Health Care Fine Art

Designer's Preferences for Art hurts Patients

Sarajane Eisen, PhD (on right) with Susan Rodiek, PhD

On the last day of the HCD07 Conference I attended a talk that presented surprising new research news: 
Interior Designers choices for art in healthcare can hurt patients.

The research was conduced by Dr. Nanda and Dr. Eisen. They presented their findings in a talk called: EVIDENCE-BASED ART FOR HEALTHCARE
And the Difference in how Patients and Design Students Select Artwork

The take home message that I got out of the research presentation was that Interior Designers should not be swayed by their personal preferences when selecting art for healthcare clients. Instead they should select realistic nature images.

Here is why:
Experienced art viewers tend to prefer artworks that are challenging and emotionally provocative.
Interior Designers are experienced Art Viewers and like other experienced viewers, they prefer challenging and emotionally provocative artwork.
Because Interior Designers prefer challenging artwork  they are inclined to pick challenging artwork for their clients.
However, challenging artwork; such as abstract art is not preferred by regular people and in fact it can be very stressful and therefore harmful to patients.

Designers need to understand that research repeatedly shows that regular people (i.e. not experienced art viewers) have a strong tendency to favor nature scenes.
Research also shows that nature scenes are also ideal for healing environments because it can improve patient outcomes (Evidence-based Art).

Upali Nanda, PhD, American Art Resources
Sarajane Eisen, PhD, Auburn University

Does Evidence-based Design mean Paint-by-Number?

Enthusiasm for Evidence-based Design may have gone too far and that might stifle creativity and lead to prescriptive design. At least that is what one Designer said to me on the phone today.

Just because evidence-based design is a great idea (and it is!) does not mean that we have all the evidence yet. In fact, the scientists doing this type of research tell me that less than 5% of design decisions have solid evidence behind them.

Designers may assume that just because a few studies have been done on a given topic that there is a "right answer" on how to do something and they should not question it; after all, it has science behind it. But the research may be flawed, or it might not apply to their given situation. Furthermore, some kinds of questions can't be answered with numbers and therefore can't be reliably researched.

Until we have definitive evidence on a certain situation, what should we do? The Designer I was speaking with (who shall go unnamed) suggests that Designers should consider evidence-based design as only one of many tools that can be used in on a project. She urges:

• Using creativity to seek a "vision"
• Beware of making decisions that are too safe
• Take a more holistic view
• Consider meaning, consider the sacred
• Avoid "Painting by numbers"

Note: this all applies to Evidence-based Art too.

Is New Art Better?

Everything has to be New and Improved, including our art. In our commercial Western culture that is the norm.

For the last Century, Artists have been rewarded the most for creating NEW art. There is an endless and often bewildering mix of new art produced every year. Just look at what is on display at the Whitney Biennale or Documenta XII. These are two international showcases for the best of contemporary art.

Does this mean that Art for Hospitals has to be constantly striving to be new?

If you believe what Evidence-based Art research is telling us, "New" has nothing to do with the art we should be selecting for hospitals. In fact, landscapes painted 200-years ago would be just fine. Those older landscape paintings would be much better than virtually any of the art on display at the Whitney Biennale.

So where does that leave an artist who wants to create art to go in healing environments? To be satisfied as an artist, we can't simply recreate what has been done before, that would be mere craft; just copying. But on the other hand it helps to be aware of what art patients respond best to.

Kitsch Can Work

"I'm sorry, Steve, I was only dating you for the kitsch value."

Kitsch is a snooty word. Calling something Kitsch is a way of looking down your nose at something, to say it is in bad taste. To the left is a classic big-eyed painting; pure Kitsch.

The opposite of Kitsch is Avant-garde. Avant-garde means pushing of the boundaries of what is accepted, to experiment and find something new. Avant-garde is cool. As we have discussed in previous posts, this kind of challenging art does not usually work in hospitals.

Can Kitsch work in HealthCare?

Kitsch can work in healthcare if done thoughtfully. Kitsch relies on repeating a convention or formula. Much nature photography follows a formula. If one followed the "formula" for HealthCare art outlined  in Chapter 7 of "Putting Patients First" the results would probably be fine.   

Many Artists would say that Thomas Kinkade is the most famous living painter producing kitsch. If kitsch means commercially produced items that are overused and lacking in originality then, yes, his work probably is kitsch.

Would his work be appropriate in a Healthcare setting? If you read the specific suggestions of the experts I would argue that his work would be perfect. He creates non-threatening romantic landscapes that are easily appreciated by the general population. 

Hopefully the ideal art for HealthCare would be something in between Kitsch and Avant-garde. Something conventional but fresh. Something that Evidence-based research supports but also something that is new.

But please, no big-eyed paintings...

Incidentally, Susan Orlean wrote a wonderful article for The New Yorker about Thomas Kinkade called "Art for Everybody". You can download the article from Susan's website by clicking here. I highly recommend it.

I found the above cartoon by J Dator in the May 7th 2007 issue of the New Yorker.

Take it, it's good for you!

Kids receiving their daily dose of cod-liver oil from a teacher

Kids used to be forced to take Cod Liver oil because experts said it was good for you. It has been described as having the intense and obnoxious odor of rotten fish and rancid oil.

Sometimes I think connoisseur's are doing the same thing when they make the general public look at art they don't like. They feel it is their responsibility to educate those whose tastes are not as advanced. In schools, galleries and museums I can accept that argument; but not in hospitals.

It is wrong to make people in hospitals look at art that they don't like. There are enough other unpleasant things going on that to increase discomfort. We don't need to add art to the list.

It is very clear what people don't like. This has been studied hundreds of times in countries all over the world. Regular people don't like abstract art. You can see this illustrated by clicking here.

This post was prompted by listening to a new CD that I just bought: Gloria Cheng's Piano Music of Salonen, Stucky & Lutoslawski. After I was half-way through the disc I realized I was listening to it because it was good for me, not because I enjoyed it. Perhaps in time I will learn to appreciate it, but meanwhile I switched to Scarlatti: Keyboard Sonatas played by Andras Schiff. Within seconds of putting it on I started to feel more relaxed. The dogs even came back into the room...

Note: These days people still take Cod Liver oil, but usually in gel caps labeled as alpha-3 Omega. The gel caps do a pretty good job of hiding the disgusting smell.

Is Abstract Art Always Wrong?

"Ancient Sound, Abstract on Black" by Paul Klee, 1925, Kunstsammlung, Basel

When I was ten I had to sleep in the garage; there wasn't enough space for all the kids to get bedrooms. On the painted yellow concrete wall hung a poster of a painting by Paul Klee. I spent many hours getting lost staring at that abstract painting.

Even though I still love Klee's work, I wonder if abstract art like this is appropriate for hospitals. Researchers who study this says that the answer is in: Abstract art is out. Roger Ulrich is the pioneering researcher on the use of art in hospitals. He would argue something like this:

Being a patient is a very negative and frightening experience.  Abstract Art, being ambiguous is open to interpretation. If one feels bad, the interpretation is likely to be frightening which is likely to trigger negative feelings. Those negative feelings could harm the patient. Furthermore, the majority of the public does not like abstract art.

Dislike of abstract art by the general public appears to be true in every country where it has been researched.  The response to abstract art can even turn violent. Ulrich reports that in Sweden there were seven incidents of patients actually physically attacking and damaging abstract works of art. It is clear that scores of research articles suggest that abstract art is wrong in patient rooms.

Does this apply also to public spaces in hospitals? According to Kathy Hathorn,

"Regardless of its interest or critical importance, abstract art in a hospital lobby is clinically inappropriate."

Kathy Hathorn is President and Principal-in-Charge of American Art Resources in Houston.

Roger Ulrich is Professor of Architecture at Texas A&M University and serves on the board of the Center for Health Design.

Common Misconceptions About “Local” Art

Cholla Cactus_1012

Using local art for hospitals is a growing trend for many good reasons. It is nice to support local artists and they might have art that reflects unique features of the community. However at the HCD08 conference, Kathy Hathorn warned about the downside of insisting on local art.

Common Misconceptions About “Local” Art

• Local Art is within the budget
• Local Art is high quality
• Local Art is appropriate for patients
• Local Art is appropriate for project

Just because local art is made nearby does not mean it will be a better value. It pays to shop around.

Local art may be interesting, but it might not be appropriate for patients. The cactus picture above is from the Southwest, but that does not mean it is appropriate for display in hospitals. All those sharp needles can remind patients of blood draws and injections.

To help keep these problems under control, Kathy suggests having written goals for the art program. Have a clear definition about what "local" means. She suggests giving priority to quality over locality. To make sure you reach the largest pool of artists, put out a formal "Call for Artists"

Another post on this blog about this topic is "Finding Local Art". Click here

Kathy Hathorn is the CEO and the Creative Director at American Art Resources

Free Manual on Evidence-Based Art

An excellent summary of the ideas behind Evidence-based art are summarized in: A Guide to Evidence-Based Art

You can download the 23 page guide for free by clicking here.

This is a must-read if you want to learn how Evidence-based Design can help with art selection for hospitals. The paper was written by two leading experts: Kathy Hathorn and Dr. Upali Nanda.

Here are some quotes:

The physical environment is not a mere backdrop for healthcare delivery - it is an integral part of the hospital experience.

...it is risky to place in a hospital art that is ambiguous, subject to interpretation, or that has obvious negative connotations.

Carpman and Grant (1993),... concluded that patients preferred art depicting nature over scenes with urban content, pictures of people, architectural interiors, still-life, sport scenes, or abstractions.

In another preference study Eisen (2005) showed that children in hospital settings also prefer representational nature art to abstract art. ...contrary to common assumptions that children only like large cartoon-like or fantasy images...

...art programs focus on the more public areas of the hospital...patient rooms are more neglected... Yet, it is this wall that patients stare at endlessly while they are bedridden. This is why art carts, a service providing patients with a choice of art for their rooms, have gained popularity in recent years.

Art has the ability to touch us deeply, and profoundly, in our most vulnerable moments. It serves as a focal point in the environment that we are confined in, which can offer an emotional escape. We are often quick to dismiss such a minute part of the environment, yet, when the patient scans around his or her surroundings, it is this focal point that often the eyes, and the mind, rest upon. It is up to us, as designers, to make this rest restorative.

Kathy Hathorn and Upali Nanda both work at American Art Resources. Kathy is the CEO and Upali is the Director of Research.

HealthCare Art for Dummies

Click picture for larger image

Bottom line : best art for HealthCare:  Stress reducing images.

I'm embarrassed to admit this, but I read books from the "Dummies" series. If I want to just get the basics of something quickly, I've found that the Dummies books do a pretty good job.

I wish they would come out with HealthCare Art for Dummies. Some of the references to learn about the Evidence-based Art are difficult to read. They use a lot of big words that slow me down. What I really want is the bottom-line in plain English.

After reading and re-reading Chapter 7 in Putting Patients First I think I could sum up the the ideas in one sentence: The best art to use in Hospitals is art that reduces stress.

Top 5 Schools for Healthcare Interior Design

With more than 40 Billion dollars spent each year on Healthcare Construction there is a great need for Interior Designers who specialize in healthcare. To find the top 5 schools that help students prepare for this work I asked several people.

Surprisingly there was only agreement on three schools:

• Auburn University

• Arizona State University

• Stephen F. Austin University

What really struck me about the responses was the realization that the majority of designers who specialize in healthcare have not had specialty training. This is identical to the situation with healthcare Architects. Specialty training is the exception and not the norm. Most people learn on the job.

Note: the top 5 Schools for Healthcare Architecture was covered on a post last week. To read it, click here.

The response from Jocylyn Stroupe (Director of Healthcare Interiors at OWP/P) was typical: 

The challenge of finding University programs in Healthcare Interior Design is even greater than finding programs in Healthcare Architecture. I have done quite a bit of research in this regard and have identified only two true Interior Design degree programs and a couple of hybrids:

Stephen F Austin located in Texas has an on line Master's Program
Auburn University has an Interior Design Master's Program

Arizona State University offers a Master's degree in a multi-disciplinary setting and not specific to Interior Design (Healthcare Design and Healing Environments)

Another initiative under development is at the University of Tennessee where the College of Architecture and Design has launched an elective in Health and Wellness.  This initiative is expected to grow and encompass an interdisciplinary approach, inclusive of Architecture, Interior Design and Landscape Architecture.

Sarajane Eisen-Brown, Ph.D (Assistant Professor of Interior Design at Auburn University) wrote:

There are several ID programs working on a healthcare certification, courses, etc. but only 3 to my knowledge that have one up and going:  Auburn University (healthcare certification in MS - developing it still with 3 grad students enrolled), Stephen F. Austin University & Arizona State University.

University of Tennessee is working on one.  Then of course, there are programs that do teach a healthcare course in their undergraduate (as I do at Auburn as their Senior Thesis). 

I got several responses supporting those same three schools. But there was a scattering of other suggestions:

Judy Girod, (Director of Interior Design Lothrop Associates, LLP)

I am not sure what the top health care design schools might be as I think the better design schools teach the design process such that students know how to find solutions to design problems in all disciplines.  Granted, having a design specialty helps makes the designer more current on specifics and cutting edge information in their market but we get that from working on projects and having a specific or primary interest in an area.

I think the better interior design schools in this area would include NYSID, FIT, Pratt, Cornell, Syracuse and RISID. 

Cindi S. Matras, (Director of Project Development at Flad Architects) wrote:

The Council for Interior Design Accreditation indicates that the top5 ranked Interior Design Schools are:

The University of Cincinnati in Ohio
Pratt Institute in New York
Kansas State in Kansas
Cornell in New York
Arizona State in Arizona

Another designer wrote:

 ...consider including the University of Cincinnati's 5 yr., highly recognized program: Ranked No. 1 in Nation - 2008 was the 9th straight year that UC’s interior design program has topped... Cornell University, Pratt Institute and all others in the country.