Transparency comes first
This issue’s research articles raise three important questions for every design research study: The relevance and quality of the research methods employed; whether or not causality can be attributed to the environmental design characteristic in the environment-behavior equation; and how to formulate design guidelines that effectively reflect the research.
Rodiek and Lee’s exemplary study of garden design and outdoor space use among older adults living in assisted living residences faces the methodology question head on. The sample of assisted living residences included were carefully selected employing both a stratified and random sample, and thus have a high probability of being representative of the universe to which the authors later generalise. Although their major data gathering method for user behaviour and attitudes is a questionnaire,
Rodiek and Lee address this shortcoming in their “further studies” section by suggesting that behaviour mapping, focused interviews and an intervention study would refine their hypotheses and findings. The environmental data were collected using a carefully tested “Environmental Audit Tool.” And, because data analysis forms a significant part of “methodology” they demonstrate care and thoroughness in their conclusions. The point of design and health research is not to “get it right,” but to present the research and analysis transparently so that readers can decide how much reliance to place on the study.
The National Patient Safety Agency (NPSA) and Arup do an equally excellent job in approaching an even more complex environment- behaviour issue – single or multi-bed hospital rooms. I say this is more complex because these authors take on previous much heralded research that states single-bed hospital rooms are better than multi- person rooms because they improve “patient safety.” Methodological rigour – resting on a thorough plan of analysis – makes this paper a model of its kind as well. The major point the authors make serves as a warning to all design and health researchers: beware of drawing simple causal conclusions without taking into account the natural complexity of environments, their management, their use, and the diversity of those who use them.
The authors conclude that patients’ hospital experience and wishes must be respected in making hospital design decisions – and that patients do not uniformly prefer single-bed rooms. They also conclude that “environment” must be understood to include both operations and physical characteristics, thus that management, leadership, staff training, and behavioural change such as hand-washing must be taken into account in design decision making.
And finally they conclude that methods must be employed that reflect the behaviours and attitudes of all stakeholders – in this case doctors, nurses, and facility staff all of whom raise meaningful reservations about the question of single- versus multi-bed hospital rooms.
Farrow and VanderKaay’s article is also interesting, but mis-titled, referring in its title to “design standards” while it really focuses on design process. Specifically the article illustrates that decision-making stakeholders need to address intangible qualities of a design – those qualities about which there can be no standards like hope, community pride, and individual identity. This article, like the other two, makes an equally significant and universal point – no matter what data are presented to design decision makers, design is a creative act in which both users and designers aiming at high-quality design must take into account both tangible evidence-based research findings as well as designs wonderful and magical intangible qualities.
Dr 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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