Hospitals Changing Colors to Speed Healing Process

The human eye can perceive more than 9 million color combinations. But, for more years than medical administrators care to recall, the only hue found in hospitals was blue-green.

In the last decade, however, the monotony of what came to be known as hospital green has gone by the boards. Glacier blue, mauve blush, wild rose and a host of other tints have found their way into medical facilities nationwide as physicians realize that certain colors can help patients convalesce faster. And since hospitals must increasingly compete for patronage, enhanced interior designs are also intended to lure business.

A walk through a typical convalescent home today might find the walls accented in soft yellows and golds to convey a relaxed, comfortable feeling. Even green, despite its notoriety from years of dominance in hospital rooms, takes on new shades under the influence of professional designers who specialize in medical settings. The lobby at Mercy Hospital has been redecorated in rich greens intended to symbolize a garden oasis, blending with the plant-filled atrium adjoining the lobby.

“Until recently, medical facilities were stark,” San Diego designer Marshall Brown said. “Fifteen years ago, you never saw an exciting hospital environment. It would look clean but was always one color, probably picked by a hospital engineer, not by someone in design.”

Both Brown and Jain Malkin, another San Diegan and Brown’s major competitor in Southern California, began their specializations in the early 1970s at a time when such work was considered unconventional. Their work--which involves hospitals, physicians’ offices, rest homes and other medical facilities--encompasses not only color for rooms and hallways, but the shape and details of furniture and signs, to which their color schemes also will apply.

When the firms started, Malkin said that there was only grudging acceptance of physiological studies, dating as far back as the 1940s, showing that certain colors stimulate and others calm.

“Those parameters make a lot of sense,” Malkin said. “But initially there was a reluctance on the part of hospitals to alter things, because their people said that you don’t come to a hospital to have a good time. Most of that thinking has now changed.”

Scripps Memorial Hospital spokesman Mike Bardin said that designers such as Malkin--who is redesigning Scripps’ interior--add an important element to both patient and staff attitudes about their environment.

Malkin said that despite the availability of some scientific data, designers must be careful because “so much beyond the basics is subjective.”

“Every so-called color psychologist has an opinion,” Brown said. “You can find backup data to support almost any direction you want to go.” Both Brown and Malkin say that, given proper tints and consideration of a facility’s function, almost any color can be properly used in a hospital.

Such was not always the thinking, however, given the traditional dominance of green and white in hospitals.

The bad reputation of hospital green is not totally deserved, Malkin said, because valid reasons existed--and in cases still exist--for its use.

Malkin said that a surgeon who looks up at a white background after staring intently at red-colored blood and organs during an operation will see spots of dark blue, the complementary color, scientifically, to deep red. That phenomenon is a law of optics called “the successive contrast afterimage.”

For that reason, surgeons have traditionally worn blue-green smocks and the walls of operating rooms have been painted a similar color in order to eliminate such afterimages.

“And since hospitals originally started with surgeries, that may well be the reason why green came to predominate hospital color in general,” Malkin said.

Colors for operating rooms must be considered carefully. Malkin recently designed the operating rooms at an outpatient surgical center in San Diego. A 10-foot-by-10-foot vinyl-floor section under the operating table is blue-green to neutralize any afterimages. The color also allows a surgeon to find a dropped item easily.

“But you don’t do the whole floor that way because the room would then seem too dark,” Malkin said. “So we put a light gray around the perimeter.”

The walls were done in smooth, light-blue vinyl, with a little zip of rose to perk up and alter the pattern.

Malkin said that a variety of colors are used for aesthetics and to add drama to a design.

“As long as the colors are not deleterious to therapy, they should try to challenge,” Malkin said.

In discussing color fundamentals, Brown said that hues in general should be hopeful and flattering. Accepted scientific research shows that warm colors--reds and oranges--foster outward orientation, even to the point of causing a person to overestimate or underestimate the passage of time. Cooler colors--blues and greens--give a more inward orientation and are better suited for precise tasks.

Brown said that designers avoid high intensities of any color because bright hues become irritating to look at for patients and staffers confined to hospitals for lengthy periods. Intense yellow, for example, makes a patient look jaundiced.

“So much depends on the value of a hue,” he said. “We recently did a retirement home in green and mauve that worked very well because the colors were muted. The dining room is soft green and the bedrooms are pale brown.”

Brown said that, in designing a patient room, he puts the strongest color behind the bed so that it will be seen only occasionally and not irritate. He makes the other walls neutral and places a picture on one wall to give patients something to involve themselves in.

“The picture should be realistic, not abstract, and try to give hope, to suggest better days ahead,” Brown said. He told of a friend who once lay in a hospital bed staring woozily at an abstract cloud painting. The friend began to dream that the clouds were monsters attacking him.

“You don’t want to create a lot of controversy in a patient’s room,” Brown said. “You want colors that are complementary, that will make the patient happy. So that would mean a dusty rose and not an intense red.”

Brown said that, for ease in maintenance, as much as 90% of a hospital must be painted some tone of white. The use of color, then, is to offset the white and guide the observer away from the neutral hues. If too many different colors are used, Brown said, upkeep will be too difficult and the design will deteriorate. For that reason, a hospital’s housekeeping department must assent to any and all designs.

“White alone gives no visual stimulus, no hope, no mental stimulus and is not a good tone for the skin,” Brown said.

Malkin stressed the importance of designing to fit the medical purpose. Both she and Brown said they spend a lot of time in a hospital, attempting to sense what a patient goes through, before submitting a specific design.

“For example, I want more warm colors in the receiving room right after surgery because they will increase the patient’s alertness better than if a I used blues,” she said. “But if someone tells you there is only one color for one purpose, I say ridiculous. I may show a client a grayish-blue that he or she sees as mainly gray but that I see as more blue.

“And someone may not like blue, not because it has a certain physiological effect, but because as a child the person was always punished in a blue room.”

Malkin said special considerations are used for a psychiatric hospital.

“In dining rooms, you cannot use round tables since patients must be able to define their territory very clearly, where their space starts and stops. So square tables are the rule,” Malkin said.

“But in day activity rooms, where there are less supervisors (than in the dining rooms), you have to have rounded edges on the square tables so the patients won’t abuse themselves.

“In patient rooms, everything must be smooth. Window treatments are a horrendous problem, because while you want some privacy, you don’t want patients to be able to hang themselves as they could with a normal drape cord. There is one company that markets a one-track drape with a cord that immediately disconnects if someone begins to try to hang on it.”

In adding color to the basic functional requirements, Malkin attempts to match hues to therapy. At the Vista Hill psychiatric hospital in Chula Vista, a gray base was added to all color combinations to remove the “sting,” or irritation. She used grays and blues to soothe closed spaces where patients in the first stages of treatment are placed. As patients improve, they move to more open rooms with burgundy and rose colors.

“The patients themselves are aware of color being associated with different stages of wellness,” Malkin said.

In all cases, lighting plays a major role, since colors will appear in altered tints, depending on the type of lighting. Malkin uses a special lighting box in which she can manipulate 30 different types of lights on various colors.

“You don’t want lights to be uniform,” Brown said. “If you have a ceiling full of fixed fixtures, the hospital will look very institutional.”

Brown designed the Scripps Clinic to have artificial skylights and light bouncing off ceilings as a way to mute and add different shades to the browns used in the lobby.

“I always go back to a place we have done and find out what people think,” Brown said. “And interiors have a finite lifetime. After a while, you have to go back and redo them.”

Malkin said that clients pay her to “do something that will be unusually attractive,” that cannot be done by the clients themselves using Malkin’s textbook.

“There is not just one creative type of environment; that is nonsense,” Brown said, adding that he constantly checks out the medical work of his competitor for new ideas. “If you ask five good designers for ideas, you will get a half-dozen good solutions.”