Finding Evidence of Culture

Sometimes I feel more like an archeologist than an architect, unravelling the culture of both a community and an organization each time I begin work on a project.  Evidence-Based design is a buzzword that has emerged in recent years, in the healthcare sector where I mostly work and play.   I like the idea that cause and effect of design can be studied and documented and help give us some road markers.  But I also think that you can misinterpret facts and fool yourself.  A lot.  Evidence-based design, while a valuable tool, only scratches the surface of what it takes to deliver a successful project, healthcare or otherwise. It represents intent in design and measures outcomes after completion, but fails to fully connect with the process of design.
Conventional design parameters such as aesthetic guidelines, programs or budgets often override the design intent.  Department interests can conflict with those of administration, budget concerns override design intentions, and the desires of the patient and visitor population are derived through speculation, word of mouth or limited questions on Press-Gainey surveys.  The process of design can be frustrated by these constraints.  The inability to tie design elements or strategies to larger desired outcomes for the healthcare organization as a whole then results in their being undervalued by healthcare clients. 
But what if as architects, we could forge a more relevant connection between the bottom line and making great spaces that  inspire, support and heal?