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Let there be light – the importance of lighting and colour in hospitals

Good quality of light is essential for hospitals to function, however the right lighting can do much more than safely illuminate corridors. It can speed patient recovery and reduce stress in emergency units

Hilary Dalke
Professor of design
Faculty of Art, Design and Architecture,
Kingston University,
Surrey, UK

The quality of the visual environment has a positive effect on any occupant’s feeling of well-being; in the case of hospitals and healthcare buildings, this can actually affect staff performance as well as patient recovery.
Adverse results can be very costly to healthcare providers. A primary argument for the design of better lighting can be the enormous cost savings to health budgets; low staff morale, poor retention rates and even the higher levels of pain relief required for patients can result in escalating expenses.
A study in the UK on improvements in patient recovery, for example, found that patients were released one-and-a-half days earlier in a refurbished environment compared with an unchanged one, and time spent in intensive supervisory care area was reduced by 70%.[1] Measures to maximise performance through an improved environment will generally be cost-effective and lighting and colour in the décor are often the economical key.
Yet the importance of the role that lighting and colour design plays in achieving a successful healthcare building of quality is often underrated by too many healthcare professionals. Bad lighting is never ‘unseen’, just unidentifiable as the cause for a building’s poor performance or the sensing of an unpleasant atmosphere.
Good lighting is the true ‘painter’ of a building, making it ‘feel right’ or function efficiently for all the different users of the spaces. Misguided clumsy colour application – lime green or orange – in consultants’ rooms, for instance, to ‘cheer’ the place up has reportedly driven some medical personnel to distraction. Sensitive and informed colour design schemes can enhance the grimmest corners of older buildings.
The hospital environment has specific lighting needs for each typology of area. Public areas, circulation routes, ward and care areas will all have different requirements from lighting and colour application. Providing a pleasant environment for all users and helping to guide users through an often complex building are certainly priorities for lighting provision. It is essential to consider lighting and colour design at early blueprint stages in the development of a new building. Only then can a fully integrated approach to the visual environment be undertaken. If power and services are not positioned where they are required, costly disruptive work will make any changes to the building too expensive to implement.
Right from the point of entry to a hospital site to the point of finding the exit, strategic lighting is needed for simple vital tasks such as the creation of a welcoming reception area, an accident and emergency entrance with appropriate diagnostic lighting with colour rendering, and the lighting of landmarks to aid orientation and wayfinding. Reception desks work efficiently if the wall behind staff is a strong accent colour, is well lit and signposted; people who may be cognitively impaired or may be temporarily disorientated and distracted as many hospital visitors and patients are, find such a landmark useful when entering a complex building.

Instil confidence
The way a building feels is critical for the sense of well-being of patients, staff and the visitors; it is a fact that a large percentage of a population may die in a hospital, and so creating an ambient environment that can comfort and instil confidence is a critical target for construction industry management, facilities managers, lighting designers and architects.
Obviously, whether the building is old or a new-build will be a main contributory factor to the mode in which artificial lighting can be optimized for fitness of purpose and the creation of a healing environment. Neither state of old or new guarantees a pleasing or unpleasant result. However, orientation and footprint of the building will be a more determining factor in the capture and control of daylight than the age of the building. Older buildings may have less glass and fewer windows, thereby letting lower levels of daylight in than more modern ones; but simple interventions such as white-painted window reveals or louvered blinds can be used to transfer more daylight into some dark north-facing corners of a room.
A maintenance plan is essential for lighting in public buildings; drawn up at an early design stage it can ensure that the quality and standard of the visual environment remains high following a new installation or refurbishment of an old building. One major hurdle for all facilities managers will be the inevitable problems of storage of different replacement lamps and luminaires. The rationalisation of interior design and lighting supplies with relevant storage is vital for sustainable maintenance and organisation.

Reducing stress
Ambient lighting in large public areas can have the power to reduce feelings of stress; a hospital visit for patient, visitor or relative will usually be an emotional experience of some kind. Research has shown that the psychological power of controlled lighting and colour can affect the mood of people who could be anxious, over-emotional or disorientated.
If waiting areas are cramped or small, light and brighter surfaces or walls can give an illusion of a more spacious environment. In fact, illuminating the window wall in a small space can often relieve the depressing contrast of a dark surface against the daylight outside. Considerable evidence suggests that it is important to manage periods of exposure to sunlight to facilitate the synthesis of vitamin D; the building infrastructure should make provision for access to levels of daylight if possible during the day.[2]
The range of needs of specialist medical lighting is well prescribed. Generally, though, patients and visitors should see and be seen in a sympathetic diffused light source. Wall washing or warm colour temperature, fluorescent lighting in a soffit can produce quite simply a more positive visual appearance of the hospital patient. This treatment of spaces with good daylight colour rendering is vital for self-appraisal and a sense of well-being. The patient’s first sight of themselves in a bathroom post-operation can be quite shocking if not thought through and planned carefully by lighting and interior designers. Matt surfaces will help diffuse reflected light around a washroom. Colour contrast of all sanitaryware with walls and floors is critical for mobility of patients. Staff will need to have some areas of higher or lower visual stimulation and change to provide breaks in their busy schedules on wards and treatment areas. Installing different luminaires, local task lighting and a change of colour scheme can invigorate the visual environment. The accident and emergency department, major injury, mental health units and other areas throughout the hospital will all be coping with bereavement. Families and friends of these patients must have rooms where they can derive some temporary comfort and assistance with staff; sensitive lighting, colour design and décor will be of immense use here to help with the extreme feelings of loss.
Colour and lighting are inextricably linked and should not be considered independently; failure to balance these two powerful design tools can produce dire results. A properly designed visual environment harnessing both will have important benefits. Coupled in design schemes, they can be strong partners in aiding navigation and help make sense of confusing spaces. Corridors occupy a large percentage of the hospital environment and they can be unnecessarily boring and disorientating. Lighting an accent wall along a corridor can be both functional and aesthetically pleasing.
Studies have shown that improved patient recovery can be attributed to the positioning of windows for daylight, sunshine and engaging views and appropriate lighting can make places appear livelier. Reflected light from coloured surfaces or even blinds can enhance the most dingy corner of a building[1] as can wall-washing an accent colour wall in a dark corridor.[2]

Affect on staff
Deep buildings can affect staff if they have no chance to see natural daylight while at work. The important part that lightness and coloured surfaces play in transferring, enhancing and optimizing light sources should be noted in this context. A change in the colour and light reflectance value of flooring, for example, can have an unexpected impact on utilising available light within a building; lighter flooring has an immediate effect on light reflectance levels. 
The coloured coatings and paints used throughout buildings on products and walls should be tested under different illuminants to check on colour appearance or for metamerism; sometimes colour can change dramatically under artificial lighting or take on drab hues as daylight fades. Orange can turn unexpectedly grey or brown and yellow may take on a green hue.
The change in ambience within a hospital from the day into night may be extreme and unpredictable, so requires a careful lighting strategy; providing lighting to areas where art or foliage may require additional lighting at night would be advantageous. Lighting trees or landscape planting schemes outside may be an effective way of bringing an uplifting visual identity into the building at night; atria in modern buildings are always of visual interest and imaginative illumination at night can enliven the darkest gloomy places.
Lighting preferences in hospitals will vary according to several criteria one of which is the age of users. Settings for the young will require extra care, from the premature baby units to the often overlooked interests of teenage patients. 
Current legislation around the world is increasingly concentrating on lighting as an aid for visually impaired people (VIP) and those with low vision. Colour contrast and certain lighting levels can help up to 93% of registered visually impaired people identify clearly the potential obstacles and hardware in a healthcare environment.[4] Research has shown that only a slight increase in lux levels – to around 400 to 500 in a building – exponentially improves visibility for a large number of VIPs.[5]Care must be taken on the different lighting regimes for people transferring from one artificially lit area to another; the eye can take some time to adapt to the different changes in lighting levels and this, of course, becomes a more extreme problem as people age and the difficulties with glare increase.
If higher quality lighting and colour design can make just a small improvement on the performance of the hospital in terms of either staff productivity or patient recovery rates, then the price is worth paying. Colour and lighting can achieve a great deal in creating renewed pleasing environments with a minimum of effort and expenditure. This is possible with an understanding of the real power of good lighting and colour design, with the knowledge of the diversity of lighting sources from daylight to artificial lighting linked to the way they interact with coloured surfaces, materials, people and buildings.

1. Lawson B, et al. Architectural Environment and its Effect on Patient Health Outcomes. University of Sheffield 2002.
2. Lighting and the visual environment for senior living. Illuminating Engineering Society of North America. 2007 ISBN 978-0-87995-223-5.
3. Dalke H, et al, Loe D. NHS Publication: Lighting and Colour for Hospital Design 2004, The Stationery Office. p77. ISBN 0113224915.
5. Dalke H, et al. Measurement for a more visible world: colour contrast and visual impairment. National Physical Laboratory. ‘Measuring the Impossible’  Minet Conference: Measurement, sensation and cognition. November 2009. ISBN 978-0-946754-56-4.