Thank you for your comment, Nonetheless, my inquiry is on research methods in health-focused design. You attributed it to people's inherent skills. I do not deny the presence of commercialism in these issues. Although I agree that a rigorous comparison of these approaches is warranted, I have yet to see one conducted.

Thank you for introducing this book.

Heath Architecture is based on healing concepts, may be all three ideas work together but basically there are three groups involved;, patient, relatives/ companion, medical staff.

The architecture should make the path of each group very smooth and linear.

The relatives shall leave the patient at entrance and trust the medical team and the medical shall take a linear path for patients movement from basic investigation to final treatment. The healing Architecture considers the environmental as well as visual impact of architecture and landscape on the healing capability of patients. The people who are not patients but companions they must be provided with comfortable spaces,, same time the doctors and staff who faces whole day the sick people need high consideration regarding space as well as additional facilities.

understanding an architect has to consider, other functional as well aesthetic requirements of the project; this may include bylaws and environmental constrains, the need of energy, services and other additional considerations. The physical/ functional needs of patients, relatives, doctor and staff may be important but the socio-pyscho needs of all involve in health care are equal important. The rendering of surfaces, colors texture. forms- internal external play a vital role in the scheme. we cant limit health care with healing environment with set of some concepts and ideas. Hospital demand very complex strategies with diversified working environment thus no single remedy or concept would help out.

Thank you Mohammad Anvar Adibhesami, to pose this discussion. For me, I would say all three concepts EBD, Salutogenic Design and Biophilic Design are not mutually exclusive. They are all focused on addressing the relationship between our physical environment (buildings and cities) and how that influences our health. None of them necessarily only are intended for healthcare facility design, though that is where they are more commonly used. Especially EBD as the term also relates to Evidence-Based Medicine.

However, I think there are clear differences. While there are different definitions, EBD in its core refers to the process linking research and design. This includes implementing existing knowledge into the design process by developing design ambitions based upon a combination of prior academic research and project-based knowledge. Additionally, EBD requires indicating what health-related outcomes are expected with certain design solutions, which then can be evaluated when the building is there. This is much better explained by Erin Peavy and Kiley van der Wyst (2017) in their paper: Evidence-Based Design and Research-Informed Design: What’s the Difference? Conceptual Definitions and Comparative Analysis.

Salutogenic Design and Biophilic Design, on the other hand, are design approaches: a way to design buildings with certain goals in mind, relating to theory, occupants and expected outcomes. In this case theories on Salutogenics (And Sense of Coherence) or Biophilia (relation with nature). Some of the actual design solutions may be similar, while informed by different viewpoints. For instance, both Salutogenic and Biophilic designs may emphasize on the view of nature. Though in the case of Biophilic Design if maybe what 'nature' means is more elaborated.

To me the difference between restorative environmental design and salutogenic design is more interesting as those actually can have contradicting foci: restorative assumes people are experiencing negative stress and aims to reduce that (restore); while Salutogenic Design looks at what improves the quality of life regardless of someone's health status. However, note that this Salutogenic Design approach is quite underdeveloped still as used in design practice, and there are authors who argue that this is easily misunderstood. I think Lusi Morhayim can tell more about this than I.

Dear Dr. Elke Miedema, I value your participation in this conversation because your doctoral thesis and review article both followed this topic's research. this means. In your post, you have given a detailed explanation of the issue. I'm hoping that Dr. Lusi Morhayim will join us in this discussion and clarify the difference between restorative environmental design and salutogenic design. The pioneers of salutogenic science will be urged to participate in this discussion.

Thank you for the compliment Mohammad Anvar Adibhesami I am glad it is valued.

Some scientists are convinced that biophilic design is a special case of salutogenic design, and I agree. Both of these approaches (BD +SD) pursue the same goal - to make our environment more friendly. At the same time, BD and SD have different accents.

DB is based on the perception of nature as a source of health and the awareness of a person as a part of this nature. The key method of BD is to incorporate nature into the build environment. SD gives priority to the physical and mental health of people, creating a supportive psychosocial and physical environment.

I believe that in order to create evidence based design projects, the professional community (architects, builders, developers and scientists) need special tools for assessing the build environment. Knowing the strengths and weaknesses of the existing premises, specialists would be able to make recommendations on their adjustments taking into account the specific needs of people

En la salud entran en juego varios factores no solo uno, el medio ambiente es uno de ellos, también la alimentación es importante, La vida sana, y por último tenemos los gérmenes y virus que pueden dañar la salud, pero una cosa si es cierta ningún germen o virus afecta al cuerpo si este está sano por lo general cuando uno se enferma es por que hay episodios de inmuno deficiencia. Mohammad Anvar Adibhesami

Evidence-based Design can give the most reliable empirical findings. However, the BIophlic cannot be ruled out for deriving reliable empirical results.

i have always thought that Evidence based design in healthcare is poorly researched

many of the presumptions based on EBD are not based on proper research

if you examine a lot of the research papers you find many are based on Prof Roger Ulrichs research

some of this research -such as that patients recover faster if they have a room with a view dont stand up to academic scrutiny

Hi Eoin o'Morain I would love to hear more about your arguments. I am currently doing a literature review of the research done in the field. We also included a quality check for the methods being used. Maybe you have some paper about the quality of EBD research or about the weaknesses of Ulrich's theories?

Dr. Elke Miedema and Dr. Eoin o'Morain

Although my master's thesis centered on EBD theory, I'm not sure if evidence-based design can be used in either design or architecture. Evidence-based design and evidence-based medicine did not appear to be distinct. In my view, the fields of medicine and architecture should not be mixed. The layout and flow of medical and equipment functions determine how a therapeutic environment is created. I am very aware of how the architecture of hospitals will function, and I am aware that evidence-based design cannot produce architecture. Salutogenic theory, which is a design theory, seems to me to be better able to characterize this design process in architecture or urban planning. But it can also be created at the level of planetary health or even urban planning. I believe this idea has to be significantly improved in order to more clearly describe the design process.

Hi Elke

one of the main sources im sure you have is

https://www.healthdesign.org/chd/research/review-research-literature-evidence-based-healthcare-design

Advancing evidence-based healthcare facility design: a systematic literature review Farouq Halawa1 & Sreenath Chalil Madathil2 & Alice Gittler3 & Mohammad T. Khasawneh1 Received: 5 August 2019 / Accepted: 15 April 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods. Keywords Facility layout . Evidence-based design . Literature review . Layout optimization . Operations research 1 Introduction Increasing growth of outpatient services, system mergers, aging infrastructure, and healthcare consumerism have intensified new construction and renovation projects in the US. The current average age of healthcare infrastructure exceeds 30 years. Often facility layout and design are impediments to achieving efficiencies and adopting state-of-the-art clinical processes and developments [1]. Healthcare facilities are renovating, replacing, and rethinking facilities to meet changing demand for services. A 2019 healthcare construction survey [2] reports that over 23% of hospitals in the US are undertaking new construction projects, while 22% are planning renovation projects in the coming years. Health systems are placing high priority on creating cost-efficient services and optimized facilities that can provide quality care. Optimizing adjacencies of interdependent spaces reduces patients’ travel distance in hospitals, enables quicker staff responses to patient needs, and reduces wasted motion. Enabling patient-nurse surveillance through appropriate unit configuration and geometry can reduce falls in high acuity layouts [3, 4] and reduce patient depression, length of stay, and enhance comfort by enabling a greater exposure to daylight and views of nature [5–7]. Optimizing a layout must also consider demand and capacity. Inadequate patient room * Farouq Halawa [email protected] 1 Department of Systems Science and Industrial Engineering, Binghamton University, Binghamton, NY 13902, USA 2 Department of Industrial, Manufacturing & Systems Engineering, The University of Texas at El Paso, El Paso, TX 79968, USA 3 EwingCole, 14 Penn Plaza, New York, NY 10122, USA https://doi.org/10.1007/s10729-020-09506-4 / Published online: 24 May

Article on room handedness

the issue of room handedness is a good example of where research can send you on the wrong path

when i designed a 260 bed private healthcare hospital we followed the research above

all the room are 'handed' the same way-the bedhead is in the same position from the entry door to the room

(as opposed to the normal hotel style layout where each pair of rooms are mirrored)

the design was very expensive because all the plumbing and air conditioning was duplicated (-no back to back bathrooms with consequent savings)

subsequent research showed that the research was wrong- not all nurses are right handed and not all patients can be treated from the same side of the bed

Eoin o'Morain tank you, Your clarification is greatly appreciated. However, the real question is whether healthcare architecture should be limited to evidence gathered in hospitals and from medical sources. Indeed, it is critical to determine whether EBD is a systematic process that does not necessitate design processing or if it is defined within the experimental results. I'd like to provide an example to clarify my question. Architecture can be thought of as a system compiler, with the compiler providing a natural environment for design management. EBD, in my opinion, does not play this role in healthcare architecture. As a result, I do not believe that EBD can be considered an architectural design or a health-improvement solution.

the study attached is the best study i have come across

Mohammed can you explain what a system compiler is?

if it is architectural design based on a system compiler type approach where all the factors affecting a design are input in a model I dont believe that this results in good design

there is an intuitive element to design -based on experience - and also many buildings designed for other purposes work very well when repurposed to new uses

some studies have found that older hospitals with poor infrastructure are cleaner than new ones because staff are aware of the infection risks in old buildings and are more careful to clean surfaces etc

my belief is that experience based design - rather than evidence based design - is key

this feeds into Zumthors theory , Architecture is not a solid material. With our senses and the way our body responds to the sound, the smell, the color of a single material, we create architecture. If architecture was a car, our emotions and how we respond to it is the engine. There is no architecture without us.