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The art of good care – increasing the role of culture in healthcare

Marc Smith
Supervising Editor
Hospital Healthcare Europe

When the director of the UK’s National Network for the Arts  in Health (NNAH) proclaims: “From where I stand, the present is a very bright, sunshiny day,” you could be forgiven for thinking that he was talking about something other than the future role of arts in healthcare. However, there is a growing feeling among commentators in the UK that people are waking up to the idea that the arts have an increasingly important role to play in the nation’s health.

First, there is the statistical evidence: in 2003/4, NHS  trusts in England spent €7 million on art and art projects.  Available figures for 2004/5 show that many trusts increased their spending – the Central Manchester and Manchester Children’s University Hospitals (CMMCUH) NHS Trust, for example, increased its spending from €12,000 to €750,000 in this period.

Secondly, clinical evidence is now pointing to the positive  effect that art, in the broadest sense of the word, is having on patients. Prevalent among this evidence is Dr Rosalia Lelchuk Staricoff’s research project at the Chelsea and Westminster Hospital, London. This three-year study  evaluated the effect of visual and performing arts at the  hospital. Results indicate that the integration of arts:

  • Induces significant differences in clinical outcomes.
  • Reduces the amount of drug consumption.
  • Shortens length of stay in hospital.
  • Improves patient management.
  • Contributes towards increased job satisfaction.
  • Enhances the quality of service.

Thirdly, there are the people at the sharp end who are  creating new and innovative ways for the arts to make an  impact. Brian Chapman, director of Lime, a charity that is  part of CMMCUH NHS Trust and organises its art projects, has been working with arts in hospials for 30 years and believes people are understanding it better now – the evidence, as far as he is concerned, has always been there.

Unfounded criticisms?
One of the major criticisms is that money spent on the arts  would be better spent on doctors, nurses and equipment.  However, this overlooks the fact that the majority of funds  come from charitable donations and do not divert monies away from staff and facilities. Lime’s turnover was €750,000 in 2003/4, of which only €120,000 (or 16%) came from NHS core funding. Moreover, art could turn out to be an investment in the longer term – Lime has used some nationally recognised artists whose contributions could well increase in value in the future. What is more important is that art can change places, attitudes and culture away from the hospital as simply a clinical mechanism – it is a more holistic approach.

One problem for exponents of the arts is that it can be hard to measure the benefits afforded by their introduction. Peter W Mount, chairman of CMMCUH NHS Trust, sums it up as follows: “Although it is hard to measure the actual impact and effects of the arts on the physical and social environment of the hospital, I have witnessed a real sense of connection between people from different communities.”

Clinical evidence
Clinical evidence of the value of art is available. But first, it is important to be clear about what type of art is beneficial. It is not simply a case of hanging up a few paintings in waiting areas and on wards – that, says Brian Chapman, “is just dumping art on people”. People need to be involved in the process so they can feel that it relates to them and their condition. In Lelchuk Staaricoff’s study eight different research areas, including the maternity, trauma and orthopaedics wards, were chosen for analysis. The  maternity ward was selected to explore whether visual art  can induce significant physiological changes. The results  were impressive – duration of labour was reduced by 2.1  hours and epidural requests were also lower. This is  important as the longer the period of labour, the higher the  incidence of complications and the overall levels of stress  and fear.

The psychological and emotional reaction of patients facing  surgery is well known, particularly younger patients who  have not undergone surgery previously. The study  experimented with patients being subjected to visual art or  a live performance during preparation for surgery. The  results were significantly lower blood pressure and heart  rate, which has important repercussions as the amount of  induction agents needed before anaesthesia reduced as a  result.

Postoperatively, the researchers wanted to find out whether the integration of visual arts and live music could have an impact on the consumption of analgesics during the postoperative period and on the length of stay in hospital. Patients were in the presence of visual art from the time of the operation, having paintings on the ceiling and above the door in the anaesthetic room and also on the walls of the ward. The programme also included twice-weekly sessions of live music. Again the results are positive – patients consumed 69mg less analgesic per day, while the length of stay was reduced by one day.

Staff benefits
It is not only patients who can benefit – staff also enjoy  the improved working environment, which aids their  productivity and their sense of wellbeing. Those staff who  become involved in the organising of events are able to  engage in different, nonclinical ways, which help to break  down the barriers between carer and patient. More  importantly for managers, a dedicated arts programme can  dramatically improve recruitment and retention rates in  hospitals. “In Manchester,” reveals Brian Chapman, “we have seen that those hospitals with art programmes are  oversubscribed with healthcare staff wanting to join.” At the Chelsea and Westminster Hospital, 66% of staff surveyed said that the hospital’s architecture, light, colour, visual art and live music “greatly influenced their decision to apply for a job or remain in their current position”. The  arts can, therefore, add value to the hospital. Furthermore,  the addition of art can reduce the damage to hospital  property, which has obvious financial advantages.

Exploring ideas
Brian Chapman freely admits that he is not always sure what type of art works best in a given situation with a specific set of patients: “It can be just an experiment – art is about the exploration of ideas.” The only guidelines he is bound to are those governing the patients’ clinical programme and health and safety – beyond that, he feels free to come up with ideas to improve a patient’s wellbeing and the hospital’s physical environment. These ideas can range from painting and sculpture to short films and sound  installations.

A Breath of Fresh Air is a large-scale artwork that was  commissioned for Wythenshawe Hospital’s Lung Centre Clinic. The artist, Lesley Fallais, wanted to create “a visually stimulating piece, full of meaning for both staff and  patients, that evoked pleasant memories of nature and the  outdoors”. In keeping with Lime’s ethos of participation,  patients, staff and visitors all worked on the piece in  workshops set up by the artist in conjunction with the  clinic’s matron. It now hangs proudly in the waiting room,  where it can be appreciated by all those who worked on it.

Chinese Whispers (Figure 1) is a sound installation and  accompanying photographs by sound artist Andrew Hodson and photgrapher Gerald Davis devised with patients from a mental health unit in Salford. The artist invited patients to a studio to create music and share stories, jokes, songs and poems – all of which were recorded. In association with a local band, all the recordings were interpreted into a sound installation, which comprises 15 speakers randomly  positioned and suspended from a ceiling. The results were  recorded onto CD for the patients to listen to. The  accompanying photographs were taken by a user of the unit and show frank images from the workshops.


The methods may therefore seem unusual for hospitals, which Brian Chapman believes are “fundamentally about science and often a bit conservative”, but the arts are playing an important role in making people better that goes beyond simply fixing their clinical problems.