Hospital design and lighting: functionalism or empathy?


It is not easy to design a sterile, functional and welcoming environment, as Annmarie Adams of McGill University, a historian specializing in hospital architecture, notes: “Part of the best care might be keeping people calm, giving them space to be alone – things that may seem frivolous but are really important.”
The evolution of modern medicine over the last two centuries has coincided with the evolution of care and hospitalization spaces and their design. Considering the historical and cultural context is key to understanding the dynamics of the evolution of interior design and architecture. Light is a roadmap of sensitivity to patient needs, becoming both a starting point and an ending point in this historic excursus.

In the 19th century, Florence Nightingale, considered the founder of modern nursing through her application of statistics to hospitalization, promoted large hospital spaces, pavilions with long rows of beds, abundant daylight and good ventilation, convinced that damp places were unhealthy. . Over time, this model was abandoned, in particular because of the long distances to be traveled by the nurses, the difficulty of heating the spaces and the lack of privacy for the patients; the focus shifted from the need for light to the need for a sterile environment.

Hospitals have been structured differently since the beginning of the 20th century; for example, the patient rooms have been arranged in a circle around the nursing rooms to facilitate logistics and heating. Another feature introduced in the 1930s are meals and spaces, used more as “a tool of persuasion, rather than healing” to encourage trust in hospitals through their image, reports Annmarie Adams. Based on the dictates of the time, patients had to be convinced that “they were better off in the hospital than at home when they were seriously ill”.

The increasingly rapid evolution of medical technology brought about other changes, transforming the hospitals of the 1950s into places the absolute opposite of those imagined by Florence Nightingale a century earlier: no windows or light from the day, no frills, plenty of space for equipment and hardly any attention to the psychological needs of patients. It was not until the late 1980s that patients were returned to the center of hospital design. A 1984 study published by Science demonstrated that being close to the outdoors and nature significantly reduced hospitalization time. More and more studies have been conducted in this area over the years, including a 2019 scientific study demonstrating that levels of the stress hormone cortisol are reduced by 20% if hospitalized patients spend as little as 20 minutes a day outside.

Hospitals today are therefore designed around the patient as a person, with large, brightly lit central atria, as at the JKMM-designed Nova Hospital of Finland. There is of course a lot of green and a lot of natural materials, as in the case of Maggie’s Leeds designed by Heatherwick or the Santa Fé Hospital by El Equipo Mazzanti. It is also important to focus on the amount of individual light and space, as in Wind Chimney Care House, designed by Nakamura & NAP.

According to Annmarie Adams, the reason for this is the familiarity of the architecture, which makes it less frightening: “The hospital now looks like a mall or a spa. It makes you feel like, ‘Oh, I’m just at the mall. I’m not really here for my cancer treatment. Additionally, Annmarie Adams points out that it is not just about providing lots of very light green spaces, as each person will react to a given environment subjectively. According to a 2010 study at the Hospital for Sick Kids in Toronto, a large atrium can be a pleasant introduction for one patient, but unpleasant for another, perhaps because it allows you to see other patients, who may suffer from serious pathologies. .
In the end, concludes Annmarie Adams, the best solution combines patient-centric design with people’s space and light needs and users’ multicultural identities right from the planning stage, always offering a wide variety of spaces and different points of view.


Projects of:

Photo credits :
(02, 05, 08) Heatherwick – Courtesy of the architect
(06, 07, 09, 10) El Equipo Mazzanti – Alejandro Arango
(01, 12) Nakamura and NAP – Koji Fujii
(03, 04, 11) JKMM – Tuomas Uuusheimo & Hannu Rytky


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