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:
- 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.
- 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:
- 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).
- 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.).
- 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: http://www.henrydomke.com/PictureOfHealth.pdf
TAKE THE TEST
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