A study of the effects of the visual and performing arts in healthcare

Hospital Development, Jun 2001 by Staricoff, Rosalia Lelchuk, Duncan, Jane, Wright, Melissa, Loppert, Susan, Scott, James

Chelsea and Westminster Hospital Arts, entirely funded by private donations, works within Chelsea and Westminster Healthcare NHS Trust. It provides all the visual arts and live performances in public areas and wards. This integration of the arts in a hospital environment raises the fundamental question whether visual arts and live music can play a meaningful role in healthcare. This has now been addessed by a three-year research project. The results of the first year's research, which evaluates the responses of patients, staff and visitors to the effects of the arts in healthcare, are reported exclusively here.

Art has been placed in hospitals as early as the 14th century.1 For decades the concept of the arts in hospitals remained marginal; in the 1980s, however, views began to change.2 Chelsea and Westminster Hospital, London's newest NHS teaching hospital, was one of the first to commission works of arts at drawing-board stage to complement innovative architectural design.3 Chelsea and Westminster Hospital Arts, entirely funded by private donations, has been working within the hospital since its opening in 1993, providing all the visual arts, as well as weekly live performances in public areas and wards. It has staged the world's first hospital music festivals, the first operas in a hospital and in 1996 was one of six finalists for the National Art Collections Fund Prize, cited for "its innovative and imaginative approach to hospital healthcare which enhances the experience of patients, staff and visitors". The integration of the arts into a healthcare environment raises the fundamental question of whether visual art and live music can play a meaningful role in healthcare. The unique activities of Chelsea and Westminster Hospital Arts - with the emphasis on bold, challenging works of art and on high quality live music - prompted the need for a scientific evaluation to support the wealth of anecdotal evidence on the successful use of the arts in healthcare; and to address this question a three-year research project was set up in 1999 at the hospital.

We report in this paper the results of the first year evaluation of the responses of patients, staff and visitors to the effects of visual and performing arts as part of the healthcare environment. A specially-designed evaluation form was implemented to analyse these responses, to determine the level of interest and appreciation and the value assigned to the role of the arts and the work of Hospital Arts by the three identified populations. It was particularly interesting to compare the effects of the arts on the three groups since their views and expectations are clearly different when attending hospital compared with their usual environments.

In the second and third years the study will address the effects of the integration of arts into healthcare by measuring physiological and biological changes of clinical significance and their effect on parameters of outcome after treatment. Different groups of patients will be investigated, such as patients after surgical procedures. Outcomes after surgery will include length of stay, time of wound-healing and postoperative analgesia requirements.

Outcomes in obstetrics will refer to duration of labour, pain management and level of blood pressure in high risk antenatal patients. Outcomes in patients receiving chemotherapy treatment will include levels of anxiety and depression. Finally, this study will investigate the effect of the arts programme on other aspects of healthcare such as the ability to recruit and retain staff.

METHODOLOGY

The evaluation form was designed to assess the responses of three separate groups patients, staff and visitors - to: a) visual art; b) performing arts; c) the general environment and d) the value of the work of Chelsea and Westminster Hospital Arts and the role of the arts in the healing process. The study lasted from April 1999 to April 2000, covering the annual programme of Hospital Arts and sampling a cross-section of each population.

Evaluation forms were distributed to patients, staff and visitors in public areas and wards where works of art are permanently displayed and during live performances. The three populations co-operated willingly, in confidence and with anonymity, in completing the questionnaire? which had previously been approved by the hospital's Ethics Committee.

Each person was invited to score each question on a scale of ascending values: 1 to 10, low scores considered to have very low effect or none, and high scores - 7 or more to show a positive or very positive response. The collected data was entered in a specially designed database.

Statistical methods

For questions scored on a scale of 1 to 10, data are described using box and whisker plots. The box ends correspond to the interquartile range and the median marked inside. The whiskers represent the range of the data, unless there are individually plotted points, which represent points that lie beyond 1.5 times the inter-quartile range and therefore can be regarded as possible outtiers. The figures on top of the boxes correspond to the number of people who have answered that particular question.