Arts in Healthcare Recovering Art
With special focus on the Harefield Hospital, Graham Cooper explores the therapeutic qualities of interactive art creations in the healthcare environment HD November 2006.
It is widely accepted that hospital patients are likely to recover more quickly when they are exposed to views of the natural landscape. Yet, as it is unlikely that existing accommodation will occupy a suitably idyllic location, the challenge for designers is to transform the typically drab clinical backdrop into a bright and stimulating environment.
And rather than leave the patient as a passive observer, there is a strong case to let them immerse themselves, both physically and emotionally, in outdoor life. Such an approach may help patients to not only sooth their minds but provide an outlet for their own forms of imagery. An increasing number of artistic interventions are now offering creative, nature-inspired installations to enhance the ambience and experience of the healthcare setting.
With the aim of increasing patient emotional comfort prior to major heart surgery, one such interactive installation was unveiled at Harefield Hospital, Middlesex, in September this year. Commissioned by Royal Brompton & Harefield NHS Trust's charitable arts organisation, rb&hArts, the work was carried out by design consultancy AllofUs, after in-depth consultation with the hospital's patients and staff.
Distraction and interaction
In the theatre waiting space the company has introduced an interior solution that softly screens the mass of equipment. Curved wooden relief forms have been added, with integrated lighting flowing along the dado. But the dominant feature of the space is a digital projector that casts a woodland simulation on the wall. The patient is greeted with cartoon illustrations of natural phenomena, including rippling water, birds and butterflies, light and shadows, according to the specific time of day. Soothing surround-sound recordings of wildlife and birds singing combine with the visuals to enhance the sensation of calm.
Introducing a further level of engagement, the patient is invited to interface with the imagery by using a simple remote-control handset. Via the added use of a computer mouse, the patient is able to drag a curser across the picture plane and, for example, redirect a line of paddling ducks, or gently disturb the pond water. If the patient chooses not to intervene in this way, the animation returns to the idle mode default setting, in a similar way to a screen-saving device. According to AllofUs director, Mickey Stretton, the overall effect is not only to distract patients - in the same way a landscape can captivate a person gazing out of a window - but it affords the patient the ability to interact with that landscape and the activities taking place within the scene.
Central to the planning of the design work, theatre staff and two long-term transplant patients were consulted to find out what they felt would work. As the final point before a patient goes in for high-risk, life-saving surgery, the theatre waiting space almost inevitably induces a heightened feeling of stress among patients. As a means to counter this sensation, one of the ex-patients suggested the idea of optical illusions as a visual game the user could play.
"Rather than leave the patient as a passive observer, there is a strong case to let them immerse themselves, both physically and emotionally, in outdoor life"
Building on this theme, Stretton explored some of the current thinking in hospital design and was inspired by a written passage on gardens in healthcare environments, which he found in Professor Roger Ulrich's Royal Science Society lecture1. Taking this as a basis, AllofUs undertook more thorough investigation with patients and staff, presenting video-loops based on natural motifs, to assess which type of scene would be most suitable for the situation. To recreate the solution as close as possible, the footage was projected in situ onto the selected surface to determine the level of lighting and image size. As a result of its own trials, AllofUs identified the most favourably received clips. The resulting scenes depicted are: blooming flowers (bluebells were most popular); shifting light and colour of a sunrise; and a panoramic view punctuated by foliage in the foreground. On top of being well-considered in aesthetic and emotional terms, the redeveloped waiting area is also low-maintenance, adhering to strict hygiene guidelines.
Victoria Hume, manager of rb&hArts, believes the designers have created a meaningful distraction to occupy the minds of patients during a very stressful time. Originally, the hospital's operating theatre manager, Jackie Burbidge, had contacted Hume to request some static artwork. But conscious of the limited effect individual pictures might have in the area, she was inspired to explore site-specific solutions, making use of media communications technology.
She considers interactive design to be appropriate for two reasons: firstly, interaction returns a sense of control to the patient who is otherwise disempowered; and secondly, interaction makes for more effective 'distraction therapy'. Planning to conduct an evaluation study of its own, rb&hArts hopes this will produce similar results to those noted in recent research into arts in health2, such as lower anxiety, fewer analgesics and faster recovery times.
For immediate visual impact, kinetic installations need to be in constant working order. In addition, the incorporation of advances in technology dictates that a degree of obsolescence should be built into the project. Traditionally, it is relatively rare for artists to enter the clinical domain, so a great deal of sensitivity is required when invading the personal space of the patient, especially in such serious circumstances. To reduce potential conflict, personal preferences and choice should be introduced.
It is hoped that the use of interactive design at Harefield will aid the understanding and reinterpretation of healthcare scenery. Interactive design may still be in its infancy, but this project's success in generating support, enthusiasm and a sense of ownership from the hospital staff - a factor stressed by Burbidge - suggests there are many positives that can be learnt from it.
The final word goes to the hospital's senior operating practitioner anesthetist, Paul Dimmer, who points to patients exhibiting a new sense of calm prior to entering surgery. Formally associated with despair, the pre-operation area now exudes an air of confidence in the service and a brief therapeutic stay within the interactive space appears to have been adopted into the surgery schedule.
1 'The effect of healthcare architecture and art on medical outcomes', a Royal Science Society lecture by Roger Ulrich, June 2003. "There is limited evidence that garden views ameliorate stress effectively if they contain at least some of the following: verdant foliage, flowers, non-turbulent water features, a modicum of spatial openness, grassy spaces with scattered trees, compatible or harmonious nature sounds (birds, water, breezes), and visible wildlife (birds, squirrels). In other words, qualities similar to those found in many traditional English gardens often are successful in calming and distracting patients."
2 'A study of the effects of visual and performing arts in healthcare', Staricoff, Duncan & Wright, 1999-2003, in a chapter entitled 'Day surgery unit & trauma and orthopaedic ward'. This is available on the Chelsea and Westminster Hospital website www.chelwest.nhs.uk
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