B.Arch. M.Arch. AIA. NCARB. LEED AP. CSI. ACHA. It’s time to add another set of letters after architects’ names: EDAC.
Short for Evidence-Based Design Accreditation and Certification, this latest acronym comes courtesy of the Center for Health Design (CHD), a California nonprofit dedicated to advancing the use of evidence-based design practices in healthcare architecture. The accreditation test launched in a beta phase in February and was opened to the general public in April. One of its primary goals is to formalize what evidence-based design entails, in order to bolster its legitimacy and galvanize practitioners around a shared definition of the term.
“There has been an increase in interest and proposals for evidence-based design, but a lack of understanding of what that requires,” explains Carolyn Quist, a senior project manager at the CHD who helped develop the testing program. “We are defining the base knowledge.”
As of early June, 133 people had been EDAC accredited and nine more had registered to take the test, which costs $285 in the United States and $311 in other countries (including Canada). The CHD hopes to accredit at least 500 individuals by the end of the year.
Evidence-based design has emerged in the last 30 years as a way of using research and analysis to drive the design of the built environment. Early proponents include behavioral scientist Roger Ulrich, now a professor of architecture at Texas A&M University (and a CHD board member). Ulrich conducted extensive research into, for example, the benefits for patients and staff of window views and daylight in healthcare environments. In recent years, the number of practitioners claiming to use evidence-based design principles is on the rise, according to the CHD, but Ray Pentecost, vice president and director of healthcare architecture at Norfolk, Va.–based Clark Nexsen, says the approach—one that he embraces—is still in its infancy. “[Evidence-based design] with the average client is an emerging discipline. It’s embryonic,” he says.
Where it is being applied, there is confusion over what, exactly, it means. Pentecost, who is also president of the board of the AIA’s Academy of Architecture for Health (AAH), recently issued a survey to all 5,300 academy members to assess their understanding of this controversial design topic, which building owners may still skeptically regard as a mere marketing tool and which some architects may think of as vague or irrelevant. (The survey results aren’t in as of press time.)
Randy Guillot of Chicago’s OWP/P Architects agrees that there is a lot of confusion out there. “The use of … ‘evidence-based design’ has become misused jargon, and the center was really the first to want to make sure that that terminology was used appropriately,” he says. Eight members of OWP/P’s staff became EDAC-certified in the beta phase of the exam’s rollout.
The CHD now defines evidence-based design as “the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.” To that end, the EDAC exam focuses on process. Test-takers are not asked to regurgitate specific details about existing research; rather, they are tested on the means of identifying, gathering, analyzing, and implementing data related to their design projects.
Developing the test
More than 120 volunteers worked for several years to get EDAC off the ground. The concept of an accreditation system was first raised at a CHD board retreat in 2003 by Kirk Hamilton, an associate professor of architecture at Texas A&M University. “I was trying to write an article … in which I was going to describe an evidence-based project, and I discovered that I could not define it,” Hamilton recalls. He suggested developing an accreditation similar to LEED in order to “have a consensus body of people who are qualified and are in agreement” about evidence-based design.
Two years later, the CHD received a grant from the Robert Wood Johnson Foundation to fund the development of the program. Nurture by Steelcase, a healthcare furniture manufacturer, then signed on as an educational partner, helping fund the production of study materials and providing feedback on the beta test.
Six companies agreed to become “champion firms” in the beta phase: Kahler Slater, Harley Ellis Devereaux, OWP/P Architects, Salvatore Associates, the interiors firm CAMA, and American Art Resources (an art consulting firm that works with the healthcare industry). At least 30 percent of each firm’s healthcare team agreed to sit for the EDAC exam during its launch last winter. CHD also hired Applied Measurement Professionals, a company that specializes in generating accreditation testing through the use of a specialist known as a “psychometrician.”
Charles Haas, an architect associate with Milwaukee-based Kahler Slater, was one of the first practitioners to take the exam. He and 26 other Kahler Slater staffers studied three prep guides over two months. The test, he says, is based on real-world scenarios. Haas, who is also LEED accredited, saw some similarities between the LEED and EDAC exams.
“In certain aspects, they are very similar,” Haas says. “In length and in technical knowledge, they are about the same. There was a little more study involved [for] the EDAC exam.” He notes that most of the questions related to evidence-based design concern healthcare environments. “I’m assuming [that] if you don’t have much of a healthcare background, there would be a lot more reading you would have to do,” he says.
Haas suggests that the accreditation comes at an important time in the evolution of evidence-based design, especially as “evidence-based” runs the risk of becoming the new “green”—i.e., a ubiquitous term bandied about more for marketing purposes than as a legitimate credential. Haas predicts that EDAC will do for evidence-based design what LEED has done for sustainability. “Before USGBC came out with LEED, people would say, ‘I’m a sustainable architect.’ With LEED, you have a certain rigor and are expected to follow certain processes,” Haas says. LEED did serve as a model for the EDAC exam, according to the CHD’s Quist, and in fact, the CHD is looking to generate a building rating system in coming years.
A challenger, or complement, to LEED?
Will this create a conundrum for healthcare clients? Should they aim for LEED or for EDAC? Or are the two accreditations complementary?
In some cases, the answer to the last question is yes. For instance, evidence-based design strongly supports the use of natural light, as does LEED. But in other circumstances, the two may compete: For example, single-occupancy hospital rooms—favored by some evidence-based design advocates—have been shown to improve patient recovery outcomes, but they could also increase the footprint and energy consumption of the building.
“I think in most cases they do come together,” says Sue Ann Barton, a principal at Zimmer Gunsul Frasca Architects who is currently studying to take the EDAC exam. Regardless, the research should be king, Barton says—and EDAC can have advantages over LEED in that regard. “The reason the research is so important is because you can go to the [health system] CEO and discuss how a design decision will impact patient outcome and why it’s worth the investment.”
John Kouletsis, a director of strategy, planning, and design for facilities at Kaiser Permanente, believes there is room for both accreditations. His company has been applying evidence-based and sustainable design principles to their facilities for decades. When he took the EDAC exam this winter, it inspired him to rethink Kaiser’s facilities standards.
“What we discovered going through the EDAC process was that, as sophisticated as we are, there is a lot of stuff that we didn’t know,” Kouletsis says. “Our approach is a good one, but EDAC allowed us to rethink how we are doing our standard program.” One change resulting from EDAC, he says, will be the addition of a researcher to the diverse team of experts—including architects, doctors, nurses, and other healthcare staff—that Kaiser assembles in the early stages of a project.
If anyone can make peace between LEED and EDAC, it’s Robin Guenther, a principal at Perkins+Will and CHD board member who’s on the steering committee of The Green Guide for Health Care, which the USGBC is using to develop LEED standards for healthcare facilities. Of LEED, Guenther says, “I don’t think USGBC expected that their best practices would become minimum standard around the country quite as quickly as [they] did.” She notes, “The difficulty will come if people confuse evidence-based design [with] a set of design solutions, like single-bedded rooms, rather than understanding that it is a process. It runs the risk of moving to some kind of a checklist.”
Guenther believes there is significant overlap between green and evidence-based design. “The work that Roger Ulrich did about the positive impact of daylighting on patient recovery and staff satisfaction is a complete crossover topic in sustainable design,” she says. “I like to use that example because you realize that Ulrch did those studies in 1983, but they never got much traction. Then along comes sustainability in 2000, and everyone starts talking about some of the same issues, and we are beginning to see traction. When evidence-based design and sustainability join forces on specific topics, they can really accelerate the transformation of the marketplace around those ideas.”
Finding clarity amid the buzz
But not everyone is happy about the creation of yet another accreditation program. Jerry Eich, director of healthcare at HMC, notes, “We’ve had some interesting conversations here recently with our senior management and the comment was, ‘How many acronyms do we have to have behind our name before our clients realize that we’re still good architects that do due diligence, and work to bring forward the latest technology and issues that affect them, in terms of patient care and sustainability?’?”
Responses to EDAC within the membership of the AAH have been “very mixed,” Pentecost says. Besides the concerns about adding another credential, there is still fundamental debate over the application of evidence-based design. Some believe it is still too nascent an idea to embrace. “If I were summarizing the origins of the discord, it probably stems from lack of clarity,” Pentecost says. “It isn’t clear exactly what impact designing with evidence is going to have. [Evidence-based design] overall is in its infancy, and for all of the excitement and for all of the potential—in which I happen to believe—there is still not a tremendous amount of evidence on which designs can be built. Answers are still emerging.” Some architects, Pentecost adds, question the strength of the “evidence” referred to in the movement’s name and have even suggested renaming it “research-based design” for that reason.
Kouletsis, of Kaiser Permanente, agrees that clarity has been elusive, and sees EDAC as part of the solution. “People in the industry are all abuzz about [evidence-based design], but I think people are struggling with what it is. The CHD has done an invaluable service by creating this base line definition from which the industry can grow.”