Built environment design knowledge framework supportive of resilient healthcare

Although the evidence-based design (EBD) literature investigating the influence of the built environment (BE) on health services performance and outcomes is extensive, its contribution to resilient healthcare is scarce. This work presents a framework of BE design knowledge supportive of resilient healthcare. Firstly, a systematic literature review based on EBD, complexity, and resilience resulted in generic BE design knowledge that represented the role of BE in supporting resilient healthcare at different levels of abstraction. Next, the knowledge was used for thematic analysis in case studies in two teaching hospitals, tailored to workflows that occurred in the connecting areas to and from an intensive care and other hospital units of a large public hospital in Brazil and the surgical service of a private hospital in Australia. Joint findings allowed the development of a framework hierarchically composed of four meta-principles, seven principles, seven prescriptions, and 181 practical examples emphasizing a systems perspective that considers intra and inter-hospital workflows and areas. The resulting knowledge guides designers of both BE and operations phases during decision-making to support resilient health services. As a limitation, the framework was not applied during those phases, representing one of the main suggestions for future work.