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Barbara J. Huelat: Healing Our Healthcare

Color and Design in Healing Environments
By Barbara J. Huelat, FASID, AAHID, EDAC, IIDA

"Colors are the smiles of nature" - Leigh Hunt

Places without color are spaces without sunshine. Light gives us the magic of color. Indeed, light is required to experience color. The connection between sunlight and health has long been established. Cloudy days dampen our mood, while sunlight and color chase the blues away.

Color and Design Matter
Neuroscience tells us that we instinctively reach out to good design. Attractive products and beautiful space trigger parts of the brain that produce desire and reward us with feelings of pleasure. The addition of color can deepen that experience. Physicists conclude that color corresponds to various frequencies which oscillate within the electromagnetic field that account for high frequencies of violet to low frequencies of red. Healthcare designers are starting to understand the mechanics and evidence of design attraction. Color and design do impact us on a cellular level. This attraction is critically important in designing healthcare environments. Color and design has moved from an optional aesthetic to a vital environmental component that supports health.

We know that color matters. As artist Hans Hofmann pointed out, we experience the world visually through the "mystic realm of color." The importance of color is recognized in a variety of industries.

In the food industry, color signals that produce and meat are fresh, and color is added to almost all processed foods to make them more appealing. Flour is bleached; juice is made pink; apples are waxed to a high gloss all to make them more attractive.

Color is taken seriously in retail, print graphics, and marketing. Nearly every magazine photo we see has enhanced color. In retail, most large displays have been subjected to color tests, and most display producers understand that color saturation can produce afterimages and other optical illusions if not properly designed.

Costume designers for television and movie productions use color to help the audience sort out the good guys from the bad guys or to communicate a character's "personality or powers." For example, a "Nature Hero" might be dressed in green "Which can be used for good if reminiscent of nature?" (TV Tropes online, "Good Colors, Evil Colors.")Even the U.S. Department of Transportation uses color and design. The shape and color of a sign immediately conveys information to a driver - black letters on a yellow diamond-shaped sign means CAUTION and white letters on a red octagonal sign means STOP.

Color can even be a practical consideration when buying a car. Insurance adjusters tell us that yellow and orange cars are the safest to drive, gray and silver are involved in more accidents, and red cars get the most traffic tickets.

What can we learn from these related fields to help design healing environments? Retail marketing studies have helped people figure out how to attract shoppers. Can we use the same techniques to attract patients? The restaurant industry has figured out how to make food more appealing through the manipulation of food. Can the same techniques be used to make hospital food more appealing?

We attach meaning to color in three ways:

• The first is through nature. People associate certain natural elements with particular colors. For example, people associate water with blue tones, plants and vegetation with green, sun with yellow, and fire with red. Most people wouldn't associate water with red or sunlight with green.

• The second way we attach meaning to color is through our culture. These learned associations are passed down from one generation to the next and may include religious or regional relationships. For example, we find bright colors of Cuban and Caribbean influence in Florida; we find whitewash and muted colors in New England. We find rugged earth tones in the Northwest, and clay colors and teal in the Southwest. These color schemes evolve from nature.

• The third way we attach meaning to color is through our emotional experience of color. People, and bulls, "see red" when they're angry. We're "feeling blue" when we're depressed. A "yellow-belly" is a coward. The jealous-hearted are "green with envy" (due to an excess of bile, say the ancients).

Positive Distraction
Design can effectively distract from unpleasant views and help focus on the more pleasurable views. This technique can mitigate stress and even change the perception of what we see and experience. In the design of healthcare environments, this tool is most effective in high stress spaces like the emergency waiting room, radiology, dialysis and infusion suites. Designed interventions can be passive, like artwork or aquariums and beautiful lighting and forms. Window views are also a strong positive distraction. Active distraction can include social interaction, video and educational resources that are strategically located.

Delight the Senses
We perceive our world through the five senses - taste, touch, smell, hearing and sight. But eighty percent of our perception occurs through sight, and seventy percent of the physical sensation receptors are found in our eyes (Ackerman p. 230). This means design professionals who focus on visual impact can design to the most predominant sense, using color and design to impact the way we see things and create a healing environment.

Light and color interact with each other in mysterious ways. That color and light impact mood and behavior is well documented, as anyone with seasonal affective disorder could tell you. The interplay between color and light affects mental health, with balanced light reducing hyperactivity in classrooms and reducing negative behavior in prisons and mental health facilities. Furthermore, at the cellular level, the cell's ability to reproduce is affected by variances in lighting in both plants and animals. However, why color makes such a difference to behavior and physiology is poorly understood. Light can be warm and inviting or harsh and glaring. Just as color can be playful and uplifting, it can also be dull and depressing. Light and colors create attitudes and stimulate our emotions.

Science of Color
Color and light must be considered together. Color is more than pigment in paint or the swatch of a textile. Color cannot be discussed in the absence of light since light is required to see color. Light itself is colored, and the very color of light influences how we see color in the environment (Ott 1973). The visible spectrum of light is the portion of the electromagnetic spectrum that is visible to the human eye. Wavelengths from 400nm to 700nm make up the visible spectrum, with wavelengths in the low end appearing violet and blue and wavelengths at the high end appearing deep red.

Light is energy, and our cells absorb this energy. This impacts our physical and emotional self. The process of seeing color can be explained by describing eye mechanics and the processes of the brain, but science has not been able to explain why color affects behavior and physiology, creates an emotion, or supports healing. (M. Livingston 2002).

Color of Nature
We have all admired Mother Nature's beautiful color palettes - the beautiful sunrise sparkling on the horizon, the amazing indigos and purples of a sunset, the blaze of autumn in the rich fall sunlight. These shows of color and light delight us, create an emotional response and we look forward to our next encounter. As a designer, I must say, it's hard to compete with Mother Nature. Competition may be impossible, but there is much we can learn from her.

In the animal kingdom, we find the coloration evolved to fulfill a very specific need. Insect exoskeletons blend into sticks and leaves where predators won't see them. Colorful mandrill faces and baboon behinds help attract mates. Contrasting spots on bird beaks tell baby seagulls where to peck to get food from mom and dad. Certain lizards and snakes change color to regulate body temperature.

How does that tree frog blend so nicely in the forest? It adapts its skin color to match its environment. It might save bright flashes of red or orange to attract mates or frighten predators. Can we employ the same principle to create distraction from some of the disturbing views we find in healthcare environments?

We want to do more than borrow the aesthetics of nature. We want to learn why and how nature creates these effects. Nature knows what works and how to endure. Janine Benyus is credited with starting a new movement called "biomimicry," which is a philosophy inspired by nature.

Cultural Response
Cultural responses to color vary around the world. Colors play important roles in rites of passage, religious icons, and compass directions. A healing response evokes the therapeutic power of color as expressed within the culture. Varying cultures also use nature to attach meaning to ritual as seen in the ancient Chinese culture and the philosophy of Feng Shui.

Feng Shui, the Chinese art of placement, describes color in terms of the components of life: water, plants, fire, earth, and metal. Color is related to the natural component of our world and not an experience, emotion, or color preference. It groups similar colors on the color wheel while each element is associated with a specific color that supports life and health.

Similarly, reds and oranges are associated with the fire element. Greens are associated with the plant or wood element, blues and aqua are associated with the water element, earth tones are associated with the earth element, and finally grays, blacks and reflective tones are associated with the metal element. (Gerecht, p26).

The Sanskrit culture also employs color in healing. Sanskrit writings describe the body as having a series of seven major energy centers known as charkas. Liberman (p. 41) states: "These charkas, located at the sites of major endocrine glands and corresponding to particular states of consciousness and personality types, were each responsive to or ignited by a different color."

Emotional Response
The emotional response embodies personal attachment, reflecting what we like, the colors we prefer to wear, and the colors with which we surround ourselves. Emotional response may be based on nature, associating an aqua setting feeling to embrace the Caribbean Sea. It may be based on a cultural ritual, such as the stained glass window of a country church that grandma attended. The emotional response may simply reflect the mood we're in that day. For example, I'm feeling down today so I want to surround myself with bright colors.

The emotion of color is very personalized, and even within a particular individual, color preference can fluctuate. Despite this, it is important to remember that the emotional response is just as important as the scientific, cultural and nature associations, even though this factor is more difficult to quantify.

Some basic predictors reflect standardized emotional association to color. However, personal responses rely on the percentage used of the color, patterns used, location and other contributing sensual experiences used with the color. This understanding is called color psychology.
The Frank Mahnke Study conducted in the United States, Europe, Australia, and Japan in 1991-1993 found universal associations with some colors. These colors showed little variance in meaning between cultures. This study found the following emotional links to color:

• Love = Red
• Hate = Black
• Peace/Tranquility = Mid/Light Blue
• Mourning/Sorrow = Black
• Happy = Yellow
• Jovial = Orange/Yellow Orange
• Life = Green/Olive
• Luminous = Yellow
• Noble = Blue
(Mahnke, P. 1996 p.53-58)

Emotion of color can be carefully integrated into the environment through a simple process of matching the intended color palette to the desired experience of the area. It may be helpful to use some words to help describe the mood of the experience. Developing characteristics for the imaging department that reflect the desired experience might be helpful. For example, if you come up with words such as cheerful, bright, comfortable and soothing, they can be attached to a color scheme. Sometimes color words are attached to the desired function of the space, such as, cooling water tones to help the patient feel relaxed in the diagnostic area. Regardless, the emotions attached to color are an essential component of the color-planning process.

Healing in Healthcare
There is no single color that is bad or good. What makes color successful is dependent on how and where it is used. Individuals will react to color in different ways depending on their own background, culture and emotional state. In some cases, patients on prescription drugs have a heightened sensitivity to color. Although a medical professional may not specifically practice color therapy, color will have an impact on that patient. Therefore, color should be employed with knowledge, keeping in mind that colors and light do have an impact on physiology, emotion, stress and health.

Healing Color
Color therapy used in traditional medicine is thought to impact healing. A specific colored light generates energy to impact the health of a specific organ. Color therapy was once only used in complementary medicine, but today is considered a standard of care for some illnesses. For example, light and color therapy is used for inflammation of the eye and for treating jaundice. As we look at how color has been used throughout the centuries and across cultures, we begin to see some commonality.

I have often been asked, what constitutes a healing color? How is a healing color palette defined? Can a color heal? And what is the evidence? The most frequently asked question in my seminars deal with the healing attributes of color. Manufacturers have asked similar questions so they can produce materials appropriate to the healthcare market. There are some attributes of color that can support or aggravate medical conditions.

There is no straightforward answer to these questions. Often a misused tool, color selections can be influenced by fashion trends that have nothing to do with healing. Such choices can often aggravate medical conditions. The industry and the design community are searching for the prescriptive directive to create healing colors.

Color Attributes within the Healthcare Setting:

• Yellow:
- Yellow can be a happy color when used with a full spectrum palette.
- It should be used with caution as it the most difficult color to use in healthcare setting because yellow easily goes green depending on the lighting, especially cool white lighting.
- Yellow is associated with urine and other bodily fluids.
- Yellow can cause false medical reading as it can reflect poorly on skin tones.
- When using yellow, use low percentages and away from patients.

• Red:
- Red is a bold color and one that should be used with caution.
- It adds zip within a full spectrum palette.
- It should be used with its complement for balance.
- It is the most visible hue and is effective in drawing attention and facilitating wayfinding.
- Red is the first color seen by an infant and the last for the aging.
- It is linked with danger, stop, alarm and fire is linked with red.
- Red is linked with blood.

• Violet:
- Purple is consider both warm and cool.
- It is highly preferred color.
- Men often read purple as blue.
- It is associated with creativity, inspiration, spiritually.

• Blue:
- Blue is the most preferred color, especially by men.
- It is the most calming and relaxing color.
- Blue can quickly become somber if too much is used.
- Blues should always be used with warm tones.
- It is associated with water and sky.

• Green:
- It is associated with nature, clean, sustainability.
- Green is associated with "the green light".
- It is emotionally is cooling, soothing and calming.
- Green should be used with caution since cool lighting often makes it look yellow.
- It should be used with warm tones.

• Gray:
- Cool grays should be avoided since they distort and dull most other colors.
- If you must use gray, keep it with a warm violet tone.
- Gray equals low reflectance, low visibility.
- It is associated with darkness and shadow.

To use color to heal, it is very important to remember that color is an experience, not a chip from a box or paint can. The experience rather than the material creates the healing. Even when one paint color is used throughout the room, that color will have thousands of variations as it falls away from light and is reflected by other elements of the room. We must consider color in transition with expected movement.

There are mistakes in color for healthcare. Color has reflective qualities and can reflect on skin tones, which can contribute to misdiagnosis. Color plays tricks, as optical illusions demonstrate, that can contribute to vertigo. Because of these issues, boring, bland palettes are often chosen because they are thought to be safe. Yet these palettes are one of the biggest contributors to the "institutional look". Monochromatic palettes, regardless of the specific color utilized, can actually be harmful - especially if that singular color is used with intensity or used in an inappropriate area for the function of the space.

I personally find turning to the healthful aspects of nature to be extremely helpful in developing healing-color palettes. I find full spectrum color palettes, like full-spectrum lighting, are the most harmonious for healthcare environments. A full-spectrum palette balances hues, tones, and tints of all seven colors: red, orange, yellow, blue, green, indigo and violet. Using a full-spectrum palette does not mean all areas are the same color with each wall painted a different color, but that all of the colors are used, even in small percentages.

Color Planning
I call the color planning process "The 3 P"s of Color - Palette, Placement and Percentage.

This is an important component of color planning process. The most effective color planning tool that I have found is the development of an "Inspiration Image". Create your own library of inspirational beautiful outdoor environments, typically photos. These images from nature's environment illustrate how nature creates color palettes of extraordinary color combinations. These images are presented to the client, and the discussion is framed around the experience of these different places. Looking to nature for her magical secrets of color has never ceased to amaze me, and this technique has always rewarded my effort. This exercise helps develop the palette to relate to the experience.

Color planning is a process by which a color palette is developed to support a specific function with a particular desired effect. For example, I prefer to describe a blue palette as a water palette, using a simple, fresh watery blue with soft accents of sand and colorful fish. In this way, I start to define the experience, and this will help determine the amount of each color and where the colors might be located. I avoid an icy scheme, however, we should not be afraid to use icy colors and distribute those colors carefully with warmer colors.

The first [P] is palette. Color schemes can be enhanced with touches of the hue's complement, such as orange (blue's complementary color), perhaps in fabric for the cubical drapery. Looking back at the photograph of the nature scene, one can start to see many extraordinary color combinations, color adjacency and proportions. Accordingly, adding hints of red, yellow, and terra-cotta colors in solid surfacing, upholstery and art will bring instant heat into the blue scheme.

Even neutral palettes can achieve full-spectrum harmony, using soft neutrals as background with small amounts of color accents ranging from blues to reds represented in art, upholstery, plants, or other accessories. If the color palette does not support the desired experience, the area will not support healing.

The second [P] is placement. Where do you use color? Do you use it on the walls, furnishing, floors, art and accessories? Absolutely, we color in all these areas. This is where color planning becomes essential. Again returning to our inspirational image we can evaluate how nature places color. Look at a quiet pond, and see the lotus flower, the dragonfly, the sunlight filtering through the reeds. The aqua pond becomes the background color, with the creamy flower becoming the primary accent, the purple dragonfly becomes the tertiary accent, which can locate purple in artwork and/or furnishings. Look closely at the placement of these components. How does the color of the lotus overlay the primary color of the pond? This can help locate the placement of an aqua color floor with the counterpoint of creamy walls. Analysis of how colors are placed in nature can provide the philosophy for locating color in your healing environment.

The third [P] is percentage. How much color do you use? Healing environments play with percentages by combining intensities. Like bees and butterflies the attraction is to a specific color not range of hues. Yet when we observe a field of wildflowers our attraction is the overall ranges of colors in our field of vision, therefore, the most vivid tones do not compete for our attention, and instead they are all individually bright. This is due to the percentage and intensity of the hue. Again using the inspirational image, observe the percentages of the hues. Typically we are attracted to bright hues only when they juxtaposed against softer hues. Just as in nature, if you use full spectrum of color the intense hues will not come off as busy, but rather as calming and balanced. In healing environments no single color should be conspicuous by its presence or absence.

While we know there is no "bad" color or right color, palettes can be counterproductive within healing environments; but they can also support healing. Designer can achieve a healing environment with color. The following checklist may be helpful in color planning for healing environments:

Color Checklist:

• Start with an inspirational image from nature
• Start from the outside in integrating the site, building and interiors to the color plan
• Use full spectrum palettes, avoiding monochromatic schemes
• Look to nature to develop color palettes
• Consider how your color palette is experienced with adjacent palettes
• Relate the function of the area or room with the color palette
• Know the color temperature requirements of the area - should it be warm or cool, relaxing or stimulating
• Choose the lighting to support the color palette
• Evaluate your palette under the color temperature of the lighting
• Maximize the use of natural light
• Consider the reflection factor on skin tones - stronger tones distort skin tone
• Develop a palette that is comfortable to the local setting
• Incorporate color from permanent and structural elements into your color planning
• Avoid the use of fashion trends palettes
• Consider the placement of color specifically, in the locating of dark or bright hues
• Consider the percentage of each color
• Consider the entire palette as the experience of the space
• Take care that no single color is conspicuous by its presence or absence.
• Remember: color matters

Building Palettes of Materials
Healthcare design creates color palettes with materials from flooring, wall finish, millwork, furnishings and art. Palettes as found in nature are essential components in healing environments. These typically include blues and aqua from the water group, greens from the plant group, rust and reds from the fire group, purples from the mineral group and neutrals representing the earth. The healing palette is varied in texture. It is also diverse in a compatible scale as exhibited in fractals. It requires materials that work together to accomplish the palette, placement and percentage of colors. It is a skill that nature has mastered, and we admire. Healing gardens are nature's inspiration for healing spaces and places. We can look to her for inspiration of beautiful palettes. Like gardens, the healing palette can provide the focus of verdant plants, the serenity of tranquil water, enchantment of colorful fish and birds, the balance of rocks and the sparkle of minerals. Color and design inspired by nature can provide beauty to help mitigate stress and lead toward recovery of health.


Barbara Huelat
Design Principal
Huelat Parimucha Ltd. / Healing Design
635 South Fairfax Street
Alexandria, Virginia 22314
P: 703.838.8414