Evaluation of Artworks Royal Aberdeen Children’s Hospital 2006 – 2009 June 2009 Delday and Douglas, rgu insert Insert rach rgu art logo logo

(Title page)

Evaluation of Artworks

Royal Aberdeen Children’s Hospital

2006 – 2009
June 2009

Delday and Douglas, RGU

Insert Insert

RACH RGU

ART LOGO

LOGO

© Royal Aberdeen Children’s Hospital, June 2009

Artwork © artists; Kiran Chahal, Lynne Strachan, Linda Schwab

Images from creative consultations/workshops © project participants

Photography © Mike Davidson

Contents Page No.
Executive Summary 5
1. Introduction 8

1.1 Context and background to Royal Aberdeen Children’s Hospital (RACH) 8

1.2 The RACH approach aims and brief for evaluation 9
2. Evaluation 10

2.1 Focus 10

2.2 Plan 10

2.3 Methodology: what was done 10

2.3.1 Methodology: variations to and limitations of plan and requirements 10

2.4 Note to the reader 11

3. Summary of findings 12
4. Remit of the evaluation 13
5. The case studies in full 14

5.1 Case study 1: Graphic Novel 14

5.1.1 The brief 14

5.1.2 Summary of the consultation process 14

5.1.3 Early stage: Hopes and anticipated challenges 15

5.1.4 The artist’s process and responses (patients) 15

5.1.5 Staff support and involvement 17

5.1.6 Negotiating the end product 18

5.1.7 Completion of the project: reflections on process and responses to final artwork 18

5.1.8 Learning from the experience 20

5.1.9 Summary of findings 21

5.2 Case study 2: Child And Family Mental Health (CAFMH) 23

5.2.1 The brief 23

5.2.2 Summary of the consultation process 23

5.2.3 Early stage: Hopes and anticipated challenges 24

Case study 2(a) Rosehill House 24

5.2.4 Staff support and involvement 24

5.2.5 The artist’s process and responses (youth group, staff, patients and families) 25

5.2.6 Negotiating the end product 27

5.2.7 Completion of the project: reflections on process and responses to final artwork 28

5.2.8 Learning from the experience 31

5.2.9 Summary of findings 32

Case study 2(b) Lowit Unit 35

5.2.10 Staff support and involvement 35

5.2.11 The artist’s process and responses (staff and artist) 36

5.2.12 Responses and what was learnt from the experience 38

5.2.13 Summary of findings 40
5.3 Case study 3: Surgical and Medical Wards and Day Case Unit 43

Case study 3(a) Surgical and Medical Ward Entrance 43

5.3.1 The brief 43

5.3.2 Summary of the consultation process 43

5.3.3 Early stage: Hopes and anticipated challenges 44

5.3.4 Staff support and involvement 44

5.3.5 The artist’s process and responses (external partner) 45

5.3.6 Negotiating the end product 45

5.3.7 Completion of the project: reflections on process and responses to final artwork 47

5.3.8 Learning from the experience 49

5.3.9 Summary of findings 52

Case study 3(b) Treatment Rooms in Surgical and Medical Wards and Day Case Unit 53

5.3.10 The brief 53

5.3.11 Summary of the consultation process 53

5.3.12 Early stage: Hopes and anticipated challenges 53

5.3.13 Staff support and involvement 53

5.3.14 The artist’s process 53

5.3.15 Negotiating the end product 54

5.3.16 Completion of the project: reflections on process and responses to final artwork 54

5.3.17 Learning from the experience 57

5.3.18 Summary of findings 61

6. Summary of findings across the case studies 63
7. Discussion of findings 64

7.1 Areas for development (strengths) 64

7.2 Areas for development (weaknesses) 66

7.3 Questions arising with significance to the wider sector 67

8. Appendices (on CD)

8.1 RACH documents

8.2 RACH methodology (step by step & diagram)

8.3 Stakeholder questions

9. List of Art Group
10. List of illustrations

Artists working with people,

Examples of children’s work etc

Before and after images

The RACH event (Studio 77 presentation)

Executive Summary
The approach adopted by The Royal Aberdeen Children’s Hospital (RACH) was to produce high quality artwork that is informed by user consultation. The stakeholders of the projects (and participants in the process) included children and families, the staff and external youth groups. The artists, the Art Group and the coordinator were also the stakeholders.
Delivery of the programme, understood through three case studies, was considered very successful. The aims of each project, as outlined in the artists’ briefs, were ambitious – the quality invested in the process (creative consultations with a broad stakeholding) and production of high quality, contemporary art fit for purpose in a healthcare environment appropriate for young people and their families.
Successful delivery was possible because of:

1) The Art Group structure and protocols; an art coordinator was based on site, working closely with a Sub Art Group, and the particular mix of expertise responsible for managing the programme (art, education, service provision).

2) Department staff support; they gave the artists the space, information and assistance to conduct consultations.

3) Commissioning artists with an appropriate skill set; they had the ability to work sensitively with service users and were able to adapt their processes and work flexibly.

The process was fully inclusive where staff and young people were involved throughout the process from selecting the artists, participating in the consultancies/workshops, to viewing and discussing final ideas. The involvement of external youth groups was an important dimension in the consultancy (in two of the three case studies). This helped ensure young people’s views were included (in the event of young patients being unavailable) and was considered valuable by the artists. The briefs contained open-ended ideas (open to interpretation) and these were developed through the consultancy process.
The case studies (art briefs) were diverse; a Graphic Novel described as ‘by children for children’, two projects in the Surgical and Medical wards with installations in the entrance and the two treatment rooms; a project in the Department of Child and Family Mental Health (hereafter referred to as CAFMH) with a permanent artistic intervention in an old building separate from the main hospital. The creative approaches and outcomes reflect this diversity – graphic design, fine art installation and interior design.
The artists felt the breadth and level of consultancy was more thorough than in other public art projects they had previously undertaken. They responded to this challenge by producing high quality aesthetic products infused with ideas and material generated through the consultancies. In one case (2a) the artist incorporated more of the participants’ work into the final designs than ever before. In another case (3a) the artist described a ‘fundamental shift in her practice’ as a direct response to the consultancies with young people (an external youth group). While the challenges led to creative work that went beyond what they themselves had imagined at the outset, it was made possible by the excellent support and encouragement of the coordinator and department staff.
The value of the artists working in the hospital was acknowledged by staff, patients and families. Taking part in the creative process was enjoyable and staff felt workshops added value to the service – from helping to counter the boredom some children might feel, to adding significant value from a clinical/therapeutic perspective (especially Case study 2a, CAFMH). There was significant impact from an educational perspective for the external youth groups and project partners (especially Case study 3a, Surgical and Medical wards projects with Bridge of Don Academy). Some young patients unable or unwilling to do an actual (physical) activity enjoyed and benefited from telling their stories

to the artist (Case study 1, Graphic Novel). Senior clinicians thought that the artists’ workshops were especially valuable for the long-term patients in isolation rooms (Surgical and Medical) and for those attending as outpatients (CAFMH) where some parents asked staff if the workshops might continue.

This involvement engendered genuine feelings of ownership in the final product across the stakeholding (detail of the case studies is in Section 5, where summary findings are given at the end of each project). Across the projects the final product was thought appropriate for the target audience and achieved some, if not all, of the aims as per the descriptors in the briefs.

The Graphic Novel – a 24 page book, is a collage of imagery and texts incorporating patients’ stories of their ‘journey’ to the hospital and factual information about the hospital. It was felt that this would be a valuable resource for play staff to use with the children – it was bright, colourful and informative. Responses from children and adults were mixed. The young people enjoyed the aesthetic style and content and thought it useful whereas some adults found the style a bit muddled or difficult and had differing views on the target age group (12+).

The Surgical and Medical ward entrance project resulted in the installation of a large scale lumiwall (giant light box) and aluminium panel. The artist worked with an external youth group (second year school pupils) and their ideas were incorporated into the final artworks. Interesting issues arose from the consultancy in terms of the group’s involvement. The installation was thought to make the area much more ‘welcoming’ and a technical problem with the installation was easily rectified.
The treatment rooms in the Surgical and Medical Wards and the Day Case Unit (by the same artist as above) was one of the most challenging briefs undertaken by this experienced artist – cramped rooms full of medical equipment, the challenge of consulting with young vulnerable patients and, at one point, the seemingly unrealistic expectations of some of the department staff. The project did not have an external youth group involved (as was stipulated in the brief) and the artist used the experience from her other commission (the school pupils) along with input from young patients and their families. Despite the artist’s reservations as to what was deliverable – in terms of the staff’s expectations of the final artwork – it was felt that the installation was a ‘transformation’ and that it had greatly improved the space by making it ‘more welcoming’. The permanent installation – printed Perspex panels – was based on two themes, walking to a park (in Surgical) and seaside/underwater (in Medical). Staff reported a significant improvement – from the feel or ‘ambience’ of the treatment rooms as being ‘less clinical’, to the artwork being very useful for ‘distraction’, and ‘reassuring’ for young patients whilst undergoing procedures.
The CAFMH brief was originally intended to cover two sites, however, the project was withdrawn from one towards the end of the consultation stage, so the project resources were re-directed to a single site. The permanent installation in Rosehill House (vinyl designs and new furnishings) was a resounding success by all the staff and service users. Patients and families and staff benefited from taking part in the artist’s workshops with everyone feeling part of the process and a sense of pride in the final outcome. Significant value from participating in the project included, for example, increased confidence and self-esteem in young patients, through to an improvement in compliance (in children attending the department). The final work was considered a ‘complete transformation’ of the working environment and to be much more child-friendly. Clinicians also observed a reduction in stress in children and perceived a reduction in the stigma attached to mental health, amongst other benefits.
A number of lessons were learned from the withdrawal of the project from the second site; the Art Group needed to have worked more with the specific team in the department in the planning stages and to not make assumptions in the early stages of a project (ie: to ensure that the language and aims of the brief are fully understood). The coordinator needed to ‘really listen’ to staff and to recognise the possibility that the project aims might need to be delimited with less open-ended ideas and clearer outcomes. The department staff offered useful feedback on what would be their ideal project, and a recommendation in the evaluation that there was a need for an exit strategy in the event of a project not continuing.
Across the case studies, the responses show considerable positive impact from the process (artist’s consultancies/workshops) to the final product (for detail see Section 6. Summary of findings across the case studies).
Areas for development include consideration of the scope of a project in terms of the number of departments or areas within a single brief (Case Studies 2 & 3b). Another area for development concerns the relatively long timescales of the projects when working with external youth groups (e.g.: schools) and the need for more frequent contact throughout the life of the project. An important and complex issue was the need to address young people’s expectations (pupils in Case study 3a and community youth group in Case study 2a) in terms of their involvement and what the term ‘to inform’ in a large public art project might mean. This in turn raised questions of how to introduce artists’ creative processes when the outcomes (i.e. the product) are largely unknown at the outset. Another issue was how young people might better understand, or envisage, their input in the final products – which can be complex and subtle. Here the coordinator addressed this by creating situations for feedback loops to continue the dialogue between stakeholders, but this is an area for development.
The issue of the expectations of the department staff also arose (Case study 3b), where, as in other projects, the coordinator’s role was to mediate and negotiate the outcome. This experience taught the coordinator that descriptors in the brief (‘distraction’, ‘welcoming’ etc) might need to be more fully discussed with staff at the outset and that expectations are realistically achievable by developing a ‘base-line quality agreement (see Sections 7.1 and 7.2 Discussion of findings: Areas of development, strengths and weaknesses).
An outcome of the programme is an emergent model for commissioning art that relies on public consultation (stakeholder and partnership working). This reflects the RACH approach and structure. It is intrinsically ambitious. It aims to deliver on two sets of expectation (i.e.: outcomes) – enjoyment and value from user and stakeholder involvement in the creative process, and production of high quality product invested with the results from the process. The model is democratic, non-hierarchical and informal with the final artwork not precisely predictable at the outset. There are certain qualities intrinsic to an emergent model, such as trusting in the process, an acceptance of risk, close working relations between the stakeholders and learning as a primary driver. Future developments should address some of the issues and questions arising to more fully develop the model. These questions have relevance for the wider sector (see Section 7.3).

1. Introduction
1.1 Context and background to RACH
The new Royal Aberdeen Children’s Hospital opened in January 2004 to care for children up to14 years with plans to increase the group to include 16 year olds.
The first phase of the art project concentrated on the public spaces of the hospital. The RACH Art Group was formed to direct work and set out the aims (RACH Art Strategy, June 2002) (see 8. Appendices).¹ To manage the first phase, the Art Group engaged an external arts consultancy to work with them on developing a strategy, to manage the commissioning and installation of the artwork, in consultation with, and reporting back to, the Group.
The Art Group consisted of RACH staff members (Service Management and play coordinator) and Grampian Hospitals Art Trust (GHAT) members. For the most part this mix of roles and interests continued as the Art Group moved into the second phase with some of the individual members changing.

The second phase of commissioning (2006-2009) was part of the New Royal Aberdeen Children’s Hospital Arts Strategy 2002. This would address a different kind of context within the hospital by concentrating on specific areas within the departments, such as treatment rooms and family rooms – ‘places where staff and children would be on a daily basis’. It was also envisaged that a different commissioning approach would be used, one where stakeholder consultation would be intrinsic to the development of the completed artworks.

To this end, the Art Group, along with Management Service and GHAT made a strategic decision to not be reliant upon an external agency operating from a distance and ‘removed from the hospital’, but to engage an art coordinator working on-site to manage the project. The art coordinator would operate as ‘part of the staff’ using the same mechanisms of reporting back and consultation with the Art Group. It would ideally be ‘a more intimate relationship’. Originally this was a 2.5 contract for two years and was extended to three years because of the additional time it took the coordinator to secure funding.
It was understood that engaging patients in the creative process would be very difficult for reasons of ill health and patient turnover. During the first 18 months, whilst fund raising for the second phase (i.e. programme of projects), the coordinator made links with external youth groups who formed part of the funding bids. In order to produce artwork that appealed to and was appropriate for the hospital’s young patients, the external youth groups would provide creative input alongside that from patients. It was hoped that this would ensure that young people’s views and involvement would impact on the final artworks making them ‘child-friendly’ (e.g. interesting, fun, welcoming and distracting).
The stakeholding groups involved across the nine projects in the Phase 2 RACH arts programme, and stipulated in the artists’ briefs, included patients, patient family members and the staff of each department. The external youth groups were involved in four of the nine Phase 2 projects.
At the outset the coordinator conducted a survey asking staff, patients and carers what kind of art they liked and what areas of the hospital should be concentrated on. The coordinator also went to consult with pupils from a number of primary and secondary schools (Appendix)
A pilot project in the HDU (High Dependency Unit) was used to test the process with an artist working with staff, patients and an external youth group. (This work is displayed in the corridor of HDU.)
The following eighteen months (until 31^st March 2009) resulted in the completion of nine art projects across different departments and was undertaken by seven artists. ²
1.2 The RACH approach, aims and brief for evaluation
The aim of using stakeholder consultation to inform the final artwork, and to ensure high quality aesthetic artwork appropriate for specific spaces and the users of the hospital, was ambitious. This aim bridges two models of creative production – the artist as solo author and the artist working with other people in order to direct or shape the final artwork.
This contemporary approach to commissioning public art can make the process complex, particularly if a broad range of stakeholders is involved. Reflecting the RACH approach, this evaluation adopts an aspiration model that monitors and looks for different kinds of outcomes. A quality of this evaluation is that it tracks the unfolding of the programme of work, rather than being carried out once the artworks were completed.
2. Evaluation
The evaluation looks at the two aspects of making artwork using stakeholder consultation – the quality invested in the process and the quality of the finished product. These can sometimes be (in the discourse) two different sets of expectations.
2.1 Focus
The evaluation addresses the following:

1. The impact of the artist on the environment

2. The effectiveness of the creative consultation

3. The appropriateness of the artwork for the users, reflecting the diversity of age

groups attending.
2.2 Plan
Three (evidence-based) case studies were selected from the programme of nine projects.³ This represented over half the programme (four projects in the three case studies).
The three case studies are:

1. Child and Family Mental Health (CAFMH) project (2 sites)

2. Surgical and Medical Wards: Ward Entrance project and Treatment Rooms project

3. Graphic Novel

2.3 Methodology: what was done
Ethical permission was sought and approved via Robert Gordon University. Posters announcing that an evaluation was taking place were displayed throughout the hospital and any relevant external locations (youth groups, schools and community centres).
The stakeholders in this evaluation included the patients and their families, staff, the Art Group, artists, external youth groups (25 interviews were transcribed and permissions given for inclusion).
Basically there were two evaluation stages a) first stage included hopes and possible challenges at the outset + the process of the artists’ consultancies/workshops with stakeholders b) second stage included reflections on the whole process + responses to the completed artwork.
The methods used to gather material included: interviews that were open-ended but operated within a framework of structured questions (to encourage a conversational approach and give richer material on the stakeholder experience); questionnaires and direct observation during the artists’ creative consultations/workshops with young people; visual documentation of the process and the final artwork; monitoring through regular communication with the coordinator, minutes from the Art Group meetings and observation at key points of the commissioning process; collation of documents.
2.3.1 Methodology: variations to and limitations of plan and requirements
The evaluation began in December 2007 with the projected completion by March 2009. Due to slippage in the programme timescale for installation of the final artworks the report was completed in June 2009.
The scope in one of the case studies changed from the original plan. In Case study 3 (Surgical and Medical) the focus was to be the Ward Entrance only, but was extended to include the Treatment Rooms of both wards (both projects undertaken by the same artist).
There were two parts or halves to the evaluation – the process and the responses to the completed work. Because of the timescale (and typical of many evaluations) the time between the completion of the artworks (installation) and gaining feedback to the artwork was quite short (from 2 weeks to 2 months after completion).
It was very difficult to get feedback from patients for two reasons - the turnover of patients in the hospital and the perceived intrusiveness of an evaluator in the wards. Contact with the young patients was made by accompanying the artist whilst they were conducting their consultations with the children and staff in the actual departments. Subsequently much of the patient feedback came from the artists and the staff, along with the evaluator’s observations.