Nitty Gritty
It’s rare to have the chance to get stuck into a properly ‘geeky’ conversation with other professionals who are as passionate about the technical side of lighting as you are.
So I’m looking forward to the LIA TechX conference on the 2nd of July – a packed programme of practical presentations across four stages – Sustainability, Standards, Connected lighting and Lighting Design.
It would be great to see some of you at the opening session of the Lighting Design Stage. I’ll be sharing the latest research that traces visual discomfort to cortical networks in real time, how natural scene statistics and personal preferences predict performance – and what that means for lighting design and specifications. I’ll also be reviewing fascinating new work on the intersection of neurology and emotion and how ‘lighting by numbers’ may be missing the point. We’ll take a quick look at some studies from schools and offices, homes, hospitals and residential care to offer some sector-specific ammunition for professionals on a mission to shift the conversation from cost to value.
Link to register is here – hope to see you there!
Evidence-based design – what else is there?
Pondering takeaways from the thought-provoking Architecture for Health conference at Chalmers University in Gothenberg, Sweden last week.
Goran and the team were generous and welcoming hosts, from endless Fika to midsummer strawberry cake, four streams of talks, poster presentations, discovery tours of local hospitals and primary care facilities and a magical evening cruise through the archipelago. It was wonderful to make so many great connections with shared interests and a privilege to host a workshop about a current collaboration with Evidy with Professors Helle Wijk and Myriam Aries.
I also discovered the phrase ‘evidence-based design’ (or EBD).
At first I was confused. Like ‘human-centric lighting’, surely every design decision is based on some notion of cause and effect, or what ‘works’, however flawed.
But on reflection, perhaps it’s a useful starting point, if only because it poses the question of what ‘evidence’ means – and what (or who’s) evidence counts most.
Professor Anjali Joseph’s keynote was a sobering reminder that, when it comes to the spaces we build for healthcare delivery, these decisions can be a matter of life and death.
According to the WHO, one in every ten patients is harmed while receiving hospital care, with adverse events due to unsafe care being one of the top ten leading causes of death around the world – World Patient Safety Day: 50% of Adverse Events that Impact Hospital Patients are Preventable. Professor Joseph introduced me to the ‘swiss cheese model’ of risk, where ‘active’ failures or errors by front line staff, are compounded by ‘latent’ failures – the hidden risks built into the system or the infrastructure itself – Understanding the “Swiss Cheese Model” and Its Application to Patient Safety.
As she pointed out, quoting the founder of the Total Quality Management movement, American economist W. Edwards Denning, “Every system is perfectly designed to get the result that it does.”
And yet, despite the critical role that healthcare buildings play in safe and efficient delivery – and the billions of euros invested in health infrastructure across the UK and Europe, UCL’s Professor Grant Mills noted the complex framework of incentives and barriers to change, including the growing influence of financial institutions in setting priorities. He concluded that we don’t currently have any systematic way of evaluating return on investment for different design strategies within cities and regions, let alone between countries – surely the first step in an evidence-based approach.
At the individual project level, Ali Walker’s first-hand experience as a consultant paediatric anaesthetist of being ‘thrown in at the deep end’ to make critical decisions about the design of a new facility with no formal training or even a baseline framework for best practice led Ali Walker to set up Made for Health in Glasgow. She and her growing team now deliver practical training for fellow healthcare professionals – one of a number of initiatives driving change from the ground up.
I enjoyed a steady stream of heart-warming examples of the power of co-design including Tara Veldman’s children’s hospital project in Australia. She explained how patients who just wanted to enjoy a pizza and a movie with friends inspired inspired the introduction of a hatch for uber eats deliveries and a space for celebrations, lift lobbies doubling as family rooms after hours and even a dedicated garden for visits with the family pet.
Other presentations invited me to challenge preconceptions: single-occupancy rooms may reduce infection risk and privacy, but in some cultures it can leave patients feeling isolated and ignored, paradoxically increasing nurse calls. Another pointed out, although inspection windows are promoted as a way to reduce falls, most incidents happen while nurses are actually in the room.
The lively debate about whether to build bathrooms on the outside or interior walls of a hospital was a fascinating illustration of some of the tensions in evidence-based design.
The opening keynote by the ‘godfather’ of the field, Professor Robert Ulrich centred on his seminal work that demonstrated the healing power of a view, that laid the foundation for hundreds of papers that confirm the link between windows and natural light and health outcomes in acute and chronic care settings for patients, staff and families alike – View Through a Window May Influence Recovery from Surgery. An elegant thesis presentation by Masters Student Sophia Souvatzoglu celebrated the long history of solariums in antidepressant treatment from the Greeks to the 21st century, while a site visit to a primary care facility featured a lush internal greenhouse complete with palm trees inspired by the lush vegetation and ample daylight of the local community’s home countries.
Paradoxically, Professor Anjali Joseph concluded that, following extended consultation with clinical teams, all bathrooms in the new ICU would be placed on the outside wall because this layout makes it easier for staff to see the patient and to get equipment through the door faster, without the ‘neck’ created by the en-suite.
I was struck by the contrast with Professor Ulrich’s seminal work on the power of a view and more recently insights from Sean Cain and a growing number of clinicians integrating light sensor data with patient records at the facility and population scale. They all point to a consistent link between patterns of exposure and physical and mental health outcomes. They are clear that any design decision that disrupts the circadian cycle is a latent failure – an accident waiting to happen – Do no harm: the beginning of the age of healthy hospital lighting. Sleep 44.
Of course it’s complicated – big windows pose problems of thermal gain and privacy – and not every healthcare facility has the luxury of a garden – or a gardener, let alone a budget to keep it looking lush. Equipment has to be moved quickly and safely and patients need to be closely monitored, especially in an ICU. But, as sensor and building management technologies evolve and medical equipment becomes more compact, I can’t help wondering if we might look back at the decisions we make today and wonder if we asked the right questions and had the right people in the room.
With best wishes for a great weekend.