title: Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.
abstract: OBJECTIVE
  This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language.
  
  
  BACKGROUND
  Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process.
  
  
  METHODS
  To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety.
  
  
  RESULTS
  In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages.
  
  
  CONCLUSIONS
  Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures.
authors.affiliation: Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA.
authors.forename: Rana
authors.initials: R
authors.lastname: Zadeh
authors.affiliation: Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA hs825@cornell.edu.
authors.forename: Hessam
authors.initials: H
authors.lastname: Sadatsafavi
authors.affiliation: Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Xue
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000517:prevention & control; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control; D003659:Decision Making, Organizational; D017598:Efficiency, Organizational; D004865:Equipment and Supplies, Hospital / Q000191:economics* / Q000592:standards; D000067013:Evidence-Based Facility Design / Q000191:economics* / Q000379:methods / Q000592:standards; D006749:Hospital Design and Construction / Q000191:economics* / Q000379:methods / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008508:Medication Errors / Q000191:economics / Q000517:prevention & control; D055805:Moving and Lifting Patients / Q000191:economics / Q000295:instrumentation / Q000592:standards; D060051:Occupational Injuries / Q000191:economics* / Q000517:prevention & control; D019982:Organizational Case Studies; D061214:Patient Safety / Q000191:economics* / Q000592:standards; D010362:Patients' Rooms / Q000191:economics / Q000592:standards
keywords: business case; efficiency; evidence-base design; quality; return on investment; safety