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Book Review: A Visual Reference for Evidence-Based Design

A Visual Reference for Evidence-Based Design
Jain Malkin
The Center For Health Design, 2008.
Price: $199.00







This thoughtful and comprehensive book is a valuable compendium of research results that bear on the design of the built environment for healthcare delivery. The book is lavishly illustrated with photographs of various kinds of hospital environment that have been inspired by, and have applied, the new knowledge emerging from relevant research.


The book’s take on evidence-based design (EBD) is different from my own. I have written about the EBD approach as a priori, that is, research is defi ned within the context of a design project, and carried out to help make situation-relevant design decisions that can be demonstrated to have the positive effect desired. Jain Malkin – a well-known and widely respected interior architect and writer on healthcare design – develops in this book more of an a posteriori approach to EBD.

She sees the ‘evidence’ for a range of design issues and decisions as emerging from pre-existing fields of study, such as the effects of stress on patient behaviour and recovery, the impact of nature and scenes from nature on recovery and morale, studies of infection transmission and control, and studies of safety and risk management. One of the book’s most interesting chapters focuses on the patient’s experience, and how results from environment-behaviour studies of how people experience the built environment have a direct bearing on design decisions.

Jain Malkin
Making sense of design
The author argues that understanding how research can be used as ‘evidence’ to support design decisions enables design professionals to be more sensitive to how the environment affects both patients and staff, and to design healthcare environments that create a positive experience for people in stressful, uncomfortable and threatening situations.

The book provides comprehensive reviews of studies in relevant areas of research, accompanied by thoughtful discussions on what is most relevant to design of the built environment – not always a focus or even a consideration in much important health and stress research. A chapter on research methods is also included. However, the book foregoes providing clear step-by-step instructions to design professionals who are motivated to move into a more evidence-based practice in favour of providing examples of built healthcare environments that have, to a greater or lesser degree, been responsive to evidence generated by research.

One of the most interesting chapters is on patient safety and infection control. Not traditionally seen as within the building designer’s purview, this chapter is a valuable primer on the current status of research on infection transmission and control in hospitals. Some minor quibbles include confusing rankings and ratings in chapter 5, some repetition regarding the effects of stress and stress management, and occasional diffi culty following the author’s reasoning, for example, a sudden leap into symbols of ancient geometry appears in Chapter 5. The book is avowedly focused on US healthcare and architecture, but including an international perspective would have been interesting.

I would have liked more examples of wayfinding solutions – the photos show only elevators – and of diverse types of environment for staff – limited in Chapter 6 to physician and senior executive lounges. Some of the current research on how environments for work are designed and used could have been included: hospitals are also work environments.

Already the book manages to touch on an impressive range of issues. Brief summaries of large complex topics like sacred geometry and feng shui, process redesign and managing change, the ‘split’ between research  on hospital environments that excludes built space and research on the built environment that focuses on its effects on people and processes, and major studies such as the Nurses’ Time and Motion study and the TCAB (Transforming Care at the Bedside) study give the reader the urge to know more.

Illustrated with abundant photos of innovative design examples that show that applying research results to design is not an abstract exercise but has a real impact on design outcomes, this book is a must-read for members of the design and health professions, students and teachers as well.




Reviewer: Jacqueline C. Vischer PhD is a professor of design at the University of Montreal








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