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A substantial amount of research argues that built environmental interventions can improve the outcomes of patients and other users of healthcare facilities, supporting the concept of evidence-based design (EBD). However, the sources of such evidence and its flow into healthcare design are less well understood. This paper aims to provide insights to both the sources and flow of EBD used in three healthcare projects, to reveal practicalities of use and the relationships between them in practice.

Three healthcare case study projects provided empirical data on the design of a number of different elements. Inductive thematic analysis was used to identify the source and flow of evidence used in this design, which was subsequently quantised to reveal the dominant patterns therein.

Healthcare design teams use evidence from various sources, the knowledge and experience of the members of the design team being the most common due to both ease of access and thus flow. Practice-based research and peer-reviewed published research flow both directly and indirectly into the design process, whilst collaborations with researchers and research institutions nurture the credibility of the latter.

The findings can be used to enhance activities that aim to design, conduct and disseminate future EBD research to improve their flow to healthcare designers.

This research contributes to understandings of EBD by exploring the flow of research from various sources in conflation and within real-life environments.

The re-use of good design solutions is a key source of evidence and knowledge in the design of healthcare buildings. However, due to the unique nature of healthcare built environments, the critical application of this evidence is of paramount importance. The purpose of this paper is to investigate the features of such critical application and identify the aspects that need to be considered during the re-use of good designs.

Data from three case studies of hospital designs in the UK were used to explore the processes behind the adaption and re-use of design solutions during the design of healthcare buildings. Data were thematically analysed to distinguish the aspects that should be carefully compared and contrasted during design re-use.

Existing designs of healthcare buildings should be captured and evaluated along with: patient demographics, care models of the hospital, other local departmental needs and facility operational aspects in order to ensure the effectiveness of re-use. In addition, properly introducing the design to the users is also a part of successful design re-use.

The findings of this research were integrated into a framework to support healthcare designers on the effective re-use of good designs. This data-driven framework could be validated further with design practitioners. Further, this research relied on memory recall of the interviewees and the accuracy and completeness of documentary records.

This research provides details of how healthcare built environment designs are embedded in project-unique circumstances. The results could therefore be used to develop meaningful and informative evaluation mechanisms for new and re-used healthcare building design features.

This research extends the understanding of the critical application of healthcare design evidence, by explaining how healthcare design solutions should be evaluated during the design process.

This paper aims to investigate how digital capabilities associated with building information modelling (BIM) can integrate a wide range of information to improve built asset management (BAM) decision-making during the in-use phase of hospital buildings.

A comprehensive document analysis and a participatory case study was undertaken with a regional NHS hospital to review the type of information that can be used to better inform BAM decision-making to develop a conceptual framework to improve information use during the health-care BAM process, test how the conceptual framework can be applied within a BAM division of a health-care organisation and develop a cloud-based BIM application.

BIM has the potential to facilitate better informed BAM decision-making by integrating a wide range of information related to the physical condition of built assets, resources available for BAM and the built asset’s contribution to health-care provision within an organisation. However, interdepartmental information sharing requires a significant level of time and cost investment and changes to information gathering and storing practices within the whole organisation.

This research demonstrated that the implementation of BIM during the in-use phase of hospital buildings is different to that in the design and construction phases. At the in-use phase, BIM needs to integrate and communicate information within and between the estates, facilities division and other departments of the organisation. This poses a significant change management task for the organisation’s information management systems. Thus, a strategically driven top-down organisational approach is needed to implement BIM for the in-use phase of hospital buildings.

Recent earthquake-induced liquefaction events and associated losses have increased researchers’ interest into liquefaction risk reduction interventions. To the best of the authors’ knowledge, there was no scholarly literature related to an economic appraisal of these risk reduction interventions. The purpose of this paper is to investigate the issues in applying cost–benefit analysis (CBA) principles to the evaluation of technical mitigations to reduce earthquake-induced liquefaction risk.

CBA has been substantially used for risk mitigation option appraisal for a number of hazard threats. Previous literature in the form of systematic reviews, individual research and case studies, together with liquefaction risk and loss modelling literature, was used to develop a theoretical model of CBA for earthquake-induced liquefaction mitigation interventions. The model was tested using a scenario in a two-day workshop.

Because liquefaction risk reduction techniques are relatively new, there is limited damage modelling and cost data available for use within CBAs. As such end users need to make significant assumptions when linking the results of technical investigations of damage to built-asset performance and probabilistic loss modelling resulting in many potential interventions being not cost-effective for low-impact disasters. This study questions whether a probabilistic approach should really be applied to localised rapid onset events like liquefaction, arguing that a deterministic approach for localised knowledge and context would be a better base for the cost-effectiveness mitigation interventions.

This paper makes an original contribution to literature through a critical review of CBA approaches applied to disaster mitigation interventions. Further, this paper identifies challenges and limitations of applying probabilistic based CBA models to localised rapid onset disaster events where human losses are minimal and historic data is sparse; challenging researchers to develop new deterministic based approaches that use localised knowledge and context to evaluate the cost-effectiveness of mitigation interventions.