The Art of Healing Spaces That Perform

As a facet of evidence-based design, artwork plays an important role in healthcare facilities—and it is taking on exciting (and durable) new forms.

01/03/2017 By Robert Nieminen

The design of healthcare facilities has been influenced by a number of trends in recent years that share a key element in common: a focus on patients. Whether it’s creating single-patient rooms with residential touches to make them feel more inviting or providing access to daylight and views to nature and beautiful artwork, it’s clear that patient comfort, satisfaction, and outcomes have taken a front seat in the design of hospitals and outpatient medical centers.

Underlying the patient-centered care model is credible research that links design with improved patient and worker safety, patient outcomes, environmental performance, and operational efficiency.1 Better known as evidence-based design (EBD), this maturing field of practice has made tremendous strides since its adoption in the early 2000s, thanks in large part to the launch of the Center for Health Design’s Pebble Project, a dynamic collective of forward-thinking healthcare organizations, architects, designers, and industry partners that share knowledge and tools to assist in the creation of research-based healthcare design projects.2 Using EBD principles, healthcare facilities today are designed not only to support and facilitate state-of-the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient, family, and caregivers in a psycho-socially supportive, therapeutic environment.3

Additionally, the move toward patient-centered care has been accelerated recently due to the passage of the Affordable Care Act (ACA) in 2010, the largest reform to the American healthcare system since the establishment of Medicare in 1965.4 Under the ACA, for the first time healthcare providers are being rewarded for improving quality and patient satisfaction—outcomes that have been directly linked to the design of buildings.5 To design practitioners, the positive impact of the built environment on occupants likely comes as no surprise, but quantifying that claim is a bigger challenge.

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“Every element of a built environment can have a considerable positive or negative impact on our state of mind and emotional well-being, or so we like to think,” said psychologist Dr. Nicola Davies, author of “Empathy in Architecture.” “But how can we prove it? That’s where evidence-based design comes into play—and, fortunately, as research on the psychological and neurological impact of certain design elements is constantly being enhanced, designers are more equipped than ever with objective facts to back up their seemingly subjective choices.”6  
This CEU will examine the growing practice of evidence-based design in the healthcare industry, the role that art programs play in improving patient outcomes in the real world, as well as resilient materials solutions that specifiers can utilize to incorporate artwork and graphics in exciting new ways in hospitals and other medical facilities.

EBD: In Scope And Practice

By now, most architects and design professionals are familiar with the term, but for the uninitiated, let’s begin with a working definition of evidence-based design. The Center for Health Design (CHD) defines EBD as “the deliberate attempt to base building decisions on the best available research evidence with the goal of improving outcomes and of continuing to monitor the success or failure for subsequent decision-making.”7 According to Jain Malkin, author of “A Visual Reference for Evidence Based Design,” an evidence-based model can be used for all design decisions on a project, but a great deal of the research published in peer-reviewed journals can be sorted into three broad categories: safety, reduction of stress, and ecological health.8

“In some respects, it can be said that the concept of healing environments has evolved into EBD, but it’s mainly in the area of reduction of stress that this overlap occurs,” Malkin noted. She goes on to explain that the research underpinning the concept of a healing or psychologically supportive environment is drawn from the neurosciences, evolutionary biology, psychoneuroimmunology (the effect of the emotions on the immune system), and environmental psychology.9 However, Malkin also notes that “EBD goes beyond the healing environments dimension to consider the effect of the built environment on patient clinical outcomes in the areas of staff stress and fatigue, patient stress, and facility operational efficiency and productivity to improve quality and patient safety.”

In thinking about applying scientific research to the design process, it may seem as if the end result might have a rather institutional feel. However, nothing could be further from the truth. When considered from a purely aesthetic standpoint, healthcare facilities that employ evidence-based principles are actually warmer and more calming than the cold, sterile medical spaces of bygone eras. According to the Whole Building Design Guide, design teams are responsible for employing a number of design solutions that will help to create a therapeutic environment for patients and staff throughout the facility. Here are a few considerations it recommends (among others) to reduce stress and create a welcoming space10:

  • Artwork and aesthetics can enhance the soothing and calming qualities of a space.
  • Adequate space should be provided in public areas and waiting rooms to avoid crowding.
  • Perceived waiting time can be mitigated by positive distractions.
  • Visual and noise privacy.
  • Odors that are objectionable or “medical” can create stress.
  • Wayfinding—the built environment should provide clear visual cues to orient patients and families, and guide them to their destination and return. Landscaping, building elements, daylight, color, texture, and pattern should all give cues, as well as artwork and signage.
  • Acoustical treatment of corridors adjacent to patient rooms (carpet tiles, rubber flooring).
  • Provide lighting that supports natural circadian rhythm.
  • Color, while subjective, can be a design factor in reducing environmental stress when understood and used in the context of the color preferences of a project-specific population.

While the above strategies and other EBD principles certainly make for well-designed spaces, the question is: Does design have a quantifiable result in patient outcomes? The answer, of course, lies in the data.

According to a report from the Robert Wood Johnson Foundation (RWJF), one of the nation’s largest philanthropy organizations devoted exclusively to health and healthcare, there is a direct link between patient health and quality of care and the way a hospital is designed.11 For example, the report cites a number of real-world examples where evidence-based design strategies were employed, resulting in the following outcomes12:

  • Patient falls declined by 75 percent in the Cardiac Critical Care Unit at Methodist Hospital in Indianapolis, Ind., which made better use of nursing staff by spreading out their stations and placing them near patients’ rooms.
  • Medical errors fell 30 percent on two inpatient units at The Barbara Ann Karmanos Cancer Institute in Detroit that allocated more space for their medication rooms, re-organized medical supplies, and installed acoustical panels to decrease noise levels.

Further, RWJF revealed that by using EBD strategies in the redevelopment of the Bronson Methodist Hospital in Kalamazoo, Mich., the design team realized measurably improved outcomes. By incorporating design features such as private rooms with rooming-in accommodations for all patients; creative use of artwork, music, light, and nature to create a more pleasant and less stressful environment; shorter walking distances for patients and families with seating along the way; and touch-screen information kiosks at every main entrance, the hospital was able to document the following results13:

  • 11-percent reduction in nosocomial infections
  • Nursing turnover rates below 7 percent (the national average is 20)
  • 95.7 percent overall patient satisfaction
  • Improved staff satisfaction
  • Increase in market share

Additionally, according to an article in “Becker’s Hospital Review,” using EBD strategies benefits hospitals and other medical facilities in five ways, including enhanced patient safety, reduced medical errors, decreased need for patient medication, reduced staff injuries, and increased staff efficiency through improved workflow.14 In one case study, Clarian Health Partners in Indianapolis realized a nearly 70-percent decrease in medication errors by replacing its multi-level ICU with variable-acuity adaptable rooms. “Variable-acuity rooms provide different levels of care in one room to minimize patient transfers from one space to another, which can occur as often as three to six times in a patient’s hospital stay,” the article stated. “The 90-percent reduction in transfers at Clarian decreased hospital expenses and reduced medical errors while boosting patient satisfaction and staff productivity.”

As the body of available, credible research grows, EBD continues to inform the way not only hospitals are designed and constructed, but it is also making inroads into being part of the process for designing schools, office spaces, hotels, restaurants, museums, prisons, and even residences, according to the International Interior Design Association (IIDA).15  “It makes sense that EBD has its roots in healthcare, where lives are at stake and legal implications are palpable, outcomes are fragile, and decisions need to be justified by hard data,” the association observes. “[However] this need for justification is becoming more commonplace in most other building designs.”

Clearly, the data reflects the reality that evidence-based design practices have a direct impact on the people who inhabit the built environment. As such, design practitioners and healthcare professionals should consider looking to organizations like the Center for Health Design, which houses a repository of knowledge and thousands of research studies, to begin employing EBD principles. One such approach involves providing positive distractions for patients in healthcare settings—and utilizing effective artwork programs, as well as innovative material solutions to employ them—which will be examined in the following sections.


Art: The Power of Positive Distraction

Among the many tenets of evidence-based design is to provide positive distractions in healthcare facilities through appropriate art, restful views, and access to nature, thus relieving unnecessary stress and improving patient satisfaction. “Positive distraction” is a term used to describe the belief that environmental features can elicit positive feelings, hold attention and interest and, therefore, reduce stressful thoughts.16 Research demonstrates that when used appropriately, artwork can have a positive effect on medical outcomes of patients, especially as it relates to stress reduction.

NOTE OF CAUTION: While positive distraction and artwork are an essential component of EBD, it is crucial to note here that simply because one or more strategies are used in conjunction with a healthcare (or any other) project does not mean it has been founded upon credible research. In other words, beware of false claims. As Malkin warns in her book:

“[P]rojects have sometimes been labeled a healing environment based on an art program (possibly not even one based on research) or a number of cosmetic changes in interior finishes. Healing environments sounds so nice, who wouldn’t want to make a claim like this? However, several questions should be asked: Why would a specific design be expected to improve outcomes? Is the project anchored in research about reduction of stress for patients? Has anyone developed a hypothesis and attempted to measure outcomes before and after the interventions? Similar claims may, in the near future, be made about a project having been evidence-based. Articles are already starting to appear in magazines making this claim, and sometimes it is based on one or two research-based elements, but the project overall may miss the boat on many important issues. The evidence-based designation should be applied only when research has impacted the design with sufficient scope and hypotheses are tested in the process.”17


With that being said, how is art being used in healthcare spaces as one part of a broader evidence-based approach to design? First and foremost, art serves as a contrast to the often somber work being done in many healthcare settings. “Art is a counterpoint to the complexity of healthcare design,” said Cheryl S. Durst, executive vice president and CEO of IIDA. “Incorporating art and artisanal pieces into healthcare environments humanizes the experience, creates a sense of calm, and presents an opportunity to welcome others into these spaces.”18

Further, by connecting communities, supporting local artists, creating healing environments, and celebrating identity, art is often used by healthcare designers to fulfill many goals for multiple populations while still satisfying the complex design needs of healthcare spaces. For example, healthcare facilities are increasingly designed to shed the identity of being a place for those who are ailing; instead, these environments are built to be gathering places by providing programming for the public as well as event spaces and auditoriums that can be used for various community purposes. Using local artwork offers the community an opportunity to be involved with a healthcare project and provides an incentive to visit or use the facility for purposes unrelated to illness.19

Additionally, the American Society of Interior Designers (ASID) recently noted that design practitioners, in particular, feel the need to support creativity in tangible terms that move beyond technology and functional planning. In other words, they seek materials and products that “not only make sense from a design perspective, but also feed our creative soul,” noted Sandy Gordon, FASID, LEED AP, and chair of the Board of Directors for ASID. “We are committed to uniting art and space. Without a doubt, art and interior design are inextricably linked. Interior design is, in itself, an art form, bringing beauty and functionality seamlessly together in residential and commercial spaces.”20

There’s no doubt that art stimulates the visual senses and helps in the creation of aesthetically pleasing environments, but does it really have a measurable impact in healthcare settings? While the arts and sciences are often seen as divergent disciplines, data from credible research claims otherwise.

In the peer-reviewed Journal of the Royal Society of Medicine (JRSM), researchers of one published article cite a well-known scientific study of the visual environment and health outcomes which found that levels of depression and anxiety were lower in patients undergoing chemotherapy when exposed to visual art than in patients not exposed to visual art.21 Further, researchers discovered that patients recovering from open heart surgery who were exposed to an image of nature experienced less postoperative anxiety than other groups who were exposed to an abstract image or no image at all. (Interestingly, the study concluded that patients experienced greater levels of anxiety when exposed to abstract art than those with no image, suggesting that art selection is very significant; see related sidebar for guidelines.)22

Also, the JRSM article noted that the use of appropriate art in hospitals is viewed positively by both patients and staff, and had a positive effect on morale.23 In fact, 43 percent of frontline clinical staff believed that the arts had a positive effect on healing and 24 percent felt that the arts improved clinical outcomes. Further, considerable evidence has shown that mental health can be improved by participation in arts projects.24

Additionally, research shows that the visual arts also have many intrinsic and instrumental benefits in healthcare. For example, research with children suffering from cancer indicates that engaging in drawing and painting is an effective method for dealing with pain and other disturbing symptoms of illness and treatment.25 According to the 2009 “State of the Field Report: Arts in Healthcare,” other documented benefits of participating in visual arts or art therapy activities include:

  • Decreasing symptoms of distress and improving quality of life for women with cancer
  • Improving depression and influencing fatigue levels in cancer patients on chemotherapy
  • Reducing acute stress symptoms in pediatric trauma patients
  • Increasing support, psychological strength, and providing new insights about their cancer experience for individuals who participated in an art therapy/museum education program
  • Strengthening positive feelings, alleviating distress, and clarifying existential/spiritual issues for adult bone marrow transplant patients in isolation

“The scientific approach is well underway and, with it, mounting evidence that the arts are truly making a difference in people’s lives in hospitals, nursing homes, senior centers, private homes, or other locations within the community,” the “Arts in Healthcare” report concludes. “Evidence also is emerging regarding economic benefits. Thus, research findings indicate that the arts can play a significant role in humanizing healthcare for individuals, families, and the healthcare providers that serve them; and can become part of the solution to our current healthcare challenges.”

Material Solutions for Healthcare’s Challenges

There’s no doubt about it: healthcare facilities are highly demanding environments. Nowhere is traffic nearly as constant and the need for cleaning so critical as in hospitals and other medical facilities. As this article has demonstrated, the aesthetics of healthcare spaces also matters to patients’ well-being. Taken together, these factors make up a “perfect storm” of sorts when it comes to specifying products and furnishings that must meet rigorous performance, programmatic, and maintenance requirements in addition to looking good for years.

According to the World Health Organization (WHO), nosocomial infections, or infections acquired in healthcare settings, are the most frequent adverse event in healthcare delivery worldwide, affecting hundreds of millions of patients each year, leading to significant mortality and financial losses for health systems.26 In fact, hospital-acquired infections are one of the leading causes of death in the U.S. and typically affect patients whose immune systems are compromised.27 Although infection caused by airborne transmission poses a major safety problem, research indicates that most infections are acquired in the hospital via the contact pathway, and microbiologically contaminated surfaces can be reservoirs of pathogens that are transferred from healthcare staff to patients.28

As a result, surfaces that can withstand repeated cleaning with harsh chemicals without sacrificing performance or aesthetics are needed in healthcare environments. Fortunately for designers and specifiers, there are a number of decorative laminates and architectural substrates that meet healthcare’s high demands while also conforming to evidence-based design principles—particularly as it relates to providing patients with positive distractions like artwork (more on this in the next section).

From wall laminates and divider panels to displays and large-format murals, today’s surfacing solutions can provide impact resistance, abrasion and scratch resistance, chemical resistance, and superior corrosion resistance as well. Depending upon the substrates used—which include acrylic, aluminum, clear PVC, fiber-reinforced plastic (FRP), polycarbonate, PVC board, and wood—today’s surfacing products are highly stable, dimensionally consistent, and can be engineered for special performance properties including:

  • Moisture resistance. Many of these surfacing products are impervious to moisture, washable, and easy-to-clean, making them a great choice in high-traffic environments and healthcare facilities where cleanability is a concern.
  • Scratch resistance. High-traffic environments with painted walls often fall victim to scuffing and scratches—a fact that not only diminishes the aesthetics of a space but also adds to maintenance costs. Printed laminates can be a very attractive option in busy spaces such as hospital corridors, ambulatory care, assisted living facilities, and schools. These panels and tiles are extremely durable and resist a tremendous amount of wear and tear.
  • Fire resistance. Depending upon the substrate chosen, decorative surfacing products can meet the most stringent ASTM fire ratings without sacrificing aesthetics. Both Class A and Class C products are available from most manufacturers to meet code requirements for fire safety in healthcare environments.

Art + Substrates: A New Canvas for Healthcare

As the research cited earlier in this article has demonstrated, visual art can have a measurable impact on patients in healthcare settings. But because of the stringent performance and cleanability demands of healthcare environments, artwork must be placed carefully so that it doesn’t interfere with facility operations—or does it?

Thanks to advances in printing technology, new graphics programs from some leading surfacing manufacturers are able to combine graphics and imagery with an array of durable and cleanable substrates from FRP to metal. This fusion of materials and digital printing results in virtually endless design options that have the added benefit of being able to withstand high traffic and frequently cleaned environments—perfect for virtually any area of a hospital or medical center (not just lobbies or waiting areas).

Here’s how it works: Designers who are looking to incorporate visual images into a vertical service of a project can find ideas from manufacturers’ libraries and can choose from hundreds of existing images to fit the design plan. Alternatively, specifiers can upload their own custom artwork for translation into a surfacing product, assuming the manufacturer has custom-printing capabilities. The proposed design is then submitted for technical review to ensure that it meets production requirements or to determine if it needs to be modified. Customization specialists will also make certain that the design meets the client’s expectations in terms of texture, size, scale, detail, context, and brand specifications. Once a design is approved, it moves to sampling and production for approval before full-scale production begins.

To ensure the best end product that makes the biggest visual impact, the method of printing should be taken into consideration. When printing graphics and photography to substrates, there are generally two printing options available:

  1. Direct digital printing. With this method, digital printing is completed directly on the surface of the substrate, so that the image is front-and-center, almost standing off the material. The UV inks form a thin layer onto the substrate, which is then cured with UV light. This process ensures that the ink is completely bonded to the material and will not peel, crack, or delaminate if flexing occurs. With large-format digital printing, some manufacturers now offer more stock substrate options from clear materials—great for a project where the look of glass is desired—to more rigid substrate, which great for heavy-duty applications like outdoor signage. Designers also have the option of printing onto almost any substrate up to four-feet wide and eight-feet long, opening up a world of possibilities for any project. Digital printing produces high-quality, full color images that create an unforgettable impact.
  2. Sublimation. Sublimation technology began in the 1970s alongside modern computers. Special ribbons were infused with sublimation particles and a dot matrix printer was used to create monochromatic images. Today, sublimation can fuse full color, photo-quality images on a number of different substrates to create a variety of looks and textures. Sublimation printing literally embeds the image into a substrate. This is accomplished through heat and pressure which turns the dye into a gas, essentially forcing the image into the substrate. This process allows for the properties of the substrate to be visible through an image. Sublimation also creates an essentially indestructible image that is incredibly durable and will not scratch or peel. Sublimation produces beautiful images that have the added dimension of allowing the material to shine through.

In addition to printing methods, art requirements for printing products such as panels or large-format wall murals play a vital role in the success of printed surfacing products. A number of specifications need to be taken into consideration that will in large part determine the success or failure of a custom-printed product, including:

  • Resolution. For custom artwork, full size digital images at a native resolution of 300 ppi or minimum 150 ppi should be used. If those file sizes aren’t available, the manufacturer will evaluate the image and determine if it is suitable for the project’s needs. Depending on substrate and function, designers may be pleased with the quality achieved with a less-than-perfect image. Printing to substrates can be a very forgiving process and well-known manufacturers have worked with many files that fall way below any sort of conventional resolution standards with good results.
  • Photo Quality and Manipulation. Higher resolution does not always equal higher quality. An example of this is when a photo is taken in low light. Digital cameras tend to create “noise” via random speckles of off color when there should be none. It is much easier to manipulate and “fix” a lower resolution photo that is shot well than to “fix” a photo with high resolution that is poorly shot.
  • Image File Formats:
    • Raster images—Common raster image formats that are used include .psd (Photoshop), .tiff, and .jpg. These file formats are resolution-dependent, meaning that as they are scaled up in size it effectively results in a lower resolution. (For example, a 300 ppi photo scaled up to 200 percent would then be 150 ppi. Twice the size = half the resolution.)
    • Vector images—Common vector images used are .ai (Adobe Illustrator), .eps, and .pdf. These images are usually created by an artist and may be safely enlarged to nearly any size with no loss of resolution.
  • Bleeds. Documents must provide bleeds if colors, images, or graphic elements go to the edge of the final product. For bleeds, the artwork must extend 0.125" (1/8 inch) beyond the final size.
  • RGB Color Preferred. RGB has a broader range of available colors and will produce better prints. Converting files to CMYK is only for images that will eventually be converted to a halftone and used in a process like offset printing.
  • Custom Spot Colors. For PMS color matches, providing the manufacturer with a Pantone number will help guarantee a seamless look.
  • Fonts. The smallest optimum size for fonts is 12 point. Some fonts require a larger point size or bolding, especially if reverse copy is needed. Remember to provide type as “outlines” so that type conversion issues are avoided.

Finally, when it comes to selecting the right substrate for the application, remember that the nature of the backings vary considerably and will change the appearance and clarity of the graphics selected. Further, differences in performance characteristics means that some substrates will be better suited for outdoor usage or indoor signage, for example.

Use the following chart as a guide when making substrate decisions for custom-printed projects in healthcare (and other commercial) applications:

Solution and Substrate Quick Reference Chart

Following are two case studies that feature art installations using surfacing materials in innovative ways that meet the rigorous challenges unique to healthcare environments.

A Tale of Two Hospitals

Johns Hopkins Hospital in Baltimore was founded in 1889 as a teaching hospital and biomedical research facility. It has long been regarded as one of the world’s most outstanding healthcare institutions. Today, the facility continues to uphold its reputation by constantly striving to improve and excel in the medical field.

As part of the Johns Hopkins’ goal to modernize for the 21st century, it decided to remodel its 1977 Nelson/Harvey building which is used mainly for private patient rooms. Normally, when decorating a new building, interior designers could spend up to six months looking for art to adorn the walls. Art is very important in the design because it acts as positive distraction for patients, families, and staff, and gives them something more pleasant to think about—a facet of evidence-based design that has been demonstrated by research to improve patient outcomes. However, for this building, designers knew they had to compete with daily traffic and abuse, taking framed art out of the equation. Plus, they only had six weeks to complete the art design and production process.

Johns Hopkins’ designers needed a substrate material that was scratch-resistant, chemical-resistant, and Class A fire rated. In line with EBD principles, they also wanted the graphic art to feature the unique and beautiful gardens and landscapes found in Maryland from the mountains to the Atlanti Coast. Each floor was to feature large-scale murals in the main elevator lobbies with the flowers and plants from different regions in the state. The team needed the murals designed, produced, and installed in a timely manner to meet their building opening deadline. To solve their problem, the design team at JHHS Architecture & Planning partnered with a leading laminate manufacturer to create custom art that could withstand daily cleaning, bangs and bumps by equipment, as well as regular wear and tear.

After consulting with the supplier, the team chose a substrate that provided all the necessary features, while its translucent, textured quality was perfect for the printing process—which allowed the large-scale art to be fused into the back of the substrate and be protected by its durable, “pre-distressed” fiberglass surface. Johns Hopkins’ design team and their environmental graphic artist, Keith Kellner, worked closely with the manufacturer’s in-house creative team to perfect the creative, colorful images. Through sampling, Johns Hopkins fine-tuned the colors and design within the allotted time frame. In all, the design team produced seven different designs featuring colorful floral images such as tulips, black-eyed Susans, and peonies to coincide with the different floors. The patients, visitors, and staff are now greeted by the larger-than-life bright and sunny murals. It’s a delightful discovery, adding an unexpected joyful and healing experience to what is often a stressful situation.

The three-part main lobby mural was the most complex and time sensitive, and one of the most important feature designs to be developed. It depicts the new Nelson/Harvey façade with the Billings building’s famous Johns Hopkins Dome reflection. It is blended with snippets of the floral elements from each level, tying the past and present history with the garden designs and setting the tone for the art murals on the floors above. Not only did the manufacturer assist the team every step of the way, but its product versatility and nimble service proved to be exactly what Johns Hopkins was looking for. As a result, they are already planning future projects using this product as a versatile resource.

Similarly, when Georgetown Memorial Hospital, part of Tidelands Health in Georgetown, S.C., decided to renovate its building, the client also wanted to embrace the hospitality design trend in healthcare with the goal of creating more welcoming environments that focus on patients’ needs. Kristen Lopez, director of interior design at Curtis Group Architects Ltd., was the project lead and had a very specific vision in mind: to create a warm and inviting design that was also highly functional and durable.

The hospital needed to replace the existing wainscot that lined the corridors and the kick plates around the nurse stations. The new material needed to be durable, scratch- and chemical-resistant, Class A fire rated, easy to clean, and stand up to the high traffic present in hospitals. Lopez also wanted something that added to the overall design.

“We wanted to create a warm feeling—we didn’t want it to look cold and sterile,” she said. “We also wanted something to match our paint colors so it would blend into the design.”

At first, Lopez considered two different products on the market; however, one was not an FRP and the cost did not suit the budget, and the other featured a significant amount of texturing, making it difficult to clean. The designer ultimately chose a popular translucent FRP product, which encompassed all the functional features she was looking for as well as a bonus—the manufacturer’s custom printing process—which allowed a custom color to be fused into the product. The supplier was able to embed a solid color to the back of the substrate that perfectly matched the hospital’s paint scheme, making it a seamless addition to the design.

“The idea was to give the wall extra protection, but we still wanted it to look like the painted surfaces and blend in for a natural feel,” Lopez said.  With the color on the back, the FRP protects the image so it can never be damaged.

Another benefit for Lopez and her team was the ease of installation and the size variations of the surfacing product. Installation was simple for the contractors and the longer lengths of the substrate lessened the amount of vertical reveals.

Georgetown Memorial Hospital has been very happy with the result. As renovation continues, more product with the same fused color is being added to the design because, as Lopez said, “it was one of the items that helped bring the whole design together.”

As these case studies and credible research demonstrate, artwork plays a vital role in the design of healthcare spaces that perform—and thanks to the ability to print on a variety of substrates, the beauty and power of art comes with the added benefit of standing up to the most demanding environments.


Guidelines for Choosing Artwork in Healthcare Facilities

In the healthcare environment, art is often the most visible component of a space. Today, nearly 50 percent of all hospitals in the U.S. have arts programs.29 In spite of the costs associated with art programs, the Society for the Arts in Healthcare (SAH) and the National Endowment for the Arts (NEA) concluded from a joint analysis that hospitals use the arts “to create a more uplifting environment” in addition to “create a welcoming atmosphere and build community relations.” And as this CEU has demonstrated, the impact that art has on patients can be verified by credible research, making the process of selection an important one.

The following guidelines published in a study by Ulrich and Gilpin (2003) can help designers and specifiers choose artwork in hospitals and medical centers wisely:

Additionally, three aspects of art need to be taken into consideration for healing environments, according to The Center for Health Design’s “Guide to Evidence-Based Art,” including:

  1. Location of artwork (considering where the artwork is going to be located and how it can be the most effective in enhancing the physical environment and developing a healing atmosphere).
  2. Needs of special patient populations (evaluating the unique needs of the kind of patients who will view the artwork. For example, art for pediatrics may differ from art for palliative care.).
  3. Role of demographics in the healing environment (considering the ethnic, gender, and age makeup of the location of artwork and choosing art accordingly).

“Investigating issues of content, composition, and color with respect to variables such as culture, age, ailment, cognitive function, and length of stay are now warranted to enable the growth of the existing evidence base and make informed design decisions based upon them,” the CHD observed in its Guide. “In addition to the appropriate content of art, investigation on the role of art placement is also warranted. Patients are often supine, or have a limited line of sight, which must be taken into consideration. Efficacy of art interventions with respect to placement, location, and size of artwork must be further investigated to develop thorough guidelines.”

Sensitivity to these issues will go a long way in ensuring that artwork selected for healthcare environments will have the positive effects it is intended to.

For further reading, download a copy of Picture of Health: Handbook for Healthcare Art by Henry Domke, Ph.D. at:




1, 2 “Pebble Project.” The Center for Health Design. From

3, 10 Smith, R.; Watkins, N., Ph.D. (2010). “Therapeutic Environments.” Whole Building Design Guide.

4 “Obamacare Bill: Full PPACA & Related Laws.” (2016). From

5 Griffin, C. H. (2016). “Healthcare Architecture and the Affordable Care Act.” AIA’s Academy of Architecture for Health.

6 Davies, N., Dr. (Feb. 2, 2015). “Evidence Based Design: When Neuroscience, Psychology, and Interior Design Meet (Part 1).”

7-9, 17 Malkin, J. (2008). A Visual Reference for Evidence Based Design (1st Edition). Center for Health Design.

11-13 “Evidence-Based Hospital Design Improves Healthcare Outcomes For Patients, Families and Staff.” (2004). Robert Wood Johnson Foundation.

14 Gamble, M. (Nov. 22, 2010). “5 Ways Evidence-Based Design Adds Value to Hospitals.” Becker’s Hospital Review.

15 Whitemyer, D. (May 13, 2010). “The Future of Evidence-Based Design.” IIDA

16, 21-24 Lankston, L., Cusack, P., Fremantle, C., Isles, C. (Dec. 1 2010). “Visual art in hospitals: case studies and review of the evidence.” Journal of the Royal Society of Medicine.

18, 19 Fitzgerald, L. (March 2016). “A Sense Of Place: Art Connects Healthcare To Community.” interiors+sources.

20 Gordon, Sandy. (May 2016). “Art+Design.” interiors+sources.

25 Rollins, J., Sonke, J., Cohen, R., Boles, A., Li, J. (2009). “2009 State of the Field Report: Arts in Healthcare.” Society for the Arts in Healthcare.

26 “Health care-associated infections FACT SHEET.” (n.d.). World Health Organization.

27, 28 Joseph, A., Ph.D. (2006). “Impact of the Environment on Infections in Healthcare Facilities.” The Center for Health Design.

29 Hathorn, K., Nanda, U., Ph.D. (2008). “Guide to Evidence-Based Art.” The Center for Health Design’s Environmental Standards Council.

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