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

Part of the play staff’s work is to accompany children into the treatment rooms and to provide distraction while they were undergoing procedures. Now they could use the artwork which was ‘lovely, bright, with plenty to look at’ to help with distraction. Depending on the child it could be useful in different ways – to begin a conversation by drawing the child’s attention to something in the imagery, or if the child pointed out something themselves. Sometimes the play specialists might be called into a room at the last minute and not know the child very well and here the artwork was especially useful as a focus to talk about. The artwork had made ‘such a difference’, it was ‘amazing’.
The ward sister (Medical) ‘loved’ the artwork in both treatment rooms and many staff had commented to her on how nice the room was now with the bright colours. The Medical Treatment room was very much seen as ‘the bad room’ and was now ‘a less threatening environment’. She gave an example she had observed of the clinical value of the artwork. The example was where boy had to have a lumber puncture and normally during this procedure a child would often ‘curl up and shut their eyes’. With this particular patient ‘the boy found it quite reassuring that he had something to look at instead of the old glass panels’ and although he didn’t say anything about the artwork (e.g:suggesting that it had made it less sore or better) he had certainly found it reassuring to have something to look at. This was clear from his body language.
The ward sister (Surgical) explained that children can be very scared when they go into the treatment room, but it was ‘very hard to judge with a child looking at the artwork what they might have been feeling before the artwork was there’. She thought that th artwork had definitely created a different, pleasant ambience or feel to the room when you walked in and was so much better as a working environment. She liked the plastic chairs, the use of Perspex as a medium and ‘the whole Tutti-Frutti cheerfulness theme’. She really appreciated the struggles the artist had with clutter and limitations of the medical equipment.⁸⁶
The department manger thought that the artwork in the treatment rooms had ‘certainly brightened them up’ and had ‘taken that clinical edge off them and given a bit more fun to the room.’ She especially liked the coloured plastic chairs that were ‘ideal from an infection control point of view’ because the design meant they were easy to keep clean (with no fussy bits). ⁸⁷
5.3.17 Learning from the experience
Senior clinical staff appreciated the challenges faced by the artist in terms of the restricted space in the Surgical and Medical Treatment Rooms and thought that she had done a wonderful job despite the limitations. A hope/concern was that that the artwork would not become old and faded or ‘un-kempt looking’, but would be ‘kept fresh’.
The play staff had learned useful art ‘tips’ and art ideas useful to them in their day-to-day work. All the staff thought that it was important to have different people (artists) coming into the hospital, to add to the activities on offer, and be a different kind of stimulation for them. This was especially important for long-term patients.

The most challenging commission undertaken by the artist

For the artist this would be ‘one of the most challenging commissions’ she had ever undertaken.⁸⁸ There were a number of reasons:

The very cramped spaces in the Treatment Rooms that were cluttered with medical equipment (she knew about this from the start but found it harder than she’d imagined)

The challenge of working with sick children, something she was slightly apprehensive about (see 3a). The breadth (and depth) of consultancy (number of staff, as well as children and their carers/families).

Staff anticipations of what an artwork would do to improve the environment.
Staff expectations of what an artwork would do

On speaking to the staff about what they wanted for each room she felt that she would never be able to satisfy all the things they were asking an artwork to do - it was just not deliverable. She felt a ‘weight of responsibility’ because of the ‘seemingly impossible’ set of expectations – to make it ‘bright, colourful and cheerful’, and to ‘relax the children’, and to ‘reduce fear in patients’. The more she spoke with staff ‘the more the wish list grew’ and it was at this point that the project got much harder. Some staff had very strong views and with some it felt as though they were asking her to re-design their workspace, and she began to think that what was really required for the project was an interior designer, not an artwork. But she ‘resisted this’ and her ‘gut reaction’ was to make a piece of physical art that could be enjoyed by people’.

Structuring the consultancy and the benefit of an external youth group

The artist appreciated that it was largely up to her how to shape the structure of the consultancy (it was not imposed, nor rigid), in discussion and agreement with the coordinator, and she described herself as the sort of person who tends to ‘really delve deeply’ into the process. ⁸⁹ From the many parents and young patients she spoke to what came out of it was ‘the diversity of people and the huge age group’ and the question of how to deal with that. Many people she spoke to talked about being outside and outdoors and the importance of the coastline and these became elements in the final work. On reflection she thought that, possibly, there were too many people involved in the consultancy.

It was at this point that the artist used the experience of working with an external youth group (Ward Entrance project) ‘in her mind’s eye’ to help guide her as to the appropriateness of the content for the design ideas (there were connections between the external youth group and the young patients in terms of connected themes). While being mindful of the staff’s ideas she was clear where her priorities lay to make artwork that children could relate to and she thought that parents would be able to clearly recognise that.
Too many changes at the final design ideas stage

The final stage of presenting visuals to staff resulted in them asking for over 40% of the designs to be changed.⁹⁰ She felt she had made enough changes in response to staff feedback already and that to change the designs further would ‘lose it’s integrity or personality’ as an artwork. She was also clear that her approach was as an artist and not as an interior designer where work is undertaken and fully directed by the client. At this stage she felt a bit ‘saturated’ by the level of consultancy and a bit demoralised and demotivated. To respond to the list of changes would mean that there would be no ‘core’ left and, at this stage, it should really just be a ‘tweak’ or removal of anything that might offend, but for the ‘major content’ to be changed at this stage was ‘not particularly fair on the artist’. She approached the coordinator to ask her to support her on this, which the coordinator gave. A second set of visuals were viewed by the Art Group and ‘we went back to original design ideas’ resulting in a final, third set of design visuals being approved by the sub Art Group.

The artist being clearer about the stages of consultancy

The artist fully acknowledged the value and necessity of consultancy in terms of people feeling ownership - so that ‘they can go on that journey with you’. She also believed that people did ‘recognise quality’ and described the process that she was more familiar with. The artist would take the brief with ‘it’s implicit challenges and problems and difficulties and ‘in a way kind of reflect those back via the consultancy process’. Usually this was with adults and done by making staged design presentations. On reflection she thought that she should have made things much clearer (i.e. reviewing the visuals with the staff ) by spelling out the consultation process step by step, and explaining that there would be x number of visuals and thereby preventing backtracking. Things were ‘too blurry’ and she should have been firmer. Also (on reflection) she thought that it would have been better for her to present the visuals to the staff face to face, rather than the coordinator showing them to the staff and gathering feedback and relaying this to her (by email).⁹¹

Two models of working – informal, democratic, informed and hierarchical, formal

When asked, the artist said that she thought that a more formal presentation might have been better, but would have been very difficult because of there being 4 groups of staff, (i.e. including the Art Group), the distance (for her to come) and the ‘complexity of it all.’ She felt the more ‘casual nature’ of the presentations might have caused people to feel they could carry on commenting, yet to have had a more formal presentation and that was the end of it - ‘doors closed’ - did not reflect the type of hospital nor the in the way it functions.

She commented that she had worked on projects where there were no arts staff on the steering group, they were all mangers, with very formal structures and a hierarchy. Whereas, with the RACH project, she had ‘been talking to everybody - from the domestic staff to the nurses, to patients - and that, by comparison, this was ‘much more democratic’ and less formal and you could ‘bob down’ and show anyone images to see if they liked them. She valued the RACH Art Group approach and structure. By comparison (and increasingly in her view) there was a tendency for designers (and architects) to be working on major public art commissions (including hospitals). Design practice was much more comfortable with iterative design developments tailored specifically to the client’s requirements. The problem with this (in her view) was that ‘design by committee’ (and lacking arts expertise) meant public art could sometimes be ‘anonymous’ – the person (or personality) who had made it was almost removed by the consultancy process and the work could have been made by anyone. Consulting with large numbers of people means you cannot keep everyone happy and where there are young adolescents in the mix this can also make it tricky because they are not necessarily persuadable – they’ve decided on something and ‘that is that’, so to have arts expertise on the commissioning body was very important.
Role of coordinator in mediating and supporting the artist

The artist felt that the coordinator played a crucial role. She had enabled ‘an open framework but with checks’ and felt ‘supported without being stifled’. She had assisted her throughout the life of the project which took place over a long time (a year) so it was easy to ‘lose momentum’. The coordinator had encouraged her when she felt that she was flagging and had ‘kept her going’ and was responsive to any concerns because by being present at some point, for all the sessions, she really understood the issues. She had also been invaluable in mediating the final designs. However, the fact that the coordinator was part-time meant ‘the whole process felt more fragmented’, for example having to request things in plenty of time otherwise the response (sometimes crucial) was delayed.

An open, supportive framework that embraces risk

The artist compared another commission she was working on (in a heart hospital) where the consultancy process was much more structured and staged. In her view, compared with the RACH approach, this commissioning approach could ‘stop the artist being fearless’. When the process is more controlled (and usually a hierarchical structure) with fixed deadlines to see incremental development in a predetermined set of visuals, this can make the artist focus on an idea at a very early stage in the process, which is not a good thing. With the more open structure people may not know what they want, but they do want to see ideas. The RACH structure and the support and expertise of the coordinator had enabled her to really push her thinking as far as possible and to develop the artwork as a genuine response to the needs of the hospital users.

She valued, and thought it unusual to work as closely and productively with an arts manager/coordinator. The fact that the coordinator herself was a practitioner meant that they could really discuss the artwork and, because there was trust, this helped to push the development of the artwork as far as possible:
‘Working with (the) arts coordinator is brilliant. She is so hands-on, which is what I like. Maybe some people wouldn’t like this, but for me as an artist it’s really productive - we can knock ideas around, spark off each other. She understands the working process of an artist and trusts it and she has the trust of the staff teams too, by and large she wins them over – it encourages you to go for it. She’s prepared to take risks.’
Working closely and collaboratively with trust meant they could be ambitious in terms of the final product.
Her advice to the Art Group was to continue their good work in terms of approach and ambition. Her advice to other artists (working in a hospital) was to be ambitious because there would be compromise with installing art in a hospital because of the clinical requirements, and to not underestimate the criticality of children.
The need for ‘a basic quality agreement’ with staff

The coordinator was very aware that the artist ‘had had a bit of a wobbly stage’ during the consultation, because of the anticipation of the staff, and admired her for making a professional decision at the final stages to not change the designs further and fully supported her on this decision.⁹² The staff had asked for a list of changes at a stage when it should have been ‘fine-tuning the designs’ almost ‘cherry picking’. On reflection the coordinator thought that this was because of a specific focus by staff for the artwork to be purely for distraction, but this was only part of the brief. The brief also described the artwork as engaging the viewer on entering the space by making it more ‘welcoming’. She noted that this emphasis by staff on the function of the artwork to distract was something she had observed in other projects as well.⁹³

This led the coordinator (reflecting across the programme) to believe there was a need to more fully understand staff aspirations at the beginning of a project. On asking what might she do differently, she thought that it might be necessary - at the outset - to have ‘a basic quality agreement’ in place with staff, noting that, if in the artists’ briefs ‘you promise the world, then people will be disappointed’ and this was unfair on the artist.
The importance of a SubArt Group with art expertise

The coordinator noted the vital importance of having a ‘Sub Art Group’ that was able to make final decisions and agreements on the artwork (i.e. on reviewing the visuals). This was absolutely essential in the process and in supporting her role. Because the Sub Art Group had art expertise, informed decisions were possible, and she had felt fully supported by the Group.

Visualising the final product

Reflecting across the programme the coordinator commented that sometimes, once the artwork was installed (or partially installed), staff immediately assumed that it was finished and didn’t appreciate that maybe there would be additional work to be done to make it more compete or to adjust something. This was something she had to ‘constantly explain’ during at the final stages. Quite a number of staff commented (to the evaluator and across the case studies) on being (pleasantly) surprised by the finished product and it not being what they expected. This was in part an inability to imagine the work installed compared with the (paper or screen) visuals.

5.3.18 Summary of findings
(Focus: 2.1)

1. The impact of the artist on the environment

2. The effectiveness of the creative consultation

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

groups attending.)
Process and product

Senior clinical staff appreciated and enjoyed being involved in the project and felt that the level of communication by the coordinator from beginning to end was excellent. Staff found the artist approachable, likeable and very able to engage with the children and families. Surgical and Medical wards were extremely busy at this time so the clinical staff could not take part in the consultancy process as much as they would have liked, but they thought that the artist brought ‘a positive energy’ to the environment. They felt that it very appropriate and productive to have the artist working closely with the play staff and using the play area as a base for art activities. Consultation in the Day Case Unit was much harder for the artist without the support of the play staff and the short time available to spend with children and families. It felt much more ‘adult’ with less time to develop relationships with the service users.

Breadth of consultancy

The breadth of consultancy was considerable. An advantage with this, as noted by the coordinator, was that it extends responsibility. The project’s success becomes a shared endeavor. Also, by throwing the net wide, it ensures that at least a few people from each stake holding group will take part. The involvement of an external group in Case study 3(a) helped to ensure that young people’s views were taken on board along with those of the young patients and contributed to the thinking and final product (the external group was useful in this project though not stipulated).

Face to face presentation with staff

An important point made by the artist (on reflection) was that things should have been made clearer with the staff in terms of the creative process and the number of visuals. Also, it would have helped to have had a face-to-face presentation to the staff herself (not via the coordinator), although this was very difficult because there were so many groups involved (i.e. 4 including the Art Group) and she also lived at a distance.

Ambition of the project

The artist found this project one of the most challenging she had ever undertaken, partly because of the cluttered space in the Treatment Rooms with little room for an artwork, but also due to the breadth and depth of consultancy (and she had found it useful to have the experience of an external youth group from her other commission Case study 3(a). At one stage she had felt that she could not deliver on the staff’s expectations (e.g. reducing fear). Interestingly, the staff responses to the artwork shows that the completed work has delivered in terms of the descriptors outlined in the brief (‘more welcoming’, ‘less clinical’, ‘child friendly’). It is useful for ‘distraction’ (particularly for the play staff) and acts as a focus (for clinicians). A clear example by a ward sister (Medical) illustrates that, to an extent, the artwork can help reassure a child when undergoing a clinical procedure. Equally, the ward sister (Surgical) explained that it was very difficult to know the effects of the artwork on a child but she could certainly that the feel or ambience on entering the Treatment Room had been greatly improved and that it felt less clinical.

Delivering more

It is interesting that the ambition of the RACH project briefs (i.e. breadth of consultation + descriptors) and the points of tension during the consultancy resulted in the artist delivering more. In the Ward Entrance (Case study 3(a)) the spaceman piece was made and in both the Ward Entrance and in the Treatment Rooms (Case study 3(b)) there was work after installation was completed - and contractually finished - i.e. painting on walls. However, it is noteworthy that it was the mutually supportive and close working relationships between artist and the coordinator and that between the coordinator and the Sub Art Group which produced the high quality product.

The importance of a Sub Art Group

When it became necessary for the coordinator to mediate on the design ideas (between staff and the artist), she fully acknowledged the vital importance of the Sub Art Group. This sub group consisted of 3 people who met monthly and it was to this group that she reported. Crucially 2 people in the sub group had art expertise and could therefore give an informed view and support the artist as well as the coordinator.

An emergent model for commissioning and managing public art (art by pubic consultation)

Despite the challenges the artist faced and responded to, the RACH Art Group approach and support structure gave the artist the space to ‘be fearless’ i.e. to be more ambitious in the artwork undertaken. This highly experienced artist thought that the RACH approach was unusual and commendable. It was democratic and informal (reflecting the ethos of the hospital), in contrast to the more usual, hierarchical and formal. Also unusual was the fact that the coordinator was a practitioner herself and so could really understand the issues and work productively with the artist. It was also the coordinator’s preparedness to embrace risk and to ‘trust in the process’ that gave the artist the confidence to push the work as far as possible – to be ambitious.

An important dimension to the emergent model is the structure of RACH commissioning process across the programme. Stakeholders are involved from the start, for example, the external youth group expressing their views, and the involvement of the members of the (sub) Art Group and clinicians from the department where the project will take place in the artist interviews and throughout the process.
Areas for development
Ambitious yet realistic – ‘a basic quality agreement’

Due to the difficulties that arose in the consultancy the coordinator thought that future work would involve creating ‘a basic quality agreement’ with staff at the outset of the project and that this would make it fairer on the artist i.e. to create a realistic understanding of what is achievable. This is a very interesting area for development given the intrinsic risk of engaging artists where the end product is not known at the outset, but is developed through consultation, and this is key to the RACH approach and the (emergent) RACH model for commissioning art.

Development of this might begin by deconstructing the descriptors in the artist’s brief and developing an understanding (with staff) that not necessarily all of them, nor each being of equal measure, would be deliverable. Equally (as we saw in 3a) preconceptions of what artists do needs to be addressed early on. This is possible through the artists themselves describing/explaining this to staff, to external youth groups etc. However, as noted by this artist, it can be tricky because the artist does not want to appear inflexible, yet it is crucial to know what people’s anticipations are.
Scope of work in the brief

A consideration in future commissions is the number of wards or units included in the brief and the extent of consultation. In this project there were three, with three sets of staff and service users. The Surgical and Medical Wards were physically close and separated by the play area used by the artists as a useful base (also used by two other artists in their projects). They also worked closely, for example their agreement to share Treatment Rooms to accommodate the installation if need be. However, the Day Case Unit was situated on the 1^st floor and operated very differently. Also it did not have play staff there to support the artist. It is possible that the difficulties the artist encountered during the consultation was because of this difference between the three areas and the number of people consulted.⁹⁴ Part of the consultation for this artist was observing how the 3 spaces were used.⁹⁵ Possibly including fewer areas within the scope of the brief would be beneficial for the artist and the staff as well as service users.⁹⁶ (This was a major issue in Case study 2).