10.3 Step 4: Creating and Innovating Evidence-Based Design Concepts

Key Takeaways

  • Step 4 of CHD's eight-step EBD process is to create and innovate evidence-based design concepts from the interpreted evidence.
  • EDAC study materials list six schematic design tasks: annotate diagrams, document assumptions, update hypotheses, test design concepts, select the best options, and construct mock-ups.
  • Annotated diagrams communicate the intent behind EBD interventions and link them to expected outcomes.
  • Testing each design concept against the project's guiding principles gives a consistent way to judge how well it addresses the original goals.
  • The Design domain of CHD's exam content outline adds coordinating the program with the approved budget, using an information repository, and obtaining milestone approvals from executive leadership and key stakeholders.
Last updated: September 2026

Step 4: Creating and Innovating Evidence-Based Design Concepts

EDAC Core Concept: Step 4 of CHD's eight-step process is to create and innovate evidence-based design concepts. It is where interpreted evidence (Step 3) becomes spatial ideas—and where EBD teams do extra work that typical design teams skip: annotating diagrams, documenting assumptions, updating hypotheses, and testing each concept against the project's guiding principles before choosing a direction.


Where Step 4 Happens in the Project

EDAC study materials describe the research plan, the vision, and the business case being linked during the schematic design and design development phases. During this work:

  • New design ideas for interventions often emerge.
  • New hypotheses may come to the team's attention. There may be many, but not all of them need to be researched (Section 8.1).
  • The research plan continues to be updated with new information, assumptions, and ideas throughout the design phase.
  • Early in design, the team should make sure the business case clearly states the costs, benefits, and executive support for incorporating EBD.

Design-Domain Tasks in CHD's Current Exam Content Outline

Domain 4 (Design) of the outline expands Step 4 into a set of tasks the interdisciplinary team carries through schematic design and design development.

Coordinate the Program With the Approved Budget

The team coordinates the functional and space programs with the approved budget and develops design diagrams incorporating the accepted EBD concepts and strategies, checking that concepts, strategies, and interventions are consistent with the project goals and objectives, the budget, and the schedule.

Develop, Test, Adjust, and Refine Concepts Using Many Data Sources

The outline lists the information used to develop and refine concepts:

Data SourceHow It Informs Concepts
Project vision, goals, and objectivesDefines what a concept must achieve
Guiding principles and design guidelinesProvides the test each concept is scored against
Research questionsKeeps design choices connected to what will be studied
Components of systems-based planningChecks people, systems, and operations, not only the physical space
Relevant evidence in the information repositorySupplies appraised research and project records
BenchmarkingCompares options with peer facilities and internal performance
Additional literature review and critical evaluationFills gaps that new ideas reveal
User group and key stakeholder inputAdds operational knowledge and experience
Pilot studies, simulations, and physical and virtual mock-upsTests ideas before they are built

The team then critically evaluates and incorporates research findings to select the best options for adjacencies, flow, user and staff experiences, safety, building systems, material choices, and structure and finishes.

Record and Synthesize: The Information Repository

The outline calls for recording and synthesizing information in an information repository—an organized, searchable record of evidence, decisions, assumptions, hypotheses, mock-up findings, and stakeholder input. It keeps the link between design strategies and EBD goals visible when people change and value engineering begins. The team also determines the documentation required to illustrate the link between design strategies and the EBD goals.

Techniques for Developing and Documenting Concepts

The outline lists techniques used to develop, evaluate, and document EBD concepts during design development and for future research: user group and key stakeholder input, annotated diagrams, hypotheses, business case development for each design strategy, virtual simulations, and conceptual and structural mock-ups. Research plans prepared for the Institutional Review Board are covered in Section 6.4.

Approvals at Project Milestones

Before proceeding to the next stage of design and documentation, the interdisciplinary team should obtain approval at project milestones from the owner's executive leadership team (governing body) and key stakeholders. Milestone approvals confirm that the direction still supports the vision and budget, and they make later reversals less likely.


The Six Tasks of Schematic Design Development and Evaluation

EDAC Study Guide 3 lists what is important during schematic design development and evaluation:

TaskWhat It InvolvesWhy It Matters
1. Annotate diagramsLabel plans and diagrams with the intent behind each EBD intervention and the outcome it targetsAnnotated diagrams communicate intent and link interventions to expected outcomes, so the reasoning survives handoffs and value engineering
2. Document assumptionsRecord the assumptions behind design choicesDocumenting assumptions is typically a qualitative statement that does not need to be specific or quantitative
3. Update hypothesesRefine or add hypotheses as concepts changeKeeps Step 5 and the research plan current
4. Test design conceptsEvaluate each concept against the guiding principlesProvides a consistent method to judge how well each concept addresses the original project goals
5. Select the best optionsCompare alternatives using explicit criteriaMakes trade-offs transparent
6. Construct mock-upsBuild physical or virtual prototypes of key spacesThe time and money saved later outweigh the up-front cost (Section 10.4)
Interpreted evidence (Step 3)
        │
        ▼
Design concepts ──► annotate diagrams ──► document assumptions ──► update hypotheses
        │
        ▼
Test each concept against GUIDING PRINCIPLES
        │
        ▼
Select best options (considering implementation, operations, flexibility,
project & operating costs, schedule, systems components, outcomes)
        │
        ▼
Mock-ups ──► refine ──► design development ──► construction documents

Testing Concepts Against Guiding Principles

The guiding principles defined at the start of the project set the goals, serve as a planning framework, and guide decisions (Section 7.2). In Step 4 they become the yardstick: testing each design concept against the project's guiding principles gives the team a consistent evaluation method for deciding to what extent a planning and design concept addresses the original goals.

A simple scoring grid works well:

Guiding PrincipleConcept AConcept BConcept C
Patients can see caregivers and caregivers can see patientsStrongModerateWeak
Families are supported as partners in careModerateStrongModerate
Staff walking and interruptions are minimizedStrongWeakModerate
Design adapts to future care modelsModerateModerateStrong

Selecting the Best Options

Beyond the guiding principles, EDAC study materials list other considerations for choosing among design options:

  • Complexity of implementation
  • Impact on operations and functional programs
  • Long-term flexibility
  • Project costs
  • Operational costs
  • Schedule and timeline
  • Systems-based components, formerly the Environment of Care (Section 2.3)
  • Outcomes

Because the systems-based components act concurrently, a concept that looks best on paper can fail if it ignores operations, systems, or implementation.


Innovation With Evidence

"Create and innovate" does not mean copying a prior project. EBD innovation means:

  1. Starting from the goals and the appraised evidence, not from a favorite precedent.
  2. Combining evidence with expertise and user input—the same triad described in Section 1.2.
  3. Treating new ideas as hypotheses to be tested in mock-ups and, where feasible, measured after occupancy.
  4. Documenting the reasoning meticulously so the links among goals, evidence, and design decisions stay visible.

Exam Watch: High-Yield Traps & Pitfalls

[!WARNING] Trap 1: Assumptions vs. hypotheses. Documenting assumptions is usually qualitative and need not be specific or quantitative; hypotheses are testable predictions.

[!WARNING] Trap 2: What concepts are tested against. Design concepts are tested against the project's guiding principles to see how well they address the original goals.

[!WARNING] Trap 3: Research every idea? Many hypotheses may arise during design, but not all need to be researched.

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Step 4 Workflow: From Evidence to Tested Design Concepts
Test Your Knowledge

During schematic design, an EBD team wants a consistent way to judge how well each of three planning concepts addresses the project's original goals. According to EDAC study materials, what should each concept be tested against?

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Test Your Knowledge

An architect records the statement, 'We assume families will spend more time at the bedside if the room includes a daybed.' According to EDAC study materials, how should documenting assumptions like this be characterized?

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Test Your Knowledge

Which set of tasks do EDAC study materials identify as important during schematic design development and evaluation?

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