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 Phillip Rollfing  

Heathcare Design

Professor-architect is proponent of
evidence-based healthcare design


Texas A&M University architecture professor Kirk Hamilton is a man on a mission: he's determined to make his discipline more rigorous by focusing on objectively measuring the impacts of designers' choices on the environments and occupants of the structures they build.

Hamilton, a registered architect who specialized in hospital design for 30 years and was an owner of a 120-person firm before joining Texas A&M, also earned a masters degree in organizational development, a process that convinced him to embrace the tenets of evidence-based design.

"My work in practice and my studies at Pepperdine University convinced me that hospital designers must work like doctors, relying on evidence as the basis of their decisions," Hamilton says. "If the profession refuses to evolve in this direction, we run the risk of becoming just highly educated draftsmen. We explore the relationship between evidence-based design of healthcare facilities and measurable performance of the organizations which use those facilities, and we must report our findings."

Hamilton's work was the first to be published applying such social science measurement methods to healthcare building design. He has proposed a certification process by which evidence-based projects could be compared, and the Robert Wood Johnson Foundation is funding a pilot program to make that process happen. Bases for such comparisons might include overall organizational performance judged by financial and economic indicators (margin, average cost per patient day), clinical and safety measures, ways in which healing environments reduce stress, performance improvements in efficiency and systems initiatives, usage and leverage of medical, computer and labor-saving technologies, and sustainable design, including energy consumption, material selection, water conservation and site planning.

"While the concept of evidence-based design has been appealing to many architects and design professionals, there are elements of the process that may require acquisition of new capabilities," Hamilton notes. "As the typical practitioner develops evidence-based skills, he or she also needs to develop mastery of the literature search, the use of applied research methodologies in the field, and an understanding of the intellectual rigor needed in the interpretation and reporting of findings. These efforts are worth it, because they promise higher levels of performance and superior results in the final design and development of a project."

In his current role at the College of Architecture, Hamilton can help future architects learn these skills. He came to Texas A&M in 2004 as part of the college's "signature faculty" program, designed to attract seasoned professionals to teach in its design studios. He is a tenured associate professor in the architecture department and a fellow in the college's Center for Health Systems and Design.

During just two years, Hamilton has created new courses centered around the foundations and evolution of healthcare architecture and typologies of contemporary hospital design, and he plans another course in designing facilities to maximize organizational performance. Students seeking the healthcare certificate offered to master of architecture candidates have been quick to embrace Hamilton's approach.

"Professor Hamilton's expertise and experience has enriched our knowledge of evidence based design. His unique approach to teaching has directly influenced my desire to pursue a career in healthcare architecture. Professor Hamilton's knowledge of organizational culture gave me specific ways to achieve my learning goals and actualize my career path," said Chris Grossnicklaus, second-year master of architecture student.

Hamilton sees himself as a guide or an interpreter for what he terms the "emergent idea" of evidence-based hospital design based on clinical and social science evidence, neither of which comprise the traditional bases of architectural design. For example, he continues to advise practitioners on what constitutes "best evidence" on which to base the design process.

"As many of my colleagues, like Leonard Berry at Mays Business School and Mardelle Shepley, Jim Varni and Roger Ulrich here at this college, have shown, there is powerful evidence that the physical environment impacts patient psychology and physiology and thus clinical outcomes," Hamilton says. "True evidence-based design offers the promise of a bright and exciting future for healthcare architecture. We want to create an approach to designing patient- and family-centered healthcare facilities that provide healing, therapeutic environments for the real people that will use them. Now that we understand the connection, we have no less than a moral obligation to do so."

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Kirk Hamilton