As reimbursement models shift from fee-for-service to value-based care, healthcare leaders are focused on improving the value and outcomes their organizations deliver.
While leaders increasingly recognize the significant impact social determinants of health (SDOH) have on outcomes, access, and value, what’s less known is the role evidence-based design (EBD) can play in improving access, strengthening the patient experience, and enhancing the value that health systems deliver.
To learn more about the role of evidenced-based, SDOH-informed design, Becker’s Healthcare spoke with Tatiana Orozco, PhD, healthcare research & data analyst, and Dagmar Bachmann, MID, healthcare design researcher, both from design firm Gresham Smith.
A more holistic view
Health is shaped by far more than clinical care. Social and economic conditions are now widely recognized as primary drivers of health outcomes and health disparities.
However, healthcare policy changes have included rollbacks of mandates for SDOH reporting or screening.
Today SDOH language has shifted to targeting upstream drivers of health or closing rural health gaps. Yet, the core idea still holds that to improve the health of communities, it is necessary to understand and address social factors.
“The key is that a facility should not be studied in isolation; it should be understood as part of its larger social system,” Ms. Bachmann observed.
The basics of SDOH-informed design
SDOH-informed design starts with understanding the demographics and healthcare needs of a community. This includes the age of the population, the ethnicities represented, and the languages spoken. It’s also about understanding the community’s healthcare needs through health needs assessments and journey maps.
This is where SDOH and EBD converge ; EBD is separate from SDOH research and SDOH-informed design, but SDOH can greatly inform EBD. Important sources of evidence include scientific literature, health system data, and listening to what members of the community need.
The approach then involves designing facilities and processes to address SDOH and better meet the community’s healthcare needs.
Insights gathered from community-specific SDOH research and EBD can inform which services should be offered to a community, in which facilities and locations. It can also help determine what spaces are needed for social work, nutrition, and other community-based programs and determining which services are decentralized, the hours at different sites, and which sites require accessibility features.
“Evidence-based, SDOH-informed design often results in highly accessible and flexible spaces,” Ms. Bachmann said.
Other improvements that can result from evidence-based, SDOH-informed design include co-locating services to address social needs alongside medical care; clearer wayfinding, for example, with simple instructions and visualizations; and incorporation of inclusive design features that reflect cultural and social diversity.
Ms. Bachmann said that when used most effectively, evidence-based, SDOH-informed design is used throughout the full patient journey.
“Use the opportunity to reduce friction across the entire care journey,” Ms. Bachmann said. “Integrate social support, community health resources, legal aid, and nutrition services and build in flexible spaces for non-clinical interactions. Design this as an access hub, not a treatment site alone.”
Evidence-based design that takes SDOH into consideration results in more welcoming, non-institutional environments that build trust. In turn, building trust increases access because community members feel more comfortable seeking care.
“Communities are more likely to engage with organizations they trust,” Dr. Orozco said. “You want design that supports community trust, reducing the institutional feel and providing flexible care options.”
Rethinking design for value
Design shortcomings occur when decisions are made without evidence, relying on the opinions of internal stakeholders rather than the lived experiences of patients, family members, and employees. An administrator may believe the facility’s check-in process is streamlined and efficient, for instance, while patients and family members feel lost navigating the building. The best-designed facilities don’t rely on staff observations; they collect real-world evidence and improve from the user’s perspective.
That human-first mindset also requires rethinking how value is defined. Most organizations rely on traditional measures such as readmission rates, throughput, and volumes, but Dr. Orozco encouraged leaders to broaden their scope. Value can be shown through patient referrals, community engagement, and spaces designed to be flexible, adaptable, and highly utilized. Access can serve as an especially valuable metric: an organization that demonstrably increases access has increased its value to the community.
Acting on those ideas means working within real constraints. With most health systems under financial pressure, making every desired improvement may not be feasible. Dr. Orozco pointed to several priorities including designing for flexibility and adaptability as policies and reimbursement shift, identifying services that can be co-located to improve efficiency and utilization, and pursuing low-hanging fruit. Often, small, targeted interventions that reduce friction, improved signage and wayfinding, for example, deliver significant impact at minimal expense.
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.