October 02, 2008

Evidence-Based Design: Pros and Cons

Foresttrail_blog

Forest-Trail_4698

Dr. Anjali Joseph recently wrote a helpful post on the Center for Health Design's Blog. She explores some of the current controversies around Evidence-based Design (EBD). Since many experts feel that EBD should be applied to the use of Art in Healthcare, I thought it would be useful to try to summarize the ideas:

Con: EBD is old hat
Pro: EBD formalizes that old hat

Con: EBD is cook-book design
Pro: EBD is only one part of the process

Con: EBD is the mindless application of research
Pro: EBD looks to see if existing research applies to your project

Con: High-quality research does not exist to answer most design questions
Pro: It is true that EBD is in it’s infancy, but that does not mean it is wrong

Con: It is hard to find what research has been done
Pro: Use a Resource librarian

To read Dr. Joseph's post click here

October 01, 2008

Is Abstract Art relevant today?

Actionabstractionblog

Catalog for the current exhibit: Action/Abstraction: Pollock, de Kooning, and American Art, 1940-1976

The use of abstract art in healthcare is controversial. But where does abstract art fit in the larger art world; beyond the walls of hospitals? The exhibit: "Action/Abstraction: Pollock, de Kooning, and American Art, 1940-1976" has me ruminating on the history of abstract art and it's place today.

My conclusion: Abstract art is now a minor player in the confusing jumble of contemporary art.

Richard Kalina wrote in the September issue of Art in America:

Does...abstraction have anything to tell us about today? In what ways ... does this relate to the problems we face in a much larger and more complex artworld? Art now seems to have no boundaries, literally and figuratively. Art is made and displayed virtually anywhere in an exponentially expanding art world of art fairs, biennials ... the Internet...essentially in any form conceivable.

On the one hand this is liberating, on the other it is confusing.

It is confusing! It would be so much easier if there was truth in art like the time period covered by this exhibit (1940-1976). During that era Art critics Clement Greenberg and Harold Rosenburg wrote convincing essays about right and wrong. They believed there was one right truth about art. Many artists and art connoisseurs believed them.

Today that is all gone and abstract art is now merely one of a thousand possible answers for what art can be. I miss that era of certainty!

The book of the exhibit is available from Amazon.com, click here

Information on the exhibit at the Jewish Museum, the Saint Louis Art Museum and the Albright-Knox Art Gallery, Buffalo can be found by clicking here

September 17, 2008

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

Vaughnicublog

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:

Badicuartblog

Continue reading "ICU Art so bad I wanted to cover it with a towel" »

Green Design - a Hoax?

Greenblog

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.

September 09, 2008

Hospital Art in 100 years

Hospitalroomin100yearsblog

In 100-years, could your hospital room looks like this?

Predicting the future may be impossible, but it is fun to fantasize.

If research and technology keep growing at an exponential rate, then we will be in for some interesting art. For one thing, we will know much more about what art really is best for patients. If we are at the birth of Evidence-based Art today, in a century we should actually have a lot of good evidence.

Plus, art itself will evolve. Artists might not like to admit it, but technology has a major impact on what we create. Music really took off after the industrial revolution brought us machines that could make complex musical instruments like pianos. Painting took off after the industrial revolution allowed for canvas to be mass produced and for paint to be put into tubes.

Digital imaging is not quite two decades old, but it's impact is already huge. Imagine how that might change in the next century.

Virtual reality would be the most obvious ways for art to evolve. If views of nature are good, how much better would being immersed virtual nature like the picture above? It is not too far-fetched to imagine that virtual reality would evolve beyond just images and sound and incorporate our other senses.

Your hospital room would be transformed into a 3D space complete with sound, touch and smell. You could feel the gentle breezes and smell the wildflowers that are blooming at your feet. You can reach out and touch them. Not only would you see the stream above flowing, but you could hear it and dip your hand into it.

Today we have a glimpse of interactive virtual reality with Second Life. Could such technology evolve so that friends and family could visit in a virtual way that felt real?

Or, perhaps in 100 years we won't need hospital art because we will no longer need hospitals.

I sure hope I am around to see the changes...

September 04, 2008

Evidence-based Design Under Attack (Part 2)

Ebdvsrbd2

Last week we had a post about an article in World Health Design that took a critical look at Evidence-based Design. I had been unable to reach the author,  Dr. Jacqueline Vischer before putting up that post. Now she has responded to a series of questions.

Note: in this interview, EBD: Evidence-based Design while RBD: Research-based Design and POE refers to Post Occupancy Evaluation

I'm not really clear on how EDB and RBD design are different. They are both involved with using scientific method's  to test  a hypothesis about a design process that might measurably improve patient outcome aren't they? How do hey differ? Cyndi McCullough wrote that "EDB is rooted more in healthcare provider observation and anecdotal evidence", while " RBD is more rigorous and is based on studies using comparative research instruments..." Why is that true?

I do not distinguish between Research-Based design and Evidence-Based design, it seems to me that the terms could be interchangeable. EBD is gaining currency as a defined and specific approach whereby social science measurement tools are applied in a field situation to generate ‘proof’ that one design action or another is likely to be a more effective design solution, in terms if adding value to the designed outcome. Value that is added is usually in terms of beneficial effects on users, but users are a large and diverse group (staff, visitors, cleaners, the public …) and not limited to health-care environments. I think the issue facing EBD – as I have written – is what constitutes ‘evidence’, as most data analysis and testing is based on the statistical probability of one or another outcome being the result of something other than chance. The designer, as the participant who transposes the ‘evidence’ into a concrete act, still has the job of interpreting the results.

Research-based design seems to me at this point to be a slightly vaguer term, in that ‘research’ can include just about any activity that the designer opts to engage in as part of their problem analysis. My students use ‘research’ to describe looking up design solutions in magazines, studying the designs of published architects, reading articles and books related to the topic and or to the design process, as well as going into the field and questioning (systematically or otherwise) stakeholders. In reference to your question, I do not use either EBD or RBD to indicate a ‘design process’ – that for me is another term with a whole other meaning, or set of meanings. I also do not consider that either term is limited to health care environments, although this is where EBD is gaining currency at the present time.

Are you saying that  EBD is fast and practical and that RBD isn't? If so, why?

No I do not think ‘fast’ and ‘practical’ characterize either EBD or RBD. I wrote that the temptation to do research ‘fast’ can lead to dangerous waters both in terms of validity, that is, what exactly we think we are measuring, as well as reliability – that is, the effectiveness of the testing or measuring we decide to use. For me the appeal of EBD is the logical and practical link into design decision-making, such that spaces designed for specific uses are based on what is known about user behaviour rather than on the designer’s speculation or limited personal experience. We used to think we could fix this problem with POE but we were not always effective. I think EBD is a better way of improving the situation but realistically it is not possible to perform research projects on every aspect of a design project. And anyway, why would one want to? Part of what the client is paying the designer for is his or her creativity, imagination and intuitive problem-solving skills.

What are the the "ethical implications" you are referring to when discussing the dark side of  EDB? Are you are saying that EBD is more prone to rush research which is inherently a time consuming process?

Yes in part. I am also saying that there is a risk that a designer not trained in research can set up a bogus project in the name of EBD and then claim scientific validity for his or her design decisions. Most clients are not researchers either so are not in a position to distinguish between a piece of solid research and one that has taken short-cuts and led to biased results. You know the old saying: “There are lies, damned lies, and statistics”. And we definitely live in a culture that values quantitative reasoning, regardless of what it is based on!

You mention the value of Post Occupancy Evaluation (POE). Can't Post Occupancy Evaluations be used in both EBD and RBD?

I would say that RBD, as an umbrella concept, can include POE as one way of doing research for design.

In my article I distinguish between POE and EBD, but I could well see how an EBD research project might be incorporated into a broad-based POE.

You did not mention the fact that EBD is in it's infancy and the actual amount of hard data to guide designers of hospitals is remarkably small. Isn't that a serious concern for EBD and RBD?

The data that guides doctors in their medical decisions is also often ‘remarkably small’. There is no objective standard of when we have enough data to make the ‘right’ decision. In that way, designers are no different from doctors. I stress the importance of the designer’s experience, intuition, sensitivity and principles  - as well as research results - in solving design problems. We do not want to find ourselves supporting a ‘scientific’ approach to design at the expense of all those other important factors; we may end up with a lot of bad designs!

Lastly where does the title of your article "The Methods of Our Madness" come from?

From the Editor, I’m afraid!

Jacqueline Visher, PhD is Professor of design, University of Montréal.

Continue reading "Evidence-based Design Under Attack (Part 2)" »

August 28, 2008

Evidence-based Design Under Attack

Methodsofourmadnessblog














Evidence-based Design criticized

World Health Design's premier issue (April 2008) has an article introduced by Dr. Jacqueline Vischer comparing Evidence-based Design (EBD) to Research-based Design. Since selecting art for healthcare is increasingly based on Evidence-based Design, I wanted to know more.

Dr. Vischer writes:

The dark side of EBD is that time and other practical limitations might have ethical implications, leading to a compromise of research protocol or erroneous methods of data collection and analysis.

... it is important, therefore, not to substitute it for conventional research

After reading the article I could not understand how Evidence-based Design differs from conventional research (also known as Research-based Design). Because I was unable to reach Dr. Vischer I asked an EBD researcher to comment:

Dr. Xiaobo Quan writes:

The discussion around EBD has revealed again that different people may have different definitions and opinions about the same term or concept. In my personal opinion, these are the same thing. EBD is research-based.

To read the full article click here. This will download a PDF of the April 2008 World Health Design. This article starts on page 16.

Jacqueline Visher, PhD is Professor of design, University of Montréal.

Xiaobo Quan, PhD is a researcher at the Center for Health Design

August 21, 2008

Would Universal Health Care mean no art?

Nejmblog

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.

August 11, 2008

Appropriate Abstract Art for Hospitals- Your Vote

Kandinskyblog
Composition IV by Wassily Kandinsky,1911, Oil on canvas, 62 7/8 x 98 5/8 in; Kunstsammlung Nordrhein-Westfallen, Dusseldorf

The use of Abstract Art in Hospitals is controversial.

However, in a poll on this blog a couple weeks ago there was clear support for abstract art.
When answering the question:
"Is abstract art ever appropriate for patient care areas in a HealthCare setting?"
75.9% said Yes

The follow up question is:
Which Abstract Art is appropriate?
Please help by emailing me pictures
of the art that you think works.

With the pictures please include the title of the piece and the artist. Other information (date, media, owner, size, etc.) would be welcome but is not required.

Please send me JPG images attached to email.
You can send them to me at henry@henrydomke.com

To see the pictures that people send me, click "continue reading" below:

Continue reading "Appropriate Abstract Art for Hospitals- Your Vote" »

Does Beauty Merit a Show?

Chihulyblog
Street banner by Iron

Reviewing "Chihuly at the de Young" David Littlejohn asked "Does It Merit This Show?"

No! was his answer. His explanation offers insight into contemporary art. It deals with the issue of High Art vs. Low Art, with Art vs. Craft. Beauty is suspect.

He suggests that High art should make you uncomfortable; it needs to be confrontational.

...these objects strike me as ill-suited for an art museum with top-tier pretensions. ...While throngs of fans clicked away on their little cameras, I found myself nauseated by the grotesque, gleaming, pointless excess.

The word most commonly used by Chihuly-fanciers to describe the works is "beautiful," a concept of little value in defining serious art after the Impressionists. Although some Chihuly objects appear snakelike or surreal, there is never anything troubling or challenging about them. It all looks strangely safe and escapist, even Disney-like, for art of our time.

The article: "Decorative, Yes, but Why Does It Merit This Show?" was in the August 6th Wall Street Journal on page D7.

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