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  • Writer's pictureArchontia Manolakelli

Evidence-based Practice: From research to design implementation

Updated: Sep 9, 2023

Following the onset of the Covid-19 pandemic, clients, occupants and building users across multiple sectors are looking to re-imagine their spaces for better hygiene, improved wellbeing, and new ways of working. As a result, extensive discussions are taking place about the right way forward, with many individuals and organisations turning to research insights in their search for answers. In response, Evidence-based Design is currently in the spotlight, even outside the bounds of design for healthcare and specialist facilities. This article will provide an introduction to this design approach by briefly discussing its origins, core methodology and levels of adoption in practice.

evidence-based design architecture artwork

Prompt: evidence-based design architecture

Evidence-based Design has its basis in a wide movement around Evidence-based Practice, most commonly associated with Medicine. The following overviews provide a brief outline of the connections and differences between the two:

Evidence-based Practice (EBP) integrates scientific research, and practice that considers the full range of available evidence towards better-informed decision making (McKibbon, 1998, Levant, 2006). As the scientific method became increasingly utilised in research, Evidence-based Practice gained traction, particularly in the medical fields, to systematically evaluate patient treatment options. Due to physical space being an integral part of patient recovery, the approach was later popularised in architecture to support the design of healthcare facilities.

Evidence-based Design (EBD) is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes (CHC, 2021). It places emphasis on the use of insights acquired by measuring and evaluating the physical and psychological effects of the built environment, an approach that “brings empiricism to the design process to support imagination, judgement, and evaluation” (Ulrich et al., 2010, p.96). As part of this approach, design decisions derived from credible and up-to-date research with the aim to improve architectural outcomes and achieve a set of evidence-based goals.


The origins of Evidence-based Design can be traced back to the 1850s and Florence Nightingale’s novel research on the influence of environmental factors such as fresh air, quiet spaces, appropriate lighting, warmth, and clean water for recovering soldiers (Zborowsky, 2014). Her systematic approach revolutionised healthcare, saving many lives in the process.

Continuing this lineage of design for healthcare facilities, many researchers have continued to systematically assess patient experience and outcomes in later years, enriching the knowledge base of evidence to draw from. One of the most cited papers in Environmental Psychology, was written in 1984 by Roger Ulrich, Professor of Architecture at Chalmers University of Technology, indicating that surgical patients recover faster when located in rooms with a view of green space. The findings from this research have been replicated and applied to inform the design of healthcare facilities, such as the Lucile Packard Children’s Hospital at Stanford (DeTrempe, 2017), improving the lives of many over the past decades.

In more recent years, the impact of Evidence-based Design is evident in the way we design, through insights that are accepted as common knowledge within the profession. Even without realising, Architects often follow evidence-based guidance in the form of design guidelines, good practice, laws and regulations that have been developed using this approach.

Evidence-based Design Process.

Despite its origins, the applications of Evidence-based Design are not limited to the design of healthcare facilities. Any building type can benefit from this approach that helps designers make considered decisions based on reliable findings. The Centre for Health Design (CHC, 2021), an organisation founded in 1993 with a vision for creating healthier environments for patients and staff, outlines the following eight steps undertaken as part of the Evidence-based Design process:

  • Define evidence-based goals and objectives.

  • Find sources for relevant evidence.

  • Critically interpret relevant evidence.

  • Create and innovate evidence-based design concepts.

  • Develop a hypothesis.

  • Collect baseline performance measures.

  • Monitor implementation of design and construction.

  • Measure post-occupancy performance results.

When thinking about Evidence-based Design in the context of professional practice in the UK, the various stages of the process can be mapped onto the outlined RIBA (2020) design stages as described in the diagram below:

Evidence-based practice and the RIBA plan of work

Evidence-based Design is therefore a cyclical process that continually feeds information and insights back into itself with the aim to improve design outcomes. In many cases however, this rigorous approach is hard to carry out in practice as many practitioners lack the time, resources or expertise to fully implement. This leads us to the next section of this article which considers levels of adoption of Evidence-based Design which may vary from practice to practice and depending on the sector in question.

Four levels of Evidence-based Practice.

Kirk Hamilton, Professor of Health Facility Design at Texas A&M University, proposed a conceptual model of “Four Levels of Evidence-based Practice” (2004, 2020) including:

  • Level 1 - Make informed design decisions based on up-to-date literature.

  • Level 2 - Hypothesise expected outcomes based on predictive performance and measure results to reduce subjective decisions and the urge to downplay failures while accentuating successes.

  • Level 3 - Report results publicly with the aim to share information and findings beyond the design team.

  • Level 4 - Publish findings in peer-reviewed journals and collaborate with academic institutions towards achieving the highest level of rigorous review.

four levels of evidence-based practice

Most architecture practices may be interested in, and can benefit from, implementing the first two levels of Evidence-based Practice. This requires a thorough consideration of evidence from multiple sources, such as literature originating from both academic institutions and practice, current government guidance and regulations, end-user feedback etc. to improve design quality to implement this approach at level one. A structured approach can be put in place at level two to predict performance, evaluate results in an objective manner and interpret accordingly, forming the baseline of Evidence-based Design.

Most practitioners stop at levels one or two, however, according to Hamilton (2020, p.27) “an evidence-based practitioner has an obligation to share the lessons from measurement of outcomes with the larger field”, something that is expected to happen at level three. The results of the evaluation process taking place at level two are therefore to be reported more widely in an attempt to share insights beyond the original design team, often in the form of articles in professional press or conference presentations.

Given that not all projects are suitable to be subject to rigorous research, measurement, and peer-review outlined at level four, the last level of adoption is rarely achieved in practice. The longer timeframes and higher level of education required to navigate this process often creates some barriers for practitioners, however full implementation is also not impossible, as many, usually large, practices have invested in research and development (R&D) departments as well as collaborations with academic institutions and partners, creating more opportunities to explore this avenue.


Evidence-based Design is an approach that utilises high quality evidence to inform design. The process takes a cyclical form with the aim to improve design by continually feeding information and insights back into itself. It can be adopted at different levels depending on the project, resources and capabilities of different practices, but any design project can benefit from implementing aspects of Evidence-based Practice to improve quality, monitor outcomes, and share insights in a coordinated way.

Archontia Manolakelli profile photo

Archontia Manolakelli is an Architect and interdisciplinary Design Researcher based in Manchester, UK. Her commitment to designing more comfortable, inclusive and sustainable places using an evidence-based approach, led her to discover Environmental Psychology back in 2016. Since then she has continued to further her knowledge on this wonderful field through the study of psychology and approach to professional practice in architecture.


Hello. Thank you for stopping by, I hope you have enjoyed your reading! If you have any questions or feedback on this article, please don't hesitate to drop me a line on LinkedIn or via email.



CHD. (2021, February 26). What Is Evidence-Based Design (EBD)? The Center for Health Design. Retrieved from

DeTrempe, K. (2017, November 20). A healing Environment: New Lucile Packard Children's Hospital Stanford includes family and nature in care. Stanford Medicine Magazine. Retrieved from

Hamilton, K. (2003). Four Levels of Evidence-Based Practice. The American Institute of Architects, 1–2.

Hamilton, K. D. (2020). Evidence-based practice: Four levels revisited. HERD: Health Environments Research & Design Journal, 13(3), 26–29.

Levant, R. F. (2006). Evidence-Based Practice in Psychology. American Psychologist, 61(4), 271–285.

McKibbon, A. (1998). Evidence-based practice. Bulletin of the Medical Library Association, 86(3).

Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420–421.

Ulrich, R. S., Berry, L. L., Quan, X., & Parish, J. T. (2010). A conceptual framework for the domain of evidence-based design. HERD: Health Environments Research & Design Journal, 4(1), 95–114.

Zborowsky, T. (2014). The legacy of Florence Nightingale's environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19–34.


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