PASW Regional Newsletters: Autumn 2003
Regional Network Meeting Report
APPROPRIATENESS OF DESIGN - how artists can engage with the Healing Environment, Gloucester 1 May 2003
Maggie Bolt opened the meeting by welcoming everyone to Gloucester. She went on to identify the context for the day: the quality of our public buildings being under a great deal of scrutiny, the «Better Public Buildings' initiative and identification of «Champions for good design', the work of CABE and the NHS's current capital programme. Within such a context the purpose of the day, she said, was very timely ¾ to explore how artists can be integrated within the design process and how they construct appropriate solutions which help healing environments. Maggie mentioned the NHS Estates publication «Improving the patient experience - The Art of Good Health', saying this was an excellent resource for further information on the subject. She finished by introducing the meeting's speakers and then handed over to the meeting's chair, Andrew Kelly.
Andrew Kelly welcomed all to the meeting and then introduced the first speaker, Jane Willis. Jane started by saying that they were at the very beginning of a process, with no artwork having as yet been commissioned. She introduced her organisation Willis Newson. The PFI build in Gloucester , she explained, was a new development on an existing hospital site and as a development, offered huge opportunities for the arts. Whilst there was an acknowledgment that the arts should be involved in the development, there was no sense of how this could or should happen, hence a need for an arts strategy was identified. Lead Artist, Simon Ryder was appointed to work with Willis Newson on the strategy supported by PASW. There was only a time slot of four months to research, write and present, with approval then taking two months. The approval took longer than originally anticipated because of the funding commitments that were required.
Jane then offered the meeting some thoughts prepared by Simon Ryder, who unfortunately had been unable to join her for the presentation, on his experience / reflections of working on the project,"What is significantly different with the hospital context is the role of challenge in the artwork. In the other locations in which I have worked, challenging expectations and perceptions is expected, as part of the critical discourse underlying the work. This challenge is passed directly onto the viewer. But within the healing environment the critical discourse needs to be carried on in a different way. Here, challenge (in many forms, including life-threatening ones) is in the environment. So artwork made for here has to find new ground in which to function".
Jane ran through some of the highlights of the Strategy; the proposed landmark pieces, welcoming pieces, smaller works, and work that was child specific without being childish. She talked about the difficulty of being able to visualise space and therefore the need for virtual drawings of the building to be supplied by the architects. In order to open up debate amongst the hospital staff about the role of artists in the hospital a residency programme had been devised. Gallery spaces for displaying work that had been produced within the hospital was also important as was encouraging peoples' involvement in the life of the art programme once it was up and running through a website that would document and review the work delivered. Jane finished with three reflections:
• As the strategy had only just been developed the real test would be to make it happen through partnership working.
• The timing of the strategy had forced compromises in relation to a gestation process and consultation process.
• Because the building was moving ahead at a fast pace a lot of creative ideas had had to be tempered.
Andrew thanked Jane for her presentation and asked the audience for any questions or comments. The issue of more integrated works was raised. Jane said that whilst more integrated works would have been preferable, it was still possible to make a difference to the environment with less integrated works. Another comment focused on the importance in recognising that the childrens' unit involved very different age groups from young children to adolescents and that the differing needs of these age groups needed to be catered for.
Andrew then welcomed Susan Francis to the meeting. Susan started by talking about the link of an environment to the healing process and the need, therefore, to understand and define what makes a quality environment. The evidence of the link was, she said:
• scientific, with studies that linked patient outcomes to their environment.
• social, with for example, studies linking the impact of environment on staff morale.
With there being a big push to modernise healthcare and create more patient centred care, the quality of design is a big issue on the agenda including what we mean by design quality and creating indicators, the need to modernise the construction process, and consideration of sustainability. In response to these factors, NHS Estates has established Design Quality Indicators. Susan went on to say that it was within the area of therapeutic impact, what a building gives in terms of a civic presence, that art and design really have a role to play.
Susan showed a number of images of work commissioned for hospital environments that exemplified good practice. These images illustrated a number of issues:
• first impressions of entering a building and how evidence shows that peoples' behaviour once in an environment very often relates to how they feel as they enter the building.
• the importance of recognising the wider context of the hospital ie. where it is, who works there.
• orientation within a building.
• different qualities of space within a building; public space, social space and private space.
• how integrating art can stimulate the senses.
• how art can alter the human scale of a building.
• the need for innovative work that is controversial not challenging.
All of this work has to sit, Susan said, within available resources. But it is important to recognise that the money we spend on capital costs is relatively low compared to the ongoing running costs of a building and yet the impact of the design is enormous. Therefore there is a real business case for good design because it is about quality of life and about investing to save. Susan said that there was a great opportunity for the design process to be a catalyst for change and whilst it does require resources and dialogue, it is possible. She concluded by proposing the following:-
Design : a catalyst for change
People : design champions
Process : design reviews
Place : design exemplars
Andrew thanked Susan for her presentation and opened the meeting up for questions and comments. A comment about space and territory and being able to make more efficient use of space was made. The issue of shared vocabulary between architects and artists was raised which led to the comment that most architecture students' course work does not include consideration of healthcare buildings. The need for custodians of quality environments was highlighted in relation to ensuring work created was sustainable in terms of maintenance. There was a general feeling that there was a need for more hard evidence to support this research and that those limited amounts of evidence (*) that did exist should be brought together.
Andrew then introduced Dr David Reilly and Jane Kelly. David started by saying that he felt that the two things that were important in determining the outcome of a project were the intentionality and quality of vision. Hospitals, he said, as we all know, were not right and therefore a large part of our work must be about dreaming, about determining what we do want, and having an energy and defensiveness that enables us to make sure that we do not let the same old mistakes be repeated in terms of hospital design. The yard stick must be «does it or does it not enable the healing process'.
Jane and the design team were asked to make the building the art. They were not looking for add ons and they certainly wanted to avoid the personal trips of artists who used their work to vent their angst. Recent scientific research (**) demonstrates that an individual's state of mind has a notable effect on the healing process, and therefore the role of the creative process, rather than simply the product, clearly has an impact in terms of the healing sequence.
David finished by outlining the recruitment method for appointing Jane and how her presence took on a transformative role.
Jane Kelly started by talking about the seven contracts she had been issued by the hospital over a period of four years. As a result there was no linear narrative to the project. She had joined the design team when the building was a constructional shell. She went on to talk about the various contracts enhancing the building, devising an arts strategy, design and building the garden, and a fellowship to facilitate creative discussion. She had tried, she said, to build sustainability into the project, a factor which she felt was very much against current healthcare practice.
Jane then talked about the other artists and artforms that had been involved in the project. By chance, the artists had mainly been from the West Coast of Scotland, and that had in itself created an on-going level of debate. In conclusion, Jane said that what had been achieved was the result of design team collaboration. It was a process that had not always been easy but there had always been a common desire to make the place special. Many patients, she said, who arrive at the hospital have already had a long journey in all senses of the word to get there, so the first chair they sit in has to have an effect.
Andrew, having thanked both David and Jane for their presentation, invited questions or comments from the delegates. The questions asked were focused around more information about the project at the hospital, and whether the artist saw her role as artist or designer.
After a break for tea the meeting resumed for the plenary session. Having viewed a brief film about the opening of the garden project at Glasgow Homeopathic Hospital, Andrew started this session by posing some questions for consideration:
• who is space for?
• what is the process and how do we manage it?
• how do we measure whether we are doing good?
• and how do we convince others?
There followed a lively discussion that raised a number of issues:
• the role of the artist as a conduit to communicate the needs of the users.
• when is it art and when is it design?
• the challenges of working within the confines of the PFI structure whilst still maintaining the personality of a project.
• the need to create case studies, to demystify work so a shared language can be created.
• the need for projects that demonstrate that good design is not a luxury.
• the language of communication and the role of the consultant in this.
• the need for for quantitative evidence.
The meeting ended with a suggestion that key decision makers might be Àhospitalised² in order to experience, at first hand, most patient's experience.
At this timely point, Andrew closed the meeting, thanking all the speakers and saying that he hoped everyone had learnt as much as he had from the afternoon.
Nigel Buckler rounded the meeting off by talking about the Arts Councils' new funding schemes ¾ for further information see www.artscouncil.org.uk (funding page).
Finally Maggie thanked Andrew for his chairing of the meeting and all the speakers for their presentations and Gloucester NHS Trust for their support with the event. She finished by saying that the next Network meeting would be in Swindon in early November and would be looking at local authorities work in relation to developing and reviewing public art strategies.
* For links and articles see website - www.adhom.org
** Reilly D. Enhancing Human Healing. Editorial. BMJ 2001;322:120-1
Lisa Harty
Network Co-ordinator, on behalf of PASW