Sara - another provocative blog! Well done.

I would like add by humble voice to the discussion. I can say, in a purely anecdotal way, that over the last 2-3 years we are seeing a significant number of requests for more abstract and contemporary artwork on our firm's projects. These are being considered mainly for very public areas such as large lobbies and in main thoroughfare locations that might require memorable art to aid in wayfinding.

The designers, architects and facility decision-makers are looking more and more at every element that may add (or detract!) to the overall impact of properties. With competition at an all-time high for patients and their dollars, we are hearing from clients that making a phenomenal first impression has become a must. And abstract/contemporary art seems to be fitting that bill.

We always counsel clients to consider the long-accepted standard of nature art when choosing images for all care areas. As you say, the research (and my experience over a 20+ plus year career in the art-for-healthcare industry) supports it absolutely. I will say though that it has been somewhat refreshing to see Designers and C-Suite decision-makers stepping outside of that "box" and allowing for a more dynamic and visually stimulating visual experience in key areas. As a client said to me recently: "Landscapes, everywhere I look I see landscapes and flowers!" "Can we mix it up a little?" Needless to say, I was happy to oblige.

Thanks again for your blog. It is always a perfect end to my week!

Dan Day
Health Environment Art Services
713-777-3525

Great post, Sara. I think the subjectivity of art also comes into play when debating this topic. Generally, I would say that few people will look at a painting of a field of flowers and have a negative reaction. Flowers are pretty much universally viewed as beautiful. Abstract art, on the other hand, has a lot to do with personal preference and taste. I prefer it, but I know others don’t.

I think hospitals in North America typically lean toward landscape/natural art simply because it’s neutral and all inclusive—anybody can relate to it because everyone understands it. In Germany, on the other hand, it’s common to see abstract art in public spaces and in patient rooms. I don't know if there's any research explaining this, but my gut tells me it's simply because the German design aesthetic is much more modern and contemporary than what we see in North America. It’s a style they prefer.

So my overall thought is this: I don't think art should be a part of the evidence-based design discussions. When we start lumping subjective design elements in with elements that are actually proven to make a difference in patient outcomes, I think evidence-based design starts to lose a bit of its credibility.

It's time for Healtcare facilities to bring a more sophisticated approach when it comes to art. Americans' tastes have grown and holding on to the notion that landscapes are the only choice limits new possibilities. As an abstract painter I have had the opportunity of witnessing the pleasing effects my paintings have had on them.

Sara- I am always concerned when we use nature and abstract as absolute categories, when it is in fact more of a continuum- a point you make in your article. We often position our arguments pitching one against the other. In fact, it is "abstraction" that is a challenge for those who are under high stress and vulnerable. They need stimuli they can rapidly process, and which is non-threatening and positively reinforcing. If you take the same person out of a pre-op surgery room, and put them in a museum, show them the same piece of art, they will probably react very differently.

There is in fact a great amount of literature on how composition, and visual fluency, affect our aesthetic judgment. We know less about the impact on emotional response, which is where the healthcare research has focused. For example, in a study with mental health patients we found that the response to an impressionistic Van Gogh painting depicting a landscape was comparable to the response to an abstract Jackson Pollock painting. This was published in the Journal of Mental Health- and our metric was the anti-anxiety medication. A piece of research that made a business case, but also reminded us that nature content can be abstract too.

The neuroscience lit review that we conducted a few years ago showed that sharp angled forms elicit a negative response in the fear center of the brain compared to curve angled forms (this is the initial fight or flight response- which happens in a matter of miniseconds). With Dr. Pati at Texas Tech the REDCenter at AAR has taken this work further and found that in fact this finding holds true for landscape images as well. This will be presented at HCD this year.

When we have a rapid fear response- it is not always a bad thing. An initial response in the fear center of the brain is equivalent to a sense of thrill- in a museum it would make us more intrigued- make us stop at a painting- dwell on it- engage with it. However, if we are sick- very very sick- it will shoot up our blood pressure, increase our stress response, and impact our health.

Its important to remember that the hospital has a wide range of spaces and a wide range of patients (and here we can assume that staff, families, visitors are all patients in some way), at various levels of vulnerability. Mixing it up is not only an option- it's a necessity.

Kathy Hathorn, at American Art, has long been a proponent for the one-size does not fit all approach. She believes that not all nature art is appropriate for all populations. That abstraction in art can be appropriate, and even desired, in certain places. At the end of the day evidence has to be balanced with critical thinking as well as empathy, to truly serve as a guide.

Apologies for the long comment- as you can see this is a topic close to my heart. So much that we know- and so much still to investigate. Thanks Sara for always keeping us on out thinking toes...

Art should absolutely be a part of evidence-based design discussions! It now has several decades of research behind it and there is rationale for selection of this or that piece based on far more than aesthetics and personal taste. That rationale must be based not only on studies, but also on knowledge about intent. Will the art's purpose be to relax, restore, and comfort (e.g., patient treatment area)? Will it's purpose be simply to attract attention without regard to emotional impact (e.g., the "wow" in a public area)? Will it be meant to engage or activate (e.g., in a long term care setting)? The same selection would not be appropriate for all these spaces. The decision must be based on evidence not only from research on art, but also from neuroscience, geriatric medicine, and psychology (and from other fields of study for still other situations). Abstract art requires the human brain to analyze and try to make sense; it is what the brain naturally attempts to do. That is tiring and may cause a physiological stress response to varying degrees - as Upali says, depending on a person's state and circumstance. This is undesirable in certain settings, when the intent is to create a soothing environment to maximize healing potential. It is, on the other hand, possibly desirable if you want to challenge and engage and maybe activate the sympathetic nervous system response a bit. We must also be aware that all "nature" is not "evidence-based." The studies describe the overall qualities (the "active ingredients," if you will) that an image of nature should have to best promote a relaxation response, and all natural imagery does not necessarily have the content or the pattern that makes it truly "evidence-based." This is a pet peeve of mine. Just any old pretty picture of something from nature is not necessarily "evidence-based." So nature art, in proper form, has it's place, and abstraction has its place, and the best choice calls for expert assessment of the picture, the setting, the primary intent, and the primary viewer characteristics.

Thanks, Sara for opening a forum to remind us of the importance of not misunderstanding what "evidence-based" really means and how a true understanding of evidence-based considerations should impact decisions as to imagery in a healthcare - or any - setting.

In my home I have an Apple TV connected to a large screen in the living room. At various times I turn on continuous slide shows. These vary from family photos to great works of architecture to paintings that I like. I mention this only to suggest that we think about art in hospitals as much more fluid than a particular image that hangs on a wall for years. People have different tastes and attitudes toward art. People react differently to some styles or subjects. There is no one size fits all approach to the hospital environment.

There was a children's hospital that allowed a child to "personalize" their room when they checked in. If you wanted pictures of race cars on the wall, you could request that. If you liked unicorns or flowers, you could have that. This is my perfect vision of art in my hospital room. If I like Edward Hopper I select the Hopper slideshow. Technology has gotten far more inexpensive and available. It is time to give the control back to the patient tether than the hospital foundation or the largest donors.

I just had the opportunity to tour the new Diamond Neighborhood Health Center in San Diego with abstract art done by a local artist. Wonderful colors and shapes that are different for each service and waiting area that is culture neutal and appeals to all. Literal art may not have the same reference or meaning based upon culture of origin.

This is a fascinating discussion and I'm eager to hear more about it at HCD 14. I'm curious, does a person from the Midwest react differently than someone from a large urban city when they view the same image -for example a landscape; the landscape is a common scene in the Midwest but not so common in a major metropolitan area....perhaps their reaction should be another variable to consider when selecting art

Hugh has a great idea. Art that changes, whether digital or through an art exchange program, would be a welcome perk for patients and staff. Even a great work of art can become invisible or worse, annoying, for the person that sees it day after day.

Great article and wonderful comments. Abstract vs. nature has so many subtle layers to consider. Makes my job challenging and more engaging every day. I will save this entry for rereading in the future. Thanks for the in-depth information from everyone!

I think we have to be very careful placing strict rules based on "art categories". The philosophy we take is to interview marketing and management personnel to learn traffic patterns and the audience that will be viewing each piece. We like to learn about both the viewer (patient, family, and caregiver) and their state of mind when they are in each specific room.

We then go about choosing the size, placement and "MESSAGE" that each piece needs to convey. While color is important, we feel messaging trumps color choice. We have used hundreds of abstract nature photographs in high stress areas in cancer facilities where it is important to keep the message as simple as possible. This is especially important in infusion suites.

While we have never done a scientific study, we have been allowed to view customer comment cards from the hospitals and have received hundreds of letters from cancer patients, family members, nurses and doctors about the effect that our artwork has had on their day to day attitude about their treatment or their job.

One final thought. In addition to using nature images, abstract or not, we have found that all viewers respond very positively to photos of local creation. Whether these be architectural icons, recreational areas, or just local flora and fauna. It seems to soothe them that they are being treated by those who understand who they are.

The imagery also induces them to think about good times in their lives. Places where they have good memories about friends and families. We like to add and ID plate with each image that identifies where the image was taken. We find patients and families looking through the regional hospitals we have worked with to find images of their hometown.

I wish I could attach some sample nature abstract photos to this post to help underscore my statement.

[…] Why Not Some Abstract Art for Healthcare Facilities? […]

So far I haven't seen any abstract art in all these doctor's offices or the hospital that is not depressing to me.

Yet so much in museums is so breathtaking . . .

[…] After seeing Henry Domke’s post about abstract art for healthcare earlier this week, I thought I’d jump into the fray. He’s still conducting his straw poll, but most of the healthcare art experts Domke queried said no to abstract art. In a “Guide to Evidence-based Art” published by The Center for Health Design, authors Kathy Hathorn, MA, and Upali Nanda, Ph.D., present an excellent summary of the research on art for healthcare…Read more. […]

While I believe there is a logical need for for some of the mountains of "evidence", as an artist supported by sales from the health industry for thirty years, I must agree with Mr. Day (above) abstract art certainly belongs in hospitals. This reveals the lack of education in art by most in the health industry.

Evidence Based Design should be a rule of thumb and not taken so seriously that every hospital looks alike and immensely boring, wether abstract or nature/representative.
Additionally, I am yet to see an evidence based research that takes into account the education of patients or their culture.

The health industry needs to concern itself with science. I believe that is a good thing, but when it comes to art, more weight must be given to those within the art industry. As an artist I would no more suggest how to do brain surgery than uneducated leaders in health should tell me, within reason, what is best in aesthetics.

[…] vulnerability,” wrote HOK’s Upali Nanda, in response to a post I wrote last year about abstract art in healthcare. “Mixing it up is not only an option, it’s a […]

[…] The terrific healthcare design and though leader Sara Marberry recently asked a similar question on her blog: “Why Not Some Abstract Art for Healthcare Facilities?” […]