You assess need and find that indeed there is one. You review and analyze financials, consult with colleagues, with subject matter experts and close advisors.  You take time to examine options, to compare and contrast pros and cons.  And after such thoughtful consideration, after you’ve determined that all evidence points to a choice that is proven to be reliable, one that has a strong and measurable impact, you act. 

You purchase the Burberry suit.  It just hangs better.  The material by itself is a wondrous experience.  The mirror is your best friend.  You feel really good in it.  Of course, now you require accessories; shoes, a belt, a shirt or blouse, a tie or scarf, perhaps a pair of socks or some hosiery.  You breeze into Wal-Mart, purchase them on clearance, in and out in fifteen minutes.

What is wrong with this picture?  And, what does it have to do with art in healthcare?  As beautifully designed healthcare facilities are built new or expanded, art is generally lumped in with furniture, fixtures and equipment (FF&E).  This is the end of the building cycle.  Because of this, art is frequently given little forethought and is consequently reduced to a package of ubiquitous budget prints that conform to guiding principles that are, in practice, more form than substance.  Art is arguably the first thing people react to when they approach or enter a facility.   When the process for selecting and integrating art with healthcare design fully considers context, art adds value well beyond a visually aesthetic appeal.  Leaving the consideration of art until after design is complete and construction is nearing final touches is much like buying a fine suit and adorning it with cheap accessories.  The potential impact of the accessories is lost, and the quality of the fine suit is diminished.

Today, healthcare design is increasingly guided by a body of research called evidence-based design.  The goal is to inform a comprehensive design approach to create a healing environment.  Patterns of movement, exposure to natural light, inside-out views of natural settings, accommodations for patients and their families, colors, textures, technology, electronic media, art, and more, all play a role.  In this environment, elements of design each earn their way and contribute to a sense of place that fosters confidence, comfort and healing, and as such, become important allies to healthcare providers. 

There is also a clear trend toward hospitality influenced design in healthcare.  The sterile, institutional atmosphere of previous generations of medical facilities is now understood to be counterproductive in many ways.  21^st century consumers of medical services know and expect more.  Evidence-based design addresses the full human experience, the psychological, intellectual and physical response to a space and to the activities that occur in the space.

The benefit of art in healthcare is in the experience of the art.  While it may be dismissed by some as merely decoration, decades of research in Europe and the United States concludes otherwise.  The role art plays in an overall strategy to produce a healing environment has been measured against health and economic outcomes.  They include:

• clinical outcomes such as length of hospital stay, intake of pain medication, or biological markers such as blood pressure and heart rate;
• patient, family, and employee based outcomes such as how patients’ rate levels of perceived pain, satisfaction with healthcare services, with working conditions, etc.; and
• economic outcomes related to cost of patient care, cost of employee turnover, etc.

Art is a positive distraction, directly or indirectly, in a variety of situations.  It has been shown in a growing body of research to measurably reduce:

• ·        patient and employee anxiety and stress;
• ·        pain perception as measured by physiological outcomes such as blood pressure, heart-rate, and skin conductivity response, in addition to self-report measures such as pain-rating scales and surveys;
• ·        the need for analgesic medication;
• ·        depression associated with chemotherapy, dialysis and other invasive treatments;
• ·        non-operative treatment times;
• ·        operative recovery times;
• ·        mental healthcare treatment times;
• ·        abusive behaviors by mental healthcare patients;
• ·        length of hospital stay;
• ·        employee turnover, missed days;

And measurably increase:

• ·        patient and employee satisfaction;
• ·        patient, visitor and employee perception of quality of care;
• ·        brand recognition.

Another key measure of the effectiveness of a particular selection of art is its ability to maintain interest; it is art that doesn’t run out, doesn’t become invisible and irrelevant.  Art, when appropriately selected and placed, has durability, it engages the viewer, transports them, delights and amuses them, calms and reassures them, day after day. 

So, what does it mean to “appropriately select and place art?”  Context must drive the design conversation.  Healthcare facilities can be specialized or can house a variety of treatment centers.  Though there may be similarities, art that is appropriate for pediatrics will not necessarily be appropriate for oncology, art for assisted living centers may differ dramatically from memory care centers, and with a focus on impression management and wayfinding, the process for selecting and placing art in lobbies, waiting rooms, and the labyrinth of hallways varies, as well.  Demographics and local traditions, too, influence selections; for instance, which ethnic groups reside in the communities a facility serves and how is local culture expressed? 

The value of art as a positive contributor to employee and customer satisfaction, to wayfinding, and, most importantly, to healthcare outcomes, varies directly with the integrity of the process used to select and place it.  Art is most effective when integrated contextually with a thorough understanding of operations and with building, interior and landscape architecture through a collaborative design process. 

Finally, art that makes a difference does require an investment.  A rule of thumb for budgeting turn-key art services is 1-2 percent of the construction budget.  Art budgets in this range or higher allow for an art plan that aligns and integrates with organizational mission and the intentions of structural and operational design, and for a measurable return on investment.  With art, begin at the beginning, when the design conversation initiates.  Patients, employees and visitors will respond with their hearts and minds.  Administrators and investors, with an appreciation for the bottom line.

Michael Lehman is co-founder and president of BOBOSART, Inc. in Tampa/St.Petersburg, an award-winning full service art consulting and art solutions company. Serving public and private clients with a global network of art resources, BOBOSART provides turn-key services for any type of development. He can be reached at michael@bobosart.com.

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