Tag: Healthcare

A game-changer in the wireless communications industry, 5G represents the fifth generation of cellular connectivity and a significant leap forward in performance compared to 4G and LTE. However, in order to plan for its impact in industries such as healthcare, smart cities and commercial buildings, we have to understand its opportunities, limitations and design challenges.

 What is 5G?

First, it’s important to differentiate 5G from other wireless communication protocols such as Wi-Fi.

5G (along with previous standards like 3G, 4G and LTE) is a standard for wireless cellular communications, and uses licensed frequency bands which must be purchased by the carrier. Wi-Fi, on the other hand, refers to technologies commonly used for wireless local area networking – connecting users to a building or residential network which is often owned and operated by the building owner. Wi-Fi uses unlicensed frequency bands which are available for anyone to use, and which can result in an increased risk of signal interference. The new 5G standard augments existing Wi-Fi and LTE standards rather than replacing them – in fact, Wi-Fi 6 (802.11ax) is set to also dramatically change the performance of Wi-Fi communications.

With that in mind, let’s look at how 5G differs from previous generations of cellular technology:

  • Latency, or the amount of time it takes for information to travel from the sender to the receiver is reduced to a theoretical <1 millisecond end-to-end, which is on par with many wired networks. As a comparison, typical home Wi-Fi latency is 2-5 milliseconds, and cable/DSL connections can have latency up to 100 milliseconds. Reduced latency increases the responsiveness for applications like self-driving cars, and can help data speeds appear higher to the end user.
  • 5G supports a higher density of users (up to 1 million per square kilometre or 100 times the density of previous generations). This is a limitation of many existing networks and key to supporting the expansion of the Internet of Things (IoT) and the myriad connected devices carried by people all over the world.
  • Transmission speed, or the amount of data that can be sent in a given period of time, is increased from a maximum of 1Gbps with LTE to a theoretical limit of 10-100Gpbs with 5G. It is anticipated that actual speeds will be an estimated 200Mbps-1Gbps in the field, which is still significantly higher than what most users experience with LTE.
  • Ultra-high reliability of 99.999%, which translates into downtime of less than 5 minutes and 15 seconds per year, and meets the typical standard for mission-critical data centres and networks.
  • Reduced power consumption, which is key for extending the life of battery-powered field devices and IoT.

Although most users won’t notice the difference, 5G also uses different radio frequencies from past standards. Current cellular protocols typically operate on radio frequencies between 1900MHz and 2700MHz; however, 5G uses two distinctly different frequency bands: below 6GHz, which supports standard cellular connectivity (600-700MHz and 3.5GHz in Canada), and above 6GHz, which is focused on point-to-point data transfer (millimetre wave or 28-35GHz) and can only be used for line-of-sight applications. This change has implications for existing infrastructure, as radio frequency communications are highly dependent on the hardware that supports them.

When is it coming?

Frequency auctions are already happening across North America and Europe. Canadian 600MHz frequencies were auctioned off in early 2019, and higher frequencies, including 3.5GHz, are expected to be auctioned in late 2020 and early 2021. Bell Media and Rogers Communications are expected to be the major players at the 3.5GHz auction in Canada, while Ericsson, Qualcomm and other major US cellular carriers indicate that they are ready with 5G infrastructure and can deploy as soon as they own the rights to the frequencies. Some carriers in the US have already launched 5G networks on the 3.5GHz frequency band, and some frequency bands above 6GHz have been auctioned off as well, with more to come later in 2021.

What is the potential impact of 5G on the design, construction and real estate industries?

5G has the potential to support radical advances in technology, and is anticipated to become the new standard for wireless mobile connectivity. However, it doesn’t replace wired networks which still set the standard on data transfer and latency, or Wi-Fi, which uses unlicensed frequency bands to distribute wireless connectivity throughout a building, often at a significantly lower cost per gigabyte.

So where is 5G anticipated to have the greatest impact?

While typical cellular users will experience enhanced performance, better connectivity and higher data speeds, the impact of 5G will mostly be experienced by devices rather than people. Devices such as self-driving cars and robotics which must be able to analyze and react quickly to situations will benefit from the low latency of new technology, and high-bandwidth mobile applications such as virtual reality (VR) and extended reality (XR) will make use of the increased data transmission speeds. 5G also has the capability to connect to a greater number of devices and use less power than previous generations, opening up a wealth of opportunity in the effortless deployment of battery-powered, highly mobile and flexible networks of 5G sensors and devices without the need for additional wiring.

Healthcare: the reliability of 5G connections is well suited to supporting critical healthcare applications, such as continuous monitoring. Higher data transmission speeds will be instrumental in facilitating high-mobility communications for telemedicine, data collection, predictive analytics, machine learning and artificial intelligence. The ultra-low latency wireless connections will also support applications like mobile robotic surgery and virtual reality.

Commercial and Smart Buildings: the explosion of connected devices within buildings will rely heavily on the increased density of connections available under the new 5G standard. Buildings are becoming more connected, IoT devices and sensors are becoming more ubiquitous, and occupants have higher expectations around connectivity and performance. The lower power requirements of 5G also makes it easier and more cost-effective to deploy highly mobile, battery-powered devices throughout the building without significant infrastructure costs. This, along with enhanced reliability, will also support mission-critical applications such as monitoring of building systems.

Smart Cities: navigation systems and self-driving cars will benefit significantly, as will increased density of sensors and users – particularly in areas like stadiums and transit terminals. However, higher frequencies necessitate high density of end-points compared to previous generations, which could have aesthetic implications as antennas move from towers to street level.

In all of these examples, properly designed distributed antenna systems (DAS) will become increasingly critical in the extension of 5G coverage throughout buildings and other areas with limited signal coverage; however, the building itself can have a significant impact on the operation of these systems and must be carefully considered in the early stages of design.

How  do we design differently for future technologies like 5G?

When technologies change every five to ten years but buildings can last anywhere from 30 to 50 years (or even more), designing infrastructure to adapt to evolving requirements is critical to ensuring the building will be able to meet the needs of its occupants both today and for decades to come. One of the key changes with the evolution to 5G is that the new standards rely heavily on optical fiber infrastructure to achieve the required data transmission speeds, rather than traditional copper infrastructure. This means that legacy buildings may need to replace their existing infrastructure in order to deploy 5G throughout their building, and new construction should not only plan for the latest fiber infrastructure, but also install spare capacity to accommodate future generations of technology. It also means that 5G networks are not able to take advantage of Power over Ethernet (PoE) which supplies both data and power over a single cable, since PoE requires copper cable in order to deliver the power component. That being said, there are significant opportunities for PoE and other types of low-voltage distribution to work in conjunction with 5G by powering end-use devices and sensors.

From a building perspective, DAS that supports 5G requires a different topology from previous generations (known as a centralized radio access network or C-RAN topology), which may require changes to pathways and spaces compared to traditional DAS infrastructure. When designing 5G systems, it is also important to consider that higher frequencies do not penetrate buildings or obstructions as well as lower frequencies due to the inherent nature of the electromagnetic signal. Past generations such as 3G, 4G and LTE have used frequencies in the range of 1.9 to 2.6GHZ which had reasonable penetration, but the proposed 5G bands in Canada are significantly higher at 3.5GHz. While 3.5GHz provides better bandwidth and data transmission speeds than lower frequencies, it will also experience higher signal degradation and will require a higher density of antennas. This, along with the requirement for the latest fibre optic infrastructure, can create some unique challenges when performing upgrades in existing buildings which weren’t originally designed to accommodate 5G infrastructure. There are a number of solutions on the market to help ease the transition – and, in some cases, it is worth evaluating whether there are other technologies which could serve the same purpose with a lower capital investment.

Finally, the move towards more energy-efficient buildings can have a significant impact on deployment of wireless technologies of all types, and must be addressed early on in the design of the system. Many modern building materials have a negative effect on wireless signal penetration, meaning that a higher density of antennas is required to provide sufficient coverage. Additional testing may also be required after installation to optimize the system for the unique building environment.

Leveraging 5G in a Data-Connected World

5G has the potential to radically change our experience of connectivity and how we design the built environment. From smart cities to virtual reality, the world is becoming more connected every day – and technologies like 5G are playing a key part in the evolution of our environment. Designing buildings and systems to support these changing technologies in the decades to come will be critical as users increasingly expect a seamless integrated experience, no matter where they are.

Author:

Kim Osborne Rodriguez,P.Eng., RCDD

kim.osbornerodriguez@hhangus.com

Kim Spencer, P.Eng., LEED®AP, Principal, brings to her new role a wealth of experience in the healthcare sector, with two decades as a successful and multifaceted manager and mechanical engineer with HH Angus. The Health Division is the firm’s largest service group, with millions of square feet of health care facilities designed by HH Angus in the last 5 years alone. Kim leads a large team of professionals providing design and engineering services to a range of facilities across Canada, including acute care, long term care, complex continuing care, mental health, children’s care, cancer centres, elder care, and rehabilitation centres.

“Kim’s promotion into this senior leadership role not only reflects her capabilities but also underscores the quality of our people, in that we are able to grow and develop leaders from within the firm,” said Paul Keenan, President, HH Angus. “Her deep understanding of the healthcare sector, communication skills and a client-centric approach will continue to grow our Health practice.”

Kim has earned a reputation for innovative engineering, sustainable design and successful project management, as well as a deep understanding of the healthcare sector. Equally, she is widely respected for a strong focus on clients and for her leadership skills in managing both people and projects. Kim’s portfolio includes new construction, expansion and renovation of acute care, complex continuing care, long-term care and mental health facilities, and experience with all forms of procurement, including P3s.

Kim is also an effective and timely communicator who understands that responsiveness is critical to successful project implementation and to building excellent client relationships. A few notable clients include: UHN, Michael Garron Hospital (formerly Toronto East General), Thunder Bay Regional Health Sciences Centre, South Bruce Grey Health Centre, ,Northern Health, Alberta Health Services, Quinte Healthcare, among many others.

“I’m very excited about my new role,” states Spencer. “I’m fortunate to work with such a talented team and look forward to contributing even further to the success of our clients and the firm.”

If you would like to contact Kim to find out how HH Angus can help you with your healthcare project, you can reach her at ;

Kim Spencer| Associate Director, Health Division, HH Angus and Associates Ltd

+1 (416) 443 8200

kim.spencer@hhangus.com

hhangus.com

Whether planning a small departmental renovation, major redevelopment or infrastructure renewal, there are a number of important questions to ask at the outset. Having clear answers will have a positive impact on the project outcome.

In particular, project phasing can be greatly informed by asking the right questions about existing and required mechanical, electrical and plumbing services in order to arrive at a successful design solution that supports the project objectives, continued operation of the healthcare facility and safety of its patients.

So, what makes a renovation project a success?

Some key markers are meeting the schedule, staying on budget, minimally disrupting operations and having no safety issues.

Since each facility and project is unique, however, there may be additional, more specific considerations that arise.

Scoping it out COPING IT OUT

One of the most important questions is, What is the project scope? At a higher level, What problem/need will the project solve? 

It may be an identified need for redevelopment of a particular area or a key piece of equipment has been failing regularly and funding is now available to address it.

Be aware that the scope may grow beyond the initial assessment based on the requirements of current codes and standards, and existing equipment capacities, among other factors. It is essential to fully understand these impacts and determine how to deal with them.

Conditions specific to the site may dictate changes to the planned scope. For example, there may be a need to run new services into the renovation area from a distribution shaft; replace existing services and equipment to accommodate a renovation, unless alternative approaches are feasible (such as rearranging or reworking equipment to facilitate the increase in load); or phase renovations in critical areas, such as the emergency department, so they can remain operational.

Realize, too, the quality of project work is constrained by three factors: budget, deadlines and scope. A trade-off between constraints is possible but changes in one will usually mean adjustments in the other two to compensate, otherwise the quality of work will suffer.

FACING THE UNKNOWN

It’s imperative to identify and mitigate risks in advance as much as possible. A good question to ask is whether there are plans and budgets for the unexpected, such as discovering ‘serviceable’ equipment is actually on its last legs or the capacity of a generator won’t permit additional load. 

One form of technology that can help mitigate the risk of the unknown is 3-D scanning of systems infrastructure, which can greatly improve the reliability of ‘as-built’ information. Scanning is performed within a space to collect ‘as-built’ data and the resulting point cloud is reconstructed into a 3-D model. The model can accurately capture the scanned space and size of services and objects within. This approach works particularly well for plant spaces where services are exposed.

Another way to mitigate unknown risk is by pre-demolition of a space prior to finalizing the design. After demolition of walls and ceilings, the design team can physically view existing services, identify conditions that may not be observable prior to demolition and update documents accordingly. When this is possible, the schedule cost of approximately three to four weeks is often well worth it to alleviate the impact of the unexpected. Other ways to confirm the current condition and capacity of services include review of maintenance records, pipe thickness tests, drain scoping, air and water audits, and metering existing services. Unknowns are always a risk to the budget, schedule and project scope. No matter how diligent the preparations, carrying an allowance as part of the project budget is recommended.

ACCORDING TO SCHEDULE

Questions around schedule are also critical: How quickly does the project need to be designed, constructed and in operation? Is there a fixed deadline (for example, driven by financing mechanisms such as the Health  Infrastructure Renewal Fund (HIRF) or Hospital Energy Efficiency Program (HEEP))? How has the schedule been developed? Have representatives been engaged from across the
hospital team? What about the design team? And, depending on how the project is being delivered, is construction team input required?

In building the schedule, it’s important to allow time for considerations such as long delivery equipment items, after-hours work, proper infection prevention and control, and construction phasing. If phasing includes multiple phased occupancies of various areas, time should also be allotted for testing, adjusting, balancing and approvals from authorities having jurisdiction at the conclusion of each stage.

Other scheduling-related questions include: Are plans in place to meet required  procurement timelines and processes? Are requests for qualifications and/or proposals or tenders being released through a procurement department? Is the facility posting for  competitive bids? If so, does the schedule  account for the required bidder response times?

Engaging a design team experienced in healthcare renovation will greatly assist in arriving at reasonable and reliable answers to these questions. The team will also need to understand future plans for the facility. For example, if replacing boilers and the five to 10-year plan includes building an addition,  consider whether reasonable allowances can be made in the boiler project to facilitate future expansion. Sometimes spending a few extra dollars now can save on future capital and operating costs.

A MATTER OF PRINCIPLES

Answers to the preceding questions will inform the establishment of the project’s key principles; in other words, the most important factors driving the project. When faced with a difficult decision during the project, these principles will serve as a guide for making decisions. The principles may be driven by budget, schedule, patient experience or a combination of these, plus other factors. Whatever is identified as key principles, share them with the team to assist in setting  expectations and defining the scope.

When key principles are established, the sum of the parts may not lead to the outcome originally envisioned. For example, getting things done quickly does not always lend itself to the lowest cost; off-hours/overtime work may be required to meet a compressed schedule. A well-worn axiom sums up this challenge: All successful projects require sufficient time, money and quality. If one is missing, there better be lots of the other two.

PHASING IMPACT

Construction phasing — the general sequence in which the renovation work needs to be  performed in order to meet project requirements — is a culmination of addressing all the foregoing issues. Phasing is developed by considering factors such as schedule,  departmental operations, hospital operations, infection prevention and control, and budget.

The earlier construction phasing is established, the better. For a departmental renovation, for example, the ideal situation is to shut down the entire area; however, this is often not possible due to operational constraints, so phasing becomes critical.

When establishing phasing, consider how different phases will affect existing mechanical, electrical, plumbing and information technology services. These services often do not respect a renovation project’s physical boundaries. For instance, ductwork supplying one area may continue through to a completely unrelated area but the renovation may impact both. If the team includes multiple design disciplines and professionals, encourage the architect to engage the engineers early and often in the phasing planning to help mitigate some of these risks.

In the early stages of multi-phase projects, execute enabling works for later phases. For example, leave valved/capped connections for extension of medical gases; rough-in junction boxes/empty conduit; allow for proper raceways; and consider placement of any new equipment to permit easy access to expand in a future phase. These simple steps can help ease some of the challenges of building a project over multiple phases.

Minimizing disruption to operations is typically one of the most important factors in a healthcare renovation project. Some schedule-friendly approaches include seasonal replacement of infrastructure (for chiller replacement, schedule construction in non-cooling months; conversely, schedule boiler replacement in summer) and the use of pre-fabricated equipment to assist with overall schedule and phasing/turnover.

FUTURE OUTLOOK

If the initial project scope doesn’t include infrastructure upgrades, it’s important to assess the equipment serving the renovation area and clearly understand its life expectancy and operating costs. While the budget may not allow for it, investigate if spending a little more now (from the capital budget) can reduce future operating costs.

And while looking into the future and thinking about operating dollars, consider the facility’s master plan.

Can this current renovation reasonably accommodate parts of future planned renovations?

Those accommodations could include purchasing additional capacity for particular equipment, leaving space for future equipment in a location conducive to expansion or choosing modular equipment that can be readily expanded.

CODES OF PRACTICE

It’s essential to understand the impact of current codes and standards on the project. The design team can help sort through which activities and replacements should be undertaken versus those that must be done. Understanding how codes and standards relate to the project is critical as they can potentially have a major impact on the project scope and, accordingly, the budget and schedule as well. 

GROUNDWORK FOR SUCCESS

For the best chances of delivering a successful project, it is important to ask the right questions. In particular, clarity around the project’s scope and problems it addresses is vital. Determine phasing and related impacts early. As much as possible, identify and mitigate risks in advance. Finally, engaging a design team with verified healthcare renovation experience is a valuable asset in achieving these goals. 

Published in the Canadian Healthcare Facilities
Summer 2018

Kim Spencer, P.Eng.
kim.spencer@hhangus.com

Jeff Vernon, P.Eng.
jeff.vernon@hhangus.com

CHUM, modern hospital complex, multi building glass design

Meeting  stringent standards while reducing energy use.

Hospitals face unique design challenges in meeting air handling requirements, none more so than the special requirements of operating rooms. As lighting systems and building  envelopes have become more energy efficient, it is air handling systems that increasingly  represent a hospital’s greatest energy consumer. But there are options to mitigate the energy demands of these systems.

Air handling systems are an important part of any building for maintaining occupant comfort. When it comes to hospitals, there are a series of special requirements that make ventilation systems critical to the delivery of healthcare.

Firstly, air handling systems are relied on to help protect occupants and adjacent  surroundings from infectious diseases and hazards created by equipment and processes. Many contaminants are generated which must be exhausted. In many areas of a hospital, the systems are designed so that air flows from clean to less clean areas to help protect staff and other occupants. A good example of this is Airborne Isolation Rooms where differential pressures must be monitored and alarmed.

Air handling systems are also a key component of the life safety strategy for managing smoke in a fire situation. A measure of the reliance on air handling is the requirement that ventilation systems must limit smoke concentration to allow operations to be safely concluded or for critical care patients to be safely transferred.

And now the rising level of patient acuity and the pressure of high utilization, with occupancy rates well above 100%, are putting even more pressure on HVAC systems. In Canada, CSA Standard Z317.2, Special  requirements for heating, ventilation, and air-conditioning (HVAC) systems in health care facilities, is referenced in most if not all Canadian Building Codes as good practice for the design, construction and operation of air handling systems. The latest edition was published in December 2015, and work  recently started on the next version due in 2020.

Operating rooms

Operating rooms and similar spaces where invasive procedures are performed have a number of particular air supply requirements:

  • Common practice for operating rooms is to supply a high volume of air at low velocity through laminar flow ceiling diffusers in the central area of the room with the intent of achieving a piston effect. The intent is for air to generally flow first past the patient and clean surgical staff before flowing to the outer portions of the room to the exhaust grilles. Studies have shown that 20 air changes per hour is effective; note, this is a far cry from the hundreds of air changes of a true laminar flow clean room.
  • The cleanliness of operating rooms is critical. Standards call for the supply air to be filtered to at least MERV 14, but many engineers and facility managers look to increase this to a higher level. HEPA filters, which are rated to 99.97% efficiency on 0.3 micron particles, have been adopted as the standard in many cases.
  • Staff generally prefer operating rooms be kept relatively cool as they are often gowned in multiple layers to minimize the possibility of infection. The premise that a wide range of temperatures is necessary to control the temperature of the patient, particularly during cardiac surgery, is not well founded. Blankets or pads that heat or cool are used to control the patient’s temperature.
  • There has been great debate over humidity in operating rooms. Many years ago the anaesthetics in use were flammable, and operating room  humidity was maintained between 50% and 60% to minimize the possibility of static electricity discharge. As anaesthetics became safer, the low end of the humidity range was reduced to 40%. The initial concern was that less humidity would cause drying at the surgical site; however, this condition was not observed. In the 2015 version of CSA Z317.2, the lower humidity limit was lowered to 30%, similar to most other spaces in a typical hospital.
  • Design engineers must carefully analyze the psychrometrics of air supplied to operating rooms over the possible range of temperature and humidity conditions. This is particularly true in the summer when cooling coils are relied on to dehumidify moist outdoor air. If this air is not dry enough, the relative humidity limit in operating rooms kept at a cool temperature will not be maintained. Enhanced cooling coils, lower chilled water temperatures, and desiccant moisture removal are some of the solutions.
An operating room inside the Centre hospitalier de l’Université de Montréal.

Energy efficiency

These high levels of ventilation and air cleanliness, coupled with stringent temperature and humidity control and around-the-clock operation, all contribute to high energy use in hospitals; however, there are a number of strategies that can help reduce energy use:

  • Moving air at lower velocities takes less energy, so air handling equipment and ductwork with a larger cross sectional area needs less fan power to move the air.
  • Variable volume air supply and exhaust is more complex in a hospital due to the requirement to maintain directional airflow between most rooms and departments. This generally requires that each individual room or group of rooms control both supply and exhaust air in tandem so pressure relationships can be maintained.
  • A number of methods of heat recovery, when correctly applied, have proved effective while maintaining the cleanliness of the air. Projects such as the Centre hospitalier de l’Université de Montréal (CHUM) and Royal Jubilee Hospital in Victoria used enthalpy heat recovery wheels on all air handling systems to transfer heating, humidity and cooling from the exhaust air to the supply air.
  • There is a misconception that air handling systems all need to operate 24 hours a day. This is true for a number of space types but, even in more critical spaces, there are opportunities to reduce the total air volume or volume of outdoor air when the spaces are not in use, as long as certain conditions are met. Less critical areas offer more flexibility to reduce airflows or setback temperature setpoints.
Royal Jubilee Hospital interior with modern design

Published in the Canadian Consulting Engineer
January/February 2018 

Author

Nick Stark, P.Eng., CED, LEED® AP, ICD.D
nick.stark@hhangus.com

Lighting in healthcare centres requires balance between aesthetics and functionality. The right illumination is essential for medical staff to perform their duties and, as growing consensus suggests, aid in patients’ recovery. Bradford Keen speaks to architects and lighting specialists working across three continents about light’s healing properties.

From ancient Egyptians worshiping the sun god Ra to a parent parting the bedroom curtains of a moping teenager, light intuitively feels right. It is able to create perspective and alter moods. When intuition is verified by science, we feel vindicated by our innate wisdom.

Light has long been manipulated in effective design, but it is now permeating healthcare centres too. Gone are the days of bright, blue lights bearing down from above with the promise of sterility. Instead, the shifting ethos, backed by medical studies, has evolved to focus on how natural and artificial light can give patients a healthy glow.

“About five to ten years ago, healthcare design had a lot more of a clinical and institutional feel,” says Philip Schuyler. “People used really high colour temperatures – over 4,000k.” The electrical engineer at HH Angus explains that the industry now seeks to create a soothing environment mimicking someone’s home or a communal space, while balancing aesthetics, cost efficiency and functionality.

HH Angus and CanonDesign have undertaken a mammoth project. Spanning two blocks in downtown Montreal, the 21-storey Centre Hospitalier de l’Université de Montréal (CHUM) subsumes three existing facilities – Hôtel Dieu, Hôpital St Luc and Hôpital Notre-Dame – in what will be one of North America’s largest academic medical centres, spanning three million square feet. Phase one of the project, which includes the hospital and ambulatory building, was completed recently, while phase two’s office building is set for 2021. The healthcare district is set to teem  with social activity, boasting an amphitheatre,
natural green spaces and one of the country’s largest displays of artwork.

The direct health benefits of lighting – improved mood, reduced hospital stay, lower mortality rates, among others – are proven, as is light’s ability to help create a sense of shared calm for patients and their loved ones.

“Lighting makes people feel a lot more receptive to treatment,” Jocelyn Stroupe, director of healthcare interiors at CanonDesign, says. “Often, healthcare encounters are filled with anxiety. We want to be sure anyone who enters the building feels a sense of comfort.”

This mindset of making hospitals communal and homely spaces is relatively new but  gaining credence among architects.

“People usually go into healthcare facilities with humility,” says architect Joaquin Perez-Goicoechea. “They are searching for something; they need support and, if the building can help them achieve this, it brings satisfaction to all of us.”

This was the weighted starting point for the cofounder of AGi architects when designing the Hisham Al Alsager Cardiac Center in Kuwait. “People with chronic diseases require constant contact with doctors,” says Perez- Goicoechea. Their loved ones often spend many hours at their side or in the facility, which motivated the architect to design the centre as a place for social cohesion. “Light is extremely important for this. It must be a sanctuary,” he adds.

With red aluminium panels, the cardiac centre is designed and coloured – at the behest of the medical staff – to resemble a heart. Its large windows, on the north facade, open up to the dazzling blue of Kuwait Bay.

The multiple vertical skylights maximise natural light. Pollution and dust dictated their positioning. Placed flat and horizontally, they would have gathered too much grime, rendering them useless even with a stringent maintenance plan.

Lighting is a powerful “abstract and immaterial architectural tool,” says Perez-Goicoechea. “The issue is how you see the space as a structure on a sequence, which is identified by different lighting experiences depending on the use or character you want to give to that space.

“If you are going to be sitting in a waiting area for half a day, because this is the reality, you don’t want to be sitting under white, fluorescent lights. You want to be under warm ambient lighting that makes it cosier; it frames the space.”

The diffused ambiance of CHUM

AESTHETICS VERSUS FUNCTIONALITY

This is where striking a balance is essential. “It needs to be a safe environment,” Stroupe says, “and lighting has to be designed so staff can perform their job without issue.” With many hard surfaces in healthcare facilities, eliminating glare is just one necessary consideration as it will help reduce fatigue on the eyes.

It’s not only the staff, of course, but patients too. “They are often in their rooms or being transported through corridors lying on their backs,” Stroupe says. “We’d like to avoid having something in the ceiling shining in their eyes and causing discomfort.”

Nowhere is this balance between comfort and function more important than at the Dommartinlès-Toul, a short and long-term residential facility in France for people with epilepsy. While there aren’t any operational procedures being carried out, staff need to perform regular functions such as administering medication. The importance of this cannot be overstated, as was seen in a study from the early 1990s, where pharmacists’ prescription-dispensing error rate was heavily dependent on their workspaces being sufficiently lit.

A more pressing factor for epileptics is that stress – often noise and light – can be a major trigger for seizures.

“We concentrated on soft materials,” says Atelier Martel’s co-founder, Marc Chassin. The architect implemented sound absorption materials and low, non-aggressive beam lighting. The firm worked with two artists on the project to add gentle touches such as shallow, sphered indents on the external facade to pay homage to the tablet from around 600BC, considered the first written record of epileptic symptoms. Internally, a tapestry of wool acts as a centrepiece to create warmth and comfort.

“This attention to detail is very important for the people who live there,” he says. “In the bedrooms, we have really big windows that open widely, making the space feel larger, almost like a terraced area.”

A UK study from 2013 showed that patients’ length of stay in hospital was reduced by 7.3 hours per 100lux increase of daylight and, in 1998, a study of patients in a cardiac facility’s intensive-care unit found mortality rates were higher in dimly lit rooms.

An earlier study, published in Science in 1984, found patients in rooms with windows facing trees recovered 8.5% faster and required less pain medication than those with views of a brick wall.

At CHUM, there are multiple outside areas. Beyond the obvious benefit of being a place to breathe in revitalising air, they were also designed for those inside the building. “We wanted to provide people a green and healing view,” Stroupe says. “It is a very tight urban site with amazing views of the city, but this is a little more intimate.”

Lit naturally during the day and benefitting from artificial light spilling out from the inside of the building in the evening, Schuyler says they took a minimalist approach for the terraces. “There is very little specialist lighting in those terrace spaces,” he says, “but they were supposed to be more natural and comfortable.”

When natural and artificial light shine in perfect choreography, architects manage to create a “diffused ambiance”, says Perez-Goicoechea, where different sources of light react to alter the perception of space.

Studies have shown that daylight is not necessarily superior to artificial lighting but, rather, capitalising on a combination of the two yields the best results. At the epileptic care facility in France, Chassin says different sources of light are used but often with their origin concealed, rendering illumination a general impression rather than a location-specific function. “The idea of softness is in the architecture,” Chassin says, “but also in the technical aspects of light.”

Another essential function of light is how it empowers patients. “We gave people control  over their own lighting,” Chassin says. “It is important specifically for those with epilepsy because certain sorts of lighting and frequency can cause seizures.”

Even in situations where lighting does not directly impact a patient’s medical condition, it can afford them a greater sense of empowerment.

“Patients are in a stressful environment,” Schuyler says. “A big part of promoting wellness is being able to control their environment.”

A visitor bathes in natural light at the Dommartin-lès-Toul care home.

FIND THE WAY

In any healthcare facility, not least one the size of CHUM, clear navigation is essential. Staff need to find their way between departments, patients have to go for tests and therapy, and visitors wish to locate their loved ones with ease.

“Every encounter has to be understandable and clear,” Stroupe says. “The wayfinding aspect is immensely important and lighting plays a big role in how we can emphasise the passage of travel for people in this facility. Lighting needs to work to support the architectural design.”

The navigational aspect plays a huge role in epileptic patients’ comfort and orientation. In the aftermath of a seizure, patients will be muddled and confused. Using light, and external contextual cues such as the courtyards and trees outside, helps them reorient themselves, offering much needed succour.

Focusing on the human condition, architects can ensure lighting is used in healthcare centres to make the work of medical staff easier and more efficient, but also help improve the physical and psychological welfare of its patients. There may no longer be a need to invoke the power of Ra, but the benefits of light remain integral to human well-being.

Leaf Review Magazine
January 2017