Review: The devil is in the detail
 This issue’s articles demonstrate how evidence-based design can benefit from detailed analysis of design competition winners, environmental perception interviews, and research methods.
Cadenhead and Anderson study an overlooked source of design data – competition entries. The submissions included detailed descriptions of Intensive Care Units (ICU) in hospitals worldwide submitted over 17 years to a group of doctors, nurses, and architects. The data include not only plans, photographs and budget data, but also “a video walk-through with a voice-over description of the unit and the attributes the staff feel are especially important.” What a rich source of data!
Cadenhead and Anderson fi rst describe in detail themes and trends they see in the data, and then draw from them evidence of successful design practice. What do they find? Since 1998 no winners included shared bathrooms in any ICU. E-glass that becomes opaque when electrically charged and in-room bar-code scanners are prominent technological advances. No winner employed exclusively centralised nursing support, while stress-relieving access to nature for staff – a particular interest of neuroscience in architecture – appears to be on the upturn, as are space for family in the ICU and access to gardens for patients.
Pati and Harvey’s study of flexibility in medical-surgical inpatient units pays similar attention to detail. Their data are focused interviews with 48 managers, nurses, and support staff in US hospitals. The authors address how architects often design capabilities into their environments without understanding how the “end-users” of their buildings perceive those characteristics.
They identify three sub-categories of fl exibility – adaptability, convertability, and expandability – and analyse the transcribed interviews to determine how the respondents defined “flexibility” from their perspective. Of particular interest are the dimensions of fl exibility that “have physical design implications.”
Like Cadenhead and Anderson, the authors identify a handful of specifi c design characteristics of ICUs that are important to users. Interestingly, none of the respondents mentioned single patient or universal rooms. Forbes and Fleming assess a particular method to be employed in a larger study of community-based residential Alzheimer’s care.
The detailed sub-study they carried out to assess the qualities of their Environment Audit Tool (EAT) will serve them well in the major 3-year Australian study in which they are engaged. Carefully establishing that their audit tool is relevant to today’s broadly accepted person-centred Alzheimer’s care approach, they identify important failings of earlier instruments: that they were developed to assess institutional Alzheimer’s care settings – Special Care Units (SCU) – which have now been replaced with smaller scale domestic, assisted living, and care home settings; and that one of the earlier scales addresses physical environment characteristics, not in design terms, but in terms of maintenance, cleanliness, and “odour from bodily excretions.” Design tools must inform about the clinical effects of the physical environment, and address design issues like safety and security, size, visual access, stimulation, familiarity and the other characteristics.
Altogether these three articles make important contributions to the design and health literature in terms of focus on detail, analytic rigor, and defining evidence-based design criteria for ICU’s, inpatient units, and residential Alzheimer’s care. For the full comment, visit, www.worldhealthdesign.com
John Zeisel is chair of the international advisory board of the International Academy for Design & Health and president of Hearthstone Alzheimer Care
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