1. Watson, Carol A. PhD, RN, CENP, FAAN

Article Content

An excellent resource is now available on facility evaluation for practitioners and academicians who are passionate about evaluating the design of facilities that support and enhance the delivery of care to patients and families. Health Facility Evaluation for Design Practitioners1 provides a sensible guide that instructs healthcare leaders and architectural firms in the art and science of health facility evaluation research. The book focuses on developing evaluations that are readily applied in practice, provide direct feedback about the design process, and are limited to environmental rather than operational issues. It also provides a tool for practitioners interested in conducting practitioner-focused facility evaluation. This evaluation encompasses facility representatives and clinicians, architects, and designers.


The author successfully describes how to program, design, construct, use, and evaluate environments responsibly and professionally, providing multiple strategies for guiding, implementing, and integrating facility evaluation into the fabric of any new facility construction or renovation. The book is divided into 3 parts. The chapters in Part 1, Evaluation in Context, include information about the definition of facility evaluation, theoretical approaches to facility evaluation, the history of facility evaluation, maintaining objectivity in the facility evaluation process, and the business case for facility evaluation. Part 2, Evaluation in Action, includes detailed information about conducting facility evaluation, and Part 3, Conclusion, discusses future trends in facility design. Practical pointers are interspersed throughout the book with useful information to help the novice discern sensible approaches to facility evaluation. Also included are appendices with information about articles describing facility assessment, evaluation methodologies and a sample of a practitioner-focused facility evaluation.


The Time Has Come

Part 1 provides detail about design and evaluation research, discusses the importance of both preoccupancy and postoccupancy research, and analyzes the relationship of evaluation to evidence-based and knowledge-based design. A detailed discussion of groundbreaking leaders and groups in facility evaluation is included and provides a strong theoretical framework for the different levels of intensity of and hierarchical goals for facility evaluation.


Chapters 4 and 5, The Integration of Evaluation Research in Private Practice and The Business Case for Facility Evaluation, are especially helpful. Chapter 4 describes the factors that contribute to successful research by the private sector versus academic research. Also discussed are the benefits of and barriers to the implementation of facility evaluation and possible academic partners who may assist with the facility evaluation process. Chapter 5 lays out basic guidelines for estimating the costs of facility evaluation. A key consideration is whether building owners and occupiers see their built infrastructure as a necessary overhead or a value-added resource. Part 1 concludes with contributions by several design professionals who comment on the goals and accomplishments of specific healthcare facility design projects and the evaluation of those projects.


As nurse leaders, it is essential to create effective healing environments that positively impact the patients and clinicians who experience the built environment and that address quality, safety, patient and family satisfaction, and staff satisfaction imperatives. Facility evaluation is the means to objectively evaluate whether the design goals were actually achieved. Because healthcare environments are possibly the most complex of all built environments, the true test of the design process is how it performs everyday for the people who use and experience those buildings.


Where to Begin

Part 2 is organized to lead the reader through the process of evaluation in an orderly manner. Information is included about the application of the evaluation process and addresses garnering support, creating the team, conducting the literature review, developing hypotheses, working with institutional review boards, and interpreting data. The chapter on conducting the literature review provides information about relevant search engines, databases, and journals. Some of the search engines and journals cited are familiar to healthcare clinicians, but many are not.


The author suggests measures to expand the scope of traditional facility evaluation study, including clinical and safety outcomes; financial and economic outcomes; system performance; patient, family, staff, and physician satisfaction; community support; culture and design; and sustainability. The author also relates an effort by a research team from Clemson University that is spearheading an endeavor to develop a postoccupancy evaluation tool kit. Use of the tool kit will explore relationships between the physical environment and measurable outcomes across multiple dimensions, including (a) patient- and family-centered care; (b) efficiency and effectiveness in care delivery; (c) environmental safety; (d) financial strength of the hospital; (e) organizational culture/leadership; and (f) sustainable/green hospital practices.


Nurse leaders increasingly recognize that the built environment either supports clinicians' tasks or slows them down. If a space is not designed to support the tasks performed there, then clinicians must expend their energy overcoming environmental barriers to complete the tasks, leaving less energy for the tasks themselves. This relationship between clinicians and their workspace is called functional comfort, which should be a priority in all workspace evaluation. However, users' experiences of and feelings about built space go beyond whether it helps them work efficiently and effectively. Therefore, building evaluation also must consider clinicians' physical comfort and psychological comfort to confirm its effectiveness.


It becomes the responsibility of the facility that implemented the innovation to do an evaluation. For a project that introduces the concepts described above to succeed, clinicians and others who live and work with the outcomes must be involved from the very beginning and embrace the intent of the change. At the end of the project, it is equally important to demonstrate that the intended outcomes were achieved; that the new concepts do, in fact, enhance patient care and increase family and staff satisfaction; and that the governing body of the organization is satisfied that limited institutional resources were invested wisely and effectively.


There is no question that evidence-based design is a dominant theme in healthcare design and that facility evaluation is an important part of that design. This book provides nurse leaders and academicians with another resource that supports facility evaluation.




1. Shepley MM. Health Facility Evaluation for Design Practitioners. Myersville, MD: Asclepion Publishing, LLC; 2011. [Context Link]