“The ebb and flow of light in the sky affects every part of our lives, and literally makes possible life on Earth”: Thus begins the book “The Architecture of Natural Light” by Henry Plummer. In the 255 pages of this artfully crafted book, Plummer thoughtfully describes and illustrates the use of light in architecture throughout the ages. The book illustrates how buildings have been shaped, sculpted, slit, clad, and organized in manners that allow light to create memorable experiences as well as connect the inhabitants to the basic rhythms of life.

This wonderful story is woven through interpretive ideas, like the use of light as a need for heavenly perspective and the use of transparent light to expose our eyes and our intellect. It also touches upon the idea of light being a source for human wonder and how natural light and fresh air convey the “healthful benefits of nature to as many rooms as possible.”

These themes align with several evidence-based design strategies: the importance of nature and daylight on reducing pain, stress, lengths of stay, and spatial disorientation, and on improving sleep and staff satisfaction. Ironically, the text and the more than 400 magnificent images in this inspiring book include a pharmacy, thermal baths, tombs, a morgue, and a crematorium, but not one healthcare facility.

Other than in meditative/chapel spaces or perhaps in the main public lobby within hospitals, we do not fully utilize light as a tool in shaping and forming the enormous medical buildings and healthcare campuses we construct in the United States. We use excuses, such as, “It's too expensive,” “It's not efficient to carry light into these large surgical floor footprints,” or “That view corridor is not needed.” The balance between operational efficiency and the need for human health and inspiration is a constant challenge. Thankfully, healthcare has at last engaged sustainable strategies, and as light and energy have become “requirements” in new construction and renovation projects, we've become more engaged as team members with healthcare administrators, facility managers, engineers, architects, and designers in bringing light into healthcare buildings in meaningful and productive ways.

A modest renovation project within a Mid-Atlantic behavioral healthcare facility is the perfect example of how the simple task of reshaping an interior environment can balance operational efficiency and patient/staff safety with the health and healthful impact of natural light and views of nature. When patients, family members, and staff entered the original secured adolescent girls' in-patient unit, they were welcomed by a bank teller-like fortified reception desk and a less-than-inspiring view of a beige wall. If patients weren't feeling depressed already, the sadness and barrenness of that entry space truly sucked any ounce of remaining happiness away. Recognizing the changing attitudes and needs within behavioral care, the unit was reshaped. Leadership within the system sought to provide a more uplifting environment, to have staff more accessible, to continue the highest level of safety for all, and to listen to the residents themselves share with the design team what they wanted.

Interviews with the residents were inspiring. The girls were provided images of interior spaces and asked to choose their favorite place and explain why. Without exception, they chose images that had sunlight and views. They indicated that these scenes could give them a “place to be quiet, an area to calm down.” One resident responds, “I could sit in that chair and look outside and be hopeful.” The girls themselves renamed the renovated unit “teens with dreams.” These comments, along with comments from staff, were instrumental in concept diagrams that ultimately influenced the renovation.

The design team strategically repositioned the reception/nurse station and moved the staff support areas from a major exterior location to across the hall. The staff support areas were provided light and views by reactivating an unused skylight and providing a window to an interior garden in the new staff break area. The reception/nurse station is more open and in its new location is provided clear views along the patient room corridors.

By moving the staff areas, residents were given a prime location for their group rooms, allowing them an abundance of daylight and views to outdoor gardens. The renovated unit provides a transformed entry sequence and direct views to sunlight, nature, and a welcoming desk for everyone who enters the unit or who resides there. “The new space is life-changing for our residents,” says the facility manager in response to the transformation. The result: shorter lengths of stay.

“Light influences my health,” says architectural photographer Maxwell MacKenzie. MacKenzie also is a photographic artist, capturing the spirit of old buildings on the great plains of the Midwest. His photographs, inside and out, capture light and allow his trained eye to wait for just the right light to enter a scene, enabling him to capture in print what the builder, architect, interior designer, and users have imagined. The images MacKenzie recently completed of the cardiology clinic within the Children's National Medical Center illustrate this teamwork with light.

Evidence-based design strategies and sustainable design strategies focused around daylight were combined in the medical planning exercise of the clinic. Although numerous planning diagrams were sketched, the users chose the plan that provided the most daylight and views for everyone-patients, visitors, and staff alike. They recognized the importance of daylight and its influence on health. Their current clinic location within the hospital had little light and was not clearly organized.

The new plan is an efficient racetrack with daylight and views provided in the reception/waiting area, patient corridors, nursing stations, several treatment spaces, staff offices, conference rooms, and consult rooms. The highly sought-after “corner” window location was developed into the staff break room, providing views of Capitol Hill and the Washington Monument while also giving a nod to the importance of staff and their health.

The ceiling and floor planes are distinguished with curved colorful forms that are used as wayfinding elements-providing clarity for patients, who include everyone from expecting mothers to patients with congenital heart disease-that form routes to the various clinical modalities offered within the 8,500-square-foot clinic. All light fixtures selected provide diffused light that softens the often cold overhead lighting solutions.

Although the postoccupancy evaluation is not fully complete, preliminary feedback has provided a significant number of comments indicating the powerful, positive impact of the daylight. Patient and staff alike feel “cared for-a part of a supportive work environment.” Whether one is visiting this third-floor clinic during an early morning, afternoon, or early evening, varying amounts of natural light enter the major clinic corridor and nursing work area, drawing one's eyes outside to views and the ever-changing wonder of clouds for a connection with nature. Just that brief moment helps to break the stress of a medical visit and provides hope. While observing the clinic in operation, we watched as many children in the clinic pulled their parents over to the window and pointed to the sights.

Henry Plummer's book is organized around seven intriguing topics: evanescence (orchestration of light to mutate through time), procession (choreography of light for the moving eye), veils of glass (refraction of light in a diaphanous film), atomization (sifting of light through a porous screen), canalization (channelling of light through a hollow mass), atmospheric silence (suffusi
on of light with a unified mood), and luminescence (materialization of light in physical matter). The projects within provide an abundance of inspiration in just how inspirational light-filled spaces can become.

The two small renovation projects discussed in this article illustrate that introducing light and allowing light and views to be a major differentiator in the shaping and planning of healthcare spaces does not need to be overly complicated or costly. With thought and integration, these moves have a great significance on the health of patients and staff. It is possible on all projects to allow light to be a driver-to provide “free art” through every window-not just in the chapel. HCD

Tama Duffy Day, FIIDA, FASID, LEED AP, is a Principal in the Washington, D.C., office of Perkins+Will. She has been recognized by HEALTHCARE DESIGN magazine for two consecutive years as one of the 25 Most Influential People In Healthcare Design. She can be reached at tama.duffyday@perkinswill.com. Healthcare Design 2011 March;11(3):32-36

Earn 0.1 CEU at Home With This Article!

Step 1: Purchase the course online at www.asiduni.org.

Step 2: Follow the instructions in your confirmation e-mail to complete the course.

Step 3: Achieve a passing score on the quiz to download your certificate of completion.