This website is intended for community health centers and other safety net clinics planning upgrades to their facilities and was developed by The Center for Health Design (CHD), with financial support from The California HealthCare Foundation (CHCF).
In 2008 CHD received a grant from CHCF to look at what the evidence says about ambulatory care facility design, specifically in community clinics. As a result of this research, CHD created the following:
- A literature review of the evidence around ambulatory care facility design
- A compilation of best practice clinic examples
- A breakdown of recommended evidence-based design and operational strategies
- Tips from those working in the field
In 2009, CHCF provided additional funding to CHD to create this website to house and disseminate the information.
Evidence-Based Design
Definition of Evidence-Based Design (EBD)
Evidence-based design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.
(The Center for Health Design, 2008)
EBD for Healthcare
Evidence-based design (EBD) can be utilized by those planning and designing healthcare facilities to base decisions on research and critical thinking. EBD applies to all types of building design but is uniquely suited for healthcare settings given the unusually high stakes and because it involves major issues of safety and improved clinical outcomes.
When following an EBD process the resultant design should contribute to demonstrated improvements in the organization’s clinical outcomes, economic performance, productivity, customer satisfaction, and cultural measures. The EBD process creates a direct, measurable link between the design of the physical environment and an organization's patient safety and quality improvement agenda.
Basically, there are eight key steps in the EBD process:
- Define EBD goals and objectives
- Find sources for relevant evidence
- Critically interpret relevant evidence
- Create and innovate EBD concepts
- Develop a hypothesis
- Collect baseline performance measures
- Monitor implementation of design and construction
- Measure post-occupancy performance results
- Board trustees and senior leadership
- Researchers and designers
- Vendors and suppliers
- Patients
- Caregivers and family members
- Staff
- Community partners and organizations
- Donors
Additional information about evidence-based design can be found on The Center for Health Design's website at www.healthdesign.org
How to use this site
This website has four main components:
Literature Review
A growing body of research shows that the physical environment of healthcare facilities affects patients, staff, and families by impacting patient safety and quality of care. The intent of this review examined how healthcare facility designs and various physical aspects of ambulatory care environments can positively or negatively impact patient experiences. While significant effort was devoted to identifying references that are empirically derived, additional resources such as unpublished research reports by respected researchers, and other non-peer reviewed articles, reports and studies were included if found relevant.
The main findings relate physical environment features to increased or decreased positive outcomes in three main categories: patient outcomes (e.g. anxiety), staff outcomes (e.g. productivity), and operational outcomes (e.g. workflow). Physical environment features identified in the literature include spatial relationships, visual and acoustic privacy, physical attractiveness, ambient experience, and information in the environment.
The literature review has been published in the Health Environments Research and Design (HERD) Journal. Read the abstract.
In addition, The California HealthCare Foundation has published a related Issue Brief.
Best Practice Clinic Examples
A compilation of best practice facilities that serve as examples to those involved in designing new or renovated facilities. These facilities were selected by The Center for Health Design in conjunction with an independent advisory group as part of the initial grant from the California HealthCare Foundation to understand community clinic design.
The physical environment features and community attributes of safety-net facilities throughout the United States were examined through on-site visits and/or telephone-interviews with the primary care clinic's CEOs, clinic managers, facility managers, and board members. Many of the facilities vary in size, services offered, and the type of setting in which they occur (rural, suburban, and urban).
Recommended Design and Operational Strategies
The design and operational strategies found within this website are supported by evidence as identified within the literature review and in best practice clinic examples. This website contains recommendations for those undertaking complete clinic redesign, renovation or simple changes to the existing environment.
When considering a clinic redesign, renovation or improvement to the physical space, the patient experience - what a patient goes through from the moment they access a community clinic to the time they exit the building or clinic parking lot - should always be taken into consideration during the design process.
Similarly, when looking at ways to improve the patient experience, there are certain design or operational changes that are more appropriate than others depending on which aspects of the patient experience are being examined.
As such, the design and operational strategies found within this website are sorted in two ways: from the patient experience perspective and from the project development or design process viewpoint.
Tips From the Field
Community clinics across the United States share their lessons learned and what design and operational strategies they recommend.
More about the California HealthCare Foundation
CHCF commissions research and analysis; publishes and disseminates information; convenes meetings of key health care groups; and funds development of programs and models aimed at improving health care in California.
To help accomplish its goals, the Foundation focuses its effort in three program areas:
- Improving the quality of care for Californians with chronic disease.
- Reducing barriers to efficient, affordable health care for the underserved.
- Promoting greater transparency and accountability in California's health care system.
For more information, visit: www.CHCF.org
More about The Center for Health Design
The Center for Health Design (CHD), formed in 1993, is a nonprofit research and advocacy organization of forward-thinking healthcare, elder care, design and construction professionals and product manufacturers who are leading the quest to improve the quality of healthcare facilities and create new environments for healthy aging.
CHD's mission is to transform healthcare environments for a healthier, safer world through design research, education and advocacy. It accomplishes these goals by partnering with appropriate organizations to encourage the adoption of evidence-based design recommendations that connect the built environment to improved clinical and economic outcomes leading to safer, healthier, more efficient environments.
For more information, visit: www.healthdesign.org
Project Advisory Group
The California HealthCare Foundation and The Center for Health Design would like to thank the following individuals who donated their time and talents to provide invaluable oversight and direction during this project.
- Cindy Barr-Project Consultant, Capital Link
- Ronda Kotelchuck-Executive Director for Primary Care Development Corporation
- Andra Lichtenstein-Principal of Capital Incubator
- Doug Moore-Facilities Manager of Clinica Sierra Vista
- Anita Addison, MCP, MPH-Planning Director for La Clinica de La Raza
- Zara Marselian-CEO and founder of La Maestra Family Clinic
- Richard Veloz-CEO of South Central Family Health Center (SCFHC)
- David O’Neill-Senior Program Officer for the California HealthCare Foundation
- Melissa Schoen, M.B.A,, M.P.H-Senior Program Officer for the California HealthCare Foundation
- Regina Neal-Director of Performance Improvement Programs at the Primary Care Development Corporation (PCDC)
- Franklin Becker, Ph.D.-Professor and Chair, Dept. of Design & Environmental Analysis, College of Human Ecology at Cornell University
- Sonia Shah, MPH-Project Manager, Community Benefits, Kaiser Permanente Southern California Region
- Stuart Stoller, LEED AP-Architect
- Maria Montanaro, MSW-Thundermist Health Center
- Craig Zimring, PhD-Professor of Architecture, Georgia Institute of Technology
- Gowri Betrabet Gulwadi, Ph.D.-Assistant Professor of Interior Design
- Nancy Lager, Director, Project Planning, Primary Care Development Corporation
- Sara Frankfurth, Program Officer, Kaiser Permanente
