The science of physical determinism takes the position that if we, as designers, design an environment in a particular way, it is possible to influence the behavior of the users. In fact, much of the design of the built environment is based on this supposition, particularly in the discipline of functional or space planning.

What is even more interesting is that several of our design specialties have developed a high degree of sophistication in the application of physical determinism toward producing intended outcomes. For retail projects, we endeavor to generate sales at a predetermined level of dollars per square foot. For restaurant projects, the goal is to attract customers and turn the tables a certain number of times per meal period. For hotel projects, we attempt to create an experience that attracts customers and fills guest rooms.

For health care projects, there also is a unique set of desired outcomes to which design can contribute greatly, including:

• Enhance desired therapeutic outcomes.
• Improve staff satisfaction and performance.
• Increase family and visitor participation.
• Generate additional community support.

Unfortunately, in the specialized area of health care design, there has been a reluctance to embrace the benefits of this performance-based approach due to the "scientific" orientation of those who tend to be our clients. These benefits can only be credible if large scale, outcomes-based clinical trials have been completed, which, in the case of evaluating design elements as variables, is extremely difficult to accomplish.

In the specialized area
of health care design, there
has been a reluctance to
embrace the benefits of
this performance-based
approach due to the
"scientific" orientation of
those who tend to be
our clients.

Difficult yes; impossible, no. The Center for Health Design, a non-profit advocacy group in Martinez, CA, that produces the annual Symposium on Healthcare Design, is committed to demonstrating the value of environmental design as a therapeutic modality. Toward this goal, the center and its research committee are about to embark upon a multi-year research project to produce the evidence necessary to have environmental design recognized as an essential element of health care. The project will be structured in such a way that significant preliminary data will be available at several key steps in the project process. More information on the project will be announced at the Eighth Symposium on Healthcare Design scheduled for November 16 to 19, 1995, in San Diego, CA.

Twenty-five years ago, E. Todd Wheeler stated in the book Hospital Modernization and Expansion that "The doctor will then know how to write a prescription for environment even as he now does for drugs." We will never be able to achieve this high state of design performance without the backing of research that is sanctioned by the scientific community. We invite your support and the support of the health care and design industries as we take this bold step to ensure the future of our profession and improve the quality of health care.

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