6. Summary of findings across the case studies
The approach adopted by RACH in its delivery of the programme was based on creating high quality artwork that relies on user consultation to shape the final outcome. The stakeholders of the projects and participants in the process included children (patients) and their families, the staff and external youth groups. The stakeholders also included the artists, the Art Group and the coordinator.
The successful delivery (across 3 case studies) is understood as:
The RACH approach and structure:
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the structure, relationship and expertise in place to manage delivery of the programme – a Sub Art Group and a coordinator.
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an inclusive, democratic, non-hierarchical model with a negotiated final end product
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the ambition of the projects as reflected in the artists’ briefs (i.e. breadth of stakeholders involved in consultation and set of descriptors of the outcomes of the process and product)
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the quality invested in the process (selection of artists, monitoring progress, support and mediation by coordinator and Sub Art Group)
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the staff involvement and support throughout the whole process
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the particular skill sets of the artists engaged (e.g. working sensitively, flexibility)
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the high quality of final products directly informed by the consultation
Impact of the process:
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the artists’ workshops added significant value to the service of the departments
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staff enjoyed the process and felt fully involved and/or informed
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staff learned from the artists
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the children and their families enjoyed the workshops and their input helped inform the final work
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the children gained confidence and self-esteem through participation in the artists’ workshops and activities
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the workshops had significant therapeutic value for the children and their families
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for (two) artists the level of consultation (as stipulated the briefs) was the ‘most thorough’ they had undertaken
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significant educational impact on the external youth groups (partners in the projects) through their involvement (Case Studies 2 and 3)
Impact of the finished work:
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staff reported significant clinical benefits through an improved working environment as per the descriptors in the briefs (e.g. child friendly, welcoming, less clinical/threatening)
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staff reported significant therapeutic benefits for patients and their families (e.g. distracting, reassuring)
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staff, the children and their families felt ownership and pride in the finished works through playing a part in the process
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a diversity of creative product (characterised as ‘graphic design’, ‘fine art’ ‘interior design) appropriate to hospital users (children and families and staff)
Impact of the experience:
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was a learning experience for the stakeholders (staff, young people, artists, Art Group and coordinator)
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the level of consultancy ‘fundamentally’ affected the artistic practice and the aesthetic of the artworks (Case Studies 2 and 3)
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the support structure and attitude of the coordinator (embracing risk) increased the artists’ ambitions and pushed them that bit further in terms of the artworks they produced (Case study 3)
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the Art Group and the coordinator appreciated the professionalism of the artists in their ability to respond to challenges
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a desire by the staff to develop/build upon the experience i.e. process and product
Clearly different individuals within the different stakeholder groups were involved and benefited in different ways and to different degrees. Detail of this is found within the case studies and the summaries at the end)
7. Discussion of findings
7.1 Areas for development (strengths)
An emergent model – structure and characteristics
An outcome is an emergent model for the commissioning of public art in a health context. The model reflects the approach and ambition of the RACH Art Group where user consultation informs the production of high quality artworks appropriate for the children and users of the hospital.
The structure for delivery was a Sub Art Group (of 3-4 people) committing time and expertise and working closely with a coordinator as part of the staff on-site in the hospital. Art expertise in the Sub Art Group, along with the mix of administrative and operational expertise, was invaluable in bringing an informed perspective - from commissioning the artist, through to making final decisions on a negotiated outcome. The coordinator was also a practitioner, understood the issues from the artist’s perspective and could make useful suggestions for developing the artwork.
The model is characterised as democratic, non-hierarchical and informal. Clinician’s and young people’s views were included from the outset (developing the brief and selecting the artist). The ‘creative consultation’ with the artist was characterised by the breadth of people involved – young patients, their families, the staff and external youth groups. The latter helped ensure young people’s views were represented in the eventuality of no patients being available. For the artists the RACH projects were the most challenging projects to date in terms of user consultation.
The artists’ briefs reflecting the ambition were open to interpretation by stakeholders (particularly the adults involved). Direction of the work was influenced through the artists’ consultancy i.e. workshops and discussions, with the support and mediation by the coordinator.
The model’s success depended upon important qualities including trusting in the process, developing a common understanding, artists working sensitively and responsively, a level of commitment, involvement and support for the artist from staff and good communication. It was also the coordinator’s personal approach. A relationship with the artists described as ‘supportive but not stifling’, and, very importantly, her preparedness to embrace risk which, in turn, encouraged the artists themselves to be more ambitious.
An impact (of the model) was on the artistic practice itself (described as ‘fundamental’ and as increasing the artist’s belief and passion for public art to make a meaningful difference). The consultancy process impacted directly and deeply on the final aesthetic. All of the artworks are infused with a multiplicity of influences.
The model embraces a set of values. The model embraces risk. The model might not be appropriate for all situations (departments). The model does not ensure consensus, but tries to deliver a baseline of requirements with the different stakeholder groups benefiting in different ways and at different levels. A key quality of the model is learning and future development could look at ways to build this into the process (see below).
How workshops work – what does ‘to inform’ mean in creative consultation
The way the coordinator introduces the project and outlines what the young people’s input to a large project might be is key to managing expectations. However this is a complex challenge, for example, there are preconceptions about what artists do –held by adults and young people. In the case of the adolescents in the external youth groups (Case Studies 2 and 3), their expectations were for a predominant (and familiar) model of ‘community-style art’, rather than public art (i.e. art by public consultation).
The coordinator described their involvement as being to ‘inform’ the artworks, but precisely how this sort of involvement will manifest itself and play out can be complex and subtle. It might well be unknown at the outset, partly because the artists themselves do not know what the results from a workshop will be, nor do they know how this will inform the actual finished artwork. Furthermore precisely how participants’ input informs the final artwork might not be a clear, obvious visual connection; it could be much subtler.
In other cases artists’ workshops (methods and outcomes) are tried and tested and are known precisely by the artist (Case study 2). However it is significant that the process was not made explicit by the artist at the outset - she didn’t feel that this was necessary and had never done this before in projects.
On the one hand a sequence of workshops, one building upon the next was interesting because understanding developed as the process unfolded: on the other hand it was opaque and confusing (for young people and adults) in terms of how the workshop activity was relevant to the artwork and how each workshop built on the previous one. Interestingly, some children with their parents found individual workshops enjoyable and accessible and were not particularly concerned about the relevance to the finished installation.
There are two issues, firstly how participation is framed. This might be something people can dip into and get something from in a single session and also be a series of sessions that lead to a deeper involvement and understanding. The scope of how participation is framed is an important consideration given the ever-changing population of patients in a hospital, and a more consistent group such as staff and external youth groups as well as some patients and families.
The second issue is the transparency of the artistic processes. Significantly, two artists in this evaluation explained that they are not usually asked to be this transparent (Case Studies 2 and 3). This points to the need for more attention to the way the artist is introduced – by the coordinator and by the artist themselves (it was largely up to the artists to structure and plan the consultation in discussion with the coordinator). At this point it would be good to explain more clearly how the workshops and the consultation might work. (A good tactic used in the projects was to display posters announcing the artists’ workshops in the hospital as well as the coordinator personally introducing the artist, both in the hospital and externally).
The artist having a base
In all the projects the artists were given a specific room or area in which to work which was within or near the department in which they were working in e.g. the play area between the Surgical and the Medical where they could do group work but close enough to allow them to move between areas (from the play area to the wards) to maximise creative consultations.97
Working one-to-one and luck
Interestingly, all of the artists explained that, when working with patients and their families, they got better material than when working on a one-on-one basis than when working in groups. Also, they felt that luck played a part in terms of who the artist encountered and engaged with, reflecting instances where a single child and/or parent gave really useful or interesting material that influenced the work.
Some visual tactics
Some artists’ tactics that worked well included workshops where something is made quite quickly, within one day, so young participants feel good about what they’ve achieved. Artists putting participants work up on display and/or using methods to make a visual presence in the hospital (e.g. tent in the play area) encouraged patients to take part and made the process ‘not a hidden thing’. Activities where the child was able to make something that he/she could take home (e.g T-shirts) was appreciated.
A tactic by the coordinator was to also frame the work by the external youth group and have this celebrated and on display as well as the final artwork.
A dialogue with art – developing feedback loops
Reflecting on the programme the coordinator spoke of ‘a slow evolution’. In her experience making art using this approach aims for a meaningful dialogue with the stakeholders and takes time and effort from everyone involved. Appreciation and understanding evolve slowly.
Intrinsic to the model is learning. The play staff who played a crucial role in the delivery of the project are a clear representation of this. The play staff coordinator described this:
‘My understanding and appreciation of art has developed. My views on what families like or don’t like has changed and, most importantly, I now recognise the importance of art in the hospital environment… I notice since (the play team’s) involvement they have also learnt so much; I see differences in how they organise art activites, how they display children’s artwork, and most importantly, how they discuss the pieces of art with others’ (ARTworks, RACH, 2009)
Development of the model could involve actively promoting learning which, in turn, is key to creating a sense of ownership. For example, creating feedback loops where participants in the consultation would be asked to reflect on, discuss and share their experiences, as was the case at the RACH Event (March 2008). This occurred after the project was completed, but could also happen at other points e.g. (re)drafting the brief, artists’ introductions/presentations as a question-answer session, events external to the hospital presenting the work e.g. to peer groups such as the local art school.
7.2 Areas for development (weaknesses)
Scope in the briefs
The number of areas within a department, or departments grouped together within a single brief needs careful consideration. Too many areas, each with different sets of staff, patients and ways of functioning, can be unrealistic given the aims in the brief (a major problem in Case study 2(b) and to some extent in Case study 3(b) – Day Case Unit). Too many areas can also be overly ambitious, can overstretch the artist and lead to one area feeling less satisfied than others.
Managing multiple expectations – ambitious yet realistic
The ambition of the artists’ briefs included a very broad spectrum of stakeholders, each with their own needs, ideas and different kinds and levels of input into the process. The briefs also outlined the aims or hopes for the impact of the project (process and product). While ambition is crucial (and arguably raised the bar and resulted in the artworks going beyond peoples’ expectations), tensions arose when there were different expectations of what participation would mean (with the external youth groups) and the descriptors in the brief were considered to be a kind of check list of what would be deliverable (by staff). As acknowledged by the coordinator, both need improved communication.
The external youth groups (Case studies 2 and 3) did not understand their involvement as being ‘to inform’ a large-scale public art project. They had expectations of actually making the work i.e. the more familiar approach of a ‘community art-style’ project. Development would involve more discussion at the outset of a project where fundamental questions could be asked that would address preconceptions of what artists do (i.e. public consultation) and simultaneously inform young people of this more complex, contemporary approach to making art. Seeing good examples or case studies of work is an obvious way. This would also include the commissioned artists’ work. However this would require a considerable commitment in terms of time and resources to help prepare the young people for the experience, although it would have important educational benefits. To not undertake this raises ethical questions about young people’s involvement, although this was not an issue in the RACH project as steps were taken to respond to their feelings and they were actively involved through to the completion – when, interestingly, some individuals did understand more fully understand (see) their involvement in the finished product.
Staff expectations at one point became unrealistic in terms of what the artist felt was deliverable i.e. a kind of check list of what they wanted the artwork to do and led to considerable pressure on the artist because of what an artwork could realistically do. On the one hand, a set of descriptors in the artist’s brief (‘welcoming’, child friendly, ‘distracting’, ‘less clinical’ etc) gives scope for the artwork, on the other hand, equally staff need to know that not all of the descriptors, nor in equal measure, are deliverable. As with the external youth group, discussion at the outset is required along with developing a ‘baseline quality agreement’ with the aim of understanding what the minimum might be. Again this would involve time and resources to develop, with development helping to prepare and inform. Equally the artists’ consultancy processes are in themselves the primary method of developing ideas for the artwork, but this was not made explicit enough at the beginning.
Considerations regarding timescales
The timescale of the projects for the artists and the external youth groups was 12-18 months. This is a very long time for adolescents (their perception of time is very different compared with that of an adult). In purely practical terms circumstances will change - involvement of the school pupils throughout was difficult because they had moved from S2 into S3 in the middle of the project. Shorter timescales would be much better for them, coupled with a clearer idea of how they fit into the bigger picture.
The external youth groups found the time between the workshops too long and wanted more communication in the spaces between them. Condensing the workshops over a shorter period with more frequent contact with the artist would be better (Case study 2).
There was quite a long time between the initiation of the project (project briefs and funding bids) and the artists actually starting work (up to 12 months). As noted by the coordinator, there could be more done in this ‘dead period’ to liaise with staff or revisit the briefs with them or to reaffirm the young people’s involvement in the larger project (Case Studies 2 and 3).
Two of the artists commented on difficulties which arose because the coordinator worked part-time (2.5 days per week) and they thought that a full-time coordinator (or two part-time people) would have been much better given the scale of the programme (both these artists lived a considerable distance from Aberdeen).
Delivery of the programme was possible because a) the coordinator was able to be flexible and change the days she worked for RACH - crucial at the installation phase - and b) the Sub Art Group was able to undertake work when the coordinator was not available for a period of time (due to an unexpected absence from work) and there was a considerable time commitment for monthly meetings and interim meetings. There was a close, mutually supporting relationship between the Sub Art Group and the coordinator and, of particular note, were the efforts to be available made by the Chair of the Art Group which gave invaluable support to the coordinator.
The need for an exit strategy
In the event of a project not continuing through to completion, it is very important that the reasons for outcome are discussed and understood by everyone involved. This is an opportunity for dialogue and for learning (Case study 2(b)).
7.3 Questions arising of significance to the wider sector
Questions arose because of an emergent model (reflecting the RACH approach), and through the points of tension in the processes. The questions suggest a deeper ‘dialogue with art’ where children and adults are not necessarily familiar with the creative process and learning through cooperative working is assumed a primary driver in the process. The questions have relevance to the wider sector i.e. the commissioning of art through public consultation.
• How to introduce the creative process to the stakeholders when the final product is unknown?
• How to deal with preconceptions of what artists do (children and adults) and how do workshops or creative consultations actually work?
• In order to manage expectations what might ‘a baseline quality agreement’ (with staff) look like?
• How can the different stakeholding groups better understand their part in a larger process and the (often complex and subtle) influences they may have on the final product?
• What strategies might be used to build upon learning from being part of the creative process?
(END)
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