Your physician complainers and nay-sayers can themselves be criticized for failing to demand that clinical researchers thoroughly describe the settings in which clinical research is done. If clinical research regularly recorded the environmental information associated with their studies, we would probably be able to better link environmental and design factors to outcomes. They tend to say it isn't recorded because it is not relevant. I say show me the hard data that indicates it is irrelevant because I suspect the environment plays a far greater role than they imagine.

I think the good news is that there is a growing body of research; our clients are beginning to pay attention. Even if the clinical researchers are discounting the environmental impact, their COO is beginning to pay attention. Especially when it comes to operational expenses re. maintenance of the facility and energy costs. And their CEO is paying attention to the HCAHPS scores. As designers we appreciate the work being done in this field as it provides us with solid evidence to support our design process. And I will take quality over quantity any day!

Sara,
I agree with the thoughts that you express. I and my company work in emerging markets to create high-end hospitals of the quality that you are used to. However, I have a but... to your hypothesis. Evidence based, by its description, has a habit of been backward looking. We need to balance that with innovation. New technologies particularly those related to primary care and prevention. We need to think about the lack of resources - the most obvious one being lack of doctors. The use of internet and mobile telephone technology creates opportunities and the design must at the very least have the flexibility to cope with the changes that are being forced upon us but which also create opportunities for change, more effective care and costs savings.
Take a look at the OECD information on hospital discharges and even more primary care consultations and you will see just how flexible we need to be.
I have learnt that one of the most important ways of addressing healthcare is to respect individual cultures - if one does not do that, neither staff nor patient will not take any sense of ownership. The challenge but also the opportunity of working in emerging markets is that one starts with a cleaner sheet of paper - it is easier to innovate and it is a must.

Sara, I did say that I agree with the thoughts but it needs to be mixed with innovation, which I understand to be your response. I am not a hospital architect but manager and we really have to innovate and as I say, there are really massive differences bettwen the evidence of one country and another. The architects that we work with use evidence but at the same time aim to build flexibility into the key spaces to allow for new ideas that will happen during the lifetime of the hospital.
We in the UK invented Private Finance Initiatives (sometimes called Public Private Partnerships)and these are used as a way of financing hospitals. I am not a fan. The problem is that PFI/PPP put far too much emphasis on the building and not enough on the operations. The contract tends to be 30 or so years and, therefore, the dynamic of hospital use is severely compromised. There needs to be the ability for regular change to respond to changes in the delivery of healthcare.
Nor do I like the PropCo/OpCo model favoured by Private Equity Funds. This too makes for inflexibility. So all you say is realistic but it does need to fit into the variety of contexts - finance cultural operational model etc.