Decision Making and Decision Support During the Design of Healthcare Facilities: A Systematic Review

Iterative decision making is deeply embedded in the design process of healthcare facilities. A significant body of literature and practices, most notably Evidence-based Design, explicitly seeks to better inform decisions as a key pathway to achieving improved outcomes. The objective of this systematic review is to explore multiple dimensions of decision making in the healthcare design literature, including interprofessional stakeholder engagement, decision flow elements, and multidisciplinary methodologies aimed at improving decision quality during healthcare facility design processes. This review offers a comprehensive review of 114 papers from the Web of Science, CINAHL, MEDLINE, and Art and Architecture Source. Decisions made during healthcare facility design processes are characterized as complex, highly interdependent, and difficult to reverse with significant implications for human and operational outcomes. The published literature emphasizes decision support generated from ex ante or ex post research. Despite numerous references to the importance of decision making, there are considerable gaps in the study of interprofessional group decision-making dynamics. The adoption and application of decision analysis tools and integrated decision flows are emerging. This review synthesizes current perspectives and methods aimed at improving decision making during the design of healthcare facilities and proposes a potential framework for future investigations of design decision quality.