often, when the design of healthcare facilities is discussed in publications, only photographs of peaceful and welcoming lobbies are shown. Indeed, lobbies should announce the healing environments of the spaces within, and set the tone for the rest of the building, but what generally happens when visitors move beyond the lobby to the patient care areas? Too frequently, lighting reverts back to the same-old recessed lensed troffers. This strategy provides adequate horizontal footcandles, but leaves something to be desired in terms of creating a 'healing environment.'

Healthcare projects are a wonderful challenge for lighting designers. Many facilities are built out to make patient rooms look as non-institutional as possible. Creating a residential atmosphere is advantageous to patient health, and a subdued, unobtrusive lighting system can achieve that goal. However, medical staff must perform complex and meticulous visual activities in the same space. Maintenance and cleaning needs must also be considered. The following examples are representative of these kinds of challenges, with solutions that effectively balanced the visual needs of all users.

Beyond Troffers

At Evergreen Hospital Radiation Oncology Center, an outpatient care facility in Kirkland, Washington, designed by Seattle-based Mahlum Architects, several treatment rooms feature radiation equipment that requires patients to be immobilized for up to 30 minutes. A key objective of the lighting solution was to create an atmosphere in which patients can rest quietly while receiving treatments. At the same time, it was necessary to provide adequate light levels for both the set-up procedure and cleaning.

The lighting in these rooms consists of a cold cathode cove at the base of a central ceiling dome. Cold cathode 3000K tri-phosphor lamps were chosen because they could be custom fit to match the curvature of the cove, in addition to offering the same color and light output as the fluorescent lamps used throughout the project. Recessed Fresnel lens downlights are installed outside the perimeter of the dome where the ceiling plane is slightly higher, and are used only when the room is being cleaned. The hand-painted dome ceiling is reminiscent of a sunset, with blue, purple and pink tones. When patients enter the room, the cold cathode lamp is turned on to illuminate the dome. Following procedure set-up, care providers dim the cove to 'off,' allowing the patient to see twinkling stars in the ceiling. The imaginary night sky was created using end-lit fiber optic strands with metal halide lamps that terminate in the surface of the dome. Three fiber strand sizes used in a random pattern suggest stars at various distances. A dousing wheel rotating in the illuminator box randomly blocks and admits light through various fibers, creating the twinkling effect.

Although the design team considered modeling a particular galaxy, it decided against this idea; hospital staff worried that patients who should be immobile might move their heads to locate Orion or the Big Dipper.

Healing Within

Exam rooms often have one or more recessed fixtures centered in the ceiling, with a lens or louver shielding device. This creates glare and uneven illumination. To promote a more patient-friendly environment at Doernbecher Children's Hospital in Portland, Oregon, designed by Seattle-based Zimmer Gunsul Frasca Partnership, we utilized wall-mounted indirect uplights with T8 lamps and abundant daylighting in the exam rooms. As a result, electric light is often unnecessary. When it is required, there is a generous amount of soft, reflected light with good color quality-3500K with a color rendering index above 80.

The intensive care unit is a very stressful place for patients and their families, and perhaps even more so in a children's hospital. Children often have long stays, and parents are with them most of the time. Medical staff must make critical care decisions in these rooms quickly and without distraction.

At Doernbecher, we recommended that the intensive care suites use the same indirect fixtures as those in the exam rooms and be located on two walls instead of only one to provide a more balanced amount of light. The two-lamp fixtures have separate controls to provide flexible light levels. The ambient light is sufficient for all normal activities; for procedures, a task light is built into the bed equipment. The indirect light is beneficial to the staff as it has less glare, is more diffuse, and creates fewer shadows than a direct lighting system. A separately controlled wall sconce in the niche provides reading light for window seats where parents can nap or read.

Whether a waiting area, treatment room or surgery suite, indirect lighting is less institutional, while diffuse light reduces shadows and glare. Balancing comfortable patient environments with a hospital's technical requirements is a challenge, but brings lasting value to a project.

Denise B. Fong is principal of Seattle-based Candela Architectural Lighting Consultants, which offers design services for commercial, educational, and medical campuses, as well as restaurants, civic centers, hotels and entertainment environments.