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Marking the Transition: The Bedminster Family Practice, Bristol

Overview

In 2002, the Bedminster Family Practice in Bristol decided to move from its premises in a converted Victorian house in Dean Lane which were proving inadequate for such a large practice. The partners decided to buy part of the new St Peter's Court, being developed by PG Enterprises Ltd, and to build new surgery premises.

Practice partner Dr Gillian Rice has a long term interest in the enhancement of healthcare environments through the arts and was determined that the new surgery should incorporate artworks. She led the project on behalf of the practice. Lesley Greene , arts consultant, was engaged to develop an arts strategy, make funding applications and provide initial advice. Half of the £37,000 arts production budget was successfully raised from Arts Council England, South West, Arts and Business, the Irene Wellington Educational Trust and the Quartet Community Foundation. The remainder was donated by the partners in the practice. They also paid for the site preparation and installation of the artworks, and separately, for artist-designed exterior signage, demonstrating their vision and commitment to the value of the arts in healthcare settings.

Artists Annie Lovejoy and Mac Dunlop (InSites Design) were appointed, and worked closely with the partners, Dr Gillian Rice and Dr Ian Garbutt, and the practice manager Helen Derverson, to manage the production and installation of the artworks.

The artists' brief required them to work closely with the surgery community in developing their proposals, and also to make a visual connection with the neighbouring library housed in the same building development. During the initial research period at the Dean Lane surgery, the artists created visual and poetic responses to the surgery which were inspired by conversations, observation and interactions with patients and staff. From these, they develop concept designs which were then developed further through patient participation, culminating in the final production designs.

Seven new artworks were created for the glazed entrance foyer, atrium space, waiting area and upstairs meeting room. The works were designed to relate to the architecture of the building and to work together as a cohesive collection. Through close liaison between the GPs and artists over colours and materials, the surgery's interior design has been dealt with holistically, achieving an uplifting and relaxing environment.

Dr Gillian Rice has been Highly Commended in the 2006 Art & Work Awards for her role in leading the commissioning of these site-specific works alongside her full-time work as a medical practitioner.

The Commissions

Atrium Light Feature

10 acrylic panels with routed and etched designs hang in the surgery atrium above the reception desk. Using LED colour changing technology, the work responds to changes in temperature levels. Designed in collaboration with electronic engineer, Mark Newbold.

Atrium Light Feature by Annie Lovejoy and Mac Dunlop, 2005.
Bedminster Family Practice, Bristol.
Entrance Glazing and Signage

The surgery sign is based on the handwriting of practice partner Dr Ian Garbutt, and is laser cut into aluminium with blue back lighting.

The entrance glazing in the double doors and panels on either side is based on Cornish rock veined with quartz. The double glazed doors contain laminated crushed shot silk, while the double glazed side panels contain high resolution photo transparencies coupled with etched and routed glass painted copper / gold. The high resolution photographs are by Alan Russell.

Entrance glazing [detail from the street] by Annie Lovejoy and Mac Dunlop, 2005.
Bedminster Family Practice, Bristol.

The glazed surgery entrance links visually with Bedminster Library next door which also has entrance glazing designed by Annie Lovejoy and Mac Dunlop.

Aquarium with text

In a 2.5 m long aquarium in the waiting room, an 'aquascape' has been created using quartz, citrine, amethyst and crystal, intersperse with specially blown glass spheres by Sue Nixon which include text. The tank contains 40 varying species of Lake Malaw Cichlids. On the front face of the aquarium, there is a real time display of bubbles which act as natural lenses as they rise in front of changeable text. The text was produced during workshops led by Mac Dunlop.

Glazed areas in waiting room and upstairs room

The glazing on the ground floor corner of the surgery is a prime site in the new development especially after dark when late night shoppers pass by. The upper half features a large scale allium head, referring to the importance of plants in health and medications. Beneath, the three lower panes contain a very detailed back lit image of roots combined with text from Gerard's Herbal, layered with the word 'family' in a variety of languages familiar to the surgery community, including sign language.

The first floor meeting room windows have images of dew spangled wheat grass which change depending on the light and time of day.

Poetry panels

Three poetry panels on the wall of the waiting room include handwritten poetry by Alyson Hallett, combined with photographic images of the former surgery on photographic film, and vinyl etch. These works are a response to the apprehension felt by staff and patients on leaving the old surgery.

Poetry panel in waiting room [detail]
by Annie Lovejoy and Mac Dunlop; poetry by Alyson Hallett, 2005.
Bedminster Family Practice, Bristol.

Evaluation Research Project

Dr Gillian Rice been awarded £52,000 by NHS Estates to evaluate the effect of the new enhanced premises on staff / patient well-being. The research project picks up on the growing body of evidence of the value of artists' input in improving hospital environments, recovery times and patient outcomes.

The research will take place over 15 months. It will include monitoring of responses from patients and staff to the environment of the old surgery premises, and feedback at periodic intervals over the 12 months after the move to the new premises.

The methodology includes responses collected in a number of ways:

• Questionnaires completed by patients
• Interviews with patients
• Physiological measurements of patients (pulse rate and galvanic skin response)
• Questionnaires completed by staff
• Staff focus groups
• Audiometric measurements around the reception desk, waiting room and selected consulting rooms

The research work is due for completion in late 2006 and it is hoped that the results will be published in a peer reviewed journal in 2007.

Update: July 2008

Enhancing a primary care environment: a case study of effects on patients in a single general practice.

Gillian Rice, Jenny Ingram and Jacques Mizan.

Cite this article as: Br J Gen Pract 2008; DOI: 10.3399/bjgp08X319422.

From the abstract:

A total of 1118 pre-move and 954 post-move patient questionnaires showed significant increases in satisfaction scores for reception/waiting areas and consulting rooms in the new premises. Patients' satisfaction with patient-doctor communication also increased and anxiety scores were significantly reduced before and after the consultation in the new premises compared with the old. Patients highlighted the increased space and light, more modern appearance, greater comfort, and novel works of art in the new surgery. Staff workplace satisfaction increased signficantly after moving and remained higher than in the old building.

From the main report:

The introduction points out that most research into the links between healthcare environments and health outcomes has studied patients and staff in hospitals. Very few studies have been carried out in a primary care setting, despite the fact that 80% of healthcare in delivered in such environments.

In this study, comments confirmed that most patients were more satisfied with the reception area in the new building, judging it to be more patient friendly, less noisy and offering greater privacy than in the old surgery:

'Space, light, ambience - general feeling of calm. Artwork and background sound add to this.' (Female, aged 66 years).

In the phase 2 questionnaires, 88% of patients expressed a preference for the new surgery environment. In response to an open question asking them to explain their preference, the five design features mentioned most often were the greater space, increased light, cleaner and tidier surroundings, more modern appearance, and the art works (including a large aquarium).

'The new waiting area is more spacious, with soft relaxing music playing in the background. The aquarium is fantastic as it puts the patient at ease.' (Male, aged 38 years)

Contact for further information

Annie Lovejoy, www.annielovejoy.net