The Application of Root Cause Analysis and Target Value Design to Evidence-Based Design in the Capital Planning of Healthcare Facilities Institutional Repository Document uri icon


  • The US is currently engaged in a large-scale building boom to upgrade and expand healthcare facilities. Facility decision-makers need an unbiased information source in order to improve quality and maximize value for money. Concurrent with this surge in hospital construction is the growing application of Evidence-Based Design (EBD) to healthcare facility design. The objective of this dissertation research is to assist capital-budgeting decision-makers in two ways: (1) to increase accuracy—and therefore confidence—in financial savings predicted after implementation of EBD interventions by developing a framework for an Evidence-Based decision-making tool based on Root Cause Analysis, and (2) to investigate how an owner can overcome the hurdle of increased first cost sometimes associated with the application of EBD, by describing and analyzing processes used during case study projects that implemented Target Costing and Target Value Design. Results from this study suggest that (1) while a Root Cause Analysis decision-making framework for EBD is possible, accuracy will be enhanced with more rigorously controlled experimentation, and (2) the challenges of increased capital cost sometimes associated with EBD can be addressed using Target Value Design—a methodology which appears to reduce capital cost predictions by up to 20%.

author list (cited authors)

  • Rybkowski, Z. K.

publication date

  • February 2015