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Evidence-Based Design: From Health Care To Other Buildings?
OTHER PARTS OF THIS ARTICLEPt. 1: This PagePt. 2: Studies Link Green Design, Occupant ProductivtyPt. 3: How Evidence-Based Design Practices Could Aid Facility Operations
This year marks the 25th anniversary of a watershed event for the facilities industry, albeit one with which few facility executives are familiar. In 1984, Dr. Roger Ulrich of Texas A&M University performed a study showing that surgical patients who had a view of a small grove of trees healed more quickly, had better moods and developed fewer complications than patients of the same surgery who had a view of a brick wall. The implications of that study were dramatic: It provided the first hard evidence for the idea that the physical environment could help patients heal.
A quarter century later, that idea has become widely accepted in health care design. Out of Ulrich's study has come an entire field known as evidence-based design — an attempt to show that facility decisions based on research data can have an effect on occupant outcomes. In an evidence-based design project, specific, measurable goals are established at the outset, and then the project is evaluated based on how well it meets those goals, whether the objective is to cut the level of hospital-acquired infections or reduce the number of patients who fall in their hospital rooms.
Today, that research-based strategy is a powerful force in the building of hospitals. But ask facility executives responsible for other types of buildings about evidence-based design, and you may get blank looks.
Although the term "evidence-based design" usually doesn't come up in discussions of the design and operation of office buildings, schools, and other non-health care buildings, the underlying concept of using research to guide design decisions is quietly making headway. Studies of the impact of green designs on occupants have much in common with the "evidence-based" strategy in health care. And experts say that operations of existing buildings are ripe for a research-based approach.
Lost in Translation
Evidence-based design is a natural fit in the health care industry, in which research and government regulation are at the heart of the culture. Medicines and treatment options must be clinically tested and shown to be effective before they're used. The reason is obvious: Health and safety are at risk.
By contrast, in the corporate world, if a facility executive tries an energy-efficiency strategy that doesn't work, someone may lose a bonus, but no one dies. "The consequences are just different," says Franklin Becker, a professor in the Department of Design and Environmental Analysis at Cornell University.
The same thing is also true when it comes to measuring productivity or other aspects of occupant performance. Corporate decisions are predominately bottom-line based, so initiatives that have firm financial numbers behind them — like energy-efficiency projects — are usually given priority, both in the facilities department and in the C-suite.
"The real estate culture is not research-driven," says Becker. "It's about performance, and the metrics are all financial."
Dollars and cents are easy to measure. Not so with other outcomes of facility decisions, like an increase in knowledge-worker productivity. It's hard enough to measure the productivity of those employees. But it may be even more difficult to link productivity to the physical workspace.
"We have to realize that in order to better understand how design affects us, we have to develop exact measures of built form and space," says John Peponis, professor in the College of Architecture at the Georgia Institute of Technology. "This is so that we can be as precise about 'design causes' as we want to be about 'functional effects.'"
There could be a bigger problem: a lack of interest in measuring productivity, given the prevailing corporate culture. In fact, the idea of measuring the productivity of knowledge workers produces reactions ranging from skepticism to exasperation.
"Here's a bold statement: Most corporations aren't interested in measuring productivity," says Becker. "If they were they'd find a way to measure it. It's not impossible to measure the productivity of a knowledge worker, it's just that most companies aren't interested in doing it."
As a result, many facility executives are content to base their case for new operational strategies, upgrades or design techniques on only the cost savings; they take for granted that there probably are some productivity gains that result from certain strategies, but don't try to quantify them.
Attempts to show that facility designs can aid occupant performance have often boomeranged. The green building industry has touted anecdotal evidence of productivity gains resulting from green building design and operational measures. But these unsubstantiated claims have been counterproductive because they've created industrywide skepticism towards specific percentage-increase numbers. The skepticism comes because the numbers are based on flimsy evidence and, therefore, seem more of a marketing gimmick rather than a fact rooted in research. That means facility executives have an even more uphill battle trying to use productivity as a justification for a project or strategy.
Productivity Yields Gains
Even though cost savings is easier to measure than productivity, productivity gains can have a far greater effect on the bottom line. According to the Whole Building Design Guide, salaries and benefits represent about 75 to 80 percent of total expenditures for most organizations.
With that in mind, Dave Pogue, national director of sustainability for C.B. Richard Ellis, lays out the case: "If we do a really good job at energy efficiency and save 20 percent, and we're paying about $2.50 per square foot for energy, that turns out to be about 50 cents per square foot. However, if we could drive a 10 percent productivity gain, and salary costs are about $250 per square foot, that's a $25 per square foot gain. Big difference."
Despite challenges, the use of evidence-based design research as a tool for making decisions about corporate and institutional facility strategies is gaining momentum. On a common-sense level, most people accept Winston Churchill's famous remark: "We shape our buildings; thereafter they shape us." Now, more researchers are devoting more time to detailed studies, and are developing metrics that carefully link a particular building characteristic to a specific result. (See "Three Important Evidence-Based Design Studies" on page 20.) This research has produced measurable productivity-gain results — ranging from better test scores in school buildings to fewer billable hours per client (which means that employees are more productive on a per-client basis).
What will need to happen for evidence-based design research to become more widespread among facilities professionals? Peponis offers one theory: "Facility executives will need to learn how to enhance the responsibility of what facility management does. Increasingly, their role should be to help all corporate managers use facilities as instruments for organizational goals."
If organizations get used to the idea that facilities are tools that can help shape the performance of people, it's not a big step to the idea that the impact of facilities on people can be accurately measured. And if that step can be taken, it will be time to rewrite Churchill's famous statement: "We will shape our buildings so that they shape us for the better."
Evidence-Based Design: From Health Care To Other Buildings?