97, p = 0.05),
• benchmarking for best practices (z = -2.57, p = 0.01),
• using research summary databases (z = -3.46, p = 0.00),
• participating in webinars (z = -3.42, p = 0.0), and
• reading blogs (z = -2.07, p = 0.04).

 

Significant changes were also seen with “Always,” including the following:

 

• attending conferences (z = 2.10, p = 0.04) and
• using research summary databases (z = 3.75, p = 0.00).

 

Figure 10 (see PDF version) compares methods for “Always” gathering information. With respect to specific resources used in healthcare design, the predominant source continues to be the FGI Guidelines for the Design and Construction of Healthcare Facilities. Other often-used resources include HealthCare Design magazine and the annual HealthCare Design Conference. The least awareness for resources surrounded the Institute for Family Centered Care, the RIPPLE database, and InformeDesign.

 

Two significant shifts in the information resources category were “Always” attending the annual Healthcare Facilities Planning Design and Construction (PDC) Conference (z = -2.09, p = 0.04) and “Never Hearing of” the online RIPPLE database (z = 3.04, p = 0.00) (see Figure 11 in PDF version).

 

2.3 Definitions and Acceptance

Evidence-based design has been formally defined as “the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.” (The Center for Health Design, 2008)

 

To determine understanding of the term EBD, the survey posed a question about opinions for the best definition of the term. Nearly two-thirds of respondents chose the definition posited by The Center for Health Design, a statistically significant increase from last year (see Figure 12 in PDF version).

 

The shift in responses between Years 1 and 2 with statistically significant increases were the aforementioned definition (z = -3.85, p = 0.000) and decreases in the choice “All of These” (z = 4.67, p = 0.00) (See Figure 13 in PDF version).

 

Survey participants were asked about numerous perceptions of EBD, as well as a personal opinion about overall industry perceptions. Additional choices were included in Year 2 to incorporate issues of economic conditions and the EBD process. Affirmative responses were highly correlated to positive opinion statements.

 

These included perceiving EBD as a way to do the following: improve outcomes, make informed decisions, improve the quality of life in healthcare, inform decision-making, and improve safety. EBD was also viewed as a forward-thinking trend, a way to preserve design intent during value engineering, a way to reduce long-term costs, and a competitive advantage for organizations. Consistent with Year 1, respondents do not feel EBD is a waste of money, a passing fad, a way to meet RFP requirements, or a marketing gimmick. More than one-third of the respondents did not feel EBD was at risk during an economic down-turn, and nearly 60 percent felt it was more important during a weak economy (see Figure 14).

 

Only two statistically significant changes in opinions between Years 1 and 2 were reported (see Figure 15 in PDF version). The first is in the area of improved outcomes (χ² (2, N = 1148) = 7.92, p = .019). In this area, there was an observed increase in the number of negative responses (z = -2.80, p = .005.) Even with this increase, however, the percentage remains small; the preponderance of opinion has a positive association with improved outcomes. The second change was in “not enough information available” (χ² (2, N = 1002) = 7.65, p = .022). There were fewer “Yes” responses (z = 2.10, p = .035), and many more did not think about this (z = -2.33, p = .020).

 

Aside from individual perceptions, respondents were also asked to gauge industry perceptions about EBD (see Figure 16 in PDF version). While few felt the perception was all or mostly negative, very few felt it was all positive. Nearly half gravitated toward a “Mostly positive” perception.  No statistically significant changes from Year 1 to Year 2 were reported.

 

2.4 Application of EBD Features

One of the primary goals of the survey is to determine the extent to which evidence is being incorporated into the design and construction of healthcare facilities by measuring trends over time.

 

The top general EBD features being incorporated into healthcare facilities all of the time are a healing environment that is nurturing, therapeutic, and reduces stress, alcohol-based hand-rub (gel) dispensers, and surfaces and finishes to reduce contamination(see Figure 17 in PDF version).

 

The EBD features specific to inpatient units “Always” used included: highly visible hand wash sink locations, alcohol-based hand-rub (gel) dispensers, segregation of airflow direction, surfaces and finishes to reduce falls, private (single-bed) patient rooms, and patient rooms with designated zones for patients, families and clinicians (see figure 17).

 

More detailed response data are shown indicating overall use for those working on multiple projects and those working on a single project (or single project with several enabling projects)(see figures 18 and 19 in PDF version).

 

Significant changes were recorded in the use of alcohol-based gel dispensers for both general outcomes (χ² (9, N = 1153) = 28.29, p = .001) and inpatient unit environment outcomes (χ² (8, N = 1006) = 24.13, p = .002) (see Figure 20 in PDF version).

 

Additional changes specific to inpatient units included the use of private patient rooms (Goodman and Kruskal tau = .002, p = .012), acuity adaptable rooms (χ² (9, N = 996) = 17.84, p = .037), segregation of airflow (χ² (9, N = 976) = 108.70, p = .000), and wide or double doors to patient bathrooms (χ² (9, N = 966) = 18.16, p = .033) (See Figure 21 in PDF version).

 

2.5 Data Collection and Evaluation

Of those participating in the planning and design of a healthcare facility, more than 60 percent of the survey participants indicated their organization conducted formal research to assess the relevance of design strategies for a particular project. This was a statistically significant change, decreasing from last year at 66.8 percent to this year with 61.2 percent (z = 2.01, p = .044).

 

Respondents were questioned whether they generated specific preliminary research items during the design and planning of a project. The results (see Figure 22 in PDF version) show that many respondents “Always” form a hypothesis about how a design feature may improve an outcome, while some always set measurable goals. Fewer respondents consistently create data reports to inform a design decision, develop specific performance measures to quantify the results of design decisions, or create literature reviews about existing research.

 

The only statistically significant change in items generated during design was a decrease in the use of a data report about specific design features to inform decisions (χ² (3, N = 1259) = 9.70, p = .021) (see Figure 23). The specific change in the category of Data Reports was a decrease in the “Always” response (z = 2.99, p = .003).

 

 

Aside from items generated during design, researchers were asked when they were engaged in a project. More than half indicated they were included during the planning process, but many were also brought in during design, while concepts were still under development (see Figure 24 in PDF version).

 

When asked about the types of methods used to evaluate design strategies during planning and design processes, the responses indicated nearly everyone reviews past projects, tours and benchmarks other facilities, and learns about past and current research related to a specific design feature. While the results are somewhat lower than the responses provided in Year 1, there are not statistically significant changes.

 

However, last year, half of survey respondents indicated they reviewed, evaluated, and summarized research into a formal written report or conducted a systematic literature review (see Figure 25 in PDF version). Year 2 indicates a statistically significant decrease in these responses to 43.0 percent (z = 2.01, p = .018).

 

After completing a project, the most common method used to measure the effectiveness of results against predefined measures continues to be post-occupancy evaluations. However, this still remains a lower-rated item for gathering evidence about design strategies in the early phases of a project. Other frequently used methods to measure results included before and after studies and focus groups. Potentially more rigorous study types, such as prospective studies, natural experiments, or randomized control studies are less common. More than one quarter of respondents indicated that design results are never formally evaluated following project completion. The survey reported no statistically significant changes in how results were measured.

 

A new category of questions was included in Year 2 pertaining to perceived barriers to design research. Funding and time in the project schedule were indicated as the top detractors to conducting research (see Figure 26 in PDF version). Nearly two thirds felt funding was always or sometimes a problem, while more than half always or sometimes felt constraints in the project schedule.

 

In considering views of the Design Team versus views of the Provider team (see Figure 2 on page _____ [EMT4]  ), there were significant differences in perceived barrier of time (z = 2.47, p = 0.014) and the perceived commitment of the Owner (z = 2.61, p = 0.009) (see Figure 27 in PDF version).

Figure 27 : Significant Differences in Perceptions of Barriers

 

According to the survey results, research findings are most often shared internally (see Figure 28 in PDF version). Consistent with last year and reflecting no significant changes, the most used methods are project debriefing, hospital leadership meetings, and internal staff lunch and learns. The least used dissemination methods were constant in Year 2 as well, and include webinars, industry association events (such as an AIA lunch and learn), peer-reviewed journals, and interviews with local media. No significant changes between Years 1 and 2 were reported.

 

3.0 DISCUSSION

 

3.1 Awareness (Figures 4-7 in PDF version)

The surveyed audience seems to be well aware of design research in healthcare with nearly 85 percent of respondents indicating some use of design research again this year. However, when asked specifically about evidence-based design, only 71.1 percent indicated using this process. This may indicate confusion about what constitutes research and/or evidence-based design or could indicate that some teams are conducting some form of research without meeting the rigor or definition of evidence-based design.

 

The small but statistically significant shifts in awareness for respondents of the term EBD could reflect an overall increase in discussion of evidence-based design. Whether in the main stream media, internal meetings, or conference presentations, the term may be used, although in these types of forums, there may not be an extensive discussion of the process.  While improved awareness may benefit the healthcare design community, it is also important for participants to understand the implications of using an EBD process – modifying a traditional design approach through critically evaluating available research, developing hypotheses about design strategies and measuring results.

 

3.2 Information Sources (Figures 8-11 in PDF version)

Based on this year’s findings, more traditional and possibly less rigorous approaches to investigating design strategies remain the most used methods of gathering information. However, the number of significant changes in this category may reflect the state of the economy in early 2010, still rife with travel restrictions and budget controls. Methods such as site visits and benchmarking are more consistently “Never” used, while conferences are “Always” used less than last year. This is in contrast to increases in the use of blogs and webinars (less expensive options). The significant drop in the use of research summary databases (both decreases in “Always” responses and increases in “Never” responses is not quite as intuitive, but could be a sign of reduced design team fees or allocated hours for staff resources. Additional trends in this area should be evaluated over time to better determine the long-term implications of such constraints.

 

With respect to the use of specific information sources, it is not surprising that the Guidelines for the Design and Construction of Healthcare Facilities continues as a primary resource, as its use is required in nearly all areas of the United States. Due to the survey distribution, it is also not surprising, that Vendome’s HEALTHCARE DESIGN magazine and conferences were some of the more commonly used resources for gathering information about healthcare design strategies.

 

The significant change in attendance at the annual PDC Conference also seems to mirror the survey results for fewer respondents attending conferences. In an era of budget cuts, many organizations need to limit the number of attendees, forego attendance at entirely, or choose one of many conferences.

The increased awareness of the RIPPLE database (still fairly new and in a beta format) is a positive indicator that newer information sources can be introduced and potentially integrated into the design process over time.

 

3.3 Acceptance (Figures 12-16 in PDF version)

The significant changes in the selected definition of EBD seem to reflect a convergence of familiarity and language. With a significant drop for a wider view of “All of these” responses, it appears that additional people now feel EBD is a more focused and rigorous process for design. This awareness can perhaps be attributed to Evidence-based Design Accreditation and Certification (EDAC). Instituted after the Year 1 Survey, this program has created a means to develop a common understanding of the process and application of evidence-based design. Study guides have been developed surrounding areas of Exploring Healthcare and Design, Integrating Evidence-based Design, and Building the Evidence, with each guide providing definitions and processes for integrating “evidence-based” and “design” approaches

 

The positive correlation of positive opinions and responses is encouraging, especially in changes relating to the amount of available information. It is also encouraging that some of the new options pertaining to EBD and the economy were met with positive rather than negative responses (ie more important in a weak economy). With respect to new options regarding the process of EBD, it remains to be seen whether trends over time will start to shift responses from EBD being the use of features supported by research, to more specifically creating hypotheses and a measurement system and being defined as a process of outlined steps. It remains a concern that more than half of the respondents felt that EBD was something people said they did, but did not really do.

 

3.4 Application of EBD Features (Figures 17-21 in PDF version)

Due to the nature of confounding variables, there may always be some debate about what constitutes an EBD feature. Putting the debate aside, it is encouraging that of those features included in the Year 2 survey, several of the most-used features included in facilities all of the time are those that support improved safety and the reduction of nosocomial infections (ie hand-washing hygiene measures, segregation of airflow, private rooms). The significant change indicating an increase in the use of gel-dispensers is aligned with increased administrative and public awareness of hand-hygiene, but may also correlate to the weakened economy, where gel dispensers are used in lieu of more expensive hand washing sink options, especially in renovation projects.

 

Downward shifts in the use of private patient rooms, acuity adaptable rooms, and wide or double doors into patient bathrooms may all reflect the budget cuts experienced by many organizations that have the ability to proceed with projects. It is unfortunate that the first-time costs can often be so isolated in a capital budget as to preclude the savings offered through long-term operational costs. A future upward trend to use such features may very well predict the increased availability of financing and capital dollars.

 

The wide swings in changes in the use of segregated airflow in patient rooms are most likely due to the rewording and clarification of the survey statement. This is primarily evidenced by the sharp downturn in “Not Sure” responses to varying levels of increased use in other categories.

 

3.5 Data Collection and Evaluation (Figures 22-27 in PDF version)

The reduced number of respondents indicating they conduct formal research may be yet another change attributable to the economic conditions of the recession. With fewer projects and fewer available resources, research may be one of the first “additional services” to be cut from a project budget.

 

The lack of statistically significant changes in the areas of generating preliminary research and evaluating and measuring design continues to imply shortcomings in the area of generating and collecting data. It is encouraging that so many of the polled researchers (more than half) indicate they are brought on early in the design process as (or even before) design decisions are made. The use of such specialized expertise can help bridge the gap in evaluating research and understanding how to turn design ideas into research questions and study designs. However, the drop in creating data reports with specific information to support design decisions and literature reviews implies that some of the front-end work does not necessarily lead to rigorous project deliverables. Again, because creating data reports requires more time and resources than other items, the decrease could be a result of the economy and prevalent budget cuts.

 

With the top perceived barriers to research including funding and time, the speculation that the economy has an adverse impact on EBD may be true. As organizations struggle to find new and creative ways to “make ends meet,” the capacity to conduct new research may continue to suffer through the near future. Because of the time to complete the planning and design of projects, then measure results, there could be a long-term implication in the availability of new published studies beyond the next few years.

 

3.6 Data Dissemination (Figure 28 in PDF version)

Unfortunately, the survey results continue with last year’s finding that the most used methods of sharing information are internal and not broadly publicized. Conference presentations appear as the fifth most-used method of sharing information—less than award submissions. While offering more reach, few conference presentations portray the full breadth of study design and findings compared to publication in a peer-reviewed journal.

 

3.7 Limitations

In the Year 2 survey, limitations included the targeted audience, participation rate, and demographics. While the number of responses was significantly increased in Year 2, the audience was still heavily weighted toward those already familiar with the work of The Center for Health Design and venues that regularly promote the use of research in healthcare design, such as HEALTHCARE DESIGN magazine and the HEALTHCARE DESIGN conference, both produced by the Vendome Group.

 

Participation in the survey is skewed to the consulting design team participants. An important goal of the survey in future years will be to reach a larger audience through additional outreach to other professional and trade organizations for additional participation from decision makers, clinicians, staff, and facility managers within provider organizations.

 

Additionally, the weakened economy creates confounding variables, which in conjunction with an increase in responses, creates difficulty in attributing changes to individual factors.

 

4.0 CONCLUSIONS

 

Survey Takeaways

The Year 2 survey provides both positive and negative results, but few statistically significant changes. Unfortunately, while respondents may perceive that evidence-based processes are more important during a weak economy and not at risk during an economic downturn, other categories of questions and responses may imply otherwise. Possible effects of the economy may be manifest in the reduction of the following:

 

• site visits
• benchmarking
• data reports
• literature reviews
• EBD design features (private rooms, acuity adaptable rooms, wide or double bathroom doors in patient rooms)

 

On the positive side there are the following shifts:

 

• a slight increase in awareness of the term evidence-based design
• more clarity in an accepted definition of EBD
• an improved perception of the availability information
• an increased use of online resources
• an increased use of alcohol-based gel dispensers
• use of researchers while design decisions are being made

 

In addition, few perceived barriers were reported pertaining to the process, language and outcome results of research and few significant changes suggested that EBD is losing ground, even in one of the worst economies of recent history.

 

While markets slowly stabilized in 2010, many industries are still waiting to see if a real recovery is in place. The July 2010 AIA Construction Consensus Forecast indicated that healthcare construction spending would see a drop of 6.5 percent in 2010, with an estimated increase of only 5.1 percent in 2011 (Baker, 2010) . This is still significantly better than other industries however. An early 2010 Construction Consensus Forecast of 13 percent decline plummeted to 20 percent for non-residential construction by mid- year. However, authors of the 2010 Hospital Building Report published in February speculated that while prospects for hospital construction would be the same or worse in 2010, the aging population and healthcare infrastructure still “weigh in favor of continued development and a pipeline full of projects.” (Carpenter & Hoppszallern, 2010)

 

As we move into a new normal, only time will tell whether trends in EBD will continue to hold steady, backslide, or move to a slow but steady progression aligned with economic recovery.

 

4.1 REFERENCES

 

Baker, K. (2010, January 29). The American Institute of Architects - Work On the Boards, Practicing Architecture. American Institute of Architects. Retrieved August 4, 2010, from http://www.aia.org/practicing/AIAB082184?dvid=&recspec=AIAB082184

 

Carpenter, D., & Hoppszallern, S. (2010, February). Proceed with Caution: Lean Year Expected for Hospital Construction. Health Facilities Management, 23(2), 11-18.

 

Jones, H. (2009, March 10). FMI's Construction Outlook: First Quarter 2009 Report | FMI Corporation. FMI: Raleigh, NC. Retrieved from http://www.fminet.com/article/534

 

The Center for Health Design. (2008). Definition of Evidence-Based Design for Healthcare. Retrieved March 24, 2009, from http://www.healthdesign.org/aboutus/mission/EBD_definition.php

 

4.2 ACKNOWLEDGEMENTS

 

This survey would not have been possible without the generous support of corporate partner, Herman Miller Healthcare.

 

The Advisory Council was indispensable through their review and commentary on the survey development.  Participants included (in alphabetical order):

Judene Bartley, MS, MPH, CIC, Epidemiology Consulting Services

Rosalyn Cama, FASID, EDAC, CAMA Incorporated

Kerrie Cardon, RN, AIA, ACHA, Herman Miller Healthcare

Kent Gawart, Herman Miller Healthcare

Debra Levin, EDAC, The Center for Health Design

Ed Ponatoski, Martin-Blanck & Associates                          

Bill Rostenberg, FAIA, FACHA, Anshen + Allen Architects

Katherine Smith, MPH, Samueli Institute

Joseph G. Sprague, FAIA, FACHA, FHFI, HKS, Inc.

Jaynelle F. Stichler, DNSc, RN, FACHE, FAAN, San Diego State University

Craig Zimring, PhD, Georgia Institute of Technology

 

Staff from The Center for Health Design providing support, direction, and guidance for the project included:

Anjali Joseph, PhD, EDAC, Director of Research

Callie Fasholz, EDAC, Project Manager

Pamela Cheng, Senior Marketing Manager

 

 

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Copyright © 2010 by The Center for Health Design, Inc. All rights reserved. No part of this work covered by the copyright herein may be reproduced by any means or used in any form without written permission of the publisher.

 

The views and methods expressed by the authors do not necessarily reflect the opinions of The Center for Health Design, or its Board, or staff.