Rollins, J. H. (2021). “Purpose-Built” Art in Hospitals: Art With Intent. Emerald Publishing. ISBN-10: 1839096810; ISBN-13: 978-1839096815. 292 pages. $100.
Among the subjects investigated in design research for healthcare environments, quite a few enjoy rather clear-cut, if still capacious, definitions and parameters, from room orientation, lighting strategies, traffic flows, risk assessments, and processes for communication and providing care. With sufficient evidence in hand, design practitioners have developed and can routinely implement a robust set of tools, checklists, and guidelines. One subject, though—visual art in the healthcare setting—has proven rather difficult to study, its terms difficult to define, and its return-on-invest difficult to quantify.
In a way, visual art lies at the very heart of evidence-based design. Its emergence as a discipline, following Roger Ulrich’s insights and observations concerning window views in patient rooms in 1984, has been recited so often as to become a sort of folklore, an origin story. The shift from window views to visual art, while supported in some studies, ended up limiting the meaning and role of visual art, postulating a sort of functional equivalency. The subject of study then seemed limited to two-dimensional, wall-hanging work featuring “image content” or “art content.” The question of appropriate content in art for healthcare settings went on to dominate the conversation for years, with “nature content” taking the lead role.
Since 2008, A Guide to Evidence-Based Art (Hathorn & Nanda) published by the Center for Health Design has served as the primary resource for architects, designers, and art consultants. A great deal of relevant research and activity has emerged since then, and Judy Rollins’s new book, “Purpose-built” Art in Hospitals: Art With Intent, not only rounds up new findings but also helps reorient and broaden the field by asking new questions and drawing from additional scholarly disciplines. Perhaps most significantly, Rollins frames the practice of art installation in healthcare spaces in ways that may be recognizable to artists themselves and to arts-in-health professionals. For Rollins, visual art is considered as more complex and multivalent than as a container for content or a stimulus provoking a response. Instead, Rollins recognized visual art as a sort of collaboration between the artist and the viewer to make and communicate meaning together. Roll- ins relies on Gombrich’s concept of the “beholder’s share” (1960) to explore the essential role of the viewer in making art happen by experiencing and using it.
Rollins’s introduction explores this collaboration in terms of the viewer’s experience and the psychological processes he or she undertakes when engaging with visual art. Then in the first chapter, she examines the hospital experience in similar terms, identifying key elements in the physical environment and a range of psychosocial issues that individuals contend with.
Bringing these experiences and processes together, Rollins establishes that “every piece of art in the hospital has a job to do” (p. 14). It has a function and produces outcomes. In other words, to make choices about visual art is to know its purpose. And with a purpose in mind, it is possible to measure the effectiveness of an artwork by whether it achieves that purpose.
Rollins characterizes much of the work derived from Ulrich’s (1991) original insights, informed by his theory of supportive design, as concerning art for the purpose of “soothing and comforting.” The vital role of “nature content” is recognized for that purpose.
The book’s primary accomplishment is to move on from there, to identify 13 more pur- poses for art in hospitals, primarily by documenting how viewers experience and use the art. With a chapter for each purpose, Rollins provides a theoretical justification for intentions including “spirituality,” “interaction,” “identity,” “messaging,” “remembrance,” and “to build community,” among others. She then catalogues meaningful examples of artwork in hospitals in the United States and around the world, a collection of dozens of artworks that serve to inspire and inform design professionals as well as artists. Finally, she identifies established or potential health outcomes for each purpose. Through its explorations, the book updates and grows the research base.
Design professionals will find not only new ways to make art useful in healthcare settings, as well as a rich set of examples to consider, they will locate value in the “common thread” of curiosity theory that Rollins identifies throughout. In fact, Rollins argues the ability to arouse curiosity is a necessary component for art to achieve any purpose, whatever it may be. She offers a theoretical framework about the experience of curiosity that addresses its characteristics, causes, and varieties, which can equip design practitioners with a new tool for making choices about art selections. By placing curiosity at the center of the art experience, Rollins is challenging practitioners to think beyond narrow con- fines of design specifications that often limit art selections and foreclose the viewer’s experience of art.
In opening the terms of the field as she has, Rollins rallies evidence to support types of art that often have been proscribed in most typical design specifications. She proposes a dichotomy between art that is soothing and art that is “challenging,” locating examples where hospitals strike a meaningful and beneficial balance between the two. She spotlights several examples of art for more than one purpose that may be described as “abstract.” The so-called dispute in healthcare design between representational and abstract art is not addressed as such, because the parameters of purpose have obviated the terms. For Rollins, these works succeed in arousing curiosity, and they appear to achieve their intended purposes.
Part of Rollins’s strategy is to deploy not only the research from medicine and psychology (Ulrich’s early work on healthcare art stood within the discipline of “landscape psychology,” a telling presumption about what art can be or can do, much less what art should “contain”), but also includes scholarship in visual rhetoric, aesthetics, art history, as well as anthropology and sociology, where new questions are asking how patients “actually experience and use art in hospitals” (Nielsen et al., 2016).
Following Rollins’s ecumenical approach, I would also propose that the emerging discourse of the medical humanities be invited to contribute insights and interpretive strategies that would develop ideas about art in healthcare settings and even further add to the evidence. As Rollins admits, “Although research on the impact of hospital design is flourishing, studies specifically on the impact of artwork in hospitals remains scanty” (p. 196).
Indeed, a great deal of the evidence Rollins offers throughout the book is necessarily anecdotal and unreproducible, though she does helpfully point the way forward for researchers to better test, measure, and document her hypotheses concerning art for each of these intentions. And while most of the art intentions are well-grounded in established and emerging theory, others need more support, if not outright revision. Her discussion on art for messaging, for example, stands on shaky ground, citing sources that don’t meet rigorous standards. Specialists in communications studies, for example, could bolster these ideas and make them more salient to the examples provided.
Notwithstanding the usefulness of curiosity theory as a basis for visual art design in health- care settings, practitioners will find some portions of the book of limited relevance in the context of permanent installation for new construction and renovation projects. For example, in the chapter on art for empathy, a 2006 mural project for a pediatric oncology unit at Floating Hospital for Children apparently succeeded in its purpose to express empathy with viewers, as documented in the responses of patients, their families, and staff at the time the works were commissioned. The images, though, a series of six surreal compositions depicting children’s journeys through illness and treatment, subsequently served as unwelcome visual reminders for future patients and families of their condition. While Rollins does caution that “the location of empathetic art is an important consideration” (p. 59), if such murals eventually have to be removed to avoid harm to patients, then a designer with a deadline and a budget would consider this example as a disaster.
Certain such art projects are perhaps more sui- ted for a hospital’s in-house arts-in-health professional to administer. A hospital’s curator or arts administrator can stage temporary exhibitions, make flexible use of space for art displays, or engage artists in collaborative art-making with patients and staff. These purposes are less feasible in the context of a capital-intensive building project where the art is selected for permanent installation.
Following the chapters on specific art intentions, in the chapter “Transforming the Hospital Experience Through Art,” Rollins tackles some of the practical considerations of art acquisition and installation, stakeholder contribution, specific considerations for patient spaces compared to public areas, and methods for evaluating visual art programs.
It is here that Rollins explains the practice of arts program management in hospitals as distinct from the work of art consultants. Readers in the practice of healthcare architecture and design will benefit from better understanding the growing field of Arts in Health, not only as it pertains to visual art selection but in its larger context within hospital operations.
Departing somewhat from Rollins’s subject, but following this point of contact between professions, we can see tremendous value in the architectural planning process that recognizes and encourages participation by arts-in-health administrators. Besides contributing to visual art selections, they also offer unique insight into space needs for healing arts programing, including participatory and performative healing arts, rotating exhibition spaces, and even tools for directed art engagement through labels, guides, and tools for creative response. Many arts-in-health pro- grams go unsupported by the buildings where they are housed, having to make do with repurposed spaces for offices, for arts activities, and for equipment like art supplies, recording devices, and musical instruments.
Anyone selecting art for hospitals should study this book, now the most up-to-date and authori- tative resource for visual art in healthcare environments, and one that helps to bridge the gap between healthcare architecture and design on the one hand and arts in health on the other. A more robust exchange between these professions could facilitate greater input from further afield, including the humanities, where making, understanding, and interpreting visual art first emerged.
Health Environments Research & Design Journal 2022, Vol. 15(1) 353-356 a The Author(s) 2021 Article reuse guidelines: sagepub.com/journals-permissions journals.sagepub.com/home/her
References
Gombrich E. (1960). Art and illusion: A study in the psychology of pictorial representation summary. Phaidon.
Hathorn K., Nanda U. (2008). A guide to evidence-based art. The Center for Health Design. https://www.healthdesign.org/system/files/Hathorn_Nanda_Mar08.pdf
Nielsen S. L., Fich L. B., Roessler K. K., Rollins M. F. (2016). How do patients actually experience and use art in hospitals? The significance of interaction: a user-oriented experimental case study. International Journal of Qualitative Studies on Health and Well-being, 12(1). https://doi-org.ezproxy.uhd.edu/10.1080/17482631.2016.1267343.
Ulrich R. (1984). View through window may influence recovery from surgery. Science, 224, 420–421.
