Category Archives: article

Wall Street Journal, Guardian, NY Times all get in on healthcare art and design this week

In the last week three major new outlets have published detailed articles about arts, design, hospitals, and healing.

 

‘Mike Kelley 1,’ video art by Jennifer Steinkamp at the Cleveland Clinic. The Cleveland Clinic Center for Medical Art and Photography

The Wall Street Journal published a sort of arts-n-healthcare-environments primer focused largely on the Cleveland Clinic’s growing collection.

 

The next day, The Gaurdian UK published an opinion piece where, Jonathan Jones asks ” Isn’t there something patronising and untrue to the human condition in this urge to fill hospitals with jolly art?” and joins me in thinking there should be more to healthcare art then meandering nature photographs.

Two days later, the New York Times, published a sort of architecture-n-healthcare primer looking at the newly designed rooms at the University Medical Center of Princeton, highlighting the fact that in one study patients asked for 30 percent less pain medication in the redesigned space.

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Metropolis: A Culture of caring

The October 2012 issue of Metropolis Magazine includes an insightful article chronicling the unique considerations Western architecture firms must address when designing healthcare facilities for oversees markets. From the article:

For health-care designers working in far-flung regions, learning to patch the seams that split as  West meets East (and Middle East), is as important  as calculating volumes, systems, and energy loads.  In China, designers need to produce structures that integrate best-in-class Western technologies with time-tested traditional Chinese medicine. In India, developers want new hospitals to conform to the thousand-year-old practice of vastu shastra—the Hindu version of China’s feng shui. In the Islamic world, facility plans must include prayer and ablution rooms, along with gender-specific waiting areas.  And plans must be jiggered to ensure that not a single toilet in any facility faces Mecca.

“Hospitals are not Hotels”

An important opinion piece from this week’s NY Times, which reminds us that even in the best built environment, with the most earnest attempt to treat patients as people, much of the healthcare experience is going to be fundamentally difficult for those experiencing it. From the article:

“The survey evaluates behaviors that are integral to high-quality care: How good was the communication in the hospital? Were patients educated about all new medications? On discharge, were the instructions the patient received clear?

These are important questions. But implied in the proposal is a troubling misapprehension of how unpleasant a lot of actual health care is. The survey measures the “patient experience of care” to generate information important to “consumers.” Put colloquially, it evaluates hospital patients’ level of satisfaction.

The problem with this metric is that a lot of hospital care is, like pleurodesis, invasive, painful and even dehumanizing. Surgery leaves incisional pain as well as internal hurts from the removal of a gallbladder or tumor, or the repair of a broken bone. Chemotherapy weakens the immune system. We might like to say it shouldn’t be, but physical pain, and its concomitant emotional suffering, tend to be inseparable from standard care.”

+Culture Shot Manchester

It’s always exciting to see mainstream, national media picking up stories about art and healthcare environments. Last week The Guardian profiled Culture Shots, a week long art and culture initiative at the Central Manchester NHS trust, aimed at healthcare professionals working within the trust. The museum led drop-in events, which took place at all five hospital sites in Manchester, were planned to fit around a busy working day and lasted between just one minute and thirty minutes. According to the Guardian, it’s the first time in the UK that a trust hosted a museums and galleries week within a hospital setting. Here’s the premise, taken straight from the Culture Shots website:

Cultural experiences can help improve health and wellbeing, and can result in benefits that range from the physiological to the emotional. From reduced heart rates and requests for analgesia, to a reduction in the sense of loneliness felt by those suffering from mental ill-health, cultural experiences have been proven to help improve the lives of patients and those who care for them. Cultural experiences have even been linked to longer life expectancy. Culture Shots, your chance to find out why culture works, and how you can use the expertise within Manchester’s museums and galleries to improve your professional practice, and your patients’ health and wellbeing. We think culture matters, and hope that by the end of the Museums and Galleries Week, you will too.

Mini-sessions included “Music in healthcare” “How can museum artifacts help patients” “People patients and portraits” “Artmed”  and plenty of guided tours of the hospital art collections. It’s a great way to get disparate stakeholders including clinicians, administrators, curators, and artists engaging with one another in an a way that’s both enjoyable and informative.

Manchester is a hotbed of arts, health, and culture work. I feel privileged to have completed my MA thesis research within the trust there at LIME arts (an organization also involved in organizing Culture Shots).  For more information about arts and health in Manchester, check out the MMU Arts and Health website.

1989: Poor design may cost you patients

Flashback to 1989! In Februrary 1989, The Canadian Medical Association Journal published a two page article by Freelance writer Jacqueline Swartz highlighting the increasing importance of good design in healthcare facilities. Her emphasis was on private practice medical offices and articulates several thoughtful, basic elements of their design. The article opens:

Vinyl chairs, metal tables and cold, impersonal waiting rooms might have been the norm in medical offices a decade ago, but now, with increasing competition for patients in large urban areas and a growing public awareness of design, waiting rooms are taking on a new look.  “There’s a new emphasis on an attractive, inviting environment that conveys the message of comfort and wellness, rather than sterility and illness,” says Jan Suitso, an interior designer.

The general mood of the move toward human centered, consumer driven healthcare design has not changed significantly since 1989. The advent of the evidence based design movement certainly provided a database of qualitative statistics to draw from, however we can see in the CMAJ article here that carefully articulated common sense can also play an important role in design schemes. Suggestions include french doors to promote a sense of openiness,  a nurses station where simple proceedures like allergy shots can be performed, chairs with arms, and soft earth tone colors and textures. My personal favorite section:

Natural light or indirect lighting is preferable to fluorescent lighting, which makes colours appear washed out and can make even the healthy look sick. And vinyl is passe: durable nylon weaves are preferable.

Download the full article via PDF: The doctor’s office: Poor design may cost you patients

Metropolis on Biophilia

Michael Mehaffy and Nikos Salingaros wrote a post for Metropolis Magazine’s blog back in November, detailing the ideas of Biophilia. It’s a great little essay, definitely worth a read. Coined in 1984 by Harvard biologist Edward O. Wilson, the term literally means “love of life or living systems.” It suggests that human beings are hardwired to be healthier and heal faster when we somehow engage with the natural world. This is an iconic concept raised frequently in discussions of healthcare design, but generally not using this formal named concept of Biophilia. From the Metropolis blog:

In 1984, the environmental psychologist Roger Ulrich made a startling discovery. In studying hospital patients recovering from surgery, he found that one factor alone accounted for significant differences in post-operative complications, recovery times, and need for painkillers. It was the view from their windows!

Half the patients had views out to beautiful nature scenes. The other half saw a blank wall. This was an astonishing result — the mere quality of aesthetic experience had a measurable impact on the patients’ health and wellbeing. Moreover — and this certainly caught the attention of hard-nosed economists — because the patients stayed less time, used fewer drugs, and had fewer complications, their stay in the hospital actually cost less.

What mechanism could explain such an effect? One main proponent of biophilia, the noted biologist Edward O. Wilson, hypothesizes that we human beings have spent most of our evolutionary history in natural environments, and we have evolved to find good (i.e. healthy) environments pleasurable. Aesthetics, in this view that is increasingly accepted by scientists, is not some arbitrary experience, but our sophisticated biological ability to detect what is likely to be good for us.

Take this all with a certain dose of skepticism. According to the American Institute of Architect’s subpage on biophilia:

Despite fairly clear evidence of medical benefits from biophilic measures, very little research has been conducted to verify these outcomes. Ulrich told participants of Bringing Buildings to Life that there are still only about 30 pertinent studies on the relationship between views of nature and healing—despite the potential billions of dollars in healthcare cost savings that such features could achieve.

Tom Otterness and SF General Hosptial

Here’s a puzzle: how can the following commission for hospital art in San Fransisco turn wildly controversial?

A large bronze Mother with Children sculpture by acclaimed artist Tom Otterness. The charming sculpture, which features Otterness’ signature cartoon-like figures, celebrates the joy of a new baby and the role that hospitals play in providing health services in the community. For the pedestrian walkway to the entrance, Otterness designed a suite of playful small bronze heart-shaped characters engaged in activities such as talking on a cell phone to daydreaming.

Proposed Sculpture for SF General Hospital (via SFAC)

The answer: one 1977 video depicting Mr. Otterness shooting and killing a dog he had adopted. The film, titled “Shot Dog Film” is not a secret. It’s existence has occasionally appeared in one press outlet or another since 2008 and even as early as 1997. Yet there has been a recent surge of press coverage generating outrage that a dog killer was awarded two high profile commissions in San Fransisco. Every time I see one of his hundred friendly bronze blob figures in the New York subway system I must admit, for a split second, I imagine said friendly bronze blob shooting a puppy.  It is this almost inevitable association, now that “Shot Dog Film”‘s gory scenario has been etched in the collective memory of media-reading San Fransicanites, which will cost Otterness the $750,000 contract for art in the new Central Subway, offered to him by the San Fransisco Arts Commission in July 2010. What it will not cost him, is a parallel contract for a sculpture at San Fransisco General Hospital. This is largely due to the fact the city has already paid him $365,750 of $700,000 for the bronze hospital sculpture, titled “Mother with Children.” Terminating the contract would be mean loosing a over a quarter of a million dollars. According to Artinfo “Kate Patterson, spokeswoman for the Arts Commission, said the judging panel was not aware of the 1977 film’s existence when they selected Otterness. The artist told ABC7 that he hopes ‘San Franciscans can forgive him for something he did more than 30 years ago.'”” Otterness puts things a little more blunty, or at least did when the NY Observer questioned him about the video earlier this year:

“What the f do I do with this?” he said. He grew visibly upset. “Certainly the scene it was part of-it was in the context of the times and the scene I was in.” He began again. “It is something I’ve grown to understand that nothing really excuses that kind of action. I had a very convoluted logic as to what effect I meant to have with that video. Whatever I had in mind, it was really inexcusable to take a life in service of that.”

This commission is one piece of an approximately $7 million Art Enrichment fund to enhance a new nine-story, 448,000-square-foot inpatient care facility. I’ve been following the project for a while now and feel badly writing about it in the context of all this controversy because, in all actuality, it’s an impressive and unusual initiative to put a major, high profile, public arts scheme inside of a new public hospital build.  Otterness is just one of 13 artists commissioned as part of a much, much larger scheme implemented by the San Fransisco Arts Commission, the non-profit organization charged with selecting and managing art for San Fransisco’s civic spaces. I encourage you to look over all the commissioned works at the Art’s Council website here – I’m excited to see this all realized and installed! For this commission:

Arts Commission staff worked with the 13 selected artists, who represent diverse artistic and ethnic backgrounds, to develop proposals for artwork that would be appropriate for this type of setting. The guidelines provided to the artists drew upon several studies that measure the impact of art on the clinical and behavioral outcomes of patients in hospital settings. The studies indicated that patients who are exposed to art, especially works that incorporate natural imagery, experience improved health outcomes. Art has also been proven to have a positive impact on the pleasure and well-being of staff and visitors. A hospital arts committee composed of representatives from each area that will receive public art also participated in the selection process, directly contributing their knowledge and sensibility about patient care.

Below are the beginning sketches illustrating the very early phrases of a few of the works that other artists are making for the hospital.

On lab coats and scrubs

When you imagine a doctor’s office or a hospital, what is one of the most prominent visual elements of the whole experience? Here’s a hint: though not technically part of the “built environment” this element is very much part of the “designed environment.” The answer: it’s the uniforms doctors and nurses wear as they care for you. The ubiquitous white lab coats and baggy pastel scrub pants that take people who, walking down the street are just people like you, and set off a visual cue that these people could be wielding needles and frightening diagnoses;  a fact that makes the average patient’s heart race.

It’s a big week for thinking about the design of clinicians uniforms. First, the Atlantic published an article on the psychological and clinical advantages and disadvantages of white lab coats. Germs are a very real, very scary challenge and the white lab coat is an important, but not entirely effective, step to help curb their spread. The Atlantic explains that:

A physician wearing a white coat came to symbolize 20th-century medicine, argues Dr. Mark Hochberg, a professor of surgery at NYU’s Langone Medical Center. Before the late 1800s, doctors usually wore black because it was considered formal, he wrote. The shift to white paralleled progress in science and, eventually, the public’s awakening to germ-fighting habits.

But it admits that white lab coats alone will do nothing to slow their spread unless they are worn appropriately and cleaned frequently. Statistically, lab coats are just as guilty as scrubs, and even freshly laundered business casual clothing, when it comes to spreading germs. Perhaps, then, the dawning of this uniform is more related to mental reassurance and institutional ritual than actual germ prevention. The article also quotes an old article as follows:

Dr. Joseph P. Kriss, who in 1975 wrote in the New England Journal of Medicine:

The physician’s dress should convey to even his most anxious patient a sense of seriousness of purpose that helps to provide reassurance and confidence that his or her complaints will be dealt with competently. True, the white coat is only a symbol of this attitude, but it has also the additional practical virtues of being identifiable, easily laundered, and more easily changed than street clothes if accidentally soiled…. Casual or slovenly dress is likely to convey, rightly or wrongly, casual or inattentive professional handling of their problem….

It’s an interesting, quick, and important read and I recommend clicking over and skimming it.

Meanwhile, students at Pratt have been “designing for a difference” and re-thinking the cut of scrubs for “Haven Hospice Specialty Care Unit, Visiting Nurse Service of New York’s 25-bed in-patient hospice facility in midtown Manhattan.” The Huffington Post wrote about the project yesterday and explained that:

Currently, Haven’s staff wear a combination of street clothes and uniforms from a big corporate supplier — not the right fit, we thought, for a workplace focused on attending to the human spirit in addition to the human body. The winning design, by 20-year-old Hannah Ross, is an organic cotton tunic t-shirt and knit pants, topped by a buttoned and pocketed smock that’s inspired by a lab coat but looks like a stylish jacket. The uniform will be produced and worn by Haven’s nurses and nurses’ aides.

Ross also felt that:

“I knew my design had to be really far removed from a typical hospital uniform,” says Hannah. “The hospice looks like a hotel, a spa, something really calm and comforting, and I wanted to capture that.”

Even the most sensitively designed healthcare spaces tend to be filled with staff wearing this “typical hospital uniform” which creates a stark ripple in the overall holistic design. I think that as more and more attention is paid to creating comfortable, welcoming, and sanitary environments, an overhaul of providers uniforms is a natural next step to further humanizing the whole experience. Here is the design winner, Hannah Ross’s winning look, along with images of the other designs submitted:

(Images via DNA info)

 



The Atlantic: Design Thinking and Health

http://www.theatlantic.com/life/archive/2011/10/design-can-improve-healthcare-can-it-also-lead-to-new-cures/246437/

An interesting, albeit scattered, account of how Steve Jobs style “design thinking” can effect not only the physical experience of a patient within a healthcare environment, but also potentially increase patient compliance and radicalize research for cures.  An excerpt:

“While in some circles (radiating concentrically from Palo Alto, one imagines), design is, if not quite passé, at least associated with irrational exuberance and extravagant expectations (see this 2009 posting by Peter Merholz, founder of the user experience consultancy Adaptive Path, and the energetic dialog his remarks engendered), these principles have made only very preliminary inroads into medicine and healthcare.

For starters, medicine is far less “human-centered” — that is, patient-centered — than most observers appreciate. In the exact same way that well-intentioned engineers often go awry by creating features based on their own perception of what they perceive users must want, medicine has spent a lot of effort focused on a physician’s idea of a patient, rather than developing a more nuanced view of life from the perspective of the patients themselves.”

The Emerging Importance of Patient Amenities

A December article in the always-revered New England Journal of Medicine skims the surface of contemporary discourse on the value of “amenities” in hospital design and service. The article, by Dana P. Goldman, Mary Vaiana, and John A. Romley is titled “The Emerging Importance of Patient Amenities in Hospital Care” and is available online in it’s entirety at the time of this entry. While the article neglects to fully define what is concept of “amenities” we can assume that the vast majority of medical amenities likely relate to the physical design of the spaces in which care is offered, with the exception of perhaps massage or extended menu options.  As such, it is a fairly important article for those interested in facility design. One California Hospital campaigned after a renovation and touted their new facility as a “Better Way to Get Better, with private and family-friendly rooms, magnificent views, hotel-style room service for meals, massage therapy, and ‘a host of other unexpected amenities.’ Perhaps as a result, the proportion of patients who say they would definitely recommend UCLA to family and friends has increased by 20% (from 71% to 85%).” Patients now accustomed to and increasingly unsettled by brute force shows of technologically advanced equipment,  require a combination of clinical expertise and these so-called amenities to appreciate a facility and also to initially draw them there. As the article continues to explain, research has indicated that the “nonclinical experience is twice as important as the clinical reputation” for patients choosing hospitals, perhaps because nonclinical experiences are, simply stated, easier to understand or perhaps because they do very much have an effect on the healing process. Ultimately, no questions are answered regarding the relevance, benefits, or cost-effectiveness of this broad category of “amenities” but it is generally good, it seems, to have the issue addressed in any way possible in such a wide-read and respected journal.

 

ny times on new hospital design

on may 18th, the new york times published one of it’s first stories looking specificity at trends driven by research in the field of medical design, “health outcomes driving new hospital design.” author carol ann campbell takes a serious look at the importance of single-patient rooms, and mentions a mounting interest in evidence based design that suggests empirically that hospital design is directly related to the healing process. the above illustration of a single patient room in michigan accompanies the article, and i absolutely love the daybed.

last week’s piece is a slightly more research-oriented rehash of a similar story ran in 2004 called “where the healing touch starts with hospital design” which started with a basic hypothesis that the environment at a hospital effects the patient’s treatment (yes) and then lunges into a description of rikshospitalet hospital in norway, never to return to theory. back in 2000, if a hospital was utilizing design to make patients more comfortable it was grouped under the headline of “hospitals are discovering their inner spa” with the implication that good medical design was something new-agey or absurdly luxurious. i’m curious about what the times’ next hospital-design headline might be and if this shift from treating it as an extraneous element of a machine driven hospital, or a legitimate medical concern with very real effects on patients.