What is Evidenced-Based Art In Healthcare?

Fall Harmony Willamette by Mitch Baird of Portland, Oregon
How are Evidence-Based Art Programs different from regular art programs and what advantage do they offer hospitals?

Evidence-based art is based upon the principles of Evidence-based Design, and makes a commitment to basing design decisions on the best available research.  There is a small but significant body of research evidence today on the impact of art on clinical and behavioral outcomes of patients in hospital settings.
Viewing artwork with appropriate nature content has been seen to reduce stress and pain perception, as measured by physiological outcomes such as blood pressure, heart-rate, and skin conductance, in addition to self-report measures such as pain-rating scales and surveys. For example, in a study conducted in Sweden by Roger Ulrich, heart surgery patients in an ICU who were shown nature scenes with water, trees and high depth of field, showed lesser anxiety, suffered less intense pain, and required lower strength pain medication, than those shown abstract scenes or no image at all. Economic benefits of lower cost of pain medication, reduced length of stay, and increased patient and staff satisfaction, can be extrapolated from such studies and strengthen the case for taking an evidence-based approach.Unfortunately, the critical importance of Evidence-based Art programs has not yet been fully appreciated within the industry….

While experienced art consultants have the ability to provide aesthetically pleasing artwork consisting of pretty, local pictures, the insight into whether this aesthetic is appropriate for healthcare populations is often missing. Given the evidence on the therapeutic effect of using appropriate art (discussed above), this could be a critical oversight.
Yet another aspect of evidence that is relevant, in addition to the therapeutic benefit of art, relates to how presence and quality of art can effect patient/visitor perception of the quality of care at the hospital, act as a de-stressor for staff, have an impact on the branding of the hospital, serve as a point of focus and discussion for visitors, and of course, add to the overall appeal of the visual environment (these themes are emergent from a 2007 post-occupancy evaluation of the art program at MD Anderson Cancer Center, Houston). Artwork is often the most visible and noticeable aspect of the visual environment and this increases its potential impact on patients/staff/ visitors, and in the final analysis, the economic bottom-line at the hospital.
There are well-researched guidelines in place today for appropriate healthcare art based on rigorous research findings, which can be implemented, creatively, by experienced art consultants. Ulrich and Gilpin’s chapter on Healing Arts, in Frampton’s Putting Patients First, is one of the most comprehensive resources and recommends the use of

  1. Waterscapes (Calm or non-turbulent water)
  2. Landscapes (with visual depth or open foreground, trees with broad canopy, savannah landscapes, verdant vegetation, or positive cultural artifacts)
  3. Flowers (familiar, healthy and fresh, in natural settings with open foreground), and
  4. Figurative Art (depicting emotionally positive faces, diverse and leisurely in nature).

While these guidelines are in place today, an evidence-based art consultant has the onus of creative but conscientious interpretation, in order to ensure that the most appropriate art for the facility is chosen while maintaining a standard of visual appeal that is befitting to the hospital. Furthermore, there is little known on art for special populations, or different ethnicities, and mere prescriptive adherence to guidelines cannot suffice.
In the end, commitment to an Evidence-based Art program entails going the step beyond the implementation of existing guidelines, to improving and updating guidelines towards the maximum impact art can have on improving the healthcare environment. 
Published in FacilityCare Magazine. Vol 12. Number 3. May/June 2007


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