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Rigor and Replication

During the many years Wilbur "Tib" Tusler, FAIA, FACHA, served as president of the Coalition for Health Environments Research (CHER), he preached that the emerging field needed more good studies that could be repeated by others. Good studies meant increasing rigor in a field whose practitioners were relatively new to serious research and where the pool of academic researchers was small. He wanted to see practitioners and researchers repeat each other's studies so that the findings would gain validity. Tib was one of the founders of CHER and with his colleagues on the board he funded a modest line of research every year. CHER has since merged with The Center for Health Design, a cosponsor of this journal, and together they appear to be prepared to provide funding for more research in the future. We commend them for their continuing commitment to research in the field. They put their wallets where their hearts directed them, while their brains and accountants told them that there would be little return on the investment and that the research funding amounts were too small to make a major difference. This was a courageous path for a notfor- profit organization.Some have said that the number of academic researchers will continue to be small as long as research funding is limited and there are few outlets for publication in peer-reviewed journals. Career advancement in academia requires funded research and published papers. Others contend that evidence-based models of practice will not flourish until clients realize their value and request them, and unfortunately it seems that many executive suites in healthcare organizations have a marginal understanding of research-informed design. On a positive note, more credible research is occurring, HERD is offering the healthcare design field another outlet for publication, and more practitioners and their clients seem to be adopting some version of an evidence-based process. Design practitioners and their clients are eager for quality research findings that can be appraised for their efficacy in specific design projects and lead to improved clinical outcomes in safer, more economical buildings.Many in healthcare and in the design field are looking to HERD for new material. We are pleased that HERD has surpassed its annual goal for paid subscribers before the publication of its fourth issue, so there seems to be genuine interest in the field of environments for healthcare, the evidencebased design (EBD) of these environments, and growth in the body of rigorous, replicable research in this emerging cross-disciplinary field. Perhaps a snowball effect is occurring. The need for an EBD approach is being recognized, and the need for a journal that disseminates new research and ways to translate existing research into practice is gaining acceptance while it rolls down a gentle hill and grows toward a tipping point.As the field gains energy and attracts interest, another good sign of scientific rigor is that there are credible calls for cautious skepticism. Because an evidence-based model is difficult to challenge, and because its adoption might afford a potential advantage in the marketplace, some may be making unsupportable claims. An example of a call for caution is the recent advisory that the board of directors and staff of the American Society for Healthcare Engineering (ASHE) of the American Hospital Association sent to its membership. They were "concerned with potential misrepresentations of the EBD concept and the apparently widespread application of this new design methodology." The ASHE advisory lists three concerns:* The insufficient and untested nature of the "evidence" demanded and offered by EBD advocates as compared to the evidence available for evidence-based medicine;* The questionable quality and small quantity of evidence available to support design decisions; and* The differences between how "evidence" is being used in building design and in medical treatment and care. …