A review of the research literature on evidence-based healthcare design

HERD. Spring 2008;1(3):61-125. doi: 10.1177/193758670800100306.


Objective: This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.

Background: It builds on a literature review conducted by researchers in 2004.

Methods: Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence.

Results: This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified.

Conclusions: The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Environment, Controlled*
  • Evidence-Based Practice*
  • Facility Design and Construction*
  • Health Facility Environment*
  • Humans
  • Infection Control
  • Occupational Diseases / prevention & control
  • Patient Safety*
  • Quality of Health Care*