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February 4, 1998

Creativity and the Arts in Health Care Settings

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JAMA. 1998;279(5):399-400. doi:10.1001/jama.279.5.399-JMS0204-3-1

Major health care institutions across the country have recognized the power of the arts, in all their modalities, to provide messages promoting healing and a sense of community. As this new and significant trend in arts programming evolves, those of us working as health care arts consultants are fielding an increasing number of questions pertaining to the power of the arts to improve the quality of patient care.

This evolution has required many paradigm shifts. No longer are arts consultants the experts. Now we facilitate institution-based arts committees composed of doctors, nurses, administrators, patients, community members, and local artists to develop strategic plans for arts programming or to make selections for installations. The questions asked are not "What color is the furniture?" or "Does it match the carpet?" but "Who are the patients?" and "What do they need to feel comfortable in this environment?" These newer questions reflect the now widely accepted belief that the arts have a powerful effect on how we feel; and that the arts can promote the overall well-being of the patient by helping to reduce stress levels,

Several associations, such as the Society for the Arts in Healthcare and the Center for Health Design, support research investigating the link between art and well-being, and recently these two agreed to collaborate. Roger Ulrich, PhD, from the Texas A&M School of Architecture and a board member of the Center for Health Design, published a pioneering report in 1984 on the benefits of a room with a view of trees in full foliage to a group of postsurgical patients.1

Ulrich examined the medical records of 46 patients who underwent cholecystectomies between 1972 and 1981 at a Pennsylvania hospital. Half the patients had recovered in a room with a view of a stand of deciduous trees full of leaves. The other half had recovered in a room with a view of a brick wall. Controlling for factors such as age, sex, tobacco use, weight, and general level of health, the analysis showed that the patients with a view of the trees recovered more quickly, used less pain medication, and suffered fewer complications from surgery.

The conclusion was not that all patients need views of trees, but that, as Larry Dossey, MD, writes, "most ordinary perceptions have a way of entering the body and influencing rates of healing and degrees of pain."2 In an age of increasing consciousness of the cost and quality of care rendered in the hospital setting, Ulrich's study caught the attention of physicians, administrators, and arts consultants alike.

However, arts programming at major domestic and international health care institutions has been supported largely as a result of personal accounts from patients, visitors, and staff who have experienced the benefits of being in enriched environments. Their stories have spread from one hospital to another, promoting the belief that good-quality, patient-focused arts programming is providing significant therapeutic benefits to patients. Such benefits are difficult to quantify, which suggests that science's traditional measures may never reveal the entire story.

Some of the most interesting arts programming today is interactive. Artists are working at the bedside drawing, painting, and dancing with patients. Storytellers, poets, strolling musicians, and clowns are becoming more common in hospitals across the country. Art programs bring artists into the recovery facility to provide experiences that counter stress and humanize the environment. Interactions between patients and artists provide positive distractions and lend social support in environments that otherwise may be isolating and frightening.

At San Diego Children's Hospital, an in-house group called the Healing Environment Committee (HEC) has developed a comprehensive arts program with several interactive art installations in waiting areas and public spaces. The radiology department's waiting area has seating for children in the form of a railroad train and boasts a model railroad room donated by the local Model Railroad Society. This room contains a very detailed miniature village that local volunteers change seasonally. One parent told me the story of her child's insomnia, which persisted until they visited the railroad room, where the movement of the trains lulled the child into slumber.

The hospital's corridors are filled with petting sculptures and play stations comprised of interactive art. Recently, a new healing garden designed by a renowned landscape architect and the HEC opened to the public. The garden has an impressive dinosaur topiary at its entrance, a shadow room, a windmill, birds, and a dragon fountain.

Is all of this art therapeutic? Does it relieve symptoms and induce a positive outcome? What we see is that it all helps children forget that they are ill while being in a strange place that otherwise might be frightening. It connects them to delight and discovery and brings back some of the experiences of being a child, not just a sick child. The hospital's administration has initiated a study to determine the uses of the garden and the effects it may have on patient outcomes.

Paradise Valley Hospital, also in San Diego, has stood for 90 years as a central institution in its community. The hospital administration wanted an arts program that would speak to the community, which is multicultural and working class. Community groups collaborating with local artists created "The Healing Journey," a project that addressed the question: "What does healing mean to the different cultures served by the hospital?" The project tells the healing stories of the community through more than 100 works of multimedia art installed throughout the medical center.

At the hospital entrance is a series of photographs depicting the many significant gateways, landmarks, and people in the community; the installation sets a welcoming tone in the neighborhood vernacular. Another artist worked with local senior citizens and elementary school students at an after-school program to develop images depicting health and safety that now hang on the pediatric floor.

In many cultures, the support and nurturing of family and community are important factors in the healing experience. Through participation in family and community festivals and celebrations, we enhance our emotional and physical well-being. Accordingly, one local artist and a community photographer captured a year's worth of community celebrations. Their renderings of these events line the hospital's main corridor with the message that time spent with family and community in celebration is healing.

An alcove hosts the "community shrine," a series of display boxes containing amulets, figurines, religious objects, photos, folk remedies, and other 3-dimensional objects that tell different stories about healing and belief systems. Again, the shrine provides an experience for all to behold, in addition to being a place where one can reflect on personal values and beliefs about healing and wellness. Members of the community regularly visit these works, often leaving flowers and other offerings. In what more powerful way can a hospital validate the individual and the importance of community than by honoring its cultural beliefs?

The community shrine at Paradise Valley Hospital, San Diego, Calif. (Photograph by Marv Sloben.)

The community shrine at Paradise Valley Hospital, San Diego, Calif. (Photograph by Marv Sloben.)

Everywhere we are delivering medicine in communities entrenched in belief systems that intertwine spirituality and healing. If we can honor those communities' beliefs and cultures through art that shares these stories and brings delight, perhaps this art will, at the least, alleviate some fearfulness, and that is surely therapeutic.

Ulrich  R View through a window may influence recovery from surgery.  Science. 1984;224420- 421Google ScholarCrossref
Dossey  L Meaning and Medicine: A Doctor's Tales of Breakthrough and Healing.  New York, NY bantam Books1991;231- 232