Evidence-based design was used to illuminate Royal Alexandra Hospital in Edmonton, Alberta, Canada.

No other field of building design has undergone fundamental changes in perception and delivery to the same extent as healthcare. Due to new research on evidence-based design (EBD), the impact of the environment on our well-being is being understood widely for the first time. Generally, the design has been process driven, concentrating on clinical processes delivered in a low-cost building stock.

Now, we are increasingly appreciating the value of quality environments. Also, the ever-increasing focus on sustainability in built-environments is leading to innovative replacements for traditional design solutions.  For the first time, value-for-money solutions are promoted over the lowest-cost ones. Therapeutic environment design impacts factors such as treatment times, staff absenteeism and recruitment and cross infection.

Healing environments are those that include options and choices for patients, provide positive distractions and access to nature, and reduce environmental stressors. One of the largest stress-causing experiences for patients is a feeling of loss of control in the healthcare facility. Simple solutions such as giving patients control of lights in their immediate environment are inexpensive and remarkably effective in reducing stress levels. Adding a residential or spa-like feel to healthcare environments leads to a reduction of patient and staff stress levels. Effective lighting design can achieve a calming environment while maintaining light levels for critical visual tasks, energy efficiency, infection control and ease of maintenance.

The lighting and décor of healthcare environments makes a visual statement about how patients/residents are treated. The latest research in healthcare design argues in favor of creating medical environments designed to support healing. The appropriate lighting design for a hospital is evidence-based, welcoming, and free of glare and harshness to help relieve the visual stress in an environment that patients find quite stressful. It also maintains cost efficiency and ease of maintenance.The needs of staff are not usually the same as the needs of the patient or resident. Solving issues for both will often require balancing stated illuminance requirements with comfort.

Living environments designed for elderly residents include lighting surfaces – particularly the walls and ceilings. This leads to uniform, comforting lighting without the glare. Lighting spaces for elderly people with visual impairments is not just a matter of providing higher quantities of light, but also providing uniformity and reduced illuminance ratios in the field of view, as the ability to adapt is compromised in the elderly eye along with increased scattering in the aged lens. Lighting the pathways, obstacles and projections without glare will make life easier, safer and better for those with conditions such as glaucoma and other degenerative visual conditions.

Decorative wall sconces and pendants with clear visual patterns add flair and an element of design. Spa-like soothing lighting on nursing stations provide visual stimulation and promote a positive relationship with the space. Let’s look in more detail at how lighting impacts the healthcare environment.

Corridor Lighting
The long corridor has unquestionable practical advantages, but can cause general visual monotony and a lack of visual way-finding when lit in a linear fashion. It has been proven that we move around using our mental map of the world, and places that are confusing, such as long linear hospital corridors, prevent us from building that map and add to disorientation. Lighting design can lead to the implementation of visual hierarchy in a space where the entrances are highlighted and way-finding is made easier.

Lighting in corridors with a rhythm reinforces the corridor’s architecture and will help relieve the visual monotony. Indirect lighting with highly reflective surfaces will produce even illumination without glare for patients being wheeled through the corridor in a reclining position. This layout will also break the long linearity of the corridor that can cause disorientation.

The same architectural luminaires can be used for lower-illuminance night lighting. The coordination of light fixtures with doorways will provide intuitive way-finding without the need for high light levels.

Clinical Spaces
Lighting in clinical spaces should be properly distributed and controlled. Incorporating good color-rendering daylight with indirect general illumination creates a soothing effect.  Procedure rooms have good visibility for staff, but not necessarily high light levels. Providing proper contrast and good color rendering will reduce glare and create a non-threatening environment. Soft ambient light in recovery rooms provide a soothing atmosphere and reduce glare. Multi-level controls permit task lighting for staff and exam lighting for emergencies.

The patient room lighting should meet the requirements of ambient illumination, reading and night time way-finding. The patient has control of lighting from the bed. Providing supplemental reading light gives patients control of their environment and provides positive distractions.

Providing soft, low-glare and layered lighting in lounges helps provide a positive distraction from the stress of being in the hospital. A new branch of lighting research has proven the impact of light on the body’s biological clock. It has been discovered that exposure to light of a particular type for a particular duration and timing impacts our sleep/wake cycle, and results in chemical changes in our bodies that enable our self-healing systems to operate more effectively.

Increased awareness of the importance of how positive environment/patient interaction can aid in therapy and healing has led to fundamental changes in the lighting design process. Natural light has been proven to have clinically significant psychological, physiological and biological outcomes. Hence, not only is it critical that patients have access to daylight during the day, but the circadian-suitability of the night lights in patient rooms is also critical.

Human physiology and behavior are dominated by near-24-hour rhythms that have a major impact on our health and well-being. For example, sleep/wake cycles, alertness and performance patterns, core body temperature rhythms, and the production of hormones such as melatonin and cortisol are all regulated by the near-24-hour oscillator in the superchiasmatic nuclei (SCN) in the brain. In order for the circadian pacemaker to ensure that physiology and behavior are timed appropriately with the external environment, this internal clock must remain synchronized with the environment. In humans, the 24-hour solar light cycle performs this role of resetting the clock every 24 hours.

The circadian system can become unsynchronized when light exposure is modified by work schedules or work environment such as night shifts, or working in a relatively dim indoor environment without access to natural light. When the circadian system is out of sync with the natural day/ night cycle, it can lead to fatigue, reduced alertness, decreased vigilance, impaired performance and reduced sleep quality – issues that are all common in shift workers.

Laboratory experiments have found that blue light at much lower intensity can perform the same circadian function as white light. Hence, the appropriate night light for a patient sleeping room should not produce white light, as white light has a blue component. The most circadian suitable color for night lights is red as it has the least circadian effect. However, people suffering from certain types of color-blindness have difficulty seeing red light. Hence, amber is the most widely used color for night lights.

EBD – the process of applying hospital design approaches, backed by quantifiable data that contribute to improved patient care and clinical outcomes – has been a growing trend in healthcare design for nearly a decade. Making the connection between EBD and sustainable design is the best possible option for designing the healthcare environments that will act as a healing aid themselves.