Evidence-Based Design: The 8-Step Process Behind EDAC Certification (2022 Content Outline)

The Center for Health Design (CHD) defines the evidence-based design (EBD) process in eight steps. This article walks through them as listed in CHD’s EDAC Exam Detailed Content Outline (2022, Domain 1) and CHD’s EDAC Advocate Brochure (2019-20), and explains how the systems-based approach, the three business documents and the Advocate Firm commitment fit with them. It is written for practitioners who apply the process and for candidates preparing for the exam.

Which CHD documents and dates do the numbers come from?

Counts and definitions below come from two CHD documents: the EDAC Exam Detailed Content Outline, copyright 2022, and the EDAC Advocate Brochure, 2019-20 edition. The brochure counts (more than 2,600 credential holders, 44 endorsing organizations) are as of that 2019 publication and have likely changed. CHD can revise the outline; check healthdesign.org for the current outline, credential counts and Advocate Firm terms before quoting them.

Key numbers at a glance

What is evidence-based design?

CHD’s brochure defines evidence-based design as the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. The EDAC program assesses knowledge of the EBD process and its application in the design and development of healthcare environments, and teaches how to find, use and create relevant research to improve healthcare outcomes. CHD launched the credential in 2009.

Domain 1 of the Content Outline lists the outcomes an EBD process can influence: financial performance, operational efficiency, health safety and well-being, satisfaction and preferences, commitment (for example staff turnover and philanthropy), community, equity and access, cultural considerations, organizational change, environmental sustainability, and resiliency (11 outcomes). Define which outcomes matter for a project before choosing design strategies.

The exam covers six domains: Domain 1, Evidence-Based Design; Domain 2, Research; Domain 3, Project Setup and Predesign; Domain 4, Design; Domain 5, Construction and Occupancy; Domain 6, Post Occupancy/Evaluation.

What are the 8 steps of the EBD process?

Step 6 produces the pre-occupancy baseline that step 8 is measured against; without a baseline, a post-occupancy result has nothing to be compared with. Domain 6 of the Content Outline also lists how a post-occupancy evaluation is different from conducting other types of research studies, so the exam expects candidates to tell the two apart.

Why does EBD alone not produce results?

Domain 1 asks candidates to explain why an EBD process alone is not sufficient to make improvements and is more successful when considered with a range of different contributors: changes to a single component, without understanding the relationship between that component and others, can have unintended consequences.

The systems-based approach has six components that should be addressed concurrently by an interdisciplinary team (formerly called Environment of Care):

1. Concepts: do the design concepts and strategies support the project vision, goals and objectives?
2. People: does the design include the ideal experiences from the perspectives of all the people who will inhabit the spaces?
3. Systems: do the concepts and ideal experiences consider the direct impact on technical, mechanical, operational and organizational systems?
4. Layout/operations: will addressing these components concurrently inform layout and operation to increase the likelihood of desired user outcomes, staff and procedural efficiency, and operational cost reduction?
5. Physical environment: which design strategies (interventions) are hypothesized to have a specific outcome, and which metrics will measure it?
6. Implementation and evaluation: where are the opportunities and roadblocks, and will the proposed implementation strategy achieve the stated goals and objectives?

What are the 3 theoretical foundations for design for safety and health?

Domain 1 names three theoretical foundations to design for safety and health: supportive design, salutogenic design and integrative medicine. The outline lists them without definitions; for definitions use CHD’s study materials and the research they cite, not this article.

What are the 3 business documents that the EDAC exam distinguishes?

Domain 1 asks candidates to understand the difference between three documents:

What does the EDAC Advocate Firm designation involve?

According to CHD’s 2019-20 brochure, Advocate Firms dedicate a minimum of 25% of their healthcare teams to become EDAC certified. Champion Firms participated in the beta testing phase and were the first to commit staff to take the exam. To become an Advocate Firm, the brochure says to contact CHD ([email protected]).

The Evidence-Based Design Touchstone Awards are separate: they recognize use of an EBD process, and submissions are judged across three touchstones. Collaborate: submissions must demonstrate interdisciplinary team and stakeholder education, engagement and development. Evaluate: submissions must demonstrate the extent to which research was found, evaluated and applied to link design to outcomes and measurement of results. Share: submissions must demonstrate how the EBD process was applied and how the knowledge gained was captured, disseminated, and has the potential for application to future projects.

What pitfalls does the outline point to?

Every organization has a unique culture; Domain 1 asks candidates to explain how the design of the built environment can affect an organization’s culture and how culture can influence design. Four practice pitfalls follow from the outline’s wording:

1. Treating EBD as a checklist. The eight steps are a process: each step’s output (evidence found, hypothesis, baseline) feeds the next.
2. Skipping the baseline in step 6. Step 8 is measured against it.
3. Mixing up the three business documents. The project business plan, the business case for using EBD and the concept business case have different purposes.
4. Changing one component without a systems lens. The outline states that single-component changes can have unintended consequences.