Lighting

Inclusive design looks to address the needs of all end users to create a space that is safe, supports independence and reduces risk of harm or clinical error.

Though beneficial, natural light cannot be relied on to illuminate activities due to its inconsistent nature. Insufficient lighting is a risk factor for patient falls and clinical errors and will need to be supplemented with artificial light. Harsh or flickering lighting can affect patients with cognitive challenges, photosensitive epilepsy and can generally cause distress.

The tone and colour of light can help to create a sense of calm thus avoiding an institutional feel. For example, avoiding blue / cold lighting is beneficial for people who feel challenged in unfamiliar surroundings.

Recommended standards:

• Ensure light fittings provide the correct level of lighting to illuminate various activities. Reference appropriate professional resources to ensure lux-level meet the need of the space.
• Emphasise lighting in entrance lobbies to give a smooth transition between indoor and outdoor spaces.
• Treat colour and reflection of finishes and surfaces as a single entity as this can affect the overall lighting in a room.
• Ensure artificial lighting provides sufficient illumination and avoids glare, pools of bright light and strong shadows which will affect optimum visibility.
• Create comforting atmosphere with use of soft, indirect lighting in social areas. See Good practice in Design of homes and living spaces for people with dementia and sight loss.
• Ensure good lighting in toilets and avoid reflective surfaces which can cause disorientation for some users.
• Corridors, lobbies, stairs and landings should be well and evenly lit to give clear perception of the nature of the space. Areas of dark and light spaces inhibits vision and areas of shadow can be confusing, for example in lifts.
• Supplement natural light from windows and rooflights with artificial light.
• Don’t use strobe lighting (flashing energy lights) as this may induce seizures in some people with photosensitive epilepsy.

Inclusive design helps inform decisions on lighting position and levels of lighting. This can have a positive impact on tasks being carried out and support users to move safely and effectively around a building.

Poorly placed lighting can lead to errors, poor communications and have adverse impacts.

Recommended standards:

• Position lighting to illuminate people’s faces without glare or silhouetting which can hinder lip-reading.
• Don’t positioning uplighters at floor / low levels as this causes glare and obscures visibility. It can also disorientate spatial perception for some visually impaired people.
• Use diffusers or downlighters to prevent glare.
• Avoid light sources that cast shadows, are inconsistent or create areas of light and dark.
• Ensure lights and light fittings cannot be used as ligature points especially for the vulnerable and those with challenging behaviours.
• Prevent access to off limit areas for patients with cognitive challenges, under observation or with challenging behaviour by reducing the contrast of off-limit entrances.
• Fix all lighting securely to walls or ceiling surfaces with no hanging components unless out of reach and inaccessible.

Making lights easy to use creates a sense of independence and control and helps make an environment inclusive for all users. Being able to modify and adjust lighting can help to reduce stress levels for users while keeping people safe.

Recommended standards:

• Allow staff, patients and visitors control of lights in their own areas.
• Lighting should always be controlled within reception and waiting areas to provide appropriate levels of light at all times of day or night.
• Locate light fittings to ensure when used that natural light from windows provides a uniform spread of light.
• Automatic movement-detected lighting can make controlling lighting simpler and provides an energy-efficient solution. Ensure good quality and regular maintenance for effectiveness.
• User controlled adjustable lighting systems can improve the patient experience.
• Consider the locations of dimmer switches and fluorescent lights near patients as they can interfere with hearing aids systems.

Lighting can affect the overall characteristics of a healthcare setting. Use lighting to create intuitive wayfinding, provide a sense of calm and help a person be at ease within a space.

Recommended standards:

• Use lighting to enhance artwork – illuminated photographs, views within ceiling grids or on walls. Landscapes or Nature images can compensate for a lack of an external view.
• Use lighting to maintain the body’s natural rhythms by adjusting the amount of natural daylight throughout day and night.
• Use landmarks and artwork to help users recognise where they are within the building.

Use inclusive design to inform your wayfinding strategy and use lighting to create a safe and secure environment. Promote inclusion by helping users to remain independent and safe when using the facility through intuitive wayfinding that does not cause stress and anxiety. See HBN 00-04 Core Elements Circulation and community spaces for additional information.

Recommended standards:

• Use colour and art to identify routes and destinations. This can reduce the reliance on maps and signs which some find difficult to see or understand. Note: lighting is not a substitute for appropriate written signage.
• Highlight ‘landmarks’ to help people build a mental map of the facility and prevent people getting lost.
• Ensure signage is well lit and can be easily read when natural light levels are low.
• Light signs to the appropriate lux-level.
• Position lighting to avoid dark shadows over signs so that they always remain visible.

Create an inclusive environment by using contrasting wall colours. This can help people with visual difficulties to navigate their environment safely, identify features and avoid obstacles and hazards to reach their desired destination. On this occasion inclusive design permits the use of shadow to reinforce three-dimensional perception for safer movement between spaces.

Recommended standards:

• Position lighting on staircases to use shadows to highlight the separation between treads and risers.
• External lighting should be provided to ensure adequate visibility of ramps and steps
• Avoid flood lights. If installed, make sure the glare doesn’t reach street or road level.
• When considering the lighting strategy, it is important to consider the impact of moving between areas of light and dark or vice versa. This is important for all users but is especially so for those with visual impairments.

Blind and partially sighted people can be distracted by glare. Create an inclusive environment by avoiding bright patches of light and ensure rooms are evenly lit.

Recommended standards:

• Cut down on glare and shadow to ensure people’s faces are appropriately lit.
• Ensure the perception of a space remains the same under different lighting conditions.
• Ensure light is distributed effectively whether the light source is directly visible or reflected by surfaces, such as glazed screens.
• Don’t locate windows at the end of corridors, this causes glare and creates silhouettes making detailed vision more difficult.
• Use light colours on walls to minimise glare and reflect an even spread of light
• Use of Internal blinds or external mounted shading can reduce impact of direct sunlight and cut down glare.
• Avoid spotlights, flood lights or low height fixed lights as this can cause glare.
• Where patients are lying in a bed or on a trolley use wall-wash lighting, up-lighting, or perimeter lighting to avoid dazzling patients with direct light. Particularly important is the position of bedhead lighting in bed spaces and recovery bays.