More Evidence-Based Design Guidelines
There’s Evidence-based Design, and then there’s NOT Evidence-based Design.
Here are more evidence-based design art guidelines. Many of these guidelines come from “A Guide to Evidence-based Art” from The Center For Health Design, research by Ulrich and Gilpin, a case study on best practices in evidence-based design by the Mays Clinic at the MD Anderson Cancer Center, and so much more.
Waterscapes
They can be regional, generic, or seasonal. They should be calm and non-turbulent. Dramatic seascapes should be avoided, and flowing or trickling water might negatively impact full or non-functioning bladders.
Landscapes
They can be regional, generic, or seasonal. They should have visual depth or open foreground. Trees should have a broad canopy. Savannah and park-like landscapes are preferred by many. Vegetation should be lush. Empty park benches and sunsets should be avoided. The empty park bench might remind someone of loss and loneliness. A sunset might represent the end of life.
Figurative Art
Figurative art should be observational rather than interpersonal. This art should show smiling or emotionally positive faces. Figures can be diverse and appear in relaxed natural surroundings. However, figures that are too relaxed might negatively impact positive outcomes, especially for people with low motivation or in need of physical therapy.
Wildlife
Any wildlife imagery should be of animals widely considered non-threatening. Close-ups of large mammals looking directly at viewers should be avoided.
Still-life
Still-life can be used sparingly for variety.
Early in my evidence-based design career, I decided NOT to do Still-Life. I dislike drawing or painting Realism, especially as they did in the Middle Ages. I enjoy Impressionism and Expressionism, but I am an Abstract artist at heart. I have relatives who are super masterful at capturing hyper-realism. I greatly appreciate them and what they do, but it’s not anything I am interested in creating.
My studio is in Northern Michigan, and as much as I love all the wildlife, I prefer not to paint them. To capture their amazing beauty, I’ll leave that to my many local artist and photographer friends.
Figurative Art is another category I choose not to do. When I was a teen, people were often amazed at my ability to capture a person’s likeness with a Number 2 pencil. Again, it’s not something I am artistically interested in.
As an evidence-based design artist, I specialize in Waterscapes, Floralscapes (which AI says is a real word), and Landscapes. I like to go deep inside these categories and create art that strategically triggers the brain for health and happiness in others.
Mysteries In The Morning by Dorothea Sandra, EDAC 36”x36”
At first glance of this painting, it may seem as if there isn’t much deep strategy involved, but there is.
If you look at the sky, it’s a pretty blue, and it doesn’t shout or make too much of an impact on the brain. The sun and horizon are bright and cheerful, but their edges are soft and gentle. The evidence-based design purpose is to establish beauty without much impact and with no trauma. My goal was not to overwhelm the brain with too much beauty. The brain should register this area of the canvas as beautiful but mostly safe.
Photo of Lake Huron, one of the world’s largest lakes
Based on medical and scientific studies, hospital/medical facility patients also highly regard familiar nature scenes.
As our eyes see the water in the painting, there is a gradation of color. Very typical of Lake Huron (a familiar nature location for people in this area), the water remains mostly calm and non-turbulent.
I got trained to paint along New England's rocky, violent shores. Dramatic seascapes, which must be avoided in evidence-based design, are what I learned.
It was difficult, especially for my ego, but I chose to keep the water almost flat. I decided to use color (darker to lighter to almost aqua, much like Lake Huron) and brush movement to create water that is enjoyable to view but also calm and non-turbulent.
To create impact, I almost always choose abundant flowers (lush vegetation). Flowers almost always register in the brain as beautiful, representative of love, and safe. By de-emphasizing the sky and water (two areas of safety or potentially profound danger) and emphasizing the flowers (with little to no history of causing harm to humans), the overall composition helps to create feelings of well-being and happiness.
When I paint, my evidence-based design goal is not to create overwhelming beauty. This is what I was taught an artist should do. When I create evidence-based design compositions, my goal is to create art that triggers the brain to create dopamine (happiness chemicals).
Sometimes, I will add a little drama to the sky, as with this cloud below, which often appears like this over Lake Huron in the morning. Even though the cloud is loud, the colors are still soft and happy and the horizon line gently blends into the waveless water. The flowers, on the other hand, pop with color and a diversity of shapes of Impressionism.
Mackinac Memories by Dorothea Sandra, EDAC. Sold in 2025 to a collector in Fort Worth, Texas.
Is Evidence-Based Design Legitimate Or Just Another For-Profit Buzzword?
Not long ago, I left a positive comment about a Dopamine Decor article at a homes and gardens magazine. Then, I got attacked by some troll saying that Dopamine Decor was just some new way for companies to make money off people.
Usually, I do not get involved with things like this, but I felt a strong urge to explain that a lot of Dopamine Decor and Evidence-based Design art is based on real, authentic, legitimate science and medical studies.
In my book, 100 Days Of Happy Happy Art, Evidence-Based Design, I wrote: “From the 1960s until today, serious researchers with very serious studies…from different countries…from different multidisciplinary fields have converged to create a new field called Evidence-based Design.”
Even the National Library of Medicine at NIH, the National Institutes of Health, has a definition of it. “Evidence-based design is scientific analysis methodology that emphasizes the use of data acquired in order to influence the design process in hospitals. It measures the physical and psychological effects of the built environment on its users.”
In cancer center lobby.
Today, Evidence-based Design isn’t just for hospitals. It’s for all of us. It is for many of the places humans go.
What is my role in all of this? A very small one—but I think an important one. Today, my art hangs in hospitals, businesses, organizations, and homes. Using my talent and evidence-based design training and certification, I very deliberately and very strategically create HAPPY HAPPY HAPPY art for built environments.
Here’s one of my paintings as it hangs in the lobby of a cancer wing in one of the U.S. hospitals.
The person in charge of art placement at the hospital apologized for its location on a side wall in the lobby.
She thought I might be offended by not having it centered over the main mantlepiece in the waiting area. I wasn’t offended at all. In fact, people come face-to-face with it as they enter the blood draw area. Putting all artist ego aside—and focusing on patient/people needs—I thought it was perfectly located.
Too Beautiful For Words, 36”x36”
Too Beautiful For Words is a super cheerful “distraction” piece. Getting cancer and getting treated for it is often horrific, and at times, it can make patients and others feel as if they are about to lose their minds or are living through some “other world” reality. I thought adding an upbeat quirkiness to the art would help—in a positive way—identify with the circumstances and would also help release some dopamine (happiness brain chemicals).
Patients, their families, and the staff kept telling me—all the time—how happy this painting made them feel, so I decided to donate two other paintings that evolved over the years into a new evidence-based design series called Symphonies of Love.
Both paintings below are placed today in cancer patient examination rooms. People in this community with cancer or with a loved one with cancer continue to tell me how much they appreciate the heart shape, which simply but beautifully communicates to patients that they are loved.
One of these 61” x 78” evidence-based design heart paintings recently got featured on one of the world’s most prominent online art gallery websites. I was listed as one of sixty-one American artists to follow.
In patient examination room #1.
In patient examination room #2.
Click on the photo below to go to the website.
Different Types Of Evidence-Based Design
There’s Evidence-based Design, and then there’s NOT Evidence-based Design.
Here are a few evidence-based design art guidelines. Many of these guidelines come from “A Guide to Evidence-based Art” from The Center For Health Design, research by Ulrich and Gilpin, a case study on best practices in evidence-based design by the Mays Clinic at the MD Anderson Cancer Center, and so much more.
Landscapes
They can be regional, generic, or seasonal. They should have visual depth or open foreground. Trees should have a broad canopy. Savannah and park-like landscapes are preferred by many. Vegetation should be lush. Empty park benches and sunsets should be avoided. The empty park bench might remind someone of loss and loneliness. A sunset might represent the end of life.
Florals
Florals should include familiar shapes of plants and flowers. They should appear healthy and fresh, and flower colors should be vibrant. Gardens and bouquet styles are acceptable. Flowers in vases should be used sparingly and only for variety.
Taking scientific or medical study results and turning them into artistic creations is not the easiest thing to do. There are no step-by-step guides to follow, and the rules need to be there, but sometimes they need a little bending.
The painting above, Healing Flowers, spent time on exhibit in a museum and then in a gallery. It recently sold, in 2025, to an art collector in Fort Worth, Texas. Also, in Jan/Feb 2025, it was featured on the cover of Healthcare Design Magazine. In addition, in 2024, I was also asked to show it in another issue of Healthcare Design Magazine issue. On one international art gallery website, this painting received thousands of views.
While creating it, I tried to adhere to the evidence-based landscape design guidelines for healthy outcomes. By following the rules, I figured I could trigger the brain to create dopamine, which would produce in its viewers feelings of happiness.
If you look closely, you can see through the stems, which gives viewers visual depth. According to the research, seeing through the stems helps humans feel safe. It takes us back to our days of hunting on the Savannah, where dangerous animals could hide in thick grass and then attack us. While the stems were thin, I ensured the flowers appeared lush and abundant. Again, this would suggest an abundance of food.
Healing Abundance by Dorothea Sandra, EDAC
Using the same evidence-based design guidelines, Healing Abundance also sold in early 2025. It was sold from a gallery in Paris, France, and shipped to a company in Hong Kong with television channels in Hong Kong, mainland China, Macau, and other Chinese-speaking areas. The soil and stems are there, but I wanted to add lush vegetation through the flowers.
Years ago, when I was living in Asia, a good friend who was also a medical doctor ended up in the hospital. I went to visit her with a bouquet of cut flowers in hand. After she got out of the hospital, she told me that a bouquet of flowers was not the best gift. A potted plant would have been more appropriate. When I asked why, she explained that cut flowers will soon die, while a plant in soil continues to live on.
Most everything I do in the creation of an evidence-based design painting is for the health and happiness of viewers.
Why Did I Become Evidence-Based Design Certified?
A couple of years ago, I was on a very popular—and seemingly legitimate—New York City art website that was promoting art for health and healing.
Get this—misshapen and horrifically disfigured images; spread open naked human legs and rolls of unhealthy body fat; abstracts of daggers and dripping blood—all amazing works in their categories—just nothing I would consider appropriate for the elimination of stress or the recovery of human health.
This set me on a course for knowledge. I wanted to discover if I could actually learn to design/create with your health and healing in mind. I found The Center For Health Design with its excellent EDAC (Evidence-based Design) courses and certification. Imagine thousands of doctors, hospital administrators, health facility architects, hospital room designers, and many more professionals worldwide basing their creative/artistic decisions and designs on actual medical studies.
Instead of some untrained art critic or consultant setting the standards for art, health, and healing, I now had real medical professionals to learn from and follow. The EDAC exam was the most challenging test I ever took (and I’m a university graduate with high grades), but the knowledge I gained—which I now incorporate into my designs—was absolutely worth all the hard work.
It’s amazing how many people who buy my evidence-based designs tell me how this “evidence-based” art actually shifts their moods and creates positive and uplifting feelings/states of mind.
Here are four examples of what should never be promoted as evidence-based art for health and healing. Two of the pieces sold within minutes to a collector. They had merit, just not as evidence-based design art.
The first painting is titled Anguish and is part of a series I created about child abuse. This painting artistically reflects the mental and emotional suffering that children experience when they are not nurtured in healthy ways.
The second work, Killed Opportunities, shows how barren and tragic a child’s life becomes as opportunities for health and happiness are killed.
The third painting, Death By Power, reflects negative power winning. The face of a hideous creature looking at the viewer (top center) and a hand with the middle finger raised up (lower center) are perceptible.
In February 2025, I sold The Tempest, the fourth painting, again to a collector.
All four paintings have merit as works of abstract art. The art itself, however, does not de-stress or promote health and healing. In fact, it does the opposite.
Can you imagine the added stress and trauma of looking at any one of these paintings while recovering in a hospital bed? Before training to become evidence-based design certified, I wondered why influential people in the art world were calling paintings like this art for health and art for healing. It just didn’t make any sense to me.
Here are more beautiful paintings that would not be considered 100% appropriate evidence-based designs. Some I sold, some are for sale through a Paris, France international gallery, my website, Galleri Soho in Sweden, and more.
When I create evidence-based design art, I use design suggestions and strategies based on credible scientific and medical research. I get my information from a variety of sources, but I enjoy and value the trainings (which are required for EDAC recertification) at the Center For Health Design and their journals and repository information.
There’s a difference between pretty art that makes us feel happy and art that triggers our brains to feel happy based on medical and scientific research. Evidence-based design is that kind of art.
Is Evidence-Based Design Totally New?
Is Evidence-Design Totally New?
If you asked the 6th BCE Greeks of Epidaurus, they might take you to one of the most celebrated healing centers of the classical world—the Asclepieion hospital. In their hospital, patient rooms faced eastward. Why? It is believed the rooms were intuitively designed and placed toward the sun to promote healing.
Many centuries later, many movements from different countries came together in the 1970s to create a new field called evidence-based design.
Who are the people whose forces created this new discipline? Doctors, Scientists, Architects, Interior Designers, Psychologists, Sociologists, Anthropologists, and many others.
The Healing Window by Dorothea Sandra, EDAC, 36”x48”
This artist’s journey into Evidence-Based Design
Photo from the back of McLaren Northern Hospital, Petoskey, Michigan
I am known by many titles in the art world: Artist Of Happiness; a modernizer of traditional woodland compositions; a Great Lakes artist; a 21st-century experimental artist; creator of the evidence-based design collection, Symphonies Of Love; creator of the Smart City Art Collection; and more.
At the beginning of my evidence-based design artistic journey, I chose to create a painting depicting a view from a hospital room. The background of The Healing Window features Little Traverse Bay, as seen from the back parking lot of McLaren Northern Hospital in Petoskey, Michigan.
While composing this painting, I imagined myself in one of the patient rooms at McLaren Northern, looking out the window.
I also imagined myself in a patient room or in a healthcare lobby or a waiting area.
Artists always have lots of choices to make. Early in my evidence-based design floral art career, I chose creating happiness (triggering dopamine) over painting realism. My reason? I figured I would have more power to create happiness if I had more artistic power of the flowers. Not only did realism limit my ability to create happiness (dopamine), but according to medical and scientific research, traditional still-life wasn’t an art category most favored within evidence-based design.
So, is evidence-based design totally new? Yes and no. The flowers in this artwork are modern, cheerful, uplifting, and based on current evidence-based design best practices. However, I also wanted to pay homage to the accomplishments of those who came before us by incorporating elements that, especially in the design texture of the vases, evoke a rough, ancient Greek Asclepieion aesthetic.
Inside Evidence-Based Design Art
If you walked past this painting in a healthcare hallway, would your brain receive a message of love without being overly impacted or stressed by the art?
I do not have the expertise of a neuroscientist or medical researcher or practitioner, but I do LOVE to study their evidence-based design results and find ways to experiment with them in art.
Symphonies Of Love Number 12 by Dorothea Sandra, EDAC
This painting was strategically and deliberately designed using evidence-based design principles and guidelines.
My first goal for this painting was to create a soothing, stress-free background. A large body of research is consistent with the proposition that humans are hard-wired to appreciate and benefit from exposure to nature. I chose the color green for the background because green gardens and parklike settings are acceptable in evidence-based design. I could have added some dabs or splatters to the background, but I decided a super smooth, flat background would create beauty without impact or stress.
My next goal was to decide on a composition. I chose the shape of a heart because I wanted to very clearly and very powerfully create a message that said, “You are loved.” I find too much evidence-based design art today wispy and without form. I think those designs are truly wonderful and quite celebratory of nature, but sometimes humans—especially children—need a clear, up-in-your-face message, especially of love.
Can you imagine a child in this patient bed? I think an image of a heart outperforms a typical biophilic design when it comes to encouraging feelings of love, safety, and care.
My third goal for this painting was to add some fine art flair. Nationally and internationally, people have begun to recognize my signature style of making flowers and they like them. As I am forming the flowers, I use a variety of art techniques to build in and create feelings of happiness and joy.
Keeping with my evidence-based design goal of beauty without impact, I very minimally added a pistil tip to each flower.
If you walked past this painting in a healthcare hallway, would your brain receive a message of love without being impacted or stressed by the art?
Did You Know This About Our Brains And Art?
Did you know a growing body of research shows conclusively that our physical environments (rooms, buildings, walls, etc.) actually have an impact on our quality of life?
Did you know a growing body of research shows conclusively that our physical environments (rooms, buildings, walls, etc.) actually have an impact on our quality of life?
Evidence-based design has been defined as the process of basing design decisions about the built environment on credible research to achieve the best possible outcomes.
When inside built environments our brains get triggered by all kinds of things like color, lighting, texture, and especially art. In one study done on hospital waiting areas, physical and ambient properties influenced patient experiences. Areas associated with higher physical attractiveness reduced anxiety, were perceived to provide better quality of care, and were perceived to have shorter waiting times.
“Similarly, a waiting area with a nouveau (non-traditional) style was associated with lower self-reported stress and higher patient satisfaction than a traditional style.” (Improving the Patient Experience, California Healthcare Foundation)
Fun Fun Everywhere is a playful evidence-based design work of art. It’s a fun painting designed for attractiveness in a nouveau/non-traditional style.
Happy Together With Friends by Dorothea Sandra, EDAC
As I am creating this style of playful evidence-based art, there’s always the challenge of balance. One goal is to trigger the brain to create lots of feelings of fun and happiness without causing any stress. Another goal is to achieve high “distraction” levels of interest, again, without causing stress by overwhelming the viewer with too many details.
Especially when people are troubled or in pain, research studies show that happy art distractions will very positively impact the quality of human life.
For Happy Together With Friends, I was going for the moods of playfulness, happiness, and fun. I also wanted to add in a dash of ironic quirkiness with the hope of making someone—who just didn’t feel good or well—crack a smile.
I have a painting, similar to this one, in the cancer wing of a hospital. When coming out of the blood draw area and on the way to the infusion center, there it is.
Cancer patients, family members, and staff tell me all the time just how much they enjoy that painting. I’ve always suspected it’s the ironic quirkiness built into the painting’s many layers that triggers the brain to create happy emotions, especially at solemn times like this.
These paintings were created—not for their realism or beauty—but to trigger the brain to create the feelings of fun, happiness, and joy.
