Evidence based design in healthcare: integrating user perception in automated space layout planning

Despite significant technological and scientific advances in healthcare provision and treatment in past decades, economies are struggling to address increasing costs while enhancing accessibility to quality health and care services. Globally, around 8.4% of gross domestic product (GDP) is spent on healthcare, with United States spending 17.4% of its GDP. There is, therefore, a growing interest in reducing healthcare costs and improving quality of care in terms of patients outcomes and their perception. Research has found strong association between physical environments and patient outcomes and staff and patient wellbeing. The acknowledgement of this link has led to the postulation of the idea of evidence based design (EBD) of healthcare facilities, in which design decisions are based on the evidence of the impact of environment on healthcare indicators. The key challenges for integrating EBD in healthcare design are the difficulty in disaggregating past research findings (i.e. evidence) from the context and the use of these findings, often hidden behind several behavioural and demographic variables or of the form of multi-dimensional indices, in design decision-making. Another recent development in healthcare is the patient-centred approach of care, in which patients perceptions and needs take the centre-stage in the planning and delivery of their care. Local and regional healthcare authorities are, therefore, interested in incorporating patients views in all aspects of care, including the design and operation of health and care facilities. Considering the gaps in knowledge, this research was aimed at investigating: users perception of physical environment indicators that had the potential for influencing their wellbeing and care outcomes, and the integration of their perception in the design of healthcare facilities through automated space layout planning. Perceptions of physical environment indicators were investigated using structured questionnaires among three user groups: inpatients, outpatients and healthcare providers. Resulting perception indicators were then used in a prototype automated space layout planning system, developed as part of this research, to aid the optimization process. The research has identified significant differences in perception between different user groups, in particular between males and females. Analyses of scaled responses indicate that environmental design (e.g. lighting and thermal comfort) and maintenance (e.g. cleanliness) related factors are more important to users than abstract architectural design factors (e.g. aesthetics). Accommodating the variation in perception would require individual approaches for the design of constituent spaces in a healthcare facility. With regard to the integration of user perception in design, the research demonstrates that qualitative indicators such as perception can be integrated in automated design frameworks and, therefore, design decisions can be based on a mix of quantitative and qualitative evidence. The application of automated layout planning system in the design of healthcare space layouts also demonstrates that computer-mediated systems and frameworks are a promising alternative to traditional manual design, if increasing number of design factors and objectives are to be reconciled for decision making.