Review of the Research Literature on Evidence-Based Healthcare Design

by Roger Ulrich, Ph.D.; Craig Zimring, Ph.D.; Xuemei Zhu, Jennifer DuBose, MS; Hyn-Bo Seo; Young-Seon Choi; Xiaobo Quan, Ph.D.; Anjali Joseph, Ph.D.

This paper was originally published in the spring 2008 issue of HERD (Health Environments Research and Design Journal), Vol. 1, No. 3. For more information about HERD, visit the website at www.herdjournal.com.

ABSTRACT

Objective: This report surveys and evaluates the scientific research on evi- dence-based healthcare design and extracts its implications for designing better and safer hospitals.

Background: This report builds on a literature review conducted by researchers in 2004.

Methods: Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environ- ments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.

Results: This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three gen- eral types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving out- comes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation sys- tems, a good acoustic environment, nature distractions and daylight, ap- propriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.

Conclusions: The state of knowledge of evidence- based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed phys- ical settings play an important role in making hospi- tals safer and more healing for patients and better places for staff to work.

Key Words: Evidence-based design, hospital design, healthcare design, healthcare quality, outcomes, pa- tient safety, staff safety, infection, hand washing, med- ical errors, falls, pain, sleep, stress, depression, con- fidentiality, social support, satisfaction, single rooms, noise, nature, daylight