Abstract

I have been a vocal and frequently published advocate for an evidence-based, or research informed, design process for more than 15 years, and prior to that, I was a practitioner who had believed in the concept ever since my university days in the 1960s. In my published work and international speaking, I have tried to make a strong case that architectural design and planning decisions can be improved by interpretation of the current best available evidence. The simple logic of using best evidence to improve design decisions then seemed irrefutable to me, and it still does. On the other hand, my enthusiasm about the case for evidence has led many to assume that I have been advocating for every decision to be made based upon evidence; nothing could be further from the truth.
I am convinced a case can be made for the use of evidence to address a limited number of key design issues, broad attention to best practice for the majority of decisions, along with some decisions grounded in intuition, and a limited number of decisions intended as experiments in design. I believe there is strength in projects that are based on decisions that come from consensus-based best practice. I believe there is also a legitimate role for evidence, intuition, and experiment in the development of important complex projects like design for health projects.
My thinking has evolved since my early publications. As I have had more experience with the process of evidence-based design and have watched the process as it has been used in practice, I have learned to temper my advice. I recognized that by comparison with other fields, the domain of rigorous research in the area of the environment’s impact on clinical outcomes was sparse. I had to understand the difficulty with which practitioners struggled to obtain research findings; what was simple in academia was a substantial barrier for designers in practice. I recognized that experienced practitioners who had no training in research methods or evaluation of research findings were often resistant to this new model, requiring them to alter long established patterns of successful practice.
A Challenge to My Mental Model
In 2013, my thinking was challenged in a major way, requiring me to examine my beliefs about the use of research evidence in design. I was at Chalmers University of Technology in Gothenburg, Sweden, conducting a workshop on evidence-based design for Swedish architects together with Roger Ulrich. A successful architect, Stefan Lundin of White Arkitekter who was also a graduate student at Chalmers at the time, was skeptical of the need for evidence. He had designed a wonderfully successful and widely recognized project for Östra Hospital’s psychiatric unit. Ulrich had previously congratulated him, stating that he had used nearly every known evidence-based design concept appropriate for mental health facilities. Lundin claimed no knowledge of the evidence and suggested he had used intuition to arrive at the same point. My naive thinking at the moment related intuition to arbitrary, subjective decisions.
It should not be surprising that an intuitive designer might arrive at the same design concept as someone who has carefully attempted to interpret the design implications of relevant research findings, yet it seemed less likely that someone might stumble upon multiple evidence-based concepts in a single project. Lundin challenged my thinking and its then “unilateral focus on evidence” during the workshop. I was invited to return to Chalmers in 2015 to challenge him as an examiner during his successful Licentiate defense where we publicly explored the topic. Since then, we have become friends who have examined this concept of valuable tacit knowledge and intuition in architecture and design.
Lundin has evolved his thinking as well. He recognized that his intuitive interpretation of design concepts was influenced powerfully by interaction with the project’s stakeholders. He has begun to write about the information resulting from the designer’s conversations with the users. This can be described as inquiry via design dialogue and becomes another form of tacit knowledge which can be made explicit by recording and sharing it. He is also now more accepting of a search for evidence for a small number of decisions where an answer among research findings is sought for something new.
An Evidence-Based Design Process
The idea of evidence-based design practice is clearly an analog of evidence-based medicine and of evidence-based practices in other disciplines as varied as policing and breastfeeding. I was greatly influenced by Sackett, Rosenberg, Muir Gray, Haynes, and Richardson (1996) who defined evidence-based medicine in the British Medical Journal. My definition was shamelessly modeled on theirs. Evidence-based design is the conscientious, explicit and judicious use of current best evidence from research and practice in making critical decisions, together with an informed client, about the design of each individual and unique project. (Stichler & Hamilton, 2008, p.3)
Current environmental evidence linked to outcomes is sparse, although it is growing. Health Environments Research & Design (HERD) is one journal adding to the body of relevant knowledge. In addition to the work of researchers and academics, there is a need for practitioners to use their projects to collect outcomes data leading to publication. Practitioners have a role to play in increasing the body of knowledge. Design firms have begun describing projects that have used an evidence-based process in the Center for Health Design’s Touchstone Awards.
It is important to recognize that this new emphasis on decisions based on evidence is really nothing new in architecture. Architects have long based their work on evidence from engineering, material sciences, real estate economics, and other domains. What is new is that design professionals are being asked to turn to evidence from the social sciences, medicine, nursing, the clinical sciences, and unfamiliar domains of knowledge.
An Intuitive Design Process
Architects often come to design decisions based on their intuition and personal experience. Behling and Eckel (1991) who contrast analytical and intuitive decision-making describe six forms of intuition: as a paranormal power or sixth sense, as a personality trait, as an unconscious process, as distilled experience, as a set of actions, and as a residual category. The sixth sense and personality trait might belong to the cult of the genius designer, creating brilliant concepts out of whole cloth. I believe that the unconscious process and distilled experience relate most closely to the kind of intuitive design I am describing.
The characteristics of an intuitive design process allow the architect or design practitioner to mysteriously (or at least without explanation) access tacit knowledge within their unconscious. An individual’s tacit knowledge is real but beyond the brain’s ability to reach it. Tacit knowledge may come from an individual’s personal experience but lies below their conscious ability to retrieve it. The subconscious may store facts or knowledge and can develop opinions and beliefs. It is possible that the subconscious mind is able to recognize patterns and conceive of possibilities, all without recall in the conscious mind. In some cases, the designer may try to extract the subconscious content, making it explicit, in such a way as to develop a chain of logic supporting the design decision.
I wrote an editorial about the use of evidence, best practice, and intuition after grappling with my changed thinking that include the diagram included here as Figure 1 (Hamilton, 2017). I had become willing to include intuition as a design source; however, I added the additional category of arbitrary choice to help me explain my aversion to decisions based on an absence of knowledge, neither explicit nor tacit.

Sources of design inspiration, adapted from S. Lundin 2015 licentiate defense, Chalmers University of Technology, Gothenburg, Sweden.
My editor colleague, Jaynelle Stichler, has again reminded me of the role of intuition in Patricia Benner’s classic nursing book, From Novice to Expert (2001). Intuition is a high level of knowing, based on extensive experience and ability. Benner explains that intuition and associated high-level performance comes after deep immersion in the field, extensive experience, and is reflective of mastery. We should therefore consider productive intuition as a tool of the experienced master designer rather than of the novice.
Collective Intuition in a Team
Intuition as design inspiration can also be found within teams or groups. Most complex projects are completed by groups of people with complementary skill sets. There is mention of collective intuition in the literature. We conceptualize collective intuition as independently formed judgement based on domain-specific knowledge, experience and cognitive ability, shared and interpreted collectively. (Akinci & Sadler-Smith, 2018, p. 1)
Lundin’s comments about inquiry that involves dialogue about design and interaction with users and stakeholders represent another type of shared knowledge. Perhaps in the same way as collective intuition works, this exploration of collective knowledge contributes to better understanding of the design problem. The architect is educated about the problem through this sort of design dialogue with stakeholders during development of the project program or brief.
Intuition Is Not Arbitrary
There is a difference between intuitive and arbitrary decisions. I came to understand that intuitive decisions are based on tacit knowledge and experience in a way that is not at all irrational. On the other hand, arbitrary decisions are not assumed to be rational or based on knowledge. Webster’s definition of arbitrary is “existing or coming about seemingly at random or by chance or as a capricious and unreasonable act of will” (Merriam-Webster, 2019). The random nature of an arbitrary design decision indicates it is not rational or based upon some form of logic. Arbitrary decisions are not grounded in any sort of knowledge.
I believe subjective, arbitrary decisions have no place in serious work such as design for health. Of course, there are bound to be some decisions that may be partially intuitive, even partially arbitrary, and partially evidence-based, all on the same project. Still, this new perspective helped me get past my earlier reluctance to see intuition as a valid design source.
Best Practice for the Majority of Design Decisions
What is frequently described as “best practice” is a commonly used type of design decision that has been tried and accepted by many practitioners. One, after all, cannot be expected to be so innovative or creative as to make every design decision without precedent. This type of design decision which follows precedent is based within an unstated consensus among architects or designers working in a common field. They are aware of similar decisions and the resulting built concepts, and they have probably not heard anything negative about the outcomes.
I believe the majority of design decisions on a complex project ought to be best practice decisions. The common idiom, don’t reinvent the wheel, suggests wide understanding that one need not innovate everything. In designing environments for health, much has been established as acceptable and not requiring a new solution.
Experiment, Hypothesis, and Measurement
An experiment is a way of trying something new, and measurement of the results can make a contribution to the body of evidence about environments for health. Much of science is based on the results of experiments. In the world of architecture, an experiment can be considered a test of a design hypothesis. An experiment can be based on prior experience, intuition, or untested ideas. Any design experiment or design hypothesis, if implemented, must be measured to determine whether the hypothesis was supported or not.
There is an important role for experiment in architectural design. When there is an important question without an answer, designers are encouraged to turn to the evidence to seek guidance. When no answer can be interpreted from the available evidence, the designer may decide to try a physical solution which might be observed as a means of answering the question. Implementation of a physical design concept allows one to tabulate results in order to determine the success or failure of the idea. The design concept can be thought of as a design hypothesis. If the concept is constructed and occupied, the observed behavior can be measured to indicate whether the concept was successful. Such a design experiment is a way of testing a design hypothesis, and it requires some form of reliable measurement to complete the evaluation.
Design professionals may be wrongly tempted to think the answer from their study and results supporting their hypothesis provide “proof” of the concept. Scientists, researchers, and physicians would all consider any statement of proof to be an error, overstepping the value of a single study.
Observation, Interpretation, and Designed Interventions
Another of our HERD co-editors, Debbie Gregory, has shared how the iterative process of adaptive leadership has something in common with thinking about design as an experimental process. Architects are, after all, agents of change on behalf of their client organizations. Adaptive leadership is an iterative process involving three key activities: (1) observing events and patterns around you; (2) interpreting what you are observing (developing multiple hypotheses about what is really going on); and (3) designing interventions based on the observations and interpretations to address the adaptive challenge you have identified. Each of these activities builds on the ones that come before it; and the process overall is iterative: you repeatedly refine your observations, interpretations, and interventions. (Heifetz, Grashaw, & Linsky, 2009, p. 20)
Conclusion: Balance Is the Answer
My personal journey as an advocate of an evidence-based design process has been evolutionary. I began as a passionate spokesman for a process largely considered in the abstract and described with broad strokes. My early statements read like an overzealous manifesto lacking subtlety. Along the way, I learned much about how to implement these strong ideas in actual practice on real projects and how to refine my thinking about the process and its description. Over time, I developed greater clarity about how to deal with ambiguity, the scarcity of relevant evidence, and the complex reality facing practitioners who wished to utilize an evidence-based or research informed process.
One would like to think that the majority of design decisions are made with purpose in mind and based upon some kind of knowledge. Perhaps that kind of decision, based on broadly shared knowledge, can be called consensus-based best practice. Knowledge drawn from research evidence and scientific findings includes credible facts and support for strong theories. Knowledge can be extracted from experiments that test design hypotheses. Knowledge can also come from a creative and intuitive understanding of personal experience, along with tacit or subconscious knowledge. The designer should be seeking to find an appropriate balance among these types of knowledge, as appropriate for the needs of the project.
Evidence, intuition, and experiment are thus all relevant to design decision-making. The mature, experienced architect or design practitioner (or engineer, landscape architect, interior designer, and medical planner) must have access to each as a source within the design process. More available and effective tools contribute to better results. Evidence, intuition, and experiment must all work together in a balanced way for the designer, creating the strongest potential for project success.
