In the healthcare-lighting arena, the improvements and increasing affordability of light-emitting diode (LED) products, along with advancements in lighting control technology, enable creative lighting designs that benefit patients and staff members.
Studies show that natural light is critical to human function and can benefit patients and staff in healthcare settings.
“By controlling the body’s circadian system, light impacts the outcome in healthcare settings by reducing depression among patients, decreasing length of stay in hospitals, improving sleep,” writes Anjali Joseph, Ph.D., in “The Impact of Light on Outcomes in Healthcare Settings.” Joseph is the director of research at The Center for Health Design, a nonprofit research and advocacy organization.
Patients on the sunnier side of the building spend less time in the hospital, but the light exposure doesn’t affect only patients.
“The presence of windows in the workplace and access to daylight have been linked with increased satisfaction with the work environment,” Joseph writes. “A combination of daylight and electric light can meet these needs.”
Lighting designs implemented in several Southern California Kaiser Permanente facilities demonstrate new healthcare-lighting technologies and how quickly new products are coming to the market.
Kaiser Permanente, Orange County-Anaheim Medical Center, which comprises a hospital and a medical office building, remodeled its hospital tower in 2012. Kaiser Permanente San Diego Central hospital—based on the same template but with unique elements—is under construction and will open in 2017. Kaiser Permanente Antelope Valley Medical Offices opened in October 2014 as an all-LED facility.
Patients and visitors to Kaiser Permanente, Orange County-Anaheim Medical Center may be charmed as they approach the facility, both by the LED-illuminated gardens and pools that are intended as a place of relaxation and by the glass-enclosed stairwells on the corners of the main building. The stairwells are lit by stagecraft LEDs that mark seasons and events—orange lighting for Halloween, green and red for Christmas, and pink for breast cancer awareness month. Yet, since these glass stairwells are paths of egress, if a person enters a stairwell to walk up or down, the light show stops instantly, and bright white lighting illuminates a safe exit or entry.
Creative lighting design is also apparent within the facility. Brightly colored LED walls enliven the atmosphere in the pediatric department waiting area. Daylighting brightens the pediatric oncology department, a boon to the children and staff. Children undergoing chemotherapy transfusions have views of the surrounding area and of the aquarium embedded in a color-changing LED glass wall that fronts the nurse’s station.
“The focus of the area is to make the atmosphere pleasant for the children, to reduce their level of worry and apprehension about being in the space,” said Joe Stasney, project director, Kaiser Permanente, Orange County-Anaheim Medical Center and Kaiser Permanente San Diego.
In the Anaheim facility’s MRI and CT scan rooms, perimeter soffit LEDs are programmed to change colors and provide mood lighting, again with the intent of relaxing patients. Patients can insert their iPods into a player to listen to their own music during the 20–30 minute procedure.
“It tends to be a stressful situation,” Stasney said. “We’re attempting, through softer and colored lighting and music, to relax the patients during the procedures.”
Lighting products installed at Kaiser Anaheim in 2012 are a combination of fluorescents and LEDs. Only two years later, the fluorescents are being replaced with LEDs.
“Kaiser Permanente San Diego Central hospital broke ground in February 2014,” said Craig Knight, project manager, Morrow-Meadows Corp., City of Industry, Calif., the electrical contractor for the Anaheim and San Diego facilities. “We’re aiming for state-of-the-art in San Diego, but since we won’t finish construction for two years, we can’t know what will be available then. At a certain point, we have to just start installation.”
“Every six months, you’ve got something new, better and more cost-effective for healthcare lighting,” said Duc Bui of DPB Engineers, Tustin, Calif., the electrical engineer on the Anaheim and Antelope Valley facilities.
Stasney elaborated on the progress of the technology.
“What is available now is technology that allows lighting within the nursing units and patient rooms to be adjusted to adapt to circadian rhythms and adjusted to warm or cool the coloration of the room, which can influence the mood of both staff and patients,” he said.
To create the adaptation to circadian rhythms, Morrow-Meadows will install tunable white lights that range from temperatures of 2,700K to 6,500K.
“During the day, we’ll tune the light to a warmer temperature level since we’ll have more natural ambient light available,” Knight said. “At night, it will be the opposite. We’ll tune it to a cooler temperature color to provide the perception of natural daylight throughout the room. We developed a mockup and tied it to a control system so that we could program it starting at 6 a.m. and continuing to midnight to have a variation in color or temperature throughout the entire day with the incoming ambient light. Sensors will trigger the changing of the color on the tunable light fixture program, yet it can be modified to infuse natural light in a room if a patient wishes.”
Staff also will be able to control lighting inside patient rooms from a touchscreen display located outside without disturbing or waking the patient. In Anaheim, a wall switch controlled fluorescent lights. In San Diego, all of the LEDs will be controllable and mostly automatic.
“We will have switches, but [they will be] more uniquely controlled than in years past,” Stasney said. “Panels in one location will be available to control lighting in rooms. The patients will also have the ability to control lights and blinds from their beds. If they’re restricted, they will still have the ability through a touchpad to turn things on and off.”
The San Diego facility will have lighting designed to interest children. In the pediatrics waiting room, children will be able to interact with large touchscreen televisions. Another application uses a proximity sensor concept with an LED board.
“The company built a prototype for us so we could mock it up before we actually install it,” Knight said. “It’s fun and interactive. The kids will be able to wave their hands 6 to 8 inches from the board, and the LED lights will bounce around with the movement of their hands. It will be a playful element within the wing.”
Another playful element will be available in obstetrics. Nurses can activate tiny accent lights to twinkle blue if a baby boy is born or pink for a girl.
At Kaiser Permanente’s specialty medical offices in Antelope Valley, Calif., Pat Reyes-Cappelli, director of design, SoCal, was the project director. Rosendin Electric, a company based in San Jose, Calif., was the electrical contractor. In that facility, LEDs provide all lighting, and low-voltage controls manage them.
“It was interesting because there was no electrical wiring or line voltage to the switches or to the occupancy sensors. Instead, we used Cat 5 cable,” said Jason Griffin, project manager, Rosendin Electric. “Line voltage [120/277V] was brought to a control module at the fixtures, while Cat 5 cabling was used to link the lighting controls components as well as the fixtures. Before, you had to have different types of dimmers, which would get hot depending on the wattage that ran through the dimmer, and it meant you had to size the dimmer accordingly. Now, with low-voltage lighting, we’re not running the wattage through the dimmer. It’s a unique way of controlling a light fixture, but it seems to be the new trend.”
In planning the building, Taylor Design, architects from Irvine, Calif., expanded the use of daylighting to interior clerestory windows throughout hallways, sidelights next to office doors and transoms above the doors so that the interior offices, corridors and spaces receive direct daylighting from outdoors. An open courtyard in the center of the building with glass walls makes the center of the building a lightwell, bringing daylight into the core of the building.
“We needed to be able to control and optimize how much indoor artificial lighting we were providing,” said Nathan Woods, Taylor Design. “We are using 100 percent LED lights throughout the entire facility, and each light fixture has an individual, addressable IP address with a computer cable, which means we are able to dim and control each fixture individually. We also have dual technology sensors—motion sensors that come on when the space is occupied and photo sensors that come on to a preset level based on the amount of available daylight.”
This intelligent lighting controls system—combined with the efficiency of LED fixtures and extensive daylighting—has contributed to significant energy savings for the project.
“Kaiser pushed the design team to reach a net-zero energy use goal for this facility, which means the building, once a wind turbine is added, will produce as much energy as it uses, on an annual basis,” Woods said. “With limited power generation options available on-site, it was essential to significantly limit energy use to meet this goal. One of the biggest factors in meeting the net-zero goal was that all the lights in the entire facility are LED: parking lot lights, pathway lighting, interior downlights, soffit lighting, accent lighting, task lighting, general office lighting, and decorative lighting, such as backlit glass and playful firefly lights on the concourse area and more.”
DPB Engineers designed interior lighting to achieve a lighting-power density 60 percent below the allowed Title 24 2013 and ASHRAE/IES Standard 90.1 2013 thresholds. In corridors, Rosendin Electric installed occupancy sensors that provide 100 percent light output if someone enters a corridor, 50 percent output if there is no occupancy, and zero output during off hours.
In addition, Rosendin Electric installed LED downlights—2-by-4s, 2-by-2s—with outputs based on photometric studies of each area and MechoShades for the daylighting system.
“The shades are tied to the solar clock, and depending on the location of the sun at that time of year, the system controls the shades so that there is the proper amount of ambient light within the corridors,” Griffin said.
One challenge Taylor Design faced and overcame was in lighting in the ophthalmology department. When a doctor is examining a person’s eyes, the practice is to dim the lights.
“Since the Kaiser ophthalmologists wanted direct control of the lighting, we experimented with different dimming control technologies and ultimately went with the Lutron Graphic Eye system,” Woods said. “With it, we were able to preset the exam rooms to achieve a light level of about 5 percent. When a patient and doctor enter an exam room, the light is at a set level. When the doctor starts an exam and picks up one of the tools from a rack of tools, the lights automatically dim according to each doctor’s preference. Normally, LEDs dim down to 10 percent, then just shut off, unlike incandescent or fluorescent lights. We worked hard to devise a method to control the LED fixtures between 10 percent and 1 percent, so that we didn’t have to go back to fluorescent. We used Graphic Eye controllers to achieve the precise level of light the individual doctors wanted, while still using the LED fixtures.”
Taylor Design also had some fun in designing the lighting for the physical therapy gym.
“We used large—5 feet in diameter—round LED fixtures that resemble skylights, and we suspended barbell shaped fixtures that have multiple diodes in them that represent different colors,” Woods said. “A timer within digitally rotates the colors resulting in a cascading color scheme. It’s a dynamic fun element that encourages people to press harder.”
It’s clear that the healthcare industry recognizes lighting as more than a source of illumination. It empowers designers to create an environment that is conducive to healing.
“Kaiser appreciates the idea of what lighting can do for a hospital with relation to the patient experience,” Knight said. “Lighting can be artful but can also be used to establish a relationship not only with the patient but with the family.”