Healing Places: The Art of Placemaking in Health Facilities

Examines ideas of place in medical/health facilities from different perspectives. What role does art play in these places? To promote wellness, designers need to create environments that help in reducing stress. Art has an important role to play in helping people to heal.

Places do not exist in a disconnected manner. They are full of stories and meanings. A hospital means different things to different people. It can mean the place where someone was cured from an illness, or where a child was born, or where a father or friend died. It also has different meanings to the doctor, to the cleaner, to the nurse and to the administrator. It is this richness that the placemaking process makes visible so that the place embraces all of its meanings.

Marily Oppermann, 1997

HEALING AMBIENCE
The link between art and healing is as old as the link between art and religion or spirituality. Beautiful sand paintings, for example, have been created for centuries by the Navajos as part of their traditional medicine. Songs, poems, sculptures, celebrations have also been part of our search for better health. Arts have a strong link to wellness.

As our western medicine disassociated the physical person more and more from the social and spiritual person, we also disassociated the social and the spiritual from the places of healing.

The main objective was the treatment of the physical body. And for a long time there was a proliferation of blank corridors and spaces. Going to a hospital was full of fear and hope. How many women gave birth strapped to a bed and with only a clock to look at and no friendly hand to hold on to?

Still today, when we are admitted to a hospital we are expected to act as the patient and have little control over what is happening to us. We get a tag on our wrist with our name and date of birth, we lose our privacy, our will and our familiar surroundings, we might be dispossessed of our own clothes and personal belongings. But there has been a big change that we can see clearly in the Maternity wards. Women can have their babies, if they so choose, in the company of family and friends and the birthing rooms in the new hospitals look more like a hotel room or home.

During the past 20 years we have seen a considerable development in the research on the influence of environment in the well-being of the patients and staff of heath facilities. Scientific studies on the effect of design on wellness bring us experimental evidence of what a benign ambience can be. This has changed the way designers plan our health facilities. Most designers now search for solutions that create a patient-focused architecture.

What seemed common sense - to heal one needs a supportive ambience - was not enough to change the attitude of many in the health services. The "Blank walls are easier to clean, anything else is a dust collector", "deciduous trees drop leaves" mentalities still had (and have) a strong appeal to health practitioners and managers. It was necessary to bring conclusive evidence showing that patients needed fewer days in hospital if they were in a pleasant environment.

One of these studies, from a hospital in a suburban Pennsylvania, examined the recovery records of patients after cholecystectomy between 1971 and 1981. This research, by Dr Roger Ulrich, showed that patients assigned to rooms with windows looking out on a natural scene had shorter post-operative hospital stays, received fewer negative evaluation comments in nurses' notes and took fewer potent analgesics than the patients in similar rooms with windows facing a brick wall.

The experimental research showed the influence of the ambience on patient recovery, systolic blood pressure, use of analgesics, use of laxatives and use of sedatives/ soporifics.

Later, Ulrich presented a theory of supportive design for health facilities, based on research, which focused on people coping with stress. He pointed out that to promote wellness, designers need to create environments that help in reducing stress. He summarised:

"As general compass points for designers, scientific research suggests that healthcare environments will support coping with stress and promote wellness if they are designed to foster:
1. Sense of control;
2. Access to social support;
3. Access to positive distractions, and lack of exposure to negative distractions." (Ulrich 1991, page 106)
Research also indicates that social support has positive effects, reducing the risk of physical disorder, aiding the recovery process and providing a buffer against traumatic or stressful experiences. (Dressler, 1991; Whittaker, Garbarino et al., 1983; Vaux, 1988; Blythe 1983).

As the evidence that the environment plays an important role in healing becomes stronger, art also returns as a powerful element in helping patients to heal. And if artworks, besides acting as positive distractions, can give 'clues' of a caring ambience and access to social support, they will become an integral part of a benign environment.

Most designers and health administrators have progressed into a user-focused design. However some have not and there are courtyards that look like prisons, waiting areas that exclude social support and rooms that give no opportunity for a sense of control, still being built.

In England the arts in health movement began taking shape in the early seventies. In 1985 a report focusing on people with disabilities emphasised the need for the arts to be used in heath care situations. This report (Attenborough Committee of Inquiry into the Arts and Disabled People) resulted in the development of the "Arts for Health" organisation. "This report was the landmark of change and focused attention authoritatively on the value of the arts in the healing process. ... The philosophy of Arts for Health is 'that all the arts may effectively complement health care, particularly when patients, staff and the local community participate in the artwork or event'. " ( 1996, Pugh).

HOW DO HEALTH FACILITIES GET THEIR ART?
In designing health facilities, the inclusion of artworks is usually in limbo. It is not in anyone's brief. Moreover, the lack of understanding of the function of artworks can lead to the wrong choice. The most common choice is the low-priced commercial prints/posters. The prints give no identity to the place and because they follow a fashion, they will look good for a season or two. If not well planned, artworks will function as negative distractions, increasing a patient's level of anxiety and discomfort.

The selection of commercial prints by staff excludes the participation of the other users and does not reflect the local culture.

Few hospitals in Australia have commissioned art/cultural planners to design a plan that includes studying the cultural and social aspects of the place as well as the physical. Canberra Hospital in 1992, Liverpool Hospital 1993, the Royal Alexandra Hospital for Children in 1993, Bankstown-Lidcombe Hospital and Braeside Hospital in 1996 are examples of health facilities with such plans. At the moment I am starting the arts planning for the Sydney Children's Hospital.
Designing an arts plan which involves local community and users of the hospital is a process of placemaking. It respects the different functions of the hospital's departments and permits strong collaboration with architects, interior designers, builders and project management. A placemaking process will help develop a sense of ownership and strong links with the community.
Placemaking is the way all of us as human beings transform the places in which we find ourselves into places in which we live. (Schenneekloth and Shirbley 1995)

SOUTH WESTERN SYDNEY AREA HEALTH, COMMITMENT TO QUALITY AND PARTICIPATION IN HEALTH

I have co-ordinated the planning and implementation of two hospitals for the SWSAHS. Liverpool Hospital and Bankstown-Lidcombe Hospital. The two projects have involved users and local communities.

The funding for the projects is part of the redevelopment programs and varies between 0.2 and 0.4 % of the cost of the buildings. In the case of Bankstown-Lidcombe Hospital we were able to fundraise over $60,000 during the first four months of the implementation of the plan. Management support is very important in any art program in health facilities and specially during fundraising. Both hospitals are committed to ongoing arts program since the benefits of the arts have become so clear to all.

LIVERPOOL HOSPITAL, A PEOPLE'S PLACE

Liverpool Hospital has been redeveloped from a 400 bed district hospital to become a 700 bed tertiary and principal teaching hospital of the University of New South Wales. The hospital will, when fully developed, employ approximately 2000 people.

The area's population is of very diverse cultural background with one third of the population born overseas. Liverpool's population is also characterised by high unemployment and low income. Over 20% are under 15 years of age.
In 1993 Liverpool Hospital Redevelopment commissioned an art plan. At that time, working as a consultant for the Arts Council of the ACT, I managed the project which involved staff from all departments and services of the hospital. It also involved the local community. We contacted more than 500 groups and individuals during the consultation.

We collected information about the physical, social and cultural aspects of the hospital through observing physical traces and environmental behaviour, focused interviews and standardised questionnaires. The results were synthesised in the theme "Liverpool, a Living Heritage". Liverpool Hospital Arts Plan was the blueprint for the commissioning of the art for the hospital. The implementation of the plan was done in three Stages.

Stage 1 commissioned works from nine artists and included Pathology Services, Caroline Chisholm Centre for Women and Babies and Paediatric Ward. Stage 2 commissioned seventeen artists to create works for the Brain Injury Centre, Cancer Therapy Centre and Rainbow Cottage (children's physiotherapy centre). Stage 3 commissioned works from thirty five artists for the Aged Care Unit, Mental Health Unit, Clinical Services Building, Rachel and Thomas Moore Education Centre, the Hospital forecourt and the internal courtyard.

Artists' concepts were selected by an Arts Committee made of representatives of the Redevelopment Project, hospital staff, Liverpool City Council and the Arts Program co-ordinator.

Approximately half of the artworks are community art. The groups involved throughout the three stages were:

Arabic Women's Group, Arpilleras - Art to Break Isolation, Cook Islands Women's Group, Croatian Women's Group, 50+Art, Green Valley Community Centre, Green Valley Youth Centre, Hoxton Park Community Health Centre, Indo-China Chinese Association, Khmer Association Women's Group, Latin American Women's Group, Liverpool Bicentennial Museum, Liverpool Hospital CARE Group , Liverpool Girls' High School, Liverpool Migrant Resource, Liverpool Seniors Club, Maltese Women's Group, Ngunnunggula Aboriginal Day Care Group, Palestinian Club Women's Group, Patients and visitors of the Paediatric Ward, Maternity, Aged Care Unit and Mental Health Unit, Reiby Juvenile Justice Centre, Sexual Assault Unit staff and clients, Staff of the Liverpool Hospital, St. Mary's High School, St. Mary's Primary School, Urimbira Aboriginal Co-operative, University of Western Sydney, Vietnamese Women's Group.

From the implementation of Stage 3, a new program was created - the Liverpool Hospital CARE (Cultural and Artistic Enrichment). The program is supported by a group of very active volunteers. At the moment we are working in the development of "Contemporary Entertainment Kits", a project that received grants from the Australia Council and the NSW Ministry for the Arts.

Other projects being presently developed are:
" a collaboration with the Sexual Assault Service in producing interview books for the children who come to the service. The books will be done in collaboration with the children.
" a memento book for families with babies in the Neonatal Unit
It is a challenging work, one that requires a lot of understanding about how a hospital works and an open mind about art possibilities. Works need to take into consideration the patients' view of spaces and the function of these spaces - don't be surprised to see many of the works on the ceiling. Artworks need to observe infection control policies and compete with massive equipment. It is also a challenging work for the artists who need to have empathy with the users of the place. The results pay for the challenges!

References
Blythe, Betty (1983) "Social Support Networks in Health Care and Health Promotion" Social Support Networks in Human Services. New York: Aldine Publishing Company.
Dressler, William (1991) Stress and adaptation in the context of culture Albany: State University of New York Press.
Pugh, Phillip (1997) "The French Connection Art et Sante" Artery 15 Manchester Metropolitan Universitiy
Schneekloth, Lynda and R. Shibley (1995). Placemaking .Montreal: John Wiley & Sons
Ulrich, Roger (1984) "A View through the Window May Influence Recovery from Surgery" Science 224: 420-421
Ulrich, Roger (1991) "Effects of interior design on wellness: theory and recent scientific research" Journal of Health Care Interior Design 3: 97- 109
Vaux, Alan (1988). Social Support -theory, research and intervention. New York: Praeger.
Whittaker,James, J. Garbarino and associates (1983). "Mutual helping in human service practice" Social Support Networks - informal helping in the human services New York: Aldine Publishing Company.

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