Hospitals may be institutions, but their institutional look is fading. Elements from the home, the hotel and the great outdoors are adding warmth and hospitality. This change has extended across healthcare from assisted living to hospice care. Lighting plays an integral role for patients, family and friends and staff alike. Hospital owners and the communities they serve now want a showcase that embodies innovation, health and a little beauty.
While there are any number of reasons for this design shift, reducing stress for patients and loved ones has been central.
“When the patient now walks into the hospital, the idea is to avoid entering a cold space for treatment,” said Patricia Rotondo, llDA, senior principal and director of interior design, Antunovich Associates. Antunovich is an architecture, planning and interior design firm based in Chicago. “The goal is for a more welcoming environment to lessen anxiety. Hospitality touchpoints do that. Everything must perform, but they can now look beautiful. There is much more selection in countertops, lighting fixtures, furniture, fabrics and more.”
Calming wall colors, homey finishes, comfortable furniture, art installations and attractive lighting fixtures are some of those hospitality touchpoints. More outdoor light and general biophilic design choices (bringing the outdoors in) are other trends that take today’s hospitals to a different place. A lot goes on behind the scenes that contributes to this new feel in a healthcare setting, something Rotondo calls “out of sight, out of mind.”
“You just feel good in the space and maybe not know why. Contributing to that is the right air flow in the room, well-programmed lighting controls, better lighting, stronger wireless, all embedded in the design,” she said.
Lauren Schwade, L.C., EDAC, IES, is an Atlanta-based senior associate and senior lighting designer for Mazzetti. Headquartered in San Francisco with offices across the country and abroad, Mazzetti is a healthcare-focused MEP (mechanical, electrical and plumbing) engineering firm. Lighting design is one if its services.
“I can use different looks, finishes and light fixtures,” Schwade said. “I can do custom furniture for a labor and delivery room. Maybe use an overhead light that looks very modern, like a ring over a nursing station. Working with the interior designer can help you achieve that hospitality feel. But I also know, when selecting a lighting fixture, that it must give me the function and flexibility I need for the specified space. It is not just decorative. The lighting must be considered in terms of color temperature, light levels and maybe be tunable. There is a huge push right now for lighting controls and adjustability, a focus more on what light is doing.”
Across all spaces
Diana Araoz-Fraser, vice president, senior interior design for HKS Inc. in Washington D.C., finds a refined design extends across the hospital space. The international architecture firm is headquartered in Dallas.
“Every single inch matters,” she said. “Better lighting is making for a better workplace. Nursing stations are becoming larger and more attractive. A hospitality look is extending to corridors with fewer troffers and added wall sconces. LED light is spread across the ceiling for illumination. Waiting areas are being designed to calm. Gyms and rehabilitation spaces look like they should have memberships. There is stronger wireless so guests and employees can easily ‘plug in.’”
Fiber is supporting medical screens, digital health records, telemedicine and patient rooms. It is conceivable patients could one day download an app to assist with room comfort, ordering meals or calling nursing staff.
“You obviously don’t want hospitality elements to interfere with the operation of the hospital,” Araoz-Fraser said. “But you do want to extend them throughout the building to achieve a calming, hospitable feeling.”
Hospitality design is also driving lighting inspiration throughout a hospital.
“You are seeing fewer 2x2 troffers,” Schwade said. “Design is getting more creative. You do not have to sacrifice light levels as we move away from all overhead lighting. Maybe you achieve the right levels through collective sources, such as overhead, sconces and table lighting. We aim for 3,500K for general overhead and 2,700K for decorative or pendant lighting. But we may break this up using different fixtures and lighting scenes. I specialize in healthcare lighting. My interior design background helps. The 2x2 troffers look is now making way for patient rooms that look like hotel rooms. Some even have daybeds for family.”
Patient rooms are divided into a care zone, the patient area, and family or visiting space, Araoz-Fraser said.
“The key is combining those in a welcoming way. It cannot just be a sterile-looking room with a TV screen. Lighting plays a huge role. It can now be attractive and distributed. You work to improve the patient experience,” she said.
Researchers believe proper lighting control could contribute to faster recovery and healing. Measured lighting can accommodate aging patients and migraine sufferers. Research is ongoing into how lighting could positively affect mental health patients.
‘A hard shift’
“From hospitality to healthcare is a hard shift,” Schwade said. “Healthcare design has a lot of guidelines and individual needs based on the type of a space. A hospitality feel doesn’t simplify the needs and complexity of the space.”
Schwade serves on the New York-based Illuminating Engineering Society’s (IES) Healthcare Lighting Committee. The committee revises IES RP-29 “Lighting for Hospitals and Healthcare Facilities.”
The guide recommends lighting design practices (e.g., lighting levels) for healthcare environments. It complements the Facility Guidelines Institute’s (FGI) “Guidelines for Design and Construction of Hospitals;” “Guidelines for Design and Construction of Outpatient Facilities” and “Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.”
IES and FGI recommendations can inform codes and standards from the American National Standards Institute, the International Energy Conservation Code and IES. All of these address lighting control (side lighting and daylighting), lighting power and energy code compliance.
Hospitals are complex spaces that can feature varied and sometimes complex lighting. There are common areas, patient rooms, recovery rooms, rehabilitation and exam rooms, surgical suites, labs, staff lounges, offices, cafeterias and gift shops. Mechanicals need to extend to infection control (ASHRAE Standard 170).
However, budgets remain strict. Basic infrastructure (utility and telecom rooms) takes up a large share of a hospital project’s budget. An electrical contractor can lead and advise, especially when a hospitality-oriented effort invites the temptation to do everything under the sun, but cannot afford to.
“A contractor’s understanding of products can be invaluable,” Araoz-Fraser said. “A design team appreciates a contractor who can say ‘I can get you this if you can’t afford that and, if we are over budget here, we can do something there to stay on budget’.”
Araoz-Fraser shared that she had just finished a project where everyone had a say, including the EC, the general contractor, the lighting designer and the electrical engineer.
“We collaborated early on with lighting by studying different areas of the hospital. Sometimes you meet in the middle based on budget, but that is what drives creativity,” she said. “You figure out how to soften and make the space more welcoming. Not all troffers disappeared, but we used fewer. We met code and lighting-level specifications”
A home for circadian light
Lighting levels, color temperature and other tunable factors can dovetail nicely in a hospitality-styled setting for patients and workers. Biophilic design can be used to bring in more natural light through larger skylights and windows, more plants (even trees), furnishings with natural elements, and other choices. Daylighting systems can support a natural lighting balance. Circadian lighting can go further, mimicking a 24-hour light cycle.
While Schwade and Araoz-Fraser wish circadian lighting systems were more affordable, all three designers are advocates, with some caveats.
“My rule of thumb is, if a person (e.g., patient) will be in a room 24 hours or more, it’s a good application. It can help patients maintain a good sleep cycle. Any time less, the occupant is not getting the benefit of the system. Unfortunately, you cannot afford to install circadian systems everywhere,” Schwade said.
Araoz-Fraser’s firm now gets fewer questions when they incorporate circadian lighting.
“Personally, I would love to incorporate circadian systems in all the patient rooms and nursing stations if cost wasn’t a factor. I think it’s so valuable, but contractors must still do their homework,” she said.
Rotondo added it is a matter of picking the right lighting to fit the needs of that space.
“Circadian light is a beautiful approach in certain public spaces. But in a clinical space, it may not be appropriate. For instance, you might need to maintain specific light for an exam room,” she said. “There may be recovery areas where you don’t want to play with white light.”
There are certainly other ways to support a body clock. LED lighting could shift from blue light during the day to amber at night, especially in patient rooms. Amber light does not make you sleepy, but it will support your body in the evening.
“Hospitality touches and healthy design are transforming this market,” Araoz-Fraser said. “The design team is responsible for finding the best outcome based on the available budget and client direction. Know the needs of the project. That will help dictate how you approach lighting, controls, fixture choices and the lighting design. The needs of the project extend to working with the interior designer, so fixtures meet function and design. Other furnishing selections are not adversely affected by the lighting. When you walk into that healthcare space, you should just feel it welcoming you.”