Health Care Fine Art

Is the Sky Falling on HealthCare Art?

Addendum: November 22nd, 2008
There are now over 30 comments to this post. To read them click the underlined word "Comments" at the bottom of the post. To read them all, once you have gotten to the bottom of a page, if you see an icon that is an underline under two right carrots, click that to go to the next page. It looks like this:
 

The news says the sky is falling. The stock market and the housing market are crashing. Major companies are going out of business. Yet, this week at the HCD08 conference I saw no hint of dark clouds on the horizon. I talked with many designers and art consultants in healthcare who are overwhelmed with work. When I go out to dinner at night here in DC the fancy restaurants are full.

What is the truth? Is the sky falling? What impact will the economic crisis have on the use of Art in HealthCare?

I asked Charlie Peltason to give me his take on the economic outlook. He has spent his entire career in finance. He has been a good friend of mine since High School. Here is what he wrote:

1st of all I am very pessimistic. I think things are going to be simply horrific. Yes HealthCare may be relatively protected, but not all aspects of it will be ok. You know all those high priced plastic surgeons charging $5 grand for breast augmentation....forget about them and their nice shinny new offices. Discretionary surgery including cosmetic is history! Unemployment means less health insurance, who needs plastic surgery when they are worried about keeping their homes?

Hospital occupancy? History. Home health care is way cheaper.........and it implies trouble for the nursing home industry as well. So...unless it's an emergency, hospitals are going to see way less admits.............they can't hold em longer cuz they can't get reimbursed, etc.............Why would anyone in their right mind concern themselves with pretty pictures on a wall?

Like I said....even within safe industries there are going to be huge challenges.

Unemployment at 8 1/2%-9% and I may be LOW!!! DOW Industrial Average 6500! Initially, interest rates low to lower but not necessarily at the consumer level. Taxes moderated near term, eventually going much higher. Interest rates going a lot higher in a year or so.

Massive continued bankruptcies, both personal and public (i.e. Circuit City). Massive continued home foreclosures which imply continued decline in home prices. Many (a majority) of home mortgages will be upside down, in other words people will owe more than their houses are worth. This is a simply dreadful outlook because it implies so many other horrible outcomes over time.

HUGE rates of closings of restaurants, travel and entertainment will take HUGE hits. Large air carriers may go broke along with auto companies which mean either one of two things. They will be nationalized or gone, poof, gone! State and local municipalities will be unable to fund Medicaid/Medicare. Ditto other obligations. We're talking deficits at the state and local levels not seen in our lifetimes with implications that are equally horrific.

So pretty much end of the world scenario in my opinion. Cash is and will be king. Huge deflation.....before we are all done and said, huge inflation, then stabilization. I'm thinking at least 5 years of hell, maybe more. This is going to be a 21st century version of the great depression. Baby Boomers will have to work longer and or sell retirement assets at values far below what they expect or need to fund retirements.

So, don't buy stocks now, don't buy bonds now, don't buy commodities now. Think tech names and consumer durables (i.e. Microsoft, Cisco, P&G, Clorox). If you don't buy it yourself don't buy the stocks or funds who invest in those kinds of names. The PC pipeline is devastated as are the related industries. Starbucks is an example of a company who may be gone after a while! Who the hell needs a $5 cup of espresso when they can get a good cup of coffee at McDonald's for a buck? There's still huge unrevealed structural challenges and there's no end in sight. You are in a full employment city right now Henry....gov't jobs! I looked at the Federal Job sit yesterday and the wages they pay are huge by comparison to the private sector!!!! I'm betting after Christmas a lot of shopping centers will begin to close and at the least loose a lot of paying tenants.

There is no delay Henry....this is hitting the fan right now, BIG TIME. The other day DHL ceased operations in the US. A small town in Ohio, Middlebury I think it's called suddenly lost 10,000 jobs overnight and unemployment there is now 50%!!!! Think maybe that will presage a shit storm for the local grocery stores and other business's there?

There are a few areas that are relatively safe, now and for the foreseeable future. Health care and consumer durables including supermarkets. Just about everything else is going to get creamed. Art in HealthCare will get hit but only because it's discretionary not a required aspect of health care

I'd hunker down if I were you....be scared, I mean it. I know it's a self fulfilling mind set but if you don't you will regret it. Too many people have VERY real reasons to be scared and they will act accordingly and spend accordingly. Be glad you live on a farm, live near the state capital and could go back to medicine if you chose to. The sky might be puffy with patches of blue to you but I'll bet regular folk like me are going to be suffering big time, for a long time. Barack Obama can't fix this any time soon, no one could.

Reasons? For 12 years or so the economy grew because a lot of people used their home values to increase their standards of living. This was the linchpin of the whole economic expansion. Now...the birds are coming home to root (no pun intended) and we are going to have to reverse direction to make up for the massive deflation of housing values. It's a titanic disaster and one that isn't going away any time soon.

You know for example that the St. Louis Art Museum 'postponed' their $24 million capital improvement program, right? Think maybe they don't see getting the pledges any time soon? Think this is an isolated case? It's not and we are closer to the beginnings of this than the end.

This is what I think and I seriously doubt I am going to be wrong. What would I do right now? Even though I don't know the specifics, I'd be willing to bet that you and Lorna will be supporting more than one family member within a year.....and this will go on all over the US. The worst part of this is the unknown....which is that we aren't alone. The rest of the world's economies are going to get trashed and it's hard to say how much worse that will make matters. Aren't you glad you asked? :(

The crash of the hospital art market ?

Alexandra Peers writes in the Wall Street Journal today:

The art market's crash -- for that is what it is -- threatens to remake the art world. In the past few weeks, auctioneers, dealers, artists and collectors have changed strategies and policies, and it's likely that future changes will be even more sweeping.

When hospitals buy art, they typically are not dealing with the "art market" that this article is referring to: auctioneers, dealers and collectors. For healthcare art there tends to be a different mix of players: art consultants, interior designers and the hospital administration. The only similarity between the "art market" and the "hospital art market" is the artists themselves.

But the threats for those involved in the "art market" will be equally challenging to those in the "hospital art market". Is the hospital art market also crashing? Time will tell.

The article, called "The Fine Art of Surviving the Crash in Auction Prices" Click here to read the article (registration required).

Art takes a hit - Advice for artists

The San Francisco Chronicle ran an article last weekend "Even art takes a hit in economic downturn" by Julian Guthrie. "There are bubbles in all kinds of business. The art business is not immune. But it will recover. Sometimes you learn through suffering... Gallery owners are cutting costs, losing sleep and bracing for tougher times ahead. And, they're worrying about their artists..."

What is an artist to do in times like this? The article suggests:

• Have a business to fall back on
• Learn to barter by trading your art for services you need
• You can barter with doctors, dentists, restaurants, lawyers

Financial Downturn Hits Art Market

Cut Cakes by Wayne Thiebold, oil on canvas, 24 x 30 in.

No one would buy art for hospitals at the fancy art auctions held by Sotheby's and Christie's; the art is simply too expensive. However, it is interesting to see what is happening to prices as that reflects what is happening to art sales in general. According to  the Wall Street Journal this week:

The global financial crisis dealt a blow to the art market during the flagship fall auctions in New York City that concluded Friday, as fewer collectors were willing to splurge on the world's priciest artworks. Overall sales were less than half what they were a year ago, and a majority of works were offered at prices far below their presale estimates.

Art-market watchers had predicted sluggish results. These sales show that the art market is no longer immune from the global credit crisis that has already upended other industry sectors.

One of the pieces that just sold was "Cut Cakes" illustrated above. It was expected to selll for $2,000,000 to $3,000,000, but the actual sale price was $1,762,500.

The article from the November 15th issue of The Wall Street Journal is called "Call This One 'Crisis With a Pipe' Financial Downturn Finally Leaves an Impression on the Art Market" by Kelly Crow. Click here for a link (but registration is necessary)

Just say no: An artist response to donation requests

I get a lot of requests to donate my art, so Regina Hackett's post "Just say no: An artist response to donation requests" got my attention. She points out that "There's no end to the requests artists get to donate their work to auctions to benefit nonprofits."

Seattle painter Juan Alonso has decided to just say no requests. In a form letter he writes:

 ...it seems every organization believes that artists are the first professional group of people to ask for donations for their fund-raiser, no matter what the cause is.

It has gotten out of hand. I don't know of any other business group, as a lot, that is automatically called when money needs to be raised.

To read the blog post in the blog called "Art to Go", click here.

Buying Art for Hospitals on eBay

Poster Art is a widely used way to put up a pictures in a Hospital without breaking the budget. Posters are mass produced on on cheap paper to keep down cost. The colors may not be as vivid and it certainly won't be archival, but they are cheap. The trouble is that poster art looks cheap.

What if you want real art; original art on a tight budget?

One option is to look to China: click here and here. But that takes a long time and having to trust someone on the other side of the planet who may not be fluent in English.

Another option is to use eBay.

I just checked and there are 234,175 pieces of art on eBay right now. They are conveniently arranged into three categories

• Direct from the Artist
• Art from Dealers & Resellers
• Wholesale Lots

I’ve seen three examples of art on eBay recently. One was in an entire room in a gallery filled with paintings from eBay. Another is a distinguished painting professor who sells his watercolors on eBay rather than have them sit in storage. Lastly, I know an photographer who sells his platinum prints on eBay for as little as $25.

I'm certain you can find some real bargains for original art on eBay. A serious problems with this method is that it takes too much time. I suspect that most art buyers for hospitals won't take the time or risk involved with buying art on eBay.

The webstite for eBay is: www.eBay.com

Thanks to Kim for suggesting this topic after she came across a post on another blog: click here

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

Hosptial Art in Fort Worth

According to Elizabeth Bassett, Fort Worth Hospitals have discovered the value of art.  She reviews the art scene at 4 local hospitals in an article this week in the Fort Worth Business Press. You can read the article by clicking here. Some excerpts:

Andrews Women’s Hospital

"SCW Art Consulting, based in Durango, Colo., had experience commissioning art for hospitals and worked with Baylor staff for about nine months to determine what would work best for female patients and their families... more than 400 pieces of art ended up in the hospital within a budget of about $390,000"

Harris Methodist Fort Worth Hospital

"Morris Meditation Garden, which features a small waterfall, two fountains, a full garden and pathway with several places to sit and think."

JPS Patient Care Pavilion

"Hallways are lined with 535 individual pieces of art. Most of the art is prints of nature-influenced scenes in frames, ...color choices were made to remind visitors of nature.

...$200,000 of that was spent on the art collection and framing ... Arden & Associates, based in Piedmont, Okla., provided a plan with a budget"

Plaza Medical Center of Fort Worth

Artist Maris Shepherd, ...painted more than 80 scenes from Fort Worth and the surrounding area ... cost about $265,000

What's the 'correct' price for art?

Is it only art if it costs a lot of money?

Conclusion:
There is no perfect answer on how to price art. You can perform elaborate calculations and comparisons with your competitors, but in the end you just have to wing it.

Deciding what to charge for art is very difficult for most artists, especially as they are getting started. Beginning artists are so happy that anyone would be willing to display their work that they almost give it away.

Being associated with a gallery or art consultant can help a lot; they understand the market. Often they suggest pricing that is much higher than artist/photographer would pick. But of course they usually takes 50% of the sale price.

Several years ago, as I was starting I sought the advice of some experts. One suggested a pricing structure that was bizarrely complex. It required a spreadsheet to do very complex calculations such as the number of views-per-day and the length of time the art would be on display. This did not fly with my clients. I've settled in on a simple formula that considers only two things: size and what the art is printed on.

Another expert suggested that I put off discussions of pricing until the very end, even if people ask for it. The thinking was that you want to generate mystique as the client is becoming enthusiastic about your work; then negotiate. This did not work at all for me. I was getting several calls a day just asking for pricing. In the end I decided to post my prices (which are non-negotiable) on my website: click here for current price sheet.

How often to change your pricing is another concern. One person told me that I should raise my prices 10% per year no matter what. This creates the illusion that the art was appreciating in value. However, if you look at the "after-market" pricing on fine art, it almost never goes up. Only brand names in art have prices that appreciate, and then not until after the artist dies. I've decided to simply hold my prices steady unless I can see a good reason to change.

One book that I read (Profitable Photography in the Digital Age) summarized pricing well by saying: "... the reality [of pricing] is and always will be an amorphous  concept that we will never really grasp. You just have to get better at it without expecting to perfect it."

Would Universal Health Care mean no art?

There is a boom in healthcare construction in the US. That has resulted in a surge of demand for healthcare art. What would happen to the healthcare art market if political forces brought us Universal HealthCare?

My best guess: Universal HealthCare would cause no change in the high demand for healthcare art or healthcare construction.

If you look at countries that offer universal health coverage (which includes every developed nation on earth except the US) you will see that they continue to fund the purchase of art for healthcare. Some countries (such as Norway) require that 1% of the construction cost be spent on Art.

The idea for this post was triggered when reading this week's New England Journal of Medicine (NEJM). The lead article is called "Coverage for All Americans". They write:

Since 47 million Americans lack health insurance and many others have inadequate coverage, we wanted to explore how the presidential candidates propose to provide health care for all Americans while controlling costs and maintaining quality.

A free and fascinating online video discussing this topic can be found by clicking here.

The New England Journal of Medicine is the most highly respected medical journal in the US.