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Dialoguebecause they act as a blotting paper – when the particlessettle, they settle for good. But you must have a means ofcleaning the carpet properly.”Cooper adds, however, that research can also be usedto challenge cultural paradigms. “There is apparently noevidence whatsoever to support the use of laminar fl owcurtains in orthopaedic theatres, and in the US they don’tuse them.“Any why are the British more combustible than anyother nation? HTM81 is far more onerous than any otherfi re code in the US, Europe, Australia or any other area inwhich I’ve worked. This is an extraordinary restriction aswe move towards 100% single rooms.“Much of what we design is shaped entirely by therigours of fi re code. Research is needed to validatedifferent hospital arrangements that do not increase therisk of mishap or injury due to fi re.”Phil Nedin2008 Director, Healthcare BusinessLeader - Arup2008 NHS Design Review Panel member2006 – 2008 President of Institute of HealthcareEngineering and Estate Management(Now Immediate Past President)Danger of complacencyDespite his warnings about the use of evidence, Nedinsays the danger is not getting proper research done thatwill help to develop the evidence-base. “Real problemsemerge when something is intuitive and you try to writeguidance around it without the research to support it.”Recalling a recent conference presentation he gave inthe US, Nedin said: “I put up a slide of a map of the USdivided into 30 different areas to demonstrate the changingclimate from north to south, and east to west.“In some of these regions, you can naturally ventilatefor 80-90% of the year, in other areas you may not haveconsidered appropriate, natural ventilation is possible for50% of the time. In other areas, where the humidity is high,there may be ways of addressing that problem. Both thearchitects and the engineers said they would love to dothat, but that the code ensured that the fi rst decision wasalways to seal the hospital.”Warning against complacency, Nedin said that whenJohn Cooper RIBA ARBpressed on how the code had been developed to support sealing of the hospital, the designers said that when asked to attendthe guidance meetings, they had sent a junior staff member, whilst the manufacturers of the air handling units had sent theirmanaging director.Nedin said: “It was a business opportunity. If the air handling people could seal the building they would sell lots of kit. There’s alesson here, that we must not be complacent or we’ll soon have laminar air fl ow units and hepa fi lters everywhere!”Make it mandatoryCooper suggests that the only way to overcome similar knowledge gaps and ensure a continuous and comparable cycle ofresearch is to make it mandatory that every pre-business case sets out its clinical policies and explicitly establishes clinical goalsand objectives. “Rather than talking about world class facilities, let’s defi ne it. As a practising architect, I’ve only once ever beengiven clear measurable objectives.“The clinical objectives should be in every brief, so that we can apply the evidence to achieve them. Let’s also make it mandatorythat there is a universal or comprehensive methodology for post-occupancy evaluation. Every facility over an agreed value shouldbe evaluated on an annual basis in its fi rst fi ve years of operation, and then we will generate the evidence we need.”In a fi nal warning, however, Nedin says: “We have to be careful because even evidence can be ignored. Look at smoking. Wepackage cigarettes that say, ‘give us your money, and we’ll kill you’ and people still buy them. But without good research to infl uencethe guides, we’ll get guides that tell us the wrong thing, so we must never be complacent.”Marc Sansom is editorial director of the International Academy for Design & Health2002 – Present Director, Anshen + AllenPresent CABE Enabler1981 – 2002 Founding Director, Avanti Architects1972 BA (Hons), Diploma in Architecture,University of CambridgeWORLD HEALTH DESIGN | October 2008 19