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.
What Is The Definition Of Evidence-Based Design?
There are broad and specific definitions of evidence-based design.
Here is the definition from the National Library of Medicine:
“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.” (National Library of Medicine, National Institutes of Health)
Even Wikipedia now has a definition:
“Evidence-based design (EBD) is the process of constructing a building or physical environment based on scientific research to achieve the best possible outcomes.” (Wikipedia)
The definition I like best is from The Center For Health Design.
“…the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.” (www.healthdesign.org/edac)
The built environment (people-built surroundings where human activity occurs) includes art, and since my EDAC (evidence-based design) training and certification, I have sold hundreds of paintings based on these definitions.
Some of my first Great Lakes/Lakeside Lovelies paintings using Evidence-Based Design training.
Based on medical and scientific studies, hospital/medical facility patients highly regard familiar nature scenes.
When I first started creating art using evidence-based design, my first creations were what I called Lakeside Lovelies and Great Lakes Lovelies (above). They were familiar nature scenes, mainly along Highway 23 in Northern Michigan. Half of my inspiration came from Lake Huron and the Straits of Mackinac. The air in this area is clear and clean, so my eyes can almost always catch super-crisp images.
The other half of my inspiration came from the abundance and variety of flowers around town, the Upper Penisula and Northern counties, and within my own art studio’s yard. Who would have thought it? Here is a bush—and of all places—next to my garage that inspired many of my paintings. In this area, this bush is a plentiful sight in the Spring, which also makes its stems a familiar nature scene.
Credible research told me that local natural landscapes helped to achieve the best possible health outcomes, and I strongly dislike painting realism (which isn’t a requirement in evidence-based design), so I happily went with a floral contemporary Impressionism style. (Thank you, Monsieur Monet.)
At the beginning of my journey as an evidence-based design artist and having a studio in Northern Michigan (where a few people still have trophy deer heads and bear skins on their living room walls), I decided to have a little fun and help promote art in the area with the new evidence-based design paintings and videos. Here’s an older video. Enjoy!
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.
Did You Know This About Our Health And Art?
Did you know that some evidence-based designs and art are no longer categorized as just decorative? It’s the difference between designing for wall decoration to designing for health in a physical environment.
Did you know that some evidence-based designs and art are no longer categorized as just decorative?
Based on study after study, evidence-based designs and art have become part of the Environment Of Care.
“The Environment Of Care is the understanding that the experience someone has in a healthcare delivery system is a function of six components: physical environment, layout and operations systems, people, concept, and implementation.” (Integrating Evidence-Based Design, Practicing The Healthcare Design Process, The Center For Health Design)
Evidence-based designs are successful when they consider the entire Environment Of Care experience. It’s the difference between designing for just decoration (Wow! That color will look fabulous with this sofa!) to designing for health in a physical environment (Wow! That evidence-based design with those colors will look fabulous with this sofa AND they will benefit my health by meeting the guidelines of evidence-based design!).
A World Health Organization report, based on evidence from over 3,000 studies identified “prevention of illness” as a major role for the arts. What were some of the beneficial links between the arts and health?
The psychological benefits were enhanced self-efficacy, coping, and emotional regulation.
The physiological benefits included lower stress hormone responses, enhanced immune function, and higher cardiovascular reactivity.
The social benefits between arts and health showed reduced loneliness and isolation, enhanced social support, and improved social behaviors.
The behavioral benefits indication from these studies were increased exercise, an adoption of healthier behaviors, and skills development. (WHO, 2019 Report on Arts and Health)
Today, study after study shows benefit after benefit of evidence-based designs.
I am a member of The Society Of Experimental Artists and I like to experiment by taking credible scientific/medical study results and translating them into works of art. Although I have created quite a bit of art using the established evidence-based design principles and guidelines, not too much evidence-based design creation and analysis has been done with abstract art.
Here are some of my earliest experimentations into the world of evidence-based design and abstract art.
Mastering Life’s Complexities got sold to a gallery director the first day I had it on display at the gallery.
I love to donate art to raise money. Power And Gold I donated to a Crooked Tree Arts Center fundraising event in beautiful Bay Harbor, Michigan.
Power In Action is a painting I just love to have around. The colors are so deeply amazing and they move. I put it for sale on my website (https://thewonderfulworldofdorotheasandraart.com), but I haven’t turned it over to any gallery. I think I’m hoping it never sells. LOL!
With all three of these paintings, I was going after strong (at least by evidence-based design standards) POWER AND MOVEMENT WITHOUT CAUSING ANY STRESS.
Take a peek inside my new book, 100 Days Of Happy Happy Art, Evidence-Based Design.
There’s even a chapter on neuroscience and art.
Creating Joy In Abstract Art
Is it possible to create a modern work of abstract art that triggers the brain to create feelings of joy?
Is it possible to create a modern work of abstract art that triggers the brain to create feelings of joy?
Personally, I’m convinced of it. What is my reasoning? Buyers tell me all the time how happy my art actually makes them feel.
What’s the secret? Is it super talent or artistic genius or is it training and certification in Evidence-Based Design? I believe it’s a combination of talent and training. Based on established medical and scientific research, I know there are relationships between design factors and healthcare outcomes, especially when people view nature. I create and sell an abundance of nature scenes (see my websites dorotheasandra.com and the landscape category of thewonderfulworldofdorotheasandraart.com) but I also love to create and believe in abstract art as health and happiness sources.
I’m a member of The Society of Experimental Artists and also hold the EDAC (Evidence-Based Design Accreditation and Certification) designation, so I have a keen interest in trying new and different ways to create art.
Joyful Movements by Dorothea Sandra
In this triptych titled Joyful Movements, I experimented with using acceptable “evidence-based design” colors (soft and gentle) and combining them with “the abstract essences” of nature’s wind, rocks, sand, and water. Solely as an abstract work of art, Joyful Movements holds it own. The colors are amazingly beautiful and the palette knife movements create deep interest and intrigue.
My goal when designing this was to see if I could connect “evidence-based design” guidelines with “abstract art” techniques, so I stuck with “the essences” of nature—rather than identifiable shapes—for the purpose of keeping the composition free of too much impact and stress. I wanted this piece to be beautiful, but I also wanted it to do more for us. I wanted it to be gentle and soothing and to remind of us of nature’s amazing healing powers.
I wanted the brains of viewers to be reminded of nature’s water and sand and wind and rocks rather than to be touched (impacted) by them. Many of today’s neuroscientists have conducted studies on our brains and art. Professor Semir Zeki, a neurobiologist from the University of London, discovered in his studies: “When a person views art they find beautiful, it triggers an immediate release of dopamine into the brain—a chemical related to feelings of love, pleasure, and desire.”
Pierre Lemarquis, a French neuroscientist, concluded: “Art of all kinds acts on our brains in a multi-faceted dynamic way. Neural networks are formed to achieve heightened complex states of connectivity. Art can sculpt and even caress our brains.”
My overall desire for Joyful Movements was to achieve a work of art with moving nature essences that evoked in us feelings of happiness and healing.
Although this painting was created after 100 Days Of Happy Happy Art, Evidence-Based Design was published, here is an excerpt about designing with water from my book. There’s more to just painting water and nature elements when it comes to meeting all the evidence-based design standards.
For me to create “happy” art, I remember that the medical/scientific “evidence” matters.
“In evidence-based art, compositions with water should provide healing. Calm water scenes are preferred, while gushing rapids or crashing ocean waves should be avoided. Even a trickling water fountain might create negative experiences for people with full or nonfunctioning bladders.” (Distinctive Art Source, “Healthcare Art Bloopers,” 2023)
Creating Joy In Abstract Art
Is it possible to create a modern work of abstract art that triggers the brain to create feelings of joy?
Is it possible to create a modern work of abstract art that triggers the brain to create feelings of joy?
Personally, I’m convinced of it. What is my reasoning? People tell me all the time how happy my art actually makes them feel.
What’s the secret? Is it super talent or artistic genius or is it training and certification in Evidence-Based Design? I believe it’s a combination of talent and training. Based on established medical and scientific research, I know there are relationships between design factors and healthcare outcomes, especially when people view nature. I create and sell an abundance of nature scenes (see my websites dorotheasandra.com and the landscape category of thewonderfulworldofdorotheasandraart.com) but I also love to create and believe in abstract art as health and happiness sources.
I’m a member of The Society of Experimental Artists and also hold the EDAC (Evidence-Based Design Accreditation and Certification) designation, so I have a keen interest in trying new and different ways to create art.
Joyful Movements by Dorothea Sandra
In this triptych titled Joyful Movements, I experimented with using acceptable “evidence-based design” colors (soft and gentle) and combining them with “the abstract essences” of nature’s wind, rocks, sand, and water. Solely as an abstract work of art, Joyful Movements holds it own. The colors are amazingly beautiful and the palette knife movements create deep interest and intrigue.
My goal when designing this was to see if I could connect “evidence-based design” guidelines with “abstract art” techniques, so I stuck with “the essences” of nature—rather than identifiable shapes—for the purpose of keeping the composition free of too much impact and stress. I wanted this piece to be beautiful, but I also wanted it to do more for us. I wanted it to be gentle and soothing and to remind of us of nature’s amazing healing powers.
I wanted the brains of viewers to be reminded of nature’s water and sand and wind and rocks rather than to be touched (impacted) by them. Many of today’s neuroscientists have conducted studies on our brains and art. Professor Semir Zeki, a neurobiologist from the University of London, discovered in his studies: “When a person views art they find beautiful, it triggers an immediate release of dopamine into the brain—a chemical related to feelings of love, pleasure, and desire.”
Pierre Lemarquis, a French neuroscientist, concluded: “Art of all kinds acts on our brains in a multi-faceted dynamic way. Neural networks are formed to achieve heightened complex states of connectivity. Art can sculpt and even caress our brains.”
My overall desire for Joyful Movements was to achieve a work of art with moving nature essences that evoked in us feelings of happiness and healing.
Although this painting was created after 100 Days Of Happy Happy Art, Evidence-Based Design was published, here is an excerpt about designing with water from my book.