In healthcare facilities, where decisions and actions can mean the difference between life and death, where stress levels are high and decision-making time is short, where people experience some of their happiest and saddest moments, and where most individuals feel as if they have lost control over what's happening to and around them, it is critically important to create environments that support patients, families, and staff, and contribute to the quality of care.
With the publication of the first edition of Design That Cares some 30 years ago, Jan Carpman, PhD, and Myron Grant, MLA, set out not only to elevate the role of the physical environment and its impact on outcomes for vulnerable patient populations, but also to provide an expansive and accessible tutorial for designers, nondesign professionals, and students who are—or will be—involved in making design decisions. This long-awaited third edition is cause for celebration. It offers a compendium of new research findings, references, design guidelines, and design review questions, as well as overviews and learning objectives. By inference, it shows how our field has grown and continues to grow.
Design That Cares grew out of Carpman and Grant's groundbreaking work at the University of Michigan Medical Center in the 1980s. Their Patient & Visitor Participation Project used empirical research to understand the design-related needs of patients and visitors, with the goal of providing timely, design-relevant findings and recommendations that would help make a multimillion-dollar replacement hospital an exemplar of human-centered design. Carpman and Grant were among the pioneers in what we now know as a worldwide movement for evidence-based health facility design that maximizes patient outcomes and positive customer experience. When my organization, the Center for Health Design, held its first national symposium in 1988, Carpman and Grant were presenters.
Building and renovating health facilities are enormous, complex undertakings. It takes a strong, interdisciplinary team to discuss, imagine, study, debate, and come to consensus on myriad issues over an extended period of time. As members of a hospital planning and design team for six years, Carpman and Grant witnessed scores of medical and health professionals doing their best to understand design issues and options during such a project, but often feeling frustrated and having little influence. With no background in reading architectural plans or in understanding aspects of design—such as scale—nurses, physicians, healthcare administrators, and others often go along with or approve design schemes because of social pressure and time limitations without fully comprehending the behavioral implications. The authors framed Design That Cares to include evidence-based findings and guidelines, and especially design review questions, in order to make explicit what decision-makers should ask about proposed design schemes or features, and what design-behavior relationships they should advocate.
At the Center for Health Design, we are strong advocates of design solutions that use an evidence-based design process. A large and growing body of research attests to the fact that physical environments affect patient stress, patient and staff safety, staff effectiveness, and quality of care provided in healthcare settings. Basing planning and design decisions on this research to achieve the best possible outcomes is what evidence-based design is all about. Design That Cares contributes to the state of the art by addressing complex issues, including wayfinding, physical comfort, control over social contact, universal design, access to nature, sound and music, and many others. This book is an indispensable resource for making informed design decisions that will affect patients, visitors, and staff over the lifespan of a health facility—often fifty years or more.
I am proud to join the writers of forewords to the first and second editions of Design That Cares: Jepha W. Dalston, PhD, former CEO, University of Michigan Medical Center, Ann Arbor and Hermann Hospital, Houston, representing the fields of hospital administration and medical care; and Margaret Gaskie, former senior editor, Architectural Record, representing the field of architectural design. My own career in healthcare design is at the nexus of these fields: combining my love of interior design and architecture and my compulsion to help make the (healthcare) world a better place. As they did, I salute Jan Carpman and Myron Grant and Design That Cares, third edition, for offering a new generation of present and future health facility design decision-makers jargon-free, compelling, evidence-based guidelines for creating caring environments for patients and families.
Debra Levin, EDAC
President and CEO
The Center for Health Design