br A proposed two stage framework This comparativeanalysis o

A proposed two-stage framework This comparativeanalysis of the entrants to a NS-398 in the U.S. provides new insight as to how EBR&D can be woven into the fabric of future competitions. Kaiser Permanente, one of the leading healthcare providers as well as innovators in the U.S. healthcare industry, fostered a format that points in the direction of valuing quantitative knowledge as a genuine part of the process because the finalists were contracted to further develop their design on a more rigorous level in a second stage. This format acknowledged clients׳ need for a more in-depth approach than in the past and against the backdrop that an inherent disconnect still persists in many quarters between EBR&D and healthcare design itself (Kim and McCuskey Shepley, 2008; Verderber, 2010). This gap persists, in part, because the former strongly advocates empiricism while the latter does not (Richardson et al., 2001; Tetreault and Passini, 2003; Norris, 2012). The recommended protocol is a two-stage model. The first stage embraces the longstanding intuitive model whereby creativity is fostered, unencumbered by technical requirements per se. In Stage 2, the performance of the entry becomes the focus whereby the use of EBR&D becomes one of multiple sources of knowledge that is woven into the design. To this end, Figure 1 and 2 can again be of use in this type of a two-stage format, i.e., the relationship between physical environment attributes and patient/family outcomes, and the relationship between physical environment attributes and staff/organizational outcomes. Prior to the start of stage 1, all entrants agree to this format and all are thereby cognizant of its intent, structure, and scope. Stage 1: Stage 2:
Conclusion—fast forward One of the most well-known healthcare design competitions of the 20th century resulted in Alvar Aalto׳s timeless masterpiece, the Paimio Sanatorium in Finland (Spreiregen, 1979). It did not resemble a conventional hospital, as it expressed a completely new paradigm for the treatment of tuberculosis based on its orientation to natural daylight, its wooded site, patients׳ sustained transactions with nature vis-à-vis extensive exterior rooftop terraces, and multiple places for respite throughout. It expressed many early precursors of what would become core tents of EBR&D, with fundamental emphasis on landscape therapeutics (Watkins and Keller, 2008). Aalto was the first modern architect to infuse “evidence” of this type in a competition design entry in healthcare. It expressed all that was believed could help treat TB patients at the time – natural daylighting, cross ventilation, openness, nature connectivity, fresh air. Submittals to Kaiser Permanente׳s recent Small Hospital, Big Ideas Competition in the United States were comparatively analyzed (Kaiser Permanente, 2010a, 2010b, 2013; Guevarra, 2012; Planetizen, 2012). Based on the analysis reported above has been argued that EBR&D knowledge can be an illuminating component in a healthcare facility design competition. The adoption of a two-phase model can foster intuitive creativity in a first stage that can be verified in a second, more rigorous “testing” of research hypotheses such as: This subsequent verification can guide a systematic post occupancy evaluation after the winning entry is built. The competition therefore becomes a progenitor not only for design innovation, but also for innovative research hypotheses and their verification. At present, the most widely known resource that links existing and emerging EBR&D knowledge with completed case studies and post occupancy evaluations is the Pebble Project (Edelstein, 2008).The Pebble Project is the main research initiative of The Center for Health Design. It consists of a database of more than forty free research reports and white papers that link built environment outcomes to searchable databases of relevant research and built projects. The Center׳s website contains detailed information on completed and in-progress case studies (The Center for Health Design, 2013a, 2013b).