Trade-offs in Evidence Based Design: ‘the Patient Door Debate’

The door between the semi-public corridor and the single-occupancy patient room of a newly built University Medical Centre in the Netherlands has been heavily debated during its Evidence Based Design (EBD) and experience-informed design. It was also heavily debated since the wards came into use in 2018. It is well known that, regarding door design, a trade-off has to be made between aspects such as privacy, visibility, and safety. This makes our case study exemplary for the trade-offs to be made in EBD practice. This study traces back to how the design decisions for the door, dating from 2011, were made. Safety, privacy, control, and support for the social and emotional wellbeing of patients, relatives, and staff were the aim, but this is not experienced as such by all concerned. This case study evaluation highlights the tension between EBD principles and everyday practice, where the interplay between 'bricks, bytes, and behavior' has to be considered, and every consciously debated design solution might bring new and unforeseen challenges elsewhere. Our practice-based research combines the analysis of documentation on the design decision-making process with evaluation interviews with nurse managers in 2019. Our findings on 'the (Dutch) patient door debate' can contribute to awareness of trade-offs to be made in health facility design, complemented with supportive IT systems and efficient and effective staff workflows. It can enhance the understanding of the many aspects that need to come into consideration during design dialogues with experts and end-users.