Credit Valley measures superior performance through evidence based design


Implemented for the first time in a Canadian hospital, a research study will quantifiably examine the effects of design on staff and client efficiency, and formally document measured correlations to determine the positive, or negative impacts on patient recovery, satisfaction and staff movements.

This groundbreaking study will be conducted by Farrow Partnership Architects in partnership with the Credit Valley Hospital, Cancer Care Ontario and WIN Workflow Integrity Network / Queens University. This aspect of patient care will be funded through an Ontario Health Association Change Foundation research grant measuring best performance through metrics of Evidence Based Design (EBD). The Change Foundation identifies major change initiatives and funds frontline innovation and research.

The $100,000 grant will be matched by in-kind contributions, for a total research pool of $200,000, and will extend over a two-year period beginning in January 2005 at the new Carlo Fidani Peel Regional Cancer Center at the Credit Valley Hospital in Mississauga Ontario. Designed by Farrow Partnership Architects, the $85 million dollar ambulatory and cancer care centre is to open in May 2005.

“While great strides have been made by architects and health-care practitioners,” says Tye Farrow, Partner in Charge of Design for Farrow Partnership, “there is limited evidence, particularly in Canada, to show that such exemplary facilities were actually superior at improving outcomes, quality of experience, and bottom-line financials.”

“What makes this particular research project unique” he ads, “is that we now have within our resources proven empirical methods for measuring and improving both patient outcomes and providing efficient, safer and less-wasteful healing environments within the design process.”

Similar to ‘evidence-based medicine’, EBD is research-informed and employs a series of design metrics (movement patterns, number of steps, travel times, service interruptions, etc) to measure a variety of outcomes. Data collection will begin with a baseline prior to the occupancy and six months post-occupancy, allowing staff to gain a level of comfort and routine. In order to collect and quantify the data an automated function analysis tool, situation modeling and patient and staff surveys will be conducted. To organize the outcomes, a balanced scorecard approach will be adopted.

As the information gathered can potentially influence design at all levels of complexity from building layout to millwork to hospital performance, when the outcomes lead to evidence supported determinations, the team will investigate strategies to improve performance and overall value.

A consistent target group of nursing staff and breast cancer patients receiving adjuvant therapy was selected. Breast cancer patients were chosen because they will represent one-third of all outpatient visits in the new centre, and also that cancer incidence is anticipated to increase by more than 70% over the next 10 years, representing the largest incremental growth in the province.

“While there is a real need to accommodate increased patient volumes through straight operational improvements,” says Farrow, “we also recognize that space and design, when well thought out, can increase functional, financial and operational performance.”

The statistical evidence on EBD coming from the United States and Europe shows that better designed hospitals and the one-time costs of designing and building optimal facilities are repaid directly through operational efficiencies. Illness is a costly condition, whereas wellness pays direct and indirect dividends both for patients and caregivers.

In the broad picture, hospital environments can benefit from EBD in three key ways by:

  • Improving patient safety;
  • Functioning as a compliment to the user group process;
  • Eliminating environmental stressors.

Specifically, EBD is particularly helpful to hospital stakeholders including caregivers, administrators and investors. In most cases, users are aware that their physical environment and service interruptions hinder their ability to perform to their peak potential. For example, nurses spend almost 28.9% of their day walking, second only to patient care activities at 56.9% (Burgio, Engel, Hawkins, McCorick & Scheve, 1990). While the user-group process typically identifies a problem, EBD allows the design team to accurately identify the cause and propose evidence-supported solutions.

“EBD starts with values-driven hospital leadership” says Farrow, “and continues with the lessons learned which will be particularly relevant to organizations striving for best performance and excellence in client and patient-centered care. “As the physical environment is an important element in earning employee commitment to an organization, EBD is therefore a means for measuring the effectiveness of the building to successfully achieve those goals.

Too often, the work of healthcare architects has relied solely on intuitive decision-making and old habits, when in fact it must embrace a rigorous process of scientific inquiry that informs and tests. EBD is therefore a progressive step forward signaling the dawn of a promising and hopeful era in Ontario’s health care community.