Art in healthcare contexts: To evidence or not to evidence

Perhaps the role of art in healthcare is about valuing holism and recognising the uniqueness of patients as individuals regardless of their health problem and treatment.

The views expressed in this document are based on my experience in conducting a clinical trial to evaluate the effect of an art intervention in a large Dublin hospital and also my experience working as nurse.

The presence of art in hospital and community health care settings is not a recent development.  For many hundreds of years, portraits and sculptures have adorned the corridors and waiting rooms of hospitals and clinics.   The ancient Greeks and Florence Nightingale believed that a person’s environment influences their sense of wellness and well being. The reasons for its enduring presence range from it being a benevolent gift from a grateful service user or family or its enhancement of the often very sterile, cold and functional environments associated with healthcare.  However, its prevailing presence in the form of collaborative, participatory and visual art in the current healthcare setting is perhaps more to do with the belief by some key stakeholders in the value of that presence.  It is thought that art in healthcare settings (visual and participatory) makes these environments more welcoming, comfortable and stimulating which in turn reduces stress, anxiety, promotes well-being and a positive mood (Staricoff et al. 2001; Schweitzer et al. 2004; Redshaw 2004).

This is evident  also at Government level in Ireland and many European countries where a policy exists that allows for 1% of the cost of building and maintaining a health care institution to go to art works and projects, demonstrating that the value of art in healthcare is somewhat recognised (Department of Arts, Sports & Tourism 2004).  Art projects and indeed employment of Arts Officers or Directors in hospitals are generally funded through a range of sources, for example, by Arts Council grants, through hospital trusts administered by arts committees, private fundraising, charitable donations and in some circumstances directly from a hospital budget.  However, regardless of how art projects are funded, they are often criticised by the public and even some health care staff   for being a waste of money (Perry 2005, Sky and News 2005). The implications are that other than being ‘nice to look at’ art appears to be regarded as a luxury and is not valued by the general public as having the capacity to help people in any way. This re-enforces the need for rigorous, research-based evidence on the physical and psychological effect of art in healthcare contexts.

Behrman (1997) suggests that it could be difficult to provide rigorous proof of the effects of the arts on healthcare outcomes as there are too many variables to do a trial that is statistically reliable.  This remains debatable as much of the research to date is not well controlled and cannot be applied to wider populations.  The absence of rigorous evaluation of the value and effect of art in health results in uncertainty in relation to its benefits, harms and value for money (Hamilton et al. 2003; Putland 2008).  Scher & Senior (2000) also suggest that anecdotal and uncritical reporting of the role and value of art in health needs to become evaluative reporting and provide critical evidence of its effect and value.  Evaluating the psychological, physical and emotional effect of art does not require its definition or validation by others but rather provides opportunity for discussion to take place between artists, doctors, nurses, managers and other healthcare disciplines, working collaboratively and ultimately developing a common language about art that transcends all contexts. It is based on a curiosity about how and why people respond to art and what effect this has on them and their healthcare experience.

Even though art comes in many forms, it is always a subjective experience. Perhaps the role of art in healthcare is about valuing holism and recognising the uniqueness of patients as individuals regardless of their health problem and treatment.  Art is regarded as integral to the social and cultural aspects of life in all communities and perhaps it should exist in all healthcare settings for the same reasons.  However, it is important to recognise  that although there appears to be a positive disposition towards the presence of art in healthcare contexts, it is not known if art in these contexts should differ in its conceptualisation or if it is interpreted and perceived differently by an individual who is a patient as compared with one who is attending an art gallery or viewing a sculpture in the street. There is extremely limited evidence to support the belief that art is valuable for patients (and indeed employees) in health care settings and there is even less evidence to support why and how it is valuable.  This is essential information for the Chief Executive Officer of a hospital who needs to justify and explain how the budget is spent in providing a high quality service for patients.  If there is evidence that shows why and how art helps patients then it strengthens and supports the argument for spending money on introducing it throughout hospitals and healthcare settings.

There is a belief that it has value for patients in healthcare settings but without evidence it will always be regarded as dispensable.  In the current economic climate, it is to be expected that ‘unnecessary costs’ such as art projects that are considered a ‘luxury’ by managers of health care budgets will not be a priority, therefore, funding will be cut to save money.

From the perspective of a healthcare professional, evaluation of art provides an opportunity to challenge the prevailing medical model of care in favour of a holistic approach to care.  Art introduces a social and cultural dimension into organisations that are, quite rightly, primarily concerned with providing effective and economical treatment for patients in a caring manner.  Although health care professionals are concerned with caring for the individual needs of patients and providing a holistic service, this takes place often in cold clinical environments with little reference to the sociocultural and psychological needs of patients.

_{Behrman, P. (1997) Art in Hospitals: why is it there and what is it for? The Lancet, 350, 584-585.}

_{Hamilton C., Hinks S., & Petticrew M. (2003). Arts forhealth: Still searching for the Holy Grail. Journal of Epidemiology and Community Health, 57(6), 401–405.}

_{Putland C. (2008) Lost in Translation: The Question of Evidence Linking Community-based Arts and Health Promotion. Journal of Health Psychol, 13: 265-276}

_{Redshaw, M. (2004) Design for health: The impact of a new hospital environment on children, families and staff, The Stationery Office, Norwich.}

_{Scher, P. and Senior, P. (2000) Research and Evaluation of the Exeter Health Care Arts Project. Journal of Medical Humanities, 26, 71-78.}

_{Schweitzer, M., Gilpin, L. and Frampton, S. (2004) Healing Spaces: Elements of Environmental Design That Make an Impace on Health. Journal of Alternative and Complementary Medicine, 10, 71-83.}

_{Sky and News (2005) Hospitals Told: Stop Arting About. http://news.sky.com/skynews/Home/Sky-News-Archive/Article/200828513453756.  Accessed 26th October 2005.}

_{Staricoff, R. L., Duncan, J. P., Wright, M., Loppert, S. and Scott, J. (2001) A study of the effects of the visual and performing arts in healthcare. Hospital Design, June, 25-28.}