Outside-in: how art can help hospitals to become sites of cultural exchange

“Boundaries are quite like cell walls: rigid and impermeable, while borders are akin to cell membranes: at once resistant and porous”
Richard Sennett

Hospitals can be isolated places, shut off from the outside world. Think of the patient stuck in bed unconscious with no access to natural light, the child inpatient removed from everyday play and school life, or the mental health inpatient — physically restrained behind a high-security door. Even a simple day visit through winding corridors and long waits can conjure the feeling of civic dislocation: the sense that you have left the “normal” world and entered somewhere closed off, isolated, and unsettlingly removed from “real” life.

And so, we are often asked by clinicians to combat this dislocation by “bringing the outside in”.

As artists and designers we collect lost treasures of the outside world — the trees, the sunlight, the atmosphere of happy crowds, the feeling of going to a local church, library, or cafe — and bring them back into the hospital, along with their undeniable social and emotional benefits.

But things aren’t straightforward. To bring something into the hospital from the “outside” requires an act of translation and re-creation. Here’s an example: at UCLH’s proton beam therapy centre, patients travel five floors underground to receive a radical new form of treatment to beat brain and spine tumors. Down here, a sense of time and orientation is lost. You yearn for the the slow organic changes of the outside world. So how to bring a sunny day to a bunker 5 floors down?

Art in Site’s Martin Jones designed a large scale artwork that runs around the perimeter of the Macmillan Living Room. The artwork’s translucent material — “Corian” — is backlit, glowing with soft colours that fade and change slowly. Willow leaf shapes have been cut into the Corian, giving the feeling of sitting under a tree. Over the day, in real time, the sun rises in the corner of the room and sets on the opposite side. When you walk into the room, you know instinctively what time of day it is. This promotes what neuroscientists call a ‘parasympathetic rest and digest’ response — a mindful rescue for anyone feeling anxious and dislocated from the outside world.

Much of our work can be seen through this lens of recreating lost elements of the outside world: we’ve brought in a stained glass-esque window for a multi- faith room, rendering it in ‘bomb-proof’ materials to meet the strict compliancy standards of high-secure mental health environments; at St Thomas’ we developed a live-feed animation in the waiting area, which brings local weather to life on a screen; and at King’s Variety Children’s hospital, we brought large scale imagery of real patients into corridors after learning that many families might never encounter other patients throughout their visit.

Nonetheless, I think the phrase “bringing the outside in” can go much further. What if we were to widen the ambition to “bring the inside out”? What if we stopped thinking of the hospital wall as a tight border, and started to consider it a culturally permeable membrane, where art, societal connections, stories, and cultural activity flow freely in both directions between the insides and outsides of healthcare? This would be nothing less than a cultural revolution. And guess what. I think it’s already happening.

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Here are some examples:‍

The Gong at Dokk1 Library Aarhus‍

Designed by Danish artist Kirstine Roepstorff, called “The Gong,” this artwork creates a profound connection between hospital and civic space. The artwork comprises a tubular bronze bell 7.5 meters long, suspended in the center of the Aarhus library.

“When a child is born in Aarhus University Hospital at Skejby, the parents can press a button at the hospital, which sends a signal that rings The Gong at Dokk1. The Gong is engraved with a sun motif and an infinity symbol illustrating new life.”

In other words, the bell heralds the arrival of a child born in Aarhus so that the entire community will know and welcome it. New connections between mothers, families, patients, students are being made every time that bell rings. Click here to read more.

Healthcare arriving in civic space

Ventures like the Healthy Towns Initiative show a willingness to bring healthcare into the community, and I think art & cultural design will be instrumental to the success of this shift. In this vein, we recently designed an art scheme for the interior and front entrance of Solent NHS Trust’s Adults’ Health Centre — primarily dealing with sexual health, and set in a community hub’s former retail unit — which incorporates playful, large-scale geometric forms across the entrance and waiting areas.

“You can get lost in the artwork if you’re looking for distraction as you wait. Shapes in one panel are echoed in another. The environment can take you on a journey away from bored or anxious thoughts.”
Celia, Art in Site Designer

On the inside, the artwork creates a sensory sanctuary offering privacy and reassurance. Yet, on the outside, this scheme does not hide away — rather, it boldly celebrates the arrival of a healthcare space alongside it’s new civic neighbours — a cinema, retail shops, and a highstreet. It’s refreshing to see healthcare arrive in such style, showing why it needn’t hide away.

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Making inter-hospital boundaries more porous‍

These boundaries don’t just have to exist at the space between hospital and public street. In our waiting areas work, we are designing to demystify the activities of clinicians “in there”, helping everyone to better understand the human stories and logic behind wait times. Our film “Explaining Emergency” at St Thomas’ adults’ Emergency dept. features informative graphics and interviews with staff, who explain treatment protocols, waiting times, the patient journey, and how the service operates overall. This plays in waiting areas, helping to address the key concerns on patients’ minds — “why is that person being seen first?” “where am I in the queue?” — thereby helping to calm worries and prevent irritation, anger, and violence. Showcasing the expertise and dedication of staff, and the daily challenges they face, this film encourages a mutual empathy between front line staff and patients.

Just because we control for disease and risk at the border, does it follow that we can’t have a safe flow of culture at hospital/civic borders? No. We can make hospitals more culturally porous, without increasing any technical risks. All of the examples shown in this article use art in a highly compliant way, in line with all the reasonable expectations of fire regulations, infection control, easy maintenance, durability, and sustainability. The benefits, meanwhile, are huge:

• From stigma to pride: when mental health, sexual health etc. are brought into public spaces, there is the chance to reduce stigma, especially if they arrive with a joyful, bold, proud artistic identity. Think of how instrumental the rainbow icon has been to Pride movements, and for that matter, to a celebration of the NHS throughout the pandemic.
• Celebrating profundity: when healthcare is associated with grotty, peeling buildings and endlessly-blue environments it takes on an increasingly banal character in the civic imagination. Yet, as the The Gong at Dokk1 Library Aarhus shows, public art can link us back into the miraculous, the extraordinary. It can remind us that every act in healthcare is worth cherishing and appreciating in public space. And that might even have symbolic ripple effects for how we view the value of the profession as a whole.
• Demystification of the “insides” of hospital. The more we speak to patients in healthcare, the more we hear a desire for the environment to explain the inner workings of the hospital — from treatment, to the logic of wait times, to the personal perspectives and experiences of the staff. Our video work at St Thomas’ showed that this approach is hugely beneficial to patients: it can even reduce anxiety, violence and aggression, as people come to understand their situation better, and see the perspective through staff eyes.

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So here’s to more art and design that brings the inside out, the outside in, and even collapses that inside and outside distinction. What about more stories of the hospital, narrated by patients and shared in civic space near the hospital? How about more performance spaces built into new hospitals, making them a civic beacon of creativity and cultural exchange? And what about more public art that recognises the profundity of the work done by healthcare staff on a daily basis? What about using digital technology to create live artistic exchanges between the civic public and patients? Here’s to to a more interconnected culture of care.