The flagship for what is marketed as "the Apple store of doctor’s offices" makes a blue splash on the streets of San Francisco’s Financial District. Operating more like a gym or Netflix than a clinic, Forward Medical exploits technology – genetics, IT, 3D body scanners, personal devices, apps – to promote wellness and provide primary care as a service. This Silicon Valley approach to reengineering primary healthcare demanded a high-end-retail approach. The medical office, with clean, intuitive architecture by Alexander Jermyn Architecture, features seamlessly integrated, circadian lighting by Hiram Banks Lighting Design.

"A lot of our architecture is unseen. We focus a lot on details, so that you’re not seeing, necessarily, all the mechanics that are going on behind them – but that things work, and they’re sort of distilled to their essence," said architect Alexander Jermyn, principal. Hiram Banks lighting designers Matt Landl, principal, and Tobias Holden, senior designer, described a full-scale mock up of the primary spaces that Forward assembled in its HQ. "We did a whole dummy exercise. We got the fixture samples and mocked it all up. We figured out how it was going to power and how the mud-in would look," said Landl. "All this [technology and architecture] was coordinated up front. So then when they got into construction, they were trying to move really fast."

Construction on the ground floor of an older building, predictably, ran in to competition for shallow plenum space, variations in cove heights and other unforeseen field conditions. Jermyn repeatedly complimented the Hiram Banks team for their technical resourcefulness and ability to overcome on-site constraints.

Jermyn repeatedly complimented the Hiram Banks team for their technical resourcefulness and ability to overcome on-site constraints.
There's a lot of indirect lighting, so that members and people in the space aren't looking directly at light fixtures.

According to Landl, the architect and lighting design team share a "symbiotic" aesthetic favoring integrated lighting. "We were very strategic about where we put the lighting. There’s a lot of indirect lighting, so that members and people in the space aren’t looking directly at light fixtures," said Jermyn. "There’s a lot of indirect lighting and cove lighting to make the lighting of the space feel very diffuse and not obtrusive and in-your-face."

Visual comfort was a priority, particularly in the spa-like consultation rooms where reclined patients never stare up into a bare-bulb troffer. Holden explained that patients walk into a comparatively normal luminous environment suitable for reviewing test results on-screen and engaging with the healthcare provider. "But then if an exam or procedure needs to take place, there is an ‘exam’ button on the keypad that ramps the light levels up and slightly tunes the color temperature to a more neutral light…. I think the sophistication of that kind of control sequence is what makes the lighting feel more comfortable in this scenario – beyond just a regular medical office."

Holden explained that patients walk into a comparatively normal luminous environment suitable for reviewing test results on-screen and engaging with the healthcare provider.
Bringing the outside in, and vice versa

"We wanted to try to bring in as much daylight as deep into the space as we could, because the client really valued this idea of being healthy. A lot of it was focusing on the quality of the environment we created," Jermyn explained, "both from the artificial lighting perspective as well as the daylight perspective and how the two would work together."

Landl and Holden brought a Ketra dynamic lighting solution to the project. The Ketra solution used throughout the flagship, including consultation rooms, is programmed to a "natural" circadian pattern using wireless mesh controls in every fixture. Holden described his detailed controls intent as just as complicated as the lighting design. "We did a lot of programming with Ketra. We explored customizations with them and created some new fixtures."

Again, significant work in the background is not necessarily apparent in the constructed project. "[There was] a lot of forward thinking and meeting with the clients to understand what their version of circadian lighting is versus a standard textbook version of it. Because we’ve seen that vary pretty extremely across projects," Landl added.

Ketra’s high-output cove product, with on-board wireless controls, lists at 17 W/ft, which presented a challenge for Title 24 compliance. "The power densities were incredibly tight. We were cutting fixtures short by 3 inches or 6 inches, or using it as display lighting or color lighting or different things to make the code work. We didn’t cheat the code," explained Landl. "We spent hours just getting creative on how we can get this to fit so we could keep Ketra as a unified brand/experience across the project."

Ketra’s four-color LED module can produce saturated hues, along with varying white light, letting the flagship’s nighttime branding shine forth. "It’s a corner location, so there’s quite a bit of glazing. And you’re in downtown San Francisco, so you’ve got all kinds of traffic. You’re competing visually with a lot of other things going on, but there’s a really cool, sort of calming glow that’s coming out of that space," said Jermyn. "There’s a nice contrast between the fabric of this beautiful old building and the modernity of this glow. It almost feels like the building is floating above it."

He pointed out the power and flexibility of the blue-light branding compared to graphics or painted-blue surfaces, which are used minimally. "From a design standpoint that was interesting to us. We could actually create a fairly neutral envelope for the space, and then it’s the light that can modulate, as opposed to painting the walls or furnishings to reinforce the brand. It’s a more neutral palette during the day, and then at night it can be much more vibrant and have this great presence."

Client support

Forward has since rolled out five additional locations in Los Angeles and Manhattan, with more sites on the boards, according to Jermyn. These locations use the blue-light identifier in lesser ways, without the circadian solution. "We’re trying to maintain consistency within the brand as much as we can. But like in every project, there are budgetary constraints," Jermyn said. Holden keeps looking for ways to bring that "flagship swag" into the static-color rollouts. He is also seeking circadian lighting options more suited to the rollout.

Landl and Holden credit the unreserved support of Forward, particularly Daniel Malpas, head of expansion, for the success of the visually simple, yet technologically and architecturally complex flagship lighting design. The project was recognized with a 2018 SF-LUX Award of Excellence from the San Francisco Section of the Illuminating Engineering Society; at the international level it received an IES Lighting Control Innovation Award of Merit.

"Forward was looking toward the future of light just by themselves, and Alex’s office also truly appreciates what lighting can do for spaces," said Holden. The client’s investment in circadian technology integration and intense background work was key, according to Landl. "They’re off and running now, which is kind of a testament to the space…. Having a great team in place that’s willing to go the extra mile is super important. But to do things in a forward-thinking way, you need to spend the money to do that."

Forward Medical Los Angeles
Forward Medical Los Angeles
Lois I. Hutchinson

About Lois I. Hutchinson

Lois I. Hutchinson is a freelance writer specializing in lighting and energy issues. She is also the content marketing mastermind behind Inverse Square LLC, a Los Angeles–based consultancy. Contact her via lightinginsider@exponation.net with your comments and any article ideas that concern the lighting community here in the Southwest.

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