DAYLIGHTING IN

HEALTHCARE
AIA OHIO 2012 Convention
American College of Healthcare Architects Series

James W Harrell, FAIA, FACHA, LEED AP

GBBN Architects, Inc.

AIA Ohio 2012 Convention James Harrell FAIA, FACHA, LEED AP 1

 THORNCROWN CHAPEL

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 GBBN RESEARCH

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 DAYLIGHTING

MOST BUILDINGS
DAYLIGHTING GOALS = REDUCTION OF ELECTRIC
LIGHTING (ENERGY)
MENTAL & PHYSICAL HEALTH BENEFITS

HEALTHCARE
DAYLIGHTING GOALS = MENTAL & PHYSICAL
HEALTH BENEFITS
REDUCTION OF ELECTRIC LIGHTING

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 4

 LIGHT

Light impacts human health and performance by four main

mechanisms:

• Enabling performance of visual tasks

• Controlling the body’s circadian system
• Affecting mood and perception
• Facilitating direct absorption for critical chemical reactions
within the body
Anjali Joseph
The Center for Health Design

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 LIGHT

PERFORM VISUAL TASKS

Daylight preferred for fine color discrimination

CIRCADIAN RHYTHM
Three components:
• Internal oscillator - hypothalamus
• External oscillator – light/dark
• Melatonin – determines energy levels

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 DAYLIGHT

Not inherently superior to electric lighting,

however…
Blue spectrum (400nm-500nm) of daylight key factor
in determining circadian rhythm phase.
Electric lighting lacks this wavelength.

Melatonin - high levels =drowsiness

- low levels =alertness
High lighting levels suppress melatonin
production
Historically, melatonin lowers during day
when we receive blue spectrum of light

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 7

 DAYLIGHT

MOOD and PERCEPTION

Studies show people prefer daylight to artificial light sources for
seven different purposes:
Psychological comfort
Offices appearance and pleasantness
General health
Visual health
Color appearance of people and furnishings
Work performance
Fine observation
However, factors such as glare and thermal discomfort
associated with windows can negatively affect mood

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 8

 DAYLIGHT

MOOD and PERCEPTION

A study of 141 nurses in Turkey found that

nurses who were exposed to daylight for at
least 3 hours a day experienced less stress
and were more satisfied at work (Alimoglu &
Donmez, 2005).

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 9

 DAYLIGHT

CHEMICAL RECATIONS within the BODY

Light radiation is absorbed directly through the skin.

Ultra Violet (UV) radiation in daylight is key for
Vitamin D metabolism

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 10

 DAYLIGHT

Exposure to natural lighting in healthcare facilities has

been shown to provide a 12 percent increase in
patient recovery time, lower absenteeism among staff,
as well as increased productivity, job satisfaction, and
psychological well-being
U.S. Department of Energy (DOE), Energy
Efficiency and Renewable Energy

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 PATIENT ROOM

Records on recovery after cholecystectomy of patients in a

suburban Pennsylvania hospital between 1972 and 1981 were
examined to determine whether assignment to a room with a
window view of a natural setting might have restorative
influences. Twenty-three surgical patients assigned to rooms with
windows looking out on a natural scene had shorter postoperative
hospital stays, received fewer negative evaluative comments in
nurses' notes, and took fewer potent analgesics than twenty-three
matched patients in similar rooms with windows facing a brick
building wall. Ulrich, 1984

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 PATIENT ROOM

A patient room providing good outdoor views and daylighting

can increase patient well-being: a psychological state
resulting in reduced stress and anxiety, lower blood pressure,
improved post-operative recovery, reduced need for pain
medication, and shorter hospital stays.

The ability to manipulate the environment, including

bedside control of lighting and window shades, contributes
to a patient’s psychological outlook, rate of healing, and
quality of stay
Ulrich, 1992

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 13

 PATIENT ROOM

LENGTH of STAY (LOS)

Bright light reduces depression.

Bipolar depressed patients in east-facing rooms (bright morning
light) stayed 3.67 fewer days in hospital than similar patients in
west-facing rooms

A recent study illustrated that patients undergoing cervical and lumbar

surgery receiving same treatment protocols were admitted to the bright or
dim side of the same hospital. Patients on sunny side were exposed to
46% higher intensity sunlight. These patients had less stress, less pain,
took 22% less medication, and had 21% less medication costs.

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 14

 PATIENT ROOM

DAYLIT PATIENT ROOM FACTORS

AREA / LOCATION OF WINDOW
WINDOW SHAPE
PROPORTION OF ROOM
ROOM REFLECTIVITY
OBSTRUCTIONS
SAVES ENERGY
REDUCE ELECTRIC LIGHTING LOADS
REDUCE HVAC LOADS

From “Daylighting Hospital Patient Rooms”

University of Oregon & Zimmer Gunsel Frasca Architects, LLP

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 PATIENT ROOM

1 DAYLIGHT WINDOW
1 Ambient light
Full width of room
1

2 VIEW WINDOW
Placed to allow view
3
from bed
Shaded
Glare reduction

3 TOILET ROOM
Inboard or Centerline

From “Daylighting Hospital Patient Rooms”

University of Oregon & Zimmer Gunsel Frasca Architects, LLP

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 16

 PATIENT ROOM

ACUTE CARE
ICU
PICU
NICU*
PSYCHIATRIC
LONG TERM
ALZHEIMER'S

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 HISTORICAL PERSPECTIVE

Florence Nightingale hospital design principals:

…adequate ventilation, odor reduction in painted and papered rooms,
and windows that offered natural light and pleasant views.

A room with light, windows, and a view is essential to both the health
and recovery of patients.
Patients should be able to see out of a window to sunlight.
Windows must not be hermetically sealed, and should not be covered,
except by light, thin, washable curtains to ensure that light can enter a
room.

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 ST. THOMAS HOSPITAL, LONDON

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 CINCINNATI GENERAL HOSITAL

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 MEYER OSPEDALE PEDIATRICO

EU HOSPITALS DEMONSTRATION PROJECT

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

LIGHT DUCTS & SUN PIPES

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 MEYER OSPEDALE PEDIATRICO

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 RIKSHOSPITALET

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 RIKSHOSPITALET

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 DEVENTER ZIEKENHUIS

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

Garage Entry
Inpatient
Pharmacy

Inpatient Cafe
Entry Lobby

Garden

Cardiopulmonary
General MRI/CT Testing Nuclear Medicine
Emergency Radiology
Entry

Concourse

Infusion

Outpatient Registration
Future
Pediatric Pharmacy

Garage Entry
Garage Entry

Fever Lobby
Clinic
Clinic
N
Outpatient Entry

AIA Ohio 2012 Convention James Harrell FAIA, FACHA, LEED AP Floor
39 1
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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

Cardiac ICU Cardiology 33 beds

9 beds CCU 10 beds

Cardiac Surgery
44 beds
ICU 22 beds

Emergency
Surgery Surgery
Outpatient Surgery Pathology
19 OR
Blood Transfusion

Concourse

ICU 20 beds
Obstetrics Traditional Ophthamology ENT Future
Gynecology Chinese
Medicine
AIA Ohio 2012 Convention James Harrell FAIA, FACHA, LEED AP

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

Obstetrics 21
beds
Obstetrics &
Labor 6 beds
Gynecology
Delivery 4 beds
38 beds

Reproducti Chemother Dialy Futur

ve apy sis e
Center

AIA Ohio 2012 Convention James Harrell FAIA, FACHA, LEED AP

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE
Staff Elevators

Soiled/Waste
2 2 2 Patient & Visitor Elevators
Elevators 2
Food & Supply Elevators

3 6
2 2 3 3
2 3 3
1 1 3
1 1 48 beds total 5
VIP Suite
1 bed

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

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 FIRST AFFILIATED HOSPITAL OF KUNMING MEDICAL COLLEGE

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 TYPICAL CHINESE HOSPITAL

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 TYPICAL CHINESE HOSPITAL

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 TYPICAL CHINESE HOSPITAL

OUTPATIENT CLINIC

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 TYPICAL CHINESE HOSPITAL OUTPATIENT CLINIC

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 TYPICAL USA HOSPITAL

OUTPATIENT CLINIC

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 DAYLIGHT SCHEME

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 OUTER CORRIDOR

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 OUTER CORRIDOR

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 OUTER CORRIDOR

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 OUTER CORRIDOR

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 SHENZEN XINMING

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 SHENZEN XINMING

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 SHENZEN XINMING

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 SHENZEN XINMING

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 SHANDONG QIANFOSHAN

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 SHANDONG QIANFOSHAN

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 SHANDONG QIANFOSHAN

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 SHANDONG QIANFOSHAN

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 SHENZEN FUTIAN TCM

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 SHENZEN FUTIAN TCM

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 SHENZEN FUTIAN TCM

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 SHENZEN FUTIAN TCM

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 SHENZEN FUTIAN TCM

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 SHENZEN FUTIAN TCM

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 SHUNI TCM

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 TYPICAL USA HOSPITAL

310,000 SF

DN

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 TYPICAL USA HOSPITAL

115,000 SF
115,000 SF

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 UNIVERSITY of KENTUCKY

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 UNIVERSITY of KENTUCKY

134,000 SF

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 UNIVERSITY of KENTUCKY

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 UNIVERSITY of KENTUCKY

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 COURTYARD

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 GARDEN SKYLIGHT

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 SKYLIGHT

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 SKYLIGHT

PROSAIC CONNECTIVE SPACE

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 DAYLIGHT WAYFINDING

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 NICU

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 NICU SKYLIGHT

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 AMBULATORY CARE

FLOOR 7

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 AMBULATORY CARE

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 AMBULATORY CARE

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 ACUTE CARE NURSING UNIT

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 CHALLENGES
DIAGNOSTIC & TREATMENT DEPARTMENT DEEP
PLANS

ENERGY CONSERVATION

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 THANK YOU

James Harrell FAIA, FACHA, LEED AP AIA Ohio 2012 Convention 89