-By Jean Nayar

Creating ideal lighting conditions in a healthcare environment is a lot like solving a complex puzzle and with some of the pieces still being shaped. Part of the problem lies in the diversity of spaces in healing environments. Another part revolves around the often-conflicting needs between patients and hospital staff.

If you think about the typical sequence of spaces a patient or visitor might experience as he or she proceeds through a hospital or healthcare setting—a lobby, waiting area, corridor, consultation space, exam room, surgery unit, patient room, or ICU—it's easy to see that ideal lighting conditions will be vastly different in each room. Consider the kind of light that's conducive to healing for a patient versus the kind a doctor needs to perform an exam or a maintenance crew needs to clean, then you can begin to understand how the mix of light and controls needed to support all who use these spaces becomes increasingly complex.

"In our experience, doctors have a lack of understanding of what patients need for healing," says Gary Gordon, a lighting designer and principal of New York-based Gary Gordon. "They tend to think of a patient as a body, like a mechanic views an automobile. But nurses see things differently. They understand that the lighting needed for healing is different than the light needed for examination." Factors such as energy codes, LEED guidelines, and facility maintenance issues ratchet up the challenge even more. And complicating matters further is the fact that fixtures specifically designed to address the aesthetic needs of patients and families in healthcare environments are still in their infancy.

But researchers, lighting designers, architects, and manufacturers alike are making valiant efforts to improve the lighting conditions for all involved in healthcare environments, and progress is continually being made on several fronts. For example, a recent study conducted by Anjali Joseph, Ph.D. for the Center for Health Design, found that a thoughtful introduction and control of light—both natural and artificial—can not only aid and speed up the healing process for patients, but also significantly improve the performance of hospital staff undertaking a variety of visual tasks.

Lighting designers and architects have taken these and other research findings to heart in both new and renovated hospital environments by integrating an array of lighting solutions that balance the needs of both patients and healthcare providers. According to Jocelyn Stroupe, director of healthcare interiors and a principal at Chicago-based OWP/P, their lighting solutions are tailored as much as possible to the dominant activities taking place in each space. "With respect to the experience patients have as they move through different spaces, our lighting approach may be different in areas where they are ambulatory than it is in areas where they might be lying on their backs," she says.

In general, the designers aim to use soft, soothing, indirect light in patient areas as much as possible. "But in examination or treatment rooms, depending on the type of treatment, more than likely a number of fixtures with independent adjustments are used," Stroupe says. "The physician may need a focused spotlight for light levels to be dimmed. And if the patient is aware during treatment, he or she should have a positive distraction that can be created with light on the ceiling, including backlit imagery of nature like clouds or sky or trees or fiber-optic stars." Another level of light is required in these rooms, she says, for cleaning—and the fixtures themselves should be easy to wipe down.

The color rendering ability of the light sources used in these rooms is also crucial. A doctor needs a light source that renders the color of skin or a wound as accurately as possible, says Gordon, and a patient needs light that makes skin tones look healthy. "Studies have shown that patients who receive positive feedback, including comments like, 'you look better today,' from visitors tend to leave hospitals sooner than those who don't," he says. "To elicit those kinds of comments, light that provides proper color rendition is essential." The best source for accurate color rendering, according to Gordon, is natural light, but infrared reflecting halogens, ceramic metal halides, and high-color rendering tri-phosphor fluorescents are also good, he says, and they're energy efficient, too.

According to Catherine Everett, director of interiors for the Dallas-based healthcare design firm Jonathan Bailey Associates, the use of indirect light is especially important in patient circulation areas. "We typically use indirect fluorescent light coves in patient corridors to help eliminate the 'strobe light effect' that a patient experiences with direct light fixtures in a ceiling as they're being wheeled on a gurney," she says. But, she notes, such fixtures can become an issue with infection control staff during cleaning due to the dust that they can collect—though the same issue exists for other types of fluorescent fixtures, too. Light can play a key role in wayfinding in these areas. "People tend to look down in corridors," she says. "Thus, we like to develop illuminated signage in the floor with room numbers or use fixtures to illuminate the floor."

Corridors also serve as a common location for decentralized nurse's stations, which are used by all kinds of hospital personnel and require illumination that is sometimes in conflict with the needs of a patient. "In ICU areas, you'll find alcoves in the halls containing nurses stations, where hospital staff works throughout the night and needs illumination on the computer screen, while the patient in the adjacent room needs to sleep," says Jan Carlson, vice president of product development and marketing for Nurture by Steelcase. To address this issue, the company worked with Cerner, a leading healthcare information technology company and partnered with HDR, a leading healthcare architecture and design firm, to develop a new nursing station product called Sync. The ergonomically designed unit features an arm that supports the computer monitor and includes an integrated LED light source that provides very specifically directed light. According to Alan Rheault, director of product design for Nurture, the small LED source in the Sync product illuminates the flat screen surface from below without creating glare that can cause discomfort to a patient in a room nearby. The glare-free focused illumination from LEDs also aids nurses—an aging demographic requiring higher light levels due to reduced transmittance through aging lenses—in performing their functions.

To enhance the experience for everyone in patient rooms, Nurture has also developed a series of casegoods products called Opus that feature integrated LED lighting solutions in headwall and footwall units. Gordon says the problem with LEDs at the moment is that they don't render color well. But Rheault notes that there are more color rendering choices for LEDs than fluorescents and the technology is improving. The old LED lights were quite blue," he says. "However, the suppliers we are working with can actually 'dial-in' whatever temperature (or color) we would like."

Another essential ingredient in patient rooms is natural light. This idea isn't new. "Prior to WWII, most hospitals had solariums for people to sit and soak in the sun during the day," says Gordon. "But as important as the natural light, is the view." According to Joseph's research, the changing quality of natural light controls the body's circadian rhythm, which synchronizes our internal clocks to 24 hours. It also has been shown to reduce depression, decrease the length of stays in the hospital, lessen agitation in dementia patients, and even ease pain.

To ensure that waiting rooms, patient rooms, public areas, and offices have access to natural light, Everett says her team deliberately plans for rooms such as ultrasound or MRI spaces, which need little or no light, to be placed near the core of a building. "To get natural light into interior spaces that need it, we are using Solar Tubes along with natural light or artificial skylight fixtures," she says. "We are also exploring the use of Hybrid Luminaires, which supply natural light during the day and artificial light when daylight decreases, and we're looking at the use of UV light with our engineers as a supplement to normal cleaning processes in labs and other clinical spaces." These types of fixtures also help earn LEED points.

As important as access to natural light is the ability to control it—with operable shades, louvers or curtains with blackout liners. "If the idea of healing is about creating an environment where you feel at home," says Gordon, "then the best way to do that is to use a vocabulary of light—including a mix of ambient, task, and accent light as well as dimming and switching controls—that is reminiscent of residential lighting." And as the role light plays in healing environments is continually refined, the healthier and more productive both patients and healthcare providers will be.