Health Care Fine Art

Monarch Butterfly Migration

Monarch Butterfly feeding on nectar from New England Aster

I photographed this Monarch Butterfly today. The Monarchs are migrating south now that the growing season is ending.  The Fall wildflower that I see them on the most is New England Aster.

Migration has always seemed magical to me. How can a hummingbirds, which weigh only 5-grams (as much as a Nickel) have the endurance to cross the Gulf of Mexico (500 miles)?  Monarch butterflies routinely migrate farther than that, and they weigh less and are as delicate as a rose petal.

Do you see the second insect in the picture above?

Only after I started to work the picture up did I notice the Chinese mantis (Tenodera aridifolia sinensis). It is hanging just under the purple flowers; it's eyes are at the bottom. Great camauflouge! This is another example of an exotic (introduced) species.

Soybeans offer Fall Color

The Fall Season officially started this week but there is not much fall color yet. One exception is the soybeans in the field next to our house; they are starting to turn yellow.

A local farmer has planted this 20-acre field in soybeans for the last three years. We aren't in the business of growing row crops. Instead, we are using farming to prepare the soil to return to native prairie. By keeping the field in soybeans for three years we can reduce the number of exotic seeds that would sprout and take over the field.

Controlling exotic species is one of the most challenging ongoing problems we face on the 600-acres we live on; the Prairie Garden Trust. Exotic (or introduced) plants are progressively taking over most fields in the Midwest. Our hope is to reestablish a diverse community of plants that would have occurred here naturally before humans and machines arrived.

This Winter we will plant several thousand dollars worth of grass and wildflower seed. Then, over a few decades the field can return to what it once might of been. Managed burns will be important to encourage the native species.

Blazing Prairie - we set fire to our property

Prairie Fire

This afternoon we set fire to our North Prairie. Managed burns like this are a key to maintaining our property: The Prairie Garden Trust.

Burns during the growing season, when the grass is still green (like today) tend to have more smoke and the flames don't go as high.

If you burn on a dry day in Winter the flames in the tall grasses can reach 20 feet into the sky. Very intense, loud, hot. smokey.

Once the burn is over and the fields re-grow, the greens seem even more intense in the prairie.

 

Research Projects for non-Scientists

There is a tremendous interest in Evidence-based Design these days. I have had several people suggest to me that I conduct some research studying the impact of my art on patients. If I wanted to do do research, what would be involved regarding time, people and money? When I say research here I mean real research; high-value research that will stand up over time. I would want it to be research worthy of being  published in a peer-reviewed scientific journal.

To help begin to explore what needs to be considered for a research project I asked someone who does this for a living, Dr. Debra Harris. Debra is an Evidence-based Researcher for RAD Consulting. The following is an interview conducted by email:

Let's say I want to study the impact of black-and-white vs. color nature photographs in ICU patients diagnosed with a heart attack. I want to see if it alters their heart rate, blood pressure, duration in the ICU and amount of pain medication requested. I was thinking there could be three groups. One group with no art. The second group with a 30 x 40-inch color landscape and the third group with a 30 x 40-inch black-and white landscape.

First, is that a reasonable way to propose a research topic? Or should it be refined?

Yes, this is an excellent proposed study. Your research question is… Does natural photographic artwork influence the physical responses of ICU patients who have suffered a heart attack?

The dependent variables are heart rate, blood pressure, amount of pain medication used (not requested) and average length of stay. These data points are easy to collect from the patient chart. Statistical analysis will show if art is having a significant impact on the patient’s condition based on your four data sets.

What would I want to budget for a project like this if I wanted to make sure it was done properly?

This is always a loaded question. If you are hiring a research firm to conduct the study, then the cost is the expense of the research team, time and materials (equipment, expenses). If using an academic research team, the costs include the time of the research team (lead investigator, graduate students), tuition, indirect cost to the university which is an additional 25% - 53%, equipment, travel and other expenses.

If I were to guess and make certain assumptions like you were providing the artwork ready to install at no cost to the study, data collection took maximum 4 months and that the hospital was local to the research team, minimizing travel expenses, I would guess that this study could be conducted for about $40,000.

Interested in finding funding? It sounds like an interesting study!

How long would a project like this typically take from inception to publication?

The time to complete a project like this from research design to final research report would take from 8 months to a year. This would include research design, receiving approval from the IRB, collecting data, analyzing data and assimilating it into a meaningful report. This does not include publication. That is a different animal. A study of this nature could be completed in one year at an academic institution, but may require less time if a professional research firm was conducting the study. 

In order to get good evidence, how many patients would need to be studied? Should it include men and women?

Gender is a variable that should be determined while defining the research design. There may be reasons for limiting the study to one gender or the other, but for this study, I would include both men and women that suffered a recent heart attack and is recovering in the ICU.

Determining sample size requires a statistical power analysis. One cannot guess at the sample size. In order to determine sample size, one must know how big the difference needs to be to be meaningful for each variable, the confidence level (.95 is typical for peer review), the variability, and the effect size. Once you have that information, you can run the equation to determine sample size; then you need to add a percentage to account for invalid responses.

Since I am not affiliated with a University and since I have no idea how to do research properly, who do I need to hire? Where do I find them?

You could contact a university that has researchers interested in your topic which may lead to an academic research study utilizing available resources. As mentioned before, it may add time to the study plan. Another choice is to hire a professional research consulting firm like RAD Consultants that can allocate time and resources.

Are there any common road blocks I should anticipate? Are hospital ethics committees likely to veto the project?

Ethics committees at hospitals are called the Institutional Review Board (IRB). The study will have to go through an approval process with the IRB in order to collect data on your patient population.

Most medical IRBs require that the principal investigator complete an ethics course and test for certification.

The IRB process can take as little as three weeks or take months, depending on the data to be collected and the board’s satisfaction that all measures are taken to protect the health and privacy of subjects.

I do not think that an IRB board would veto this project as long is the risk to patients is very low and the research design has enough power to test the hypothesis.

Once the research is done, how does one go about submitting it for publication?

Publication to a peer review journal takes a significant amount of time. First, you have to write the article based on the methodology and the findings in a way that meets the criteria of the journal. Then, the article is submitted and may be rejected, accepted with provisional revisions or accepted with minimal changes. Once accepted, the article will be placed at the publisher’s discretion in the cue for publication. The process may take several months to a year or longer.

There was a previous post about Debra's work at RAD consulting on this blog. To see the article click here. 

Debra Harris, Ph.D., AAHID

Pictures that make me want to cry

Jane Domke, 1969

Today I shot pictures that make me want to cry; pictures salvaged from our house fire. In February of 2004 my Mother's farm house burned to the ground; everything was lost. The fire got so hot that it melted aluminum into puddles.

As the firemen were sifting through the rubble they found some family photos that had not been totally destroyed. Only 50 pictures survived out of the thousands that covered five generations of our family. I've been avoiding photographing the decomposing pictures because it is so depressing; but today I decided I had better do it before they are completely gone.

The picture above is of my sister Jane. I'm guessing it was taken in 1969.

I find the vivid wiggles of color on the right appealing. And the fact that it was salvaged from a house fire is conceptually interesting I could  imagine an art gallery might have an exhibit based on salvaged pictures. But for art in hospitals this would not work. Experts and common sense would say that pictrues like this would serve as a reminder of death and destruction and don't belong in hospitals.

Featured Artist: Sandra Bell

Geronitius by Sandra Bell, Bronze Sculture

Sandra Bell lives in Ireland and creates bronze sculptures. She is self-taught and uses the lost wax method to create abstractions of the human form. "My aim is an artist is to portray the essence of the human form and the tranquility of the inner self by means of abstract figurative expression."

One of her healthcare pieces was for the Galway Clinic. I asked her how she got that job.

It was quite by chance that a director of the clinic visited an exhibition and saw the maquette of Gerontius. He bought it to place in the foyer of Galway clinic. He had in the past bought small pieces of mine through galleries and was familiar with my work. Galway clinic features a grand piano in the foyer and the sculpture being on the theme of Elgar's Gerontius may have seemed suitable.

Tell me about where the name of the piece came from.

I find "The Dream of Gerontius" by Elgar uplifting.

What process did you use in creating Gerontius?

I concentrated on a vertical theme of the figure with a trumpet, however the base needed to be stronger visually and I added the bars to denote bars of music and strings of a harp. The sculpture seemed well balanced at that stage and I resisted doing anything further.

In the US Sandra is represented by Kearon-Hempstall Gallery in Jersey City, NJ. You can see her work on page 143 of The Guild Sourcebook Volume 23 or on her website: www.SandraBell.com

AIA Healthcare Awards 2008

CHA Women & Children's Hospital

The current issue of Architecture Week has an article about the AIA National Healthcare Design Awards for 2008. I thought it was interesting that two of the four facilities to get awards were not in North America. The name AIA; "American Institute of Architects" might suggest that they would be from the US. The winners were:

• CHA Women & Children's Hospital near Seoul, South Korea
• Shenzhen Third People's Hospital, in Shenzhen, China
• Peter and Paula Fasseas Cancer Clinic at University Medical Center North, Tuscon, Arizona
• Weill Greenberg Center, Weill Medical College of Cornell University within New York City

The article by Dan Noble, FAIA, FACHA, (which you can read by clicking here) emphasized that all four healthcare facilities incorporated extensive daylight for the benefit of the patients and staff.

For the CHA Women & Children's Hospital (shown above) the look is intended to mimic the trends in high-end shops and spas. 

...a softness of natural light, organic elements, and curving forms tempers a sleek building of glass, aluminum, and stainless steel. KMD Architects designed the facility, with associate architect yo2 Architects, to provide uncluttered respite from the surrounding neighborhood's visual noise.

The AIA website has a good article on the awards which you can read by clicking here.

Leaving Medicine - One Year Later

It has been exactly one year since I retired from medicine. I thought I would look back on the year and reflect on the experience so far.

My work as a Family Physician was tremendously social, and I thrived on that. I was concerned that I would feel isolated or lonely without that intense contact. Surprisingly, that is not true at all. 

I continue to be social, but most often through emails. I would not have predicted that emails could fill a social need, but for me they do. I may go days without leaving our farm, but I never feel isolated.

"Do you miss Medicine?" is a question I hear a lot. It is a reasonable to ask since medicine was such a major part of my life for 28-years.  Not once have I felt a pang of regret about leaving. Don't misunderstand, I loved medicine and greatly enjoyed helping people. However, two things happened:

• Something better came along (a career in art)
• I felt satisfied with the work I had accomplished and did not want to get stale.   

Yes, I feel frustrated with some things in medicine, but that is not why I retired. I do feel a profound sense of disappointment that the US does not offer Universal Health Insurance to all citizens, but that did not make me quit.

So, one year later I can say my wife Lorna was right when she said to me: "It is time to leave medicine now!"

ICU Art so bad I wanted to cover it with a towel

Click Image to see a larger view of what Vaughn saw from his bed in the ICU

My good friend and fellow photographer Vaughn Wascovich was hospitalized this week. I wanted to get his perspective on what the art experience was like as he lay there in his ICU bed for two days. He was in a brand new ICU room in a hospital close to Dallas.

What art did you see, what was it like?

I was really disturbed by the art. There was only one black-and-white print, a studio shot of a flower. Where I lay in bed I had no choice but to look at it. It was so bad I wanted to cover it with a towel.

Why did it bother you so much?

The flower was obviously a studio shot with a white background. It seemed anemic; like me. It seemed disconnected and since I felt disconnected, that was bad.  I care about home and place and this picture did not put me there, it bothered me.

You mentioned that it was black-and-white, do you think that made it worse for you?

I can't say, normally I love black-and-white photography. But in this setting it seemed dated, disconnected and not organic. Nothing around me was organic, even my limited view out the window was a parking lot.

When I was in bed I had very few options about what to look at; it's the clock, the TV or the art. The TV just made me feel worse. All the ads seemed to be about food. Since I couldn't eat that was very stress inducing. A Wendy's hamburger never looked so good...

I should have brought my iPod, that would have helped a lot, I could have closed my eyes and listened to music.

What art would you have liked?

Well, I'm drawn to landscapes, but not one by that Painter-of-Light guy, what's his name... (Thomas Kinkade). His pictures show beauty as a fantasy, they are not real. I wanted to be connected to the real world.

What was it like when you got out?

I went to a local garden and that helped tremendously. I touched and smelled the plants. It really felt good.

Vaughn Wascovich teaches photography at Texas A&M. You can see his work at: www.wascovich.com Below is a close up of the picture that was on his wall:

Green Design - a Hoax?

It seems that all HealthCare Design projects and products are "Green" these days. Are they really good for the environment or is it just a big hoax for the PR effect?

Thomas Friedman's new book: "Hot, Flat and Crowded" argues that most of what we call "green" today is just fluff to make us feel good without really doing anything meaningful:

I've heard so many people saying, "We're having a green revolution". Of course, there is certainly a lot of green buzz out there. But whenever I hear that "we're having a green revolution" line I can't resist firing back: "Really?, Really? A green revolution? Have you ever seen a revolution where no one got hurt? That's the one we're having, everyone's a winner, nobody has to give up anything, and that adjective that most often modifies "green revolution" is "easy." That's not a revolution. That's a party. ... mostly a costume party. It's all about looking green...

Even hospital art is trying to go green. I've covered the idea of green framing and green artists on other posts. Most "Green Design" in healthcare is a hoax, a harmless hoax.

There are exceptions. Recently I met Richard Dallam, partner with design firm NBBJ. He explained how their new office at Alley24 was green in many ways: lighting, ventilation and sustainability. For their efforts they were awarded an LEED Gold rating. He is designing hospitals using the same principles. Richard commented:

It's unfortunate that so many of the good intentions relating to designing a healthier, less environmentally impactful built environment are surrounded by the cloud of "hot air."  There are some legitimately helpful things being done in design that will help the design and construction industries have a substantially lower impact on the environment.

If you want to move from symbolic gestures to meaningful action on green issues, read this book. It is remarkably well written and fairly easy to read for such a ponderous topic. It's easy to see why he has already won three Pulizer Prizes.