Remember all of those hospitals finished in institutional green? It was a color referenced for decades by designers who wanted to get rid of it. Despised as it was, the color was originally conceived for a noble reason: to reduce the effect of “afterimaging,” a phenomenon demonstrated by color schemes and combinations in such works as those by Bauhaus artist Johannes Itten. The eyes, after viewing a color and looking away, see the complement of that color. For example, when orange is viewed, the afterimage is blue.

When surgeons are working closely on a patient and see the color of blood and look up, they see green. In an effort to allow surgeons' eyes to adjust more quickly, the surgical theater was painted green. Unfortunately, the use of green in healthcare facilities was misconstrued and overused in all areas. This is an example of what happens when research is misinterpreted and misused: “a gap between research on one hand and practice on the other, the infamous application gap.”1

The Coalition for Health Environments Research (CHER) recently reported on a literature search conducted by design researchers at the University of Missouri entitled, “Color in Healthcare Environments: A Critical Review of the Research Literature” (figure 1). Its purpose was to see if there was research demonstrating the use of certain colors in a healthcare setting that contributed to outcomes for patients or residents. The key investigators were Ruth Brent Tofle, PhD; Benyamin Schwarz, PhD; So-Yeon Yoon, MA; and Andrea Max-Royale, MEDes.

The researchers cite one source indicating that human response to color is based on a mix of factors: inescapable biological reactions; associations from the collective unconscious; symbolism perceived by the conscious; cultural influences and mannerisms; influences of trends, fashions, and styles; and any personal meanings attached by an individual to a specific color.2

Beach et al added, “Arousal effects of color are neither strong, reliable, nor enduring enough to warrant their use as a rationalization for applying ‘high’ or ‘low’ arousing colors to create ‘high’ or ‘low’ activity spaces.”3 For example, they said that a blue room will not automatically calm someone because other factors influence human reaction to color. Each individual will react to a color based on his or her experience, culture, and belief system.

Not substantiated in the findings of various studies is the use of warm colors to visually advance planes and cool colors to recede planes. Other findings suggest that color does affect the sense of temperature in a room and can improve thermal comfort, but only to a certain degree and only on a psychological, not physical, level.

One of the best-controlled studies identified value contrast as the most significant component creating pleasant color harmony (figure 2); the greater the contrast, the more the color combination was preferred.4 Researchers demonstrated that the “pleasantness” rating depended on the interaction between the color of the object, the background color, and the light source. The importance of this study is that it demonstrated for the first time the importance of variables other than the object color itself (e.g., background color, illumination) in determining color preference.

Contrasting values are identified as the most significant component for pleasant color harmony. (

Color preference is not a static state—it can change over time. “Colors can have many ‘meanings,’ even within one culture,” according to Hutchings.5 For example, volunteers at one hospital provided handmade baby blankets to all families of newborns as a celebratory gesture. The blankets were yellow, which pleased one family, as that particular color represented a long, fulfilling, and happy life in their culture. A red blanket would have upset them; that color in their culture signifies a short life and imminent death. Inadvertently, then, the volunteers had provided a gift that had a large cultural impact on the celebration of a newborn baby.

Historically, colors have been linked to natural phenomena in ancient religious rituals, the Old Testament, and Greek and Roman mythology. For example, among various ritual observations, red was linked with blood, which symbolized power; yellow was associated with warmth and fruitfulness because of its association with the sun; and green symbolized youth and hopefulness, as evoked by spring.

The assumption that there is a clear, universal preference for certain colors over others is not substantiated in the research literature. Likewise, research does not support the supposition that colors have inherent qualities transferable to the designed environment that would induce specific moods or affects. All of this means that color cannot be studied in isolation but should be evaluated empirically in an environmental context. Color is a powerful factor in the built environment for distinguishing between forms and backgrounds, and it contributes to identifying objects beyond their form and size. But it is also associative and symbolic, and it reflects cultural experience and regional ways of life. Reaction to it depends on how and in what context it is used.

The overall conclusion the researchers drew from the literature search is that the use of color in healthcare settings is not based on significant research. There is no magical A + B = C to guide color selection for healthcare environments. Rather, in selecting colors, return to the local: We must study systems, practices, and experiences in the local context of their traditions; identify and define the cultural groups for whom we design; and understand the society and the culture against which popular interpretation of a color takes place. Local focus groups have as much a role in color selection as they do in other facets of modern healthcare design. HD

To order a full copy of “Color in Healthcare Environments: A Critical Review of the Research Literature,” which includes a graphic chart with authors and information on each color, go to the CHER Web site at

Jane Rohde, AIA, FIIDA, ACHA, AAHID, is the Principal of JSR Associates, Inc., a senior living and healthcare consulting firm providing client focus groups for creative program and care-model development, innovative funding strategies, and interior and architectural design services based on evidence-based research, sustainable design principles, and resident/patient-centered programming. Roger B. Call, AIAKL, ACHA, LEED AP, is Director of Healthcare Architecture & Design for Herman Miller, and is responsible for guiding the strategic direction for the firm's architecture and design initiatives.


  1. Kuller R. Non-Visual Effects of Light and Colour: Annotated Bibliography. Stockholm:Swedish Council for Building Research, 1981.
  2. Mahnke FH. Color, Environment, and Human Response: An Interdisciplinary Understanding of Color and Its Use as a Beneficial Element in the Design of the Architectural Environment. New York::Van Nostrand Reinhold, 1996.
  3. Beach L. Wise BK. Wise JA. The Human Factors of Color in Environmental Design: A Critical Review. National Aeronautics and Space Administration, Ames Research Center. Moffett Field, Calif.:August 1988.
  4. Helson H Lansford T. The role of spectral energy of source and background color in the pleasantness of object colors. Applied Optics 1970; 9 1513-62.
  5. Hutchings JB. Color in anthropology and folklore. In: Nassau K., ed. Color for Science, Art and Technology. Amsterdam:Elsevier, 1998.


Of Oceans and Coffee Shops

Alfred Maskeroni, DDS, had a naval background and desired a water theme for his orthodontics practice. He also wanted a fun place for him and his staff. Overall, he wanted to create an environment that would allow his patients, predominantly children, to feel at ease and not be scared. The answer, to him, was an underwater theme.

In order for Dr. Maskeroni's office to suggest the feeling of being underwater, colors such as green and blue were used throughout, with bright accent colors that suggested saltwater fish (figure 3). The environment was further enhanced by bubble tubes creating the sound of water. After viewing the office and its ocean-inspired environment, one small patient said, “I don't want to leave.”

Color is not to be studied in isolation but in environmental context.

Although no empirical evidence demonstrates that colors directly affect patient outcomes, the associations that colors create can contribute to patient comfort. Recently one of the authors (Jane Rohde) entered a dental office waiting room and noticed a small boy sitting on a cushion, swinging his feet and looking around. She asked him, “What do you think of this room?” He responded enthusiastically, “Looks like a coffee shop!” Admittedly, the design intent had been to evoke a garden theme. But the youngster's interpretation of the space was based on his apparently pleasant personal experience of the stained wood, comfy chairs, and richly colored accent walls of coffee shops. As the designer, I was pleased to know that he was comfortable and happy in the waiting room environment. That response, after all, was the goal.

—Jane Rohde and Roger B. Call