Improvement opportunities for evidence-based design: an application of a critical realist's perspective

Both industry and academia consider Evidence Based Design (EBD) to be a positive way forward to improve the quality of the health service through better utilisation of rigorous evidence during the design process. The use of rigorous evidence is not a distinct activity of the design process; it materialises on different routes and activities scattered throughout the design process and which presents many prospects for improvement. The aim of the reported research is to identify how the evidence based design process could be improved. The research takes a critical realist's perspective. An overview of evidence based design, and critical realism are discussed in the back ground literature. Twelve semi-structured interviews with professionals working on healthcare built environment projects were used to gather data pertinent to their choice and application of different sources of evidence. Results validated a conceptually derived model of current practice of EBD and highlighted prospects for improvement. Interviews were thematically analysed to identify the rationale behind current practices and such themes were then used in deriving mechanisms and contingent conditions of the EBD. Six mechanisms that are causally efficacious prospects for improvement and four contingent conditions that flourish or suffocate these prospects were derived. Several suggestions are proposed several to improve EBD in the UK together with a discussion of the experience of adopting a critical realist's approach.