"Designing for Health" is a monthly, web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.
Efficient and effective lighting is an essential requirement in all healthcare facilities to ensure that staff and physicians can care for patients safely. Ongoing improvements in lighting technology and requirements for greater lamp efficiency create opportunity for designers to explore new and innovative lighting ideas that can enhance the patient experience. When artificial lighting and natural daylight are designed together systematically, the potential to improve both efficiency and patient experience is even greater. The newly-opened Nemours Children’s Hospital (NCH) in Orlando is one facility that maximizes the potential of new and increasingly affordable lighting technology, in concert with daylighting strategies, to create a patient experience in which children and families can truly take ownership of their healing environment.
Artificial lighting is currently undergoing a revolution as LED fixtures become more affordable for institutions as they upgrade lighting systems or plan new facilities. The federal government has taken the bold step in banning the manufacturing of incandescent lamps within the next year with the goal of improving the United States’ overall energy efficiency. Although hospitals have relied primarily on fluorescent lighting for many years, advances in LED lighting promise greater efficiency in the future. The U.S. Department of Energy has outlined a number of strategies that contribute to this, from replacing exit signage with LED fixtures to replacing magnetic ballasts with electronic ballasts in fluorescent fixtures. The DOE also frames efficiency of artificial lighting in the context of optimizing natural daylighting in hospitals as a means to reduce energy usage. The DOE is also committed to advancing solid-state lighting (LED) as a key component of the future of efficient lighting.
With so many advances occurring in artificial lighting, how can designers utilize the technology to not only improve efficiency, but to create a therapeutic and calming healing environment? This inquiry drove the design team as it developed the inpatient room for the Nemours Children’s Hospital.
NCH is conceived to be a “hospital in a garden,” capitalizing on the warm Florida climate and building on the legacy of its sister hospital in Delaware, which is adjacent to the Nemours Mansion and Gardens. Maximizing outdoor views to the gardens and bringing daylight deep into the building drive the extensive use of glass. Conceptually, the interior of the building is a “garden in the hospital,” with nature inspiring architectural elements, a full-spectrum color palette, and a variety of artificial lighting. Indirect lighting, focused spot lighting, glowing millwork, and specialty fixtures progress the spaces beyond the minimal functional requirement that is clinically necessary.
The design team of Stanley Beaman & Sears (Architect-of-record, exterior and clinic interior design) and Perkins+Will (hospital interior design) placed major focus on the quality of the inpatient room as one of the key spaces patients and families inhabit the most. Regular meetings with both clinical user groups and the Family Advisory Council, including Nemours patients, provided valuable feedback regarding both function and quality of space within the room. Families noted that simple but engaging non-themed spaces were the most calming. Children said they would love to be able to paint their room a favorite color during their stay (quite impractical from a facilities management standpoint). The design team began exploring how to utilize LED lighting to create a dynamic environment and respond to family and patient feedback.
When the Nemours rooms were in design during 2009, color-changing LED lighting had been explored extensively in rooms with MRI and CT scanners, but there were just a handful of precedents that utilized colored light in inpatient rooms. The Adopt-A-Room project by Perkins+Will at the University of Minnesota Children’s Hospital, Fairview explored light and materials as a way for young patients to control their environment. Additionally, the Patient Room Prototype studies (2003/2006) by Clemson University’s Architecture + Health graduate program explored the possibility for colored light in the room and suggested the impact it could have as a driver of exterior design. The Nemours design team built upon these precedents and conceived an inpatient room as an instrument for manipulating the healing qualities of both natural and artificial light.
Bringing the Outside In
Years of research are proving what human beings already know: it feels good to see outside of a building, particularly when we do not feel well. Conceived as a “hospital in a garden,” a major focus of the design and planning for NCH was to provide views to the outdoors, especially from the inpatient rooms. The Florida setting offers abundant sunshine to help bring daylight to the interior. External sunshading on the east, south and west façades mitigates the glare and heat gain from the large expanses of glass, while internal mechanized shades can provide additional screening or black-out conditions. The exterior wall of the patient room is completely glass to the 12’ ceiling, which slopes back to the 10’ ceiling in the center of the room. Where the curtainwall integrates with a built-in sleeping surface, the sill is as low as comfortably possible so that patients in bed can see the gardens, horizon, and sky. Additionally, one portion of the glass continues to the floor so that the even the smallest patient can get closer to the view outside.
Painting with Light
The lighting design incorporates a variety of lighting in the room for staff, the patient, and family members. Staff can control separate task lighting at the bedside workzone, handwashing sink, and the room entryway so they can have low lighting for night checks without disturbing sleeping patients. Family members can use task lighting at a desk area and a pendant light designed with the integral window seat daybed. Based on the patients’ request to have their rooms painted, the design team developed a millwork ceiling panel that organizes patient lighting, exam lighting and a cove that contains color-adjustable LED fixtures. Patients use controls at the bed that allow them to choose from a variety of colors to ‘paint’ the room their favorite color. According to Michael S. Cluff, staff architect with Nemours, patients have responded positively to the choice of colored lighting, even noting it in satisfaction surveys. When colored light is not desired, the LED fixtures easily switch to emit white light. Because lighting provides color, the room is primarily white with just a few wood and paint accents, so that the colored light at night renders exactly the way the patient wants. As evening falls in Orlando, the LED lighting transforms the building façade from a technically crisp glass and metal skin to a bold mosaic of luminous colors, each reflecting the choice of a patient within.
Allen Buie, AIA, LEED AP is a Senior Associate and Senior Project Designer with the Boston office of Perkins+Will. He can be reached at email@example.com.