With lighting equipment accounting for a good portion of a project’s FF&E costs, budget frequently drives healthcare lighting programs. At the same time, healthcare organizations realize that successful designs can pay off.

For example, proper lighting can potentially improve patient satisfaction surveys—and, subsequently, reimbursements tied to those surveys—by positively influencing patients’ perceptions of their environments. Beyond satisfaction, though, well-lit interiors can provide visually varied and stress-reducing spaces, shown by research to enhance patient outcomes and well-being. Overall, design experts agree that measuring the success of a lighting program should go well beyond aesthetics and function and focus on how the occupants are experiencing the light.

Getting comfortable
A big component of that experience is achieving a high level of patient comfort. Suggesting one approach, Jennifer Kenson, principal of healthcare interiors at Francis Cauffman (Philadelphia), recommends indirect or integrated architectural lighting to avoid the harsh effect created by direct downlighting. In addition, integrated bedside controls for dimmable light fixtures and window shades address an increased demand for patient control over personal lighting in the patient room.

For example, HOK recently collaborated with a lighting manufacturer to develop a bedside exam light with an integral LED reading lamp. The fixture is recessed in the ceiling at either side of the patient bed so no light shines in the patient’s eyes, eliminating the glare and discomfort of traditional fixtures. Additionally, “the lamp’s tight beam functions similarly to an airplane reading lamp and allows patients to read without disturbing sleeping family members within the room,” says Mark Banholzer, senior healthcare designer for HOK (Chicago).

More institutional lighting approaches of the past are also being replaced. “The style is to leave the clinical feel of corridors lined with fluorescent wraparound fixtures and move toward architecturally integrated LED fixtures that provide a soft, indirect light,” says Jonny Hoolko, a junior designer at Hiram Banks Lighting Design (San Francisco).

For example, his strategy is to create comfortable spaces where the lighting isn’t perceivable by the user, which is achieved by hiding the light sources in architectural details—such as using linear recessed fixtures and other LED products that blend into the clean lines of a building without making the ceiling look busy. The result is soft, ambient lighting that accentuates the architecture rather than competes with it.

Similarly, Banholzer says HOK selects fixtures that don’t look like what you might expect in healthcare. “As long as we can achieve the required illuminance level and the fixture can be cleaned and maintained easily, we’re open to using nontraditional lighting options,” he says. For example, HOK’s typical lighting design approach is to minimize the visual impact created by fixtures so that the light itself becomes the expression. “A combination of form, texture, and colored surfaces—washed or enhanced with light—creates a rich and varied visual environment,” he says.

To achieve an integrated feel, Kenson recommends coordinating the lighting design with the project’s architectural finish palettes and considering the design intent when selecting fixtures. For instance, a smaller-scale space might call for more decorative lighting fixtures to enhance a sense of intimacy, she says, while architecturally installed lighting could be more appropriate in a larger space.

When choosing fixtures, there are a number of factors that go into the equation, starting with which form factor—the physical shape and size of the fixture—is most appropriate for the application. “For example, do you need a recessed downlight, a linear cove product, or a wall sconce?” Hoolko says. While sconces, pendants, and surface-mounted fixtures will offer an omnidirectional ambient pool of light, downlights provide more of a dramatic, shaded effect. So the character of each space within a facility will call for different solutions. “Then you have to take into account the variables of budget, aesthetic, lumen output, wattage, etc.,” he explains.

To assist in this process, references such as the Illuminating Engineering Society’s handbook offer well-researched light levels for specific tasks and spaces within healthcare facilities, and building codes often dictate wattage requirements.

“Once the sea of products has been narrowed by these constraints, we select fixtures from a pool of reputable manufacturers. Employing this selection process across a project creates a consistent aesthetic and can result in a striking design that utilizes quality fixtures regardless of what budgetary, efficiency, or aesthetic requirements need to be met,” Hoolko says.

Tech support
Within those lighting source selections, the healthcare industry is seeing a noted increase in solid state lighting, or LEDs. “This was not the case even two years ago, but we have now reached the tipping point in LED lighting where every lighting system in a healthcare facility can use the technology,” says Tom Kaczkowski, director of lighting design for HOK (St. Louis).

In fact, Kaczkowski says that major lighting manufacturers have embraced LED technology, greatly extending their lighting fixture palettes and offering designers systems for pinpoint accent lighting, grazing textured surfaces, or softly washing broad architectural planes. “Most LED systems are also dimmable out of the box, permitting cost-effective daylight harvesting, load shedding, or simple preset high/medium/low lighting level settings,” he says.

While building owners and designers are attracted to LED’s energy savings and long life of up to 50,000 hours, Kaczkowski advises going with products that have at least three-year warranties.  “Also beware of low initial costs for ‘disposable’ LED fixtures, which must be fully replaced at their end of life,” he adds. “It can be a significant long-term surprise for future facilities’ personnel and budgets when an entire patient room must be decommissioned for light fixture replacement by an electrician, instead of just replacing the bulbs.”

Darko Banfic, senior associate and lighting designer at Peter Basso Associates (PBA; Troy, Mich.), adds that LED’s very high lumens per watt content creates an extremely bright light source that can cause glare and occupant discomfort. “The problem compounds because LEDs’ initial cost is high, and one way to reduce that cost is spacing them out while making them even brighter,” he says. To address this issue, in addition to enhancing the end-u
ser experience, Banfic recommends designing two to three layers of light within a space. Take the two-story hospital lobby the PBA designed for St. Joseph Mercy Oakland in Pontiac, Mich., where the lighting was expected to illuminate featured art, bring out the warmth of the wood finishes, showcase a textured fireplace wall, emphasize the volume of the space, and meet code requirements. While the easy solution was a simple array of LED or compact fluorescent downlights, this approach was only capable of achieving a quarter of the desired effects, Banfic says.

So PBA selected perimeter cove lighting with asymmetric distribution as a layer of light that’s hidden. For the contrast and focal points in the space, the feature art walls and the stone fireplace wall lighting, adjustable/aiming products were employed using long-life, high color rendering index metal halide lamps as the second layer of illumination. “To complete the scene, the central area of the lobby required supplemental illumination and the third layer of lighting. Since it’s hardest to access, low-maintenance LED recessed downlights were used to achieve the code-required illuminance for the space,” he says.

LEDs are also becoming an increasingly popular option for colored lighting schemes, thanks to the technology’s color range and adjustability—and particularly in light of current research on colored lighting’s effect on physical and emotional states and healing. “This technology is still in its infancy, but the stepping stones to this, such as warm-dim LED fixtures, are good examples of how color is being used in healthcare settings to provide that warm hospitality feel,” Boolko says.

In terms of impact, colored LED strips are a cost-effective, convenient way to enhance focal points, such as reception desks and nurses’ station, and backlit, graphic LED panels can function as dynamic pieces of art and provide memorable aesthetics for healthcare facilities, Kenson says. For example, backlit ceilings are coordinated with illuminated art elements at Sidney & Lois Eskenazi Hospital in Indianapolis, with lighting and color serving as identifiable landmarks.

Color-changing LED lighting can also be found in children’s hospitals to serve as distractions and within CT and MRI rooms to offer patients choice and control. “They can select a specific color or modulation that appeals to them, creating an individually tailored, relaxing environment during treatment. And research demonstrates that a reduction in medical sedation may be achieved with this approach,” Banholzer says. Applying this theory at the new Ohio State University Comprehensive Cancer Center’s James Cancer Hospital and Solove Research Institute in Columbus, Ohio, HOK incorporated LED ceiling features in radiation oncology treatment vaults. The personalized adjustable lighting provides patients with some degree of control and a pleasant distraction while undergoing an imaging procedure.

Coordination and communication
Lighting designs can go a long way toward enhancing the lighting scheme in healthcare facilities, and strategies should be implemented within a well-coordinated project delivery process. For example, it’s important to discuss issues such as white color temperature and then create mock-ups so that stakeholders can view the proposed color palette and material selections. Determining the level of warmth or coolness of the white light source, white color temperature is important as it sets the mood for a facility.

In addition to establishing this end-user dialogue early on, it’s also recommended to proactively engage the services of a lighting designer/consultant. This is particularly key if daylighting is to be a significant part of the overall design. “Often the daylighting element is determined before the lighting designer is engaged to provide guidance as to how much light is provided, where the potential glare issues are, or to account for the cost of daylighting controls,” Banfic says.

With the lighting designer involved early on, he or she can offer key input regarding the shape of the building and site orientation to optimize the daylighting design. For instance, it isn’t ideal to position people-occupied spaces with direct exposure to the sun, so orienting patient rooms and offices toward the north is recommended. In addition, “clustering rooms where people spend most of their time, to the north side, coupled with how many rooms are required will begin to shape the perimeter and/or the height of the building,” Banfic says.  

Ultimately, lighting designers can help bring a space to life by applying their knowledge and skills “that combine the owner’s and architect’s visions into the everyday reality that we, as humans, are exposed to,” Banfic says.


Barbara Horwitz-Bennett is a freelance writer based in Jerusalem. She can be reached at bbennett@bezeqint.net