How the light reflectance, colour and texture of walls and ceilings

can create healing environments

Healthcare facilities should provide a therapeutic environment in which the overall design of the building contributes to the
process of healing rather than simply being a place where treatment takes place (1). Well designed healthcare buildings can
help patients recover their health and wellbeing and have a positive effect on staff performance and retention (1).

A properly designed visual environment, with the appropriate use of colour and lighting, will have important benefits in
healthcare facilities. A relatively small investment in good, thoughtful colour and lighting design may reap major dividends
over many years for patients, staff and visitors (2). It is important to create an interior environment that captures our interest,
stimulates the senses and provides positive distractions (3).

Patients in the sunnier rooms were exposed to 46% higher

Importance of light
intensity sunlight on average. They experienced less perceived
stress, marginally less pain, took 22% less analgesic medication
per hour and had 21% lower pain medication costs (8).

There is also evidence that bright light can improve

performance, leading to a decrease in medical errors. In a
study pharmacists working in dispensing areas were exposed
to three different illumination levels (450lux, 1100lux and
1500lux). Medication dispensing error rate dropped from
3.8% to 2.6% corresponding with the lowest to the highest
illumination (9). The lighting (both artificial and natural) in a
healthcare facility affects the staff as well as the patients.
When nurses were exposed to daylight for at least three
hours each day, they experienced less stress and were
more satisfied at work (9, 10). Improved lighting conditions
Most people would agree that they feel better on a bright,
also reduces falls and allows the elderly to function more
sunny day versus one with grey clouds overhead. Research
independently by improving social contact, appetite, mood,
shows that the human body and brain respond to natural light
self-confidence, and anxiety levels (11).
in a positive way (3). Humans, animals and plants instinctively
move toward the light. This biological response may be
In addition carefully designed lighting can transform the
hardwired as a means of self-preservation (3). Several studies
appearance of a space, making it attractive, welcoming and
have documented the importance of light in reducing
either restful or stimulating depending on the effect created.
depression, modulating circadian rhythms, and improving
It can enhance the architectural appearance of the space and
sleep quality (4). Light impacts human health and performance
contribute to orientation and way-finding (2).
by four main mechanisms (5):
• Enabling performance of visual tasks
• Controlling the body’s circadian system (body clock)
• Affecting mood and perception
• Facilitating direct absorption for critical chemical reactions
within the body
A study carried out among 174 patients with severe
depression found that patients in sunny rooms had a 2.6 day
shorter stay than patients in dull rooms for example (6, 7). In
another study 89 patients were housed in sunny or shady
rooms postoperatively. Intensity of sunlight was measured
daily and psychological questionnaires were administered on
the day after surgery and day of discharge.

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How the light reflectance, colour and texture of walls and ceilings
can create healing environments
all-white environment can cause visual under-stimulation and
Use of colour
therefore stress for long-term patients (2). In dermatology
departments, orange is not recommended as a background
colour, yet orange is particularly popular for a maternity
unit. In cardiology, blue is not recommended as it makes
diagnosis more difficult. In maternity units, yellow should not
be used as it hinders the diagnosis for jaundice and in mental
health wards, oranges and reds are disliked. One hospital
department suggested that green flooring was particularly
good at showing up spills, thus helping to prevent accidents
due to slippery floors (2).

Contrast and light reflectance

Colour also has the potential to change spaces into interesting

environments, to add stimulation in an otherwise monotonous
space, and can even manage navigation or orientation for
people with dementia (12). In the literature, colours are linked
to physiological, psychological, and social reactions of human
beings (11, 13). There is a general consensus that warmer colours
tend to activate, stimulate and energise, while cooler colours
are more calming and relaxing (9, 11). Responses to colour may
vary depending on age, gender, culturally learned associations
and personal preference (11, 13, 14). Therefore any healthcare Colour has a vital role in providing information and
space does not become “active” or “relaxing” solely because of spatial orientation, helping occupants make sense of their
its colour (11, 13). surroundings (2). Approved Document M of the Building
Regulations defines visual contrast by referring to a
Some hospital patients can go through emotional upheavals,
difference in light reflectance values (between ceilings, walls
which makes them more sensitive, and at the same time more
and floors) (1). Contrast can identify obstacles and hardware
receptive, to the emotional stimuli of colour and lighting (2).
that might prove difficult to negotiate. Features of a building
Patients with mental health problems have a particularly
which create tonal detail or shadows can also aid the visually
emotional experience and their reactions to colour have
impaired. Well-designed, ambient environments will have
been shown to be extreme (2). Colour has been shown to
transitions of lighting and colour design to allow the eye
affect mood; thus, the right colours can help to create an
to adapt to changes in lighting levels (2). A relatively small
environment which is therapeutic in the sense that it inspires
percentage of people have no vision at all, so using colour
confidence and can banish fear (2). The quest for the “correct”
and contrast may enhance the environment considerably
colour, however, is not as important as devising a scheme
for partially sighted users. Many visually impaired people
which enhances the building (2).
can make out a certain level of contrast in everyday lighting
A healthcare facility colour scheme can also be determined conditions, so it is useful, for example, for walls and floors
by practical considerations. There are colour preferences to be of different light reflectances. As a general rule, a
among staff for either practical or diagnostic reasons (2). For 20–30% difference in light reflectance values between
example white is seen as hygienic and clinical, so is sometimes adjacent surfaces is sufficient for most people to understand
desired by users. However, evidence does suggest that an environments more easily (2).

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How the light reflectance, colour and texture of walls and ceilings
can create healing environments
High reflectance materials are required to give visual lightness,
otherwise the surface – and hence the space itself – is likely to
appear dark, even when high levels of light are used (2). The use
of high performance ceiling tiles with light reflectance valves of
70% or over with walls painted to give light reflectance values
at around 50% can be a great solution for helping to create
an environment that both maximises the amount of light and
assists the visually impaired with moving around.
Texture and visual interest
Every object, material and surface in an environment can
contribute to the overall success of that space for users (12).
Texture is an important design element that helps to create
therapeutic environments (3). This has applications for
furnishings, wall coverings and art installations; the most
frequently discussed product in this area is flooring (3). Surface
textures and choice of materials provide visual and tactile
clues to help people with poor vision use a building (2).
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Conclusion
In healthcare facilities, a properly-designed visual
environment, with the appropriate use of colour and lighting,
will have important benefits. Studies have shown improved
patient recovery rates and this in turn boosts overall hospital
productivity and staff retention (2). The quality of the visual
environment has a positive effect on the occupant’s feeling
of wellbeing and in the case of hospitals and healthcare
buildings this can affect staff performance and patient
recovery. The cost of hospital staff and patient treatment is
considerable; therefore, measures to maximise performance
through improved environments will generally be cost-
effective (2). The physical environment is not a mere backdrop
for healthcare delivery—it is an integral part of the hospital
experience (16).
Gypsum-based plasterboards can enhance the interior
aesthetic, including flexible boards for creating attractive
curved walls and ceilings and drywall solutions with a
choice of smooth or textured finish to complement the
interior design (15).
How the light reflectance, colour and texture of walls and ceilings
can create healing environments
References
(1) M Phiri. Health Building Note 00-01. General design guidance for healthcare buildings. Department of Health. 2014.
(2) H Dalke, P J Littlefair, D L Loe, N Camgoz. Lighting and colour for hospital design: A report on an NHS Estates Funded Research Project. NHS Estates & BRE. 2004.
(3) S Semrou. Natural elements for healthcare interiors: Using light, colour and texture to bring the outdoors inside. Aug 2015.
(4) Ulrich R, Zimring C, Xuemei Zhu, DuBose J, Hyun-Bo Seo, Young-Seon Choi, Xiaobo Quan, and Anjali Joseph. A Review of the Research Literature on Evidence based
Healthcare Design. Health Environments Research & Design, 1(3), 2008.
(5) A Joseph. The impact of light on outcomes in healthcare settings. The Center for health Design. Issue paper No. 2. 2006.
(6) A van den Berg, F Jaspers, C Wagenaar. Health Impacts of Healing Environments: A review of evidence of nature, daylight, fresh air, and quiet in healthcare settings.
Foundation 200 years University Hospital Groningen. 2005.
(7) Beauchemin, K.M, Hays, P. Sunny hospital rooms expedite recovery from severe and refractory depressions. Journal of Affective Disorders, 40 (1), 49-51. 1996.
(8) D Fong. Evidence-based lighting design for healthcare: How research can inform our designs to support better patient outcomes. Neocon. 2011.
(9) Ampt A, Harris P, Maxwell M. The health impacts of the design of hospital facilities on patient recovery and wellbeing: A review of the literature. Centre for Primary
Healthcare and Equity, University of New South Wales, Sydney. 2008.
(10) Joseph, A. The Impact of Light on Outcomes in Healthcare Settings. The Center for Health Design. 2006.
(11) H Salonen , L Morawska. Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities: A review. Intelligent Buildings
International, 2013.
(12) H Dalke & M Matheson. Colour design schemes for long-term healthcare environments. 2007.
(13) Tofle, R.B., Schwartz, B., Yoon, S.-Y., Max-Royale, A. Color in healthcare environments - A research report. 2003.
(14) Manav, B. ‘Color-emotion associations and color preferences: A case study for residences’, Color Research & Application, 32 144-150. 2007.
(15) GPDA highlights wellbeing role of gypsum products. Spec Finish magazine. Jul 2014.
(16) K Hathorn & U Nanda. A guide to evidence-based art. The Center for Health Design. 2008.

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