Dana Hoff

Depending where you are standing, bad news can seem even worse. Just ask a medical social worker.

“If I told a patient’s loved one in a hallway that the patient was dying, I would get a much more adverse reaction than if I took them into a nice, quiet, calming room with a view,” says Lorissa MacAllister, AIA, an architect and former medical social worker who began to see how the physical environment could affect people’s emotions and reactions—in good ways and bad.

And, she’s not the only one.

In recent years, academics and practitioners in the fields of architecture and healthcare have become acutely aware of the relationship between design and health. Sterile white rooms with buzzing lights are not only unpleasant, they can actually be unhealthy.

“We’re needlessly harming hundreds of thousands of Americans due to infections and preventable medical errors in hospitals, and are spending far too much for healthcare, but there’s evidence that the built environment can play a role in addressing those problems,” says Craig Zimring. An environmental psychologist and professor of architecture at the Georgia Institute of Technology, Zimring has helped to pioneer the concept of evidence-based design, an approach to architecture that uses data to guide the design process. Often, it’s an approach taken in the healthcare setting with one main goal in mind: Let the design help, not hurt.

Under the leadership of Zimring—who also sits on the board of the Center for Health Design—the Georgia Tech College of Architecture is at the forefront of this work. Through a Ph.D. concentration in evidence-based design, doctoral students are developing new ways to understand and address architecture’s potential to heal patients through a building’s impact on the behavior, satisfaction, and performance of individuals and organizations. Gathering evidence can tell designers, for example, that workers are likelier to be happy in rooms with more natural light. Or that fewer mistakes occur in rooms. Or that fewer patients will fall through the cracks if facilities are designed to encourage more coordination between healthcare providers.

But this is not new information in healthcare, the spaces of which have been transformed by evidence-based design over the last 20 years. Outside of healthcare, however, evidence-based design is just now starting to influence the ways in which architects approach a range of typologies.

Buildings such as prisons, courthouses, and embassies—what Zimring calls “high-stakes buildings”—as well as schools and office buildings can benefit from this type of design. Students in the evidence-based design concentration are looking at things such as the importance of wayfinding, the measurable benefits of natural light, environmental contributors to stress, and the ways people relate to complex building forms and layouts.

And because the concept of evidence-based design can cross disciplines, the Ph.D. students in Georgia Tech’s evidence-based design concentration are exposed to a wide variety of coursework and classmates in industrial design, health systems engineering, applied physiology, mechanical engineering, and city planning. Specialists in architecture, healthcare management, nursing, medicine, and psychology typically sit side by side in lectures and labs, a unique approach that Zimring says is representative of the multifaceted design challenges that the field faces. He argues that by emphasizing outcomes, such as improvements in patient health or workplace productivity, a focus on evidence-based design helps prove the value of architecture to clients.

And the clients do seem to be receptive. Students work on research from a range of sources, such as the National Institutes of Health, the Robert Wood Johnson Foundation, the Military Health System, and the Global Health and Safety Initiative. The program has also been intimately involved in various military hospital designs, including the newly opened Fort Belvoir Community Hospital in Virginia.

MacAllister, the former medical social worker now two years into her Ph.D. at Georgia Tech, focuses on the relationship between user satisfaction and the way that

people experience the physical design of medical settings. Her research shows significant correlations between the two, and she’s hoping to work with the planners and designers of healthcare environments to improve the sometimes unpleasant experiences of hospital visits.

Altug Kasali, another Ph.D. candidate in the evidence-based design program, has taken a more localized approach by correlating data and design’s intent in a medical facility under construction in Georgia. Kasali’s research draws from a number of sources—both scientific and anecdotal evidence proffered by senior healthcare executives, designers, engineers, doctors, and nurses.


Hui Cai graduated from Georgia Tech’s evidence-based design program last year, she’s led research at the Health+Science Practice Group in RTKL’s Dallas office. The firm has instituted a new initiative, “Performance-driven Design,” and Cai says she’s analyzing architectural, clinical, environmental, and financial performances of the firm’s previous best practices, and conducting Post Occupancy Evaluation (POE) to help develop a database of guidelines for future projects. “The hope is that with the accumulation of projects, we’ll gradually build more and more knowledge around what we know about design and what we can do better,” Cai says.

Zimring says the evidence-based design concentration is purposely preparing doctoral students for leadership positions such as Cai’s. Other graduates are in similar leadership positions, both in practice and academia, which Zimring and others see as key to the future of the architecture profession. The evidence-based approach, Zimring argues, “adds value to a field constantly pressed by economic concerns.” -Nate Berg

Learn more at gatech.edu.