Using the "Five Whys" as a decision-making framework for Evidence-Based Design Conference Paper uri icon


  • Evidence-Based Design (EBD), the judicious and conscientious use of current best evidence to make design decisions for unique projects, is being applied to the design of healthcare facilities with increasing frequency. Because of both the need to replace and expand aging buildings and a retiring baby boom generation, construction of healthcare facilities is currently on the rise in the US. Advocates of EBD argue that its rigorous application will reduce incidence of medical error and improve rates of patient recovery. However, while some promises made by EBD can be scientifically substantiated, design of facilities may not be the only appropriate solution to the problems EBD advocates cite; healthcare facility designers are pressing for EBD adoption, even when a less costly, non-capital program response might be equally effective. This paper suggests that while the error-proofing logic of EBD makes sense, a structured framework for the "Five Whys" should be rigorously implemented by design decision-makers, to ensure that multiple options are considered before final solutions are adopted.

author list (cited authors)

  • Rybkowski, Z. K., & Ballard, G.

complete list of authors

  • Rybkowski, ZK||Ballard, G

publication date

  • December 2008