Knowledge produced within the feld of evidence- based design seeks credible data to support decision- making in the architectural design process. When directed towards the design of healthcare settings, such knowledge can support both the optimisation of patient healing and the improvement of staff performance in ways that correlate positively with patient safety and well-being. Spatial confgurations that improve co-worker proximity, visibility, and communication can have a positive infuence on staff perceptions of work culture, available support, and workplace safety that, in turn, support the delivery of patient care. 1 Spatial proximities also have a direct infuence on the types and frequencies of socialisation that will take place within spaces between patients, family members, and staff. 2 This can support or hinder the formation of social support networks that can assist patients and family members to cope with stress, and healthcare workers to cope with stress and work-related grief. 3 Evidence-based design researchers have also argued that design can be utilised to improve infection control, reduce falls, and minimise errors in medication dispensing. 4 A clear disparity exists, however, in the quantity of evidence available to guide the designers of hospital-based palliative care and hospice facilities relative to general hospitals. While there are a small handful of international design guidelines available for palliative care settings, these are typically created in consultation with small working groups that usually include medical practitioners but seldom other end-users. While guidelines do include references to evidence- based design research, they typically rely on research conducted within non-palliative care settings. In Australia, for example, the Victorian Department of Health and Human Services’ Hospice Unit Generic Brief cites just fve references to hospice design practice and four of these comprised (non- research based) reviews of recently constructed hospice buildings. 5 In a similar guideline provided by the Irish Hospice Foundation, only one from eighty-four references discussed hospice-specifc design research. 6 Palliative care, however, provides a unique design proposition that can be practice 1 practice Where guidelines are absent, how can we evaluate healthcare settings? This article argues for a reconceptualisation of the built environment’s value as a support for well-being. Briefing a children’s hospice: bridging the evidence gap and redefining value in contemporary healthcare design Rebecca McLaughlan and Alan Pert doi: 10.1017/S1359135520000275 arq (2020), Page 1 of 12. © The Author(s), 2020. Published by Cambridge University Press. distinguished from general hospital settings because the emotional trauma associated with end- of-life events can exert a longer-term infuence on the well-being of families and healthcare staff. 7 Evidence-based design, as a feld of research, has existed for just over two decades. 8 Far from providing comprehensive guidance, research from this feld provides a complementary resource for architects to employ in making and justifying decisions within the design process. 9 Healthcare environments have complex functional requirements, multiple and diverse stakeholders, and lengthy procurement programmes that regularly see design solutions outpaced by evolving technology and increasing service demand. It is not surprising, therefore, that healthcare providers are asking for evidence-based design solutions in the construction of new facilities. But what can a designer do when the evidence they require simply isn’t there? Within this article, we examine a research process undertaken within the context of a university-practice partnership to provide a feasibility study for the future redevelopment of an eight-bed paediatric hospice in Australia [1]. The hospice forms an integral part of a larger, regional organisation that offers in-home support, counselling services, and respite care. Around three hundred patients access the hospice on a regular basis for respite care up to a total of twenty-one days per annum. In addition to respite care, end-of-life care is provided to between thirty and forty patients each year. The organisation commissioned the feasibility study in recognition of signifcant changes in the needs of their patient cohort occurring over the three decades since the hospice frst opened in 1985. Initially, oncology patients were over represented within this patient cohort. Compared with the hospice’s current patient cohort, oncology patients had a much greater capacity for mobility and social engagement. Today the hospice caters to a more diverse patient cohort many of whom, as a direct result of their illnesses, live with severe limitations to their movement and verbal communication. This shift has exposed