Application of environmental psychology theories and frameworks to evidence-based healthcare design

Environmental Psychology provided a crucial knowledge foundation towards the development of Environment and Behavior (EB) studies in the 1960's. The central objective was to bridge environmental design research and design practice. The perceived need for a new field could be ascribed to concerns regarding the separation between the designers and the users of a building. Over the decades, however, EB had little exemplary influence on design practice, leading to disquiet among environmental psychologists and EB scholars regarding research utilization. Events in the American healthcare industry in the 1990s became a catalyst for transformation of the research-design relationship. A report by the Institute of Medicine highlighted the level of preventable deaths occurring in American hospitals. There was growing recognition that risks and hazards of health care associated injury and harm are a result of problems with the design of systems of care rather than, solely, poor performance by individual providers. Furthermore, there was substantial evidence that the design of hospital physical environments contributes to medical errors, to increased rates of infection and injuries from falls, and to slow patient recovery and high nurse turnover. As a result, the central focus in the healthcare industry became designing safer and more efficient hospitals. There was an urgent and emerging need for a novel approach to optimize healthcare quality within cost, legal, and cultural constraints. Evidence-Based Medicine (EBM) provided a source of inspiration for healthcare design leading to Evidence-Based Design (EBD). In the past decade principles, framework, theories, and methods of Environmental Psychology have played a crucial role in the evidence-based design process. It has helped develop a structured approach to collating and examining evidence, representing information, and identifying knowledge gaps where further research is warranted to support design decisions. Growing research points to the need to change facility development and design methodologies of the past to integrate patient safety concepts in the design. This chapter describes the applications of environmental psychology to evidence-based healthcare design, and the manner in which environmental psychology concepts are transforming the design of hospitals.