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Contents                                       Art              in Health Care
 Focus on Health Care Facilities Art
Art in Health Care                             seems to be the consultant’s in-depth
The Healing Power of
                                                                                              Art Car...
The End of “Art for Art’s Sake”
M.D. Anderson Cancer Center at the University of Texas
Medical Center Uses Art ...
artwork is purchased and installed.          notes that this                M.D. Anderson Cancer Center
“We also look to A...
                  Communications / Resources & Assets / Safety & Security / Staff Responsibiliti...
system. These include fire alarms, exit
routes and signage, emergency commu-
nication systems, life support systems,
and s...
Function 5: Utilities                              zation may want to ensure that it has      refueling before they depart...
The End of “Art for Art’s                                             Artwork Draws Praise
Sake” (continued)
Continued fro...
Art in Health Care                          shared anecdotal reports of an increase      all productivity of staff, which ...
budget is generally between $1 and $3
per gross square foot, or 0.5% to 1% of
the total construction budget. Items that
Volume 12, Number 11,
        November 2009

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Environment of Care News Nov 2009


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Environment of Care News Nov 2009

  1. 1. Contents Art in Health Care Focus on Health Care Facilities Art Facilities 1 Art in Health Care Facilities—Designing Sights for Designing Sights for Sore Eyes Sore Eyes 4 CASE STUDY: The End of “Art for Art’s Sake”—M.D. Anderson Cancer Center at the University of Texas Medical Center Uses Art to Help Heal 6 EM’S 6 CRITICAL FUNCTIONS: Function 5: Utilities Management—Avoiding Utilities Failure During a Disaster Healing artwork enlivens new space at Providence Regional Medical Center, Everett, Washington, and is an important part of a design and construction project. patient lies in his hospital bed, This is the world that art can create A trying to ignore the pain that radiates from the tumor that threatens his life. He’s frightened and in health care facilities. A 2002 study1 showed that the interior design features in a hospital have a significant effect on lonely, and as he waits for the caregiver how satisfied patients are with their to administer the pain relief he needs, he hospitalization experience. According to feels isolated from his family and friends. this study, the hospital environment— But across from him is a painting that including the art in patients’ shows a waterfall surrounded by lush rooms—can improve the quality of green plants and a cascade of colorful health care. flowers. Dozens of times each day, his Almost half of all U.S. hospitals eyes travel to that serene scene, and each now have programs for the display and time it brings him a measure of relief. Continued on page 2 Visit the EC News blog at
  2. 2. Art in Health Care seems to be the consultant’s in-depth (continued) experience in health care. Like design- Continued from page 1 ing a hospital itself, designing and pro- use of art in their facilities. In 2003, the ducing a comprehensive health care art Executive Editor: Kristine M. Miller, M.F.A. Senior Project Manager: Christine Wyllie, M.A. Society for the Arts in Healthcare display program is challenging and Associate Director, Editorial Development: Diane Bell (SAH) and the National Endowment complex, especially because many facili- Executive Director: Catherine Chopp Hinckley, Ph.D. Technical Support and Review Provided by for the Arts (NEA)2 analyzed hospitals ties are including evidence-based design Standards Interpretation Group, accredited by The Joint Commission. principles in their projects. Division of Accreditation Operations: Patricia Adamski, R.N., M.S., M.B.A., Director; Their aim was to assess the arts in George Mills, M.B.A., F.A.S.H.E., C.H.F.M., C.E.M., health care. In spite of the costs associ- A History of Healing Senior Engineer; Jerry Gervais, C.H.F.M., C.H.S.P., Associate Director/Engineer; John D. Maurer, ated with art programs, SAH and the According to a white paper titled C.H.F.M., C.H.S.P., Associate Director/Engineer; Michael Chisholm, C.H.F.M., Associate NEA concluded that hospitals use the “A Guide to Evidence-Based Art,” by Director/Engineer arts “to create a more uplifting environ- Kathy Hathorn, M.A., CEO and cre- Division of Standards and Survey Methods: ment” in addition to “create a welcom- ative director, and Upali Nanda, Ph.D., John Fishbeck, R.A., Associate Director Contributing Writers: Catherine Rategan, Kathleen ing atmosphere and build community American Institute of Architects (AIA) Vega relations.”2 vice president and director of research Editorial Advisory Board The majority of health care art pro- at American Art Resources (AAR), “Art Tracy L. Buchman, D.H.A., C.H.S.P., C.H.C.M., University of Wisconsin Hospital and Clinics, Madison, grams dealing with the display of visual is an integral component of human WI art are created and administered by art evolution, both as a species and as a Jen Carlson, M.P.H., M.B.A., Loyola University Health System, Maywood, IL consultants, often hired by either the society.”3 In fact, as early as 1860, in David P. Klein, P.E., Department of Veterans Affairs, facility’s architect or interior designer. her famous Notes for Nursing,4 Florence Washington, DC Michael Kuechenmeister, F.A.S.H.E., C.H.F.M., C.P.E., The hiring process usually involves a Nightingale described the patient’s need West Chester Medical Center, Cincinnati, OH John W. McKinney III, Atrium Medical Center, request for proposals issued by a formal for beauty and made the argument that Middletown, OH art committee. While other characteris- the effect of beauty is not just on the William R. (Bill) Morgan, S.A.S.H.E., C.H.F.M., St. Alphonsus Regional Medical Center, Boise, ID tics can be attractive to hospitals hiring mind but on the body as well. Jim Riggs, M.P.A., C.S.P., University Health Systems, a consultant, the single most important “Because of the profound effect Greenville, NC George A. (Skip) Smith, C.H.F.M., S.A.S.H.E., credential for selecting an art consultant that art can have on healing, it must be Catholic Health Initiatives, Denver, CO Thomas S. (Scott) VanDerhoof, Major, U.S.A.F., M.S.C., selected very carefully in C.A.A.M.A., Air Force Medical Operations Agency, health care settings,” Office of the Surgeon General, Brooks City-Base, TX says Nanda. “Art has a Subscription Information The 2009 12-issue subscription rates for the United strong impact, not just States, Canada, and Mexico are $319 for both print and on patients but also on online and $299 for online only; for the rest of the world, the rates are $410 for both print and online and $299 for caregivers.” She notes online only. Back issues are $25 each (postage paid). Add $25 for air mail delivery. Orders for 20–50 single/back that “today there is a issues receive a 20% discount. Site licenses and multi- shift in practice towards year subscriptions are also available. To begin your subscription, call 800/746-6578, fax orders to evidence-based design; 218/723-9437, or mail orders to Joint Commission in other words, basing Resources, 16442 Collections Center Drive, Chicago, IL 60693. For more information, call 800/746-6578. design decisions on the Environment of Care® News (ISSN 1097-9913) is pub- lished monthly by Joint Commission Resources, 1515 best available evidence West 22nd Street, Suite 1300W, Oak Brook, IL 60523. and committing to © 2009 Joint Commission on Accreditation of research on how design, Healthcare Organizations. No part of this publication may be reproduced or transmitted in any form or by including art, affects any means without written permission. one’s health care experi- Joint Commission Resources, Inc. (JCR), a not-for-profit ence.” affiliate of The Joint Commission, has been designated by The Joint Commission to publish publications and A significant body multimedia products. JCR reproduces and distributes these materials under license from The Joint of evidence on the Commission. impact of art on health E-mail us at with your article ideas. outcomes, especially Visit us on the Web, at with respect to nature To contact the Standards Interpretation Group with standards questions, phone 630/792-5900. images, is already in Artwork at Northwestern Memorial Hospital, Chicago place. Research has 2 Environment of Care News November 2009
  3. 3. The Healing Power of Art Carts Art carts are now a feature of hospital life in many health care facilities. Customarily, a hos- pital employee or a volunteer stacks a rolling cart with various pieces of art and transports the art to the rooms of new patients, where patients are asked to select which art they’d like to have hung on the walls of their rooms. This lets patients interact with a caring person and offers them a sense of control in affecting their own environment. When Upali Nanda and her colleague Kathy Hathorn of American Art Resources con- ducted a study at St. Luke’s Episcopal Hospital in Houston, Texas, in 2006, they found several benefits of using an art cart program. Among them were the following: ■ Pictures become a means for patients to interact with volunteers and thus provide Artwork at Prentice Women’s Hospital, Chicago social support. ■ Having choice in artwork gives patients a sense of control. shown that viewing nature images An Art Preference ■ Patients explore the narrative scope in that contain positively reinforcing fea- Study artwork and make stories around the pic- tures can reduce stress and anxiety In 2006 an art preference tures to discuss with friends and family. among patients and staff and can study5 with inpatients at St. This is true for caregivers as well. lower the patient’s perception of pain. Luke’s Episcopal Hospital in ■ Patients appreciate the service, which Research further suggests that nature Houston, Texas, found that they perceive as a pleasant surprise, and art (or art with views or representa- patients preferred nature they comment positively about the quality tions of nature) will promote restora- scenes and representative of care at the hospital. tion if “it contains the following fea- images to stylized or abstract Volunteers have their own unique meth- tures: calm or slowly moving water, art—even when the latter were ods of approaching patients and selecting art- verdant foliage, flowers, foreground rated as “bestsellers” by online work. This selection is largely sensitive to spatial openness, park-like or savan- art vendors and included clas- patient preferences; however, an orientation nah-like properties (scattered trees, sics by artists such as Van session about the reasons for the art cart pro- grassy undershot), and birds or other Gogh, Klimt, and Chagall. In gram could be helpful. On occasion, patients unthreatening wildlife.” fact, patients made a distinc- have had extreme reactions to a picture they The same research suggests that, tion between pictures they don’t like, such as covering it with a newspa- in addition to nature art, humans are would like to see in their per or a cloth. Mostly, however, they appreci- genetically predisposed to notice and homes and those they wanted ate the artwork and welcome the change and be positively affected by smiling or to see in their inpatient rooms. the choice offered by the art cart. Landscapes, sympathetic human faces. According Not surprisingly, when this nonthreatening animals, and flowers are popu- to Nanda, while these guidelines are survey was conducted with lar with patients and volunteers alike. an excellent starting point for art interior design students, popu- “We found that an art cart program, selection, it is important to avoid a lar art rated higher. Also, there although a relatively small intervention, “one-size-fits-all approach.” Careful was a low correlation between embodies the principles of supportive design,” consideration of the specific patient the students’ emotional says Nanda. “It’s a positive distraction that population and the health care setting response and their aesthetic offers patients a sense of control and a source are warranted before making decisions response (or preference) to of social support.” on health care art. Continued on page 10 November 2009 Environment of Care News 3
  4. 4. CASE STUDY The End of “Art for Art’s Sake” M.D. Anderson Cancer Center at the University of Texas Medical Center Uses Art to Help Heal he M.D. Anderson Cancer Services, and T Center believes in evidence- based art. “To us, that means art that supports the healing environ- among the other members are employees ment and produces an unambiguously from positive experience for both patients Development, and staff,” says Lynn Bouchard, the Facilities center’s senior facilities design plan- Management, ner. But that wasn’t always the case. Institutional First the center had to re-evaluate its Diversity, and approach of “art for art’s sake.” Public Affairs. More than 10 years ago, the cen- “We all agree ter formed an art committee staffed that a broad- with representatives from various dis- based commit- ciplines within M.D. Anderson. The tee representing following year, a working group the breadth of decided that the hospital’s policy of the organization choosing art for its own sake needed is key,” says to be replaced with a broader and Bouchard. more compelling philosophy: Art “This allows us should help improve patient out- to tap into comes. The first tasks of that working those resources group were as follows: to answer ques- 1. Identify characteristics of the kind tions as they of art that contributes to the quali- come up.” ty of the environment The art 2. Develop a policy regarding acquisi- committee tion and display of art drafted an 3. Develop guidelines for selection of eight-page art policy statement 4. Define where the art will be placed and then “The Tree of Life” sculpture at Mays Clinic, M.D. Anderson Cancer engaged an art Center, symbolizes hope. The Art Committee consultant The M.D. Anderson working through a request for proposals tracted art consultant has been group was made up of members who process to advise on which artworks American Art Resources (AAR) in have other jobs in the organization to acquire and where to place them. Houston, Texas, which uses the cen- and for whom the art committee was The committee works closely with the ter’s art policy as a guide in recom- an extracurricular responsibility. For art consultant and reviews art that the mending artwork for acquisition. A instance, the current chairperson is art consultant recommends for acqui- site survey is done of the pieces that the executive director of Volunteer sition. Since 2002, the center’s con- go in, a budget is formulated, and the 4 Environment of Care News November 2009
  5. 5. artwork is purchased and installed. notes that this M.D. Anderson Cancer Center “We also look to AAR for their comment “really Profile expertise in deciding which donations highlighted for the to accept,” says Bouchard. rest of us on the M.D. Anderson is one of the largest cancer centers in the committee the dif- world, with more than 17,000 faculty and staff members Art at Work ferent viewpoints of working in 25 buildings in Houston and central Texas. Much of the artwork M.D. our patients.” The physical plant includes an inpatient pavilion with 507 Anderson has chosen in the past Artwork on beds, 5 research buildings, 3 outpatient clinic buildings, decade graces the walls of the Mays display at M.D. 2 faculty office buildings, a proton radiation clinic build- Clinic, an ambulatory outpatient Anderson must ing, and a patient–family hotel. In addition, the following treatment and research center, which convey a positive facts describe the center: opened in 2005. “Once we completed image and must be ■ 90,000 patients are expected in 2009, one-third of the installation of art in that building familiar and com- them new. and added the right furniture and forting; the media ■ The average number of beds is 510, up 7% over lighting, our consultants were able to range from oils to 2008. begin documenting the premise that acrylics and from ■ There are 956,245 outpatient clinic visits a year for artwork contributes to the healing photos to sculpture. treatments and procedures. environment,” says Bouchard. “When The subjects we completed our post-occupancy include floral work, urban landscapes, work, Bouchard cites “The Tree of evaluation, we learned that our and natural landscapes, and the art- Life,” a massive two-story sculpture approach is achieving the effect we work must have broad-based appeal that conveys a feeling of vitality and want.” in order to serve the hospital’s diverse that many patients and visitors use to Bouchard believes fervently in and wide-ranging patient group. help orient themselves (see the illus- knowing as much as possible about “We’re not just a regional or national tration on page 4). “The sculpture has the populations that the art must sup- cancer center,” Bouchard says. “M.D. become an icon for the clinic itself— port and keeping in mind the Anderson is world-renowned, and an embodiment of our philosophy of thoughts, feelings, and needs of people come here for care and treat- healing and hope,” says Bouchard. patients and staff. As an example, ment from all over the globe. So we Bouchard relates the story of an art stay away from showing only regional Positive Responses committee member who is also a can- scenes.” to Art cer survivor. The committee member Much of the art at M.D. There’s little or no difference in pointed to a Anderson is the kinds of art that are selected to slide in a pres- original, which appeal to patients with different kinds entation, not- enables the of cancer, with the exception of the ing that it consultants to art chosen for pediatric patients. Most showed “a piece meet specific of the artwork on display in the pedi- of fine art, criteria for size, atric diagnosis and treatment areas is something you color, material, done by M.D. Anderson patients might see in a and subject. Is themselves. “We have an outstanding museum.” The a piece of art children’s art program,” says artwork incor- ever moved to a Bouchard. “The children find it high- porated four new location? ly therapeutic to make art, especially views of the “Almost never,” when it shows what they’re going same piece of Artwork at M.D. Anderson Cancer Center says Bouchard. through.” fruit. But by the “Typically once Each day the center experiences last section of we install the the benefits of its artwork in the over- the artwork, the image depicted sim- artwork, it’s there to stay. If the art is whelmingly positive response from ply the core of an apple. “To a cancer taken down for reconstruction or visitors, caregivers, and patients them- patient, that image could signify a redesign, we do find another spot for selves. “Rather than statistical, it’s process of wasting away,” the commit- it.” anecdotal, such as comments that a tee member explained. Bouchard As an example of positive art- Continued on page 9 November 2009 Environment of Care News 5
  6. 6. EM’S 6 CRITICAL FUNCTIONS Communications / Resources & Assets / Safety & Security / Staff Responsibilities / Utilities Management / Patient Clinical & Support Activities FUNCTION 5: Utilities Management Avoiding Utilities Failure During a Disaster his is the fifth of six articles dis- direct cause of emergencies. During some ways, this is the most specific and T cussing the six critical functions of emergency management: com- munication, resources and assets, safety normal business operations, utility sys- tems run unnoticed, but if a utility sys- tem fails, its absence is apparent to all straightforward of the emergency man- agement standards,” says Gervais. “An organization must establish ahead of and security, staff responsibilities, utilities and may cause a significant disruption time how it is going to maintain criti- management, and patient clinical and in patient care. “In order to prevent cal utilities during an emergency and support activities. For the previous arti- such situations from spiraling out of ensure that those backup systems will cles, see the January, March, June, and control, an organization must pro- function when the time comes.” August issues of EC News. actively address how it is going to pro- Although the standard is straightfor- A disaster is bad enough, and if vide utility systems during an emer- ward, complying with the standard your hospital’s utilities fail during that gency and continue the level of opera- involves some careful consideration and crisis, things go from bad to worse. tions that everyone takes for granted,” due diligence. The following sections During an emergency, a failure of your says Jerry Gervais, C.H.S.P., C.H.F.M., take a closer look at the utilities cov- organization’s utilities can escalate a sit- associate director, Standards ered within the standard and provide uation and move it from a small, con- Interpretation Group, The Joint suggestions on how to comply with its trollable event to a large, multifaceted Commission. requirements. disaster. For example, if a hurricane The Joint Commission addresses descends on a hospital during a steamy the topic of preserving utilities during Electricity (EM.02.02.09, week in August, the storm itself may an emergency in Standard EP 2) not represent a catastrophic event. But EM.02.02.09. This standard and its “The electrical systems are to an if the storm knocks out power and seven elements of performance (EPs) organization what the central nervous shuts down the air-conditioning system walk the organization through the dif- system is to the human body,” says for five days, the emergency can ferent utilities that must be maintained Gervais. “And as with the human body, increase in both size and scope. during an emergency and require an a failure in such systems can have far- Utility failures can not only com- organization to anticipate and prepare reaching consequences.” Most, if not plicate emergencies, they can be the for failures involving these utilities. “In all, health care organizations have an emergency electrical power system in place that will turn on in the event of a power failure. Often, this power system consists of one or more diesel-powered generators or something similar. “The key element to meeting this require- ment is not that you have an emer- gency electrical power system—because most organizations do. Instead, focus on what equipment and systems are powered by the emergency power sys- tem and whether all the appropriate systems are covered,” says Gervais. The Joint Commission requires that certain systems and equipment be Utility failures can easily escalate an already dangerous situation. powered by the emergency power 6 Environment of Care News November 2009
  7. 7. system. These include fire alarms, exit routes and signage, emergency commu- nication systems, life support systems, and so on. (A complete list of what The Joint Commission requires can be found in Standard EC.02.05.03.) “Although meeting these requirements is important, they only scratch the sur- face of what an organization should be covering with its emergency backup power systems,” says Gervais. “For example, covering heating, cooling, and air-conditioning (HVAC) systems via emergency backup power is not Make sure you have enough clean water for emergency use. required by the standards. However, if a prolonged power failure occurs dur- “Typically, when normal power is inter- fines of the requirements; instead, you ing extremely hot or cold temperatures, rupted, there is up to a 10-second lag should look at how your organization your organization is going to have a before emergency power kicks in,” says will operate during an emergency and real problem if the HVAC system is Gervais. “This may not seem like a ensure that you have enough elevators offline. Not only could everyone’s com- long time, but it’s enough to bring available and functioning.” fort be affected, but so could the orga- down an entire computer system. Different organizations have differ- nization’s ability to maintain the Depending on what the system is being ent emergency backup power needs, so patient isolation that relies on con- used for, your organization may want it is important to determine what your trolled air flow. If an organization can- to overcome the 10-second delay by needs are and verify that your backup not maintain patient isolation, the keeping computer systems on battery power is covering all systems relevant dynamics of an emergency can get power.” During normal business opera- to your organization’s performance. To more complex, and the ability to tions, the battery would be continuous- determine what should be covered respond to the emergency can become ly charged by regular power, and dur- under emergency power, the Joint more limited.” Of ing emergencies, Commission recommends that an course, the HVAC the battery would organization conduct a gap analysis. system requires a sig- “During an emergency, be charged by Such an exercise allows an organiza- nificant amount of a failure of your emergency back- tion’s leaders to examine which systems power, so organiza- organization’s utilities up power. and equipment are currently covered tions will need to can escalate a Another by emergency power and which sys- think carefully about system that an tems should be covered by that power situation and move it how much of the organization but are not. Depending on the results from a small, system they want to should consider of the gap analysis, your organization place on emergency controllable event to a including on may have to reevaluate its emergency power and how to large, multifaceted emergency back- power system and add more capacity. reduce the amount disaster.” up power is the (See the Joint Commission’s Sentinel of energy the system vertical trans- Event Alert #37, at http://www.joint uses. portation system. The Joint Commission does not “Although Standard EC.02.05.03 SentinelEventAlert/sea_37.htm, for require computer systems to be covered requires an organization to have one more information on gap analysis.) under emergency power, but if your elevator on emergency backup power; organization uses an electronic medical if you are working in a large hospital Water (EM.02.02.09, record, placing that system on emer- and plan to continue providing patient EPs 3 and 4) gency power is important. In some care during a power outage, you will Water is a critical resource for every cases, an organization may want to need more than one elevator working,” health care organization, and every connect its computer systems to an says Gervais. “In this situation, it is not organization uses two types of water: uninterruptible power source. realistic to work just within the con- Continued on page 8 November 2009 Environment of Care News 7
  8. 8. Function 5: Utilities zation may want to ensure that it has refueling before they depart. Management (continued) access to steam during an emergency. Consequently, organizations must have Continued from page 7 Many organizations use steam to steril- enough fuel to address the potential 1. Potable water—that which is fit for ize medical equipment and supplies, needs of their suppliers. drinking or use in health care wash dishes, and prepare food. If steam There are two ways to make sure procedures. is not available during an emergency or there is adequate fuel during an emer- 2. Nonpotable water—that which is if the quality of the steam is compro- gency. One is to stockpile fuel at the used within the organization’s clean- mised, the safety of patients and the facility, although this is not very practi- ing systems, boilers, bathrooms, and environment can be negatively affected. cal. The other is to make arrangements so on. with a local supplier—such as a nearby “Organizations often focus on Fuel (EM.02.02.09, EP 5) gas station. “It’s important to remem- ensuring that there will be enough The requirements related to emer- ber that gas stations often don’t have potable water during an emergency. gency management have always focused emergency power generators and thus This is very important, but it’s also on ensuring enough fuel to operate will not be able to operate their fuel critical to ensure that there’s enough emergency backup power and other pumps during a power outage,” says nonpotable water,” says Gervais. “In building systems during an emergency. Gervais. “Because of this, your organi- fact, to function effectively during an Recently, however, the Joint zation may find itself in the difficult emergency, an organization will proba- Commission added requirements position of being near a fuel source but bly need more nonpotable water than regarding another aspect of fuel man- not able to access it.” To overcome this potable water.” Nonpotable water is agement: transportation services. “If problem, your organization should necessary to flush toilets, operate the your organization remains open during work with the gas station to determine boiler, and perform other critical activi- an emergency, you will need fuel to how you can obtain gasoline during a ties. Not having enough nonpotable operate any vehicles you use as part of power outage. This may involve sup- water can quickly lead to sanitary operations—such as ambulances and plying the gas station with a generator issues, heating and cooling issues, and other transportation vehicles,” says during emergency situations. “When other problems. Gervais. “This is particularly important seeking fuel sources, it is not enough to To be adequately prepared for any during an evacuation situation, when sign a memorandum of understanding emergency, an organization should seek you want to ensure that you have (MOU) and forget about it. Your emergency sources of both potable and enough fuel to operate the vehicles that organization must probe into how the nonpotable water. As with other sup- will transport your patients off site.” supplier can get fuel and take owner- pliers, your organization should ensure In addition to operating your own ship of investigating that capability,” that water suppliers can access your transportation vehicles, suppliers com- says Gervais. organization during an emergency and ing to the facility during an emergency provide sufficient supplies. may have only enough fuel to get to Medical Gas and In addition to water, your organi- the organization and may require Vacuum Systems (EM.02.02.09, EP 6) As with the other utilities dis- cussed in this article, organizations must make sure there is access to med- ical gas and vacuum systems during an emergency. Per Standard EC.02.05.03, such systems must be connected to emergency backup power. Although the backup power will allow the med- ical gas and vacuum systems to keep functioning during an emergency, these systems are known to malfunction and break down. “In order for your organi- zation to be confident that medical gas and vacuum systems will continue to You’ll need fuel if you have to transport patients off site. Continued on page 9 8 Environment of Care News November 2009
  9. 9. The End of “Art for Art’s Artwork Draws Praise Sake” (continued) Continued from page 5 The response to M.D. Anderson Cancer Center’s artwork has been overwhelm- patient or nurse would share,” says ingly positive. The following are just a few of the comments that Lynn Bouchard Bouchard. Some of the comments are at M.D. Anderson received via American Art Resources: shown in the box “Artwork Draws ■ “The artwork lifts your mood when you get into the lobby after fighting the Praise,” on page 9. The center has commissioned some traffic. Art reminds me that there is a future. Sometimes you get bogged down pieces for use in highly visible areas, by the details of your situation—and then you look at the art. I think it’s and an attempt is made to use at least stunning.” one piece of art in every exam room, —Breast imaging patient where posters are sometimes used, espe- cially if they have high impact. The art ■ “The artwork takes you away from the pain and your mind off the treatments committee is responsible for placing art and puts a smile on your face.” not just in the Mays Clinic but —Outpatient MRI patient throughout the hospital, except in the back of the house and in the staff areas, ■ “The art demonstrates what M.D. where staff members can bring in their Anderson is about: patient care to the own art. “We’re quite careful about maximum, and a continuing search where we place the art and where we for a cure for the disease.” spend our dollars. We keep in the fore- —Nursing staff member front of our minds the need to be good stewards of the institution’s assets.” ■ “The artwork is the main reason why A favorite image is bluebonnets, a the Mays Clinic doesn’t feel like a flower that’s indigenous to Texas. “If hospital. Whenever friends or family someone asks where to find art similar visit me, I make a point of having to that, we refer them to the art con- them tour the artwork in this building.” Artwork at M.D. Anderson Cancer sultant,” says Bouchard. Artwork is dis- —Patient services staff member Center played without labels or plaques show- ing the names of the artists. But requests sometimes come from patients artists so they can acquire some of the will provide the names of artists,” says and/or visitors for the names of certain artists’ work. “In those instances, we Bouchard. EC NEWS Function 5: Utilities Taking a Proactive unpleasant surprises during emer- Management (continued) Approach to Utilities gency situations.” Continued from page 8 Management Advance planning not only helps operate during emergency situations, As previously mentioned, avoid surprises, it also allows an your organization should have a supply compliance with this standard organization to make effective deci- of parts on hand to fix the equipment requires organizations to carefully sions about evacuation. “Utility sys- if it breaks,” says Gervais. “Obtaining examine what utility systems they will tems can be a driver in determining parts during an emergency is nearly need during an emergency and deter- whether an organization can stay in impossible, so it would be beneficial mine how they will provide those its facility during an emergency or for your organization to identify critical systems. “Many health care organiza- needs to evacuate,” says Gervais. “If parts and ensure that you stockpile tions have not done a complete analy- the organization has done some good those before an emergency occurs. This sis of which utility systems they will advance planning, organization is not only true for medical gas and need during an emergency, particular- leaders can make well-thought-out vacuum systems but also for any utility ly during a protracted one,” says decisions about evacuation and ensure systems that need to continue func- Gervais. “Without such planning, the best possible care for their tioning during a disaster.” organizations may be in for some patients.” EC NEWS November 2009 Environment of Care News 9
  10. 10. Art in Health Care shared anecdotal reports of an increase all productivity of staff, which in turn (continued) in aggressive behavior in a psychiatric translate directly into cost savings. Continued from page 3 ward in response to abstract art pieces. A post-occupancy evaluation of an different pictures, whereas for patients More research is warranted before the evidence-based art program at M.D. these two were highly correlated. This final word is given on abstract art, Anderson Cancer Center in Houston, indicates that designers may prioritize including considerations of elements Texas, showed that the artwork con- aesthetics at the cost of the emotional such as color, composition, forms, and tributed to the patients’ perception of well-being of patients and reinforces the so on. However, designers must be cau- the overall quality of care, which in turn importance of rigorous research to tious about selecting art for hospitals has significant financial ramifications. inform decisions on art selection for based on personal preference or pure hospitals. aesthetic merit. Nanda reminds us of Selecting and Nanda states that the maxim “first, the major differences in the emotional Placing Art do no harm” holds true for art selection states of someone visiting a museum To maximize the impact of art, in health care environments because of versus a patient anxiously awaiting a designers and art consultants must the vulnerability of patients and care- procedure or recovering from an ail- select and place it carefully. The follow- givers. Research by Roger Ulric et al.6 ment or a hardworking caregiver who ing aspects of art discussed in the white showed that viewing abstract art with deals with life and death each day. paper by Hathorn and Nanda are angular forms worsened outcomes in Nanda believes that, in the current important in healing environments3: intensive care unit patients recovering economic environment, a strong busi- ■ The location of artwork. Locate the from surgery. In a recent study with ness case can be made for an evidence- artwork where it will be the most psychiatric patients, Nanda and her col- based approach to art. A landmark effective in enhancing the physical league Sarajane Eisen, M.D.,7 found study by Ulrich in 19849 showed that environment and developing a heal- that on days that an abstract art piece merely viewing nature from the window ing atmosphere. by a renowned artist was displayed on significantly reduced the length of stay ■ The patient’s sightlines. Consider the walls, there was an increase in the of patients. The reduction in PRN the patient’s sightlines when placing PRN medication requested, as com- medication previously mentioned also art in hospital rooms. For example, pared to days when a realistic nature has a financial implication. Reduced mammography is done one side at a image following the guidelines was dis- patient anxiety and stress affect the time time, and patients are repositioned played. A previous study by Ulrich8 and success of procedures and the over- accordingly. This creates limitations in the lines of sight. Two different works of art should be displayed, one for each line of view. ■ The needs of special patient popu- lations. Evaluate the unique needs of the kind of patients who will view the artwork. For example, art for pediatrics may differ from art for pal- liative care. ■ The role of demographics in the healing environment. Consider the ethnic, gender, and age makeup of the health care population in a given location and choose art accordingly. The Art Budget Realistically, a budget for art should be a line item in the construction budg- et. In the past, hospitals could rely on funds from operating budgets or from donations, but not today. Hathorn and Artwork at St Luke’s Community Medical Center, The Woodlands, Texas Nanda’s rule of thumb for an adequate 10 Environment of Care News November 2009
  11. 11. budget is generally between $1 and $3 per gross square foot, or 0.5% to 1% of the total construction budget. Items that are typically covered in an art budget include art, framing and display, instal- lation, specialty lighting, plaques, asset management tools, and consulting fees. “It’s important to create a hierarchy early in the program development process in order to set and maintain pri- orities for art in the facility,” says Hathorn. “This hierarchy should include all art locations and quantities and the medium or media considered appropriate for each area of the facility.” Forming an Art Committee According to Hathorn, an art com- mittee should be formed early in the design and construction process so that the organization can bring an art con- sultant on board. This allows an art program to be coordinated seamlessly with the architecture and interior design and enables it to focus on factors such as art placement, art in architec- ture, lighting, structural needs, wayfind- ing, and so on. The art committee and the art consultant are also responsible for fostering good will, creating positive Artwork at Sacred Heart Medical Center at RiverBend, Eugene, Oregon public relations throughout the com- munity, and capitalizing on fund-raising Undertaking an art survey to compare patient opportunities. Hathorn, M.A., and Upali Nanda, Ph.D., a versus student art preferences. Environment and A group of 5 to 10 people allows source document for this article, can be found at Behavior, 40(2):269–301, 2008. 6. Ulrich R.S., Lundén O., Eltinge J.L.: Effects of for fair representation of a cross-section Exposure to Nature and Abstract Pictures on of the entire facility. The most effec- documents/Hathorn_Nanda_Mar08_001.pdf . Patients Recovering from Heart Surgery. Paper tive committees include members presented at the Thirty-Third Meetings of the Society for Psychophysiological Research, from a number of hospital depart- References Rottach-Egern, Germany . Abstract published in ments, along with representatives 1. Harris P.B., McBride G., Ross C., Curtis L.: A Psychophysiology 30(1):7, 1993. place to heal: Environmental sources of satisfac- 7. Eisen S.J., Nanda U.: Effect of Art on from the community. tion among hospital patients. Journal of Applied Psychiatric Patients. Paper presented at the Under the guidance of a knowl- Social Psychology 32:1276–1299, Jun. 2002. Society of Arts in Healthcare, Buffalo, Apr. edgeable and experienced art consultant 2. Wikoff N.: Cultures of Care: A Study of Arts 22–25, 2009. Programs in U.S. Hospitals. Washington, DC: 8. Effects of Hospital Environments on Patient Well- and a dedicated and inspired art com- Americans for the Arts, 2004. being. Research report from the Department of mittee, evidence-based visual art can 3. Hathorn K., Nanda U.: A Guide to Evidence- Psychiatry and Behavioral Medicine, University Based Art, 2008. of Trodheim, Norway, 9(55):1–13, 1986 . enhance the beauty of the healing envi- advocacy/adgroups/documents/Hathorn_ 9. Ulrich R.: View through a window may influ- ronment as it positively affects the well- Nanda_Mar08_001.pdf. ence recovery from surgery. Science being of patients and staff. EC NEWS 4. Nightingale F.: Notes on Nursing: What It Is, and 224:420–421, Apr. 27, 1984. What It Is Not, 1860. http://digital.library 10.Nanda U.: Laguna Honda Art Survey: Research Report. Paper presented at the Society of Arts in Editor’s Note: The full text of the white paper “A nursing.html. Health Care, 2008 . Guide to Evidence-Based Art” by Kathy 5. Nanda U., Eisen S., Baladandayuthapani V.: November 2009 Environment of Care News 11
  12. 12. Volume 12, Number 11, November 2009 Send address corrections to: Environment of Care News Superior Fulfillment 131 W. First St. Duluth, MN 55802-2065 800/746-6578 W ! Meeting The Joint Commission’s NE 2010 National Patient Safety Goals Understand how to meet the Joint Commission’s 2010 National Patient Safety Goals with these valuable articles, book excerpts, useful tips, and suggestions. This new book includes the complete text of the 2010 National Patient Safety Goals, as well as detailed information on topics such as the following: • Improving the timely reporting of critical test results and values • Improving the accuracy of patient identification • Improving the safety of using high-alert medications • Reducing the risk of patient harm resulting from falls • Preventing health care–associated pressure ulcers • Using the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery™ Item Number: MNPSG10 Price: $65.00 For more information, or to order this publication, please visit our Web site, at, or call our toll-free Customer Service Center, at 877/223-6866. Our Customer Service Center is open from 8 A.M. to 8 P.M. ET, Monday through Friday.