The Application of Large-scale Imagery and Graphics in Healing Environments

There is an increasing body of research that shows the use of artwork in healthcare settings leads to improved patient well-being and better outcomes. In addition, the rise in awareness of biophilia and its impact on the calmness and mental state of patients also points to the use of such elements in healing environments.

This white paper seeks to briefly lay out the research behind these trends, and then to offer several examples where both beautiful imagery, and fun and whimsical graphics have been applied in actual real-world healthcare settings.

In a blog for the Huffington Post, Brooke Seidelman wrote on evidence-based design and the impact of art in healing:

In 1984, a landmark paper by Dr. Roger Ulrich¹ helped establish the field of Evidence-Based Design through a study in which he found that patients who had hospital rooms with a window required less pain medication and recovered at faster rates than patients in rooms without windows. Since that publication, the field of Evidence-Based Design has expanded and numerous studies have shown that artwork in patient rooms offer comparable benefits – promoting healing, relieving patients' pain and stress, and increasing their overall well-being².

One term being applied to the application of artwork is "positive distraction." Robert Niemenen writing in Interiors and Sources³, points to a caution – artwork is just one of several factors that can play a role in improved outcomes:

According to Jain Malkin, author of A Visual Reference for Evidence Based Design, "Projects 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?

Malkin is correct in pointing to the risk of blindly accepting art as a single-source solution, but Niemenen quick counters with this insight:

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."⁴

Suffice to say that the vast number of studies, articles and academic papers all overwhelmingly point to the benefit of incorporating artwork in achieving better patient outcomes, as well as improving their overall satisfaction with their healthcare experience.

Over the span of history, humans have developed an affinity for the life-supporting aspects of the natural world. This attraction to nature is referred to as biophilia, literally meaning "love of nature".

This natural love of nature has spurred innovation in the architectural community. Designers have endless opportunities to reconnect us with nature by incorporating biophilic elements in their designs.

In the article, What is biophilic design in architecture? appearing on EarthTalk.org, author Stephen Kellert says that unfortunately, while man may have evolved in the natural world, most of us spend 90% of our time indoors. Kellert contends this has led to an increasing disconnect with the natural world.

It is the interior space where healthcare happens. After all, don't we say things like, "Your Uncle Al is in the hospital"? Patients in healthcare settings often experience high stress, either due to their actual condition or just the difficulties of diagnostic procedures and testing. Oliver Heath, writing for HumanSpaces.com, said,

The experience usually happens at a time when the individual is in need of care or restoration and the visit in itself can be stressful. For many of us the fear and anxiety associated with clinical settings can make treatment more difficult or create barriers to seeking help in the first place, both of which can exacerbate healthcare issues.

Heath goes on to speculate that "connecting with nature can be a way to alleviate stress and anxiety [thus] improving the user experience in healthcare environments," and he adds that the benefits of biophilic design would also spill over to families, visitors and healthcare workers.

What one comes to quickly realize is that there is significant consensus among design professionals that: Incorporating nature makes us feel better. Yeah, we get that. However, there appears to be an equally significant lack of empirical evidence that biophilic design equals improved patient outcomes.

A classic measure would be reduced hospital stays. In an article in Commercial Architecture (Feb. 2016), Senior Editor Ken Betz, returns to the Ulrich study and writes:

Roger Ulrich, Ph.D., EDAC, a professor of architecture at the Center for Healthcare Building Research at Chalmers Univ. of Technology in Sweden didn't use the term biophilia when he did a study in 1984 that suggested simply that surgery patients recovered better in rooms with a view through a window. But "what few realize is that Ulrich's famous study was essentially about the impact of biophilic design on the built environment," said David Navarrete, director, research initiatives, The Sky Factory, Fairfield, IA.

Catie Ryan expanded on the importance of Ulrich's classic study, which measured the influence of natural and urban sceneries on patients recovering from gallbladder surgery. "Some patients were provided with views to nature, whereas others looked at brick walls. With all other variables equal, his findings revealed accelerated recovery rates and reduced stress for the patients who had views of nature. On average, patients whose windows overlooked a scene of nature were released after 7.96 days, compared with the 8.71 days it took for patients whose views were of the hospital's exterior walls to recover sufficiently to be released–a decrease of 8.5%," she said.

Those are some impressive numbers, to be sure. But, Ullrich's work is nearing 35 years old. What we would hope is for others in healthcare design to work at repeating or augmenting Ulrich's research; that is, bringing evidence-based rigor to the process of quantifying biophilic design's impacts.

Still, we feel confident in saying that utilizing nature as a healing distraction benefits all ages of patients. By allowing the lines between interior and exterior to blur, the benefits of the outdoors can be brought inside. Similarly, accessible outdoor spaces that carefully address safety concerns can be calming, positive and therapeutic distractions.

We conclude this white paper by turning our attention to several recent projects where hospitals employed large-scale imagery in either new construction or major renovation. In the following examples, you will see applications of colorful graphics and geometric shapes, as well as images drawn from nature to beautify a healing environment. The images were produced as Inpro’s Aspex® Digital Wall Protection, or as larger scale digital wall art.

1. View through a Window May Influence Recovery from Surgery. Roger S. Ulrich. Science, New Series, Volume 224, Issue 4647 (Apr. 27, 1984), 420-421.
2. Tse, M. M., Ng, J. K., Chung, J.W., & Wong, T.K. (2002). The effect of visual stimuli on pain threshold and tolerance. Journal of Clinical Nursing, 11(4), 462-469.
3. The Art of Healing Spaces the Perform. interiors+sources, January 2017
4. Fitzgerald, L. (March 2016). “A Sense Of Place: Art Connects Healthcare To Community.” interiors+sources.