Colour in the intensive care unit

About the positive influence of colour and light on patients* and nursing staff in intensive care units 

by Alexa Blum and Jean Odermatt

Corona – what contribution can we as scientists and designers make in the crisis? What is the role of researchers who deal with the topic of health from a perspective that focuses on the relationship between people and the designed environment? Is it appropriate, in the face of a pandemic in which people are dying in intensive care units, to discuss design issues and talk about colours and materials? We think so – and to anticipate this from the outset: a new, groundbreaking study by the Bergische Universität Wuppertal and the Helios Clinic in 2019 shows that colour alone in intensive care units can reduce the need for painkillers by a third. The positive effects of the intervention not only affect patients, but also the staff, whose condition is known to have a strong impact on the recovery process of patients.

Hospital Giovanni XXIII, Bergamo, Photo: Sergio Ramazotti/Spiegel

Against this background, we believe it makes sense to discuss design issues today – and especially now – at a time when the crisis seems to be upsetting our ideas and the world we know. This is particularly important in view of the question of what we learn from the crisis and how we want to shape the world after it. Hardly ever before has the issue of health and the functioning of health care systems been discussed more intensively in almost all circles of society worldwide than it is now. In the crisis, shortcomings are becoming apparent even in the well-developed health systems of Central Europe. Where economic efficiency and a focus on logistical processes were the top priorities in hospital planning and budgeting, there are now fears that the number of available beds and equipment is too limited, as is the physical and mental capacity of staff. At the same time, until a few weeks ago, the “cost explosion”  in the health care system was at the top of the political agenda. A dilemma that requires new approaches to solve. As long as technical and pharmacological progress opens up new possibilities, we will want to use them – and the costs in the health care system will continue to rise. However, the study by the Bergische Universität Wuppertal described in more detail below shows that, in addition to the medical approaches mentioned above, there are also alternative treatment approaches that can achieve measurable success even in crisis situations, such as a stay in an intensive care unit. In our opinion, targeted research into these approaches is a forward-looking investment in health research. 

A first important step towards this would already be the mere acceptance of the fact that the design of rooms can have a positive influence on people. This would mean getting involved in new and complementary treatment methods, researching and expanding them and finally anchoring them in the health system. This applies both to medical circles and to the formation of a general consciousness within our society. This is a fact- and evidence-based examination of the question of which methods lead to health and help to maintain or regain it even in times of crisis. Although the awareness of using design to specifically support health and wellbeing is already present in research and in professional circles, it is still largely unknown to a broader public. 

An emergency centre was set up on the premises of the Swiss Paraplegic Centre in Nottwil. @zentralplus

Design issues are usually associated with decoration and lifestyle, the “beautiful living” of an affluent society. This expresses an attitude which, although it considers the “beautiful” to be desirable, in an emergency declares it to be mostly irrelevant. Colour, form, material or appearance become a supposedly dispensable luxury. However, research provides numerous proofs that the space in which we move has a significant influence on how we feel. Visual signals can convey a sense of well-being and security, they can be stimulating or disturbing and can trigger stress. Colours are an essential factor in this respect. We understand design not only as an aesthetic element, but also as a means of triggering sensations, associations and emotions, as well as conveying specific information. We are convinced that we have an important set of instruments at our disposal, but their effect is still largely underestimated today. In times when health is a major issue, however, alternative and complementary approaches to health can be used in addition to medical measures to reveal new ways of understanding health. 

For decades, environmental psychologists, sociologists and design institutes all over the world have been engaged in studies on the effects of the environment on people and their well-being. In doing so, they have made visible considerable correlations that are likely to be of the greatest relevance for the design of private and public spaces and, in today’s situation, should be applied above all in healthcare facilities. However, these research results are hardly known in the public perception and are therefore not widely disseminated. 

The current situation of the corona crisis could perhaps now change this. Provided we conduct a broader discussion, place the current crisis in a broader context and ask ourselves what the term “health” actually means: How does health come about? Which factors support health and are suitable for strengthening people? As early as 1986, the WHO defined in the Ottawa Charter that well-being and an environment that enables the positive development of the individual are essential prerequisites for health. The creation of a positively stimulating environment leads in the long run to a higher resilience of the individual. A society that internalizes this principle sustainably strengthens the healthy development of its members. The creation of an environment that appeals to emotions, intellect, and all senses equally is an important part of this. 

It is obvious to see the effect of a positively stimulating environment first of all as a process which accompanies the development of a person over a longer period of time. However, there are also studies which indicate that even short-term impulses – such as colour in a room – have an effect. 

In the most unfavourable course of corona disease, patients are treated with intensive care. As the already mentioned Helios study shows, even in a crisis situation, which is an intensive care unit, a short-term impulse can have a measurable effect. The intensive care unit of the Helios Clinic has been redesigned in terms of colour, replacing clinical white with warm colour tones. Various measurable data taken before and after the intervention impressively show a positive effect on patients and staff. This is an insight that should not be ignored, especially in the current situation, and must be discussed when designing intensive care units in the future. 

About the Helios study

The world’s largest research study of the Helios University Hospital Wuppertal was conducted in cooperation with the Bergische Universität Wuppertal over a period of 24 months (October 2017/2019) in the intensive care units of the hospital in Barmen. In close coordination between the two cooperation partners, the influence of a new colour and light concept for the intensive care unit on people was investigated. 

©Helios.Kliniken

The patient/family surveys as well as staff interviews prove the effectiveness of colour and light on the well-being and satisfaction of the person. “The evaluation of the surveys shows excellent results: The patients’ satisfaction with the premises was increased by a third thanks to the new colour and lighting design”, says Prof. Dr. Axel Buether (2). However, the effect extends not only to the perception of the architectural space, but also to that of care. The spatial impression of the lounges and patient rooms, described by those affected as a “feel-good atmosphere”, ensures more effective care. 

The positive evaluation of the care measures increased by almost 30% among patients after the renovation. “In addition, the patients feel much more private and comfortable on the ward after the renovation work. In particular, feelings of security and safety are a decisive factor in the patients’ recovery. Here we have achieved an increase of over 55% after the renovation,” explains Dr. Gabriele Wöbker. 

However, the redesign of the ward has not only increased the satisfaction of the patients, but also that of the staff. “The room quality of the patient rooms is even rated 40% better by the staff”, says Prof. Dr. Axel Buether. The satisfaction of the staff with their work was also increased by 12% as a result of the project. 

Another important aspect is the identification of the employees with their workplace: After the redesign of the station, the employees have identified much more strongly with their workplace. An increase of almost 30% was achieved in the comparison period. “We can also draw on groundbreaking results when it comes to the effect of color and light on patients’ medication consumption. For example, the consumption of medication was reduced by an average of 30% in the comparison period,” says Dr. Gabriele Wöbker. 

(1) https://www.helios-gesundheit.de/kliniken/wuppertal/unser-haus-karriere-presse/aktuelles/detail/ news/research study-confirms-positive-influencement-of-color-and-light-on-patients-and-personnel-of-int/

(2) Büther & Wöbke ( 2019), https://axelbuether.de/wpcontent/uploads/2018/03/Evaluation_HeliosStudy_Colour_Light_110319.
pdf retrieved on 9.12.2019

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alexablum

Alexa Blum is a designer and corporate design manager with over twenty years of experience in the development of colour concepts for public spaces with a focus on buildings in the healthcare sector. She works as a researcher at the Bern University of the Arts (HKB).

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