Funder Forum on Arts in Medicine

Gay Hanna with Lorie Lewis and Judy Rollins

One of the key issues of our time is health care. We know that it is complicated because of its vast scale of services and intimate reach into every life, family, and community in this country. The search for access to high-quality health care for millions of Americans is often difficult. Medical advances of the twentieth and the twenty-first centuries have extended the life span, cured pandemic diseases like polio, and have made it possible to manage chronic illnesses once debilitating. However, these technical triumphs of medicine have not replaced the need for enlightened care from health care providers, family members, and community agencies. To this end, the arts have had and still do play an important role in supporting healing and continuing care.

The medical model of health care based on cure of disease is evolving into a humanistic model of care. Along with this shift come opportunities for the arts (produced by artists and arts organizations) to support long-term care and the health care environment at large via environmental design and visual and performing arts participation. The arts lift the human spirit by building strength of will and hopefulness to endure, survive, and, finally, thrive throughout the medical treatment process. Artists and arts organizations also have an increasing role acting as bridges for individuals to journey out of clinical treatments back into their homes and community life.

GIA, with support from the Barr Foundation, has dedicated leadership and resources to investigate the field of arts in medicine. The first step in this initiative was the development of a literature review to find key research studies showing the impact of the arts on health and wellness across the life span in clinical care.1 Next, GIA held a funder forum, which included a pre-forum visit to the University of Florida (UF) Health Shands Arts in Medicine program. The purpose of this forum was to explore the role of artists and arts organizations in being effective health care partners. The third piece of this initiative is this article, a report summarizing the day’s discussion.

Twenty-eight forum participants including eighteen funders and ten experts from the field of arts in medicine gathered from across the country at the Dr. Phillips Center for the Performing Arts in Orlando, Florida, on February 24, 2017, to discuss three basic questions:

  1. How can funders support the development of the diverse, quality creative workforce needed to sustain the integration of the arts into medicine?
  2. How can funders best engage the health care community to establish the arts as an enduring feature of effective medical practice?
  3. What kind of framework needs to be developed to empower next steps on the local level, and how can funders play a catalytic role?

The forum included four thought leaders active in arts in medicine from the worlds of academia, the arts, and health care.

Anne Basting, PhD, professor of theater at University of Wisconsin-Milwaukee, president of TimeSlips Creative Storytelling (http://www.timeslips.org), and a MacArthur Fellow, creates community-wide storytelling on-site and online based on imagination focused on serving people with memory loss.

Patricia Dewey Lambert, PhD, is an associate professor and director of the Arts and Administration Program, including a newly formed master’s degree in Arts in Healthcare Management at the University of Oregon.2
She is the editor of the recently published book Managing Arts Programs in Healthcare.3

David Leventhal, program director and founding teacher of Dance for PD®, an international dance program developed by the Mark Morris Dance Group in partnership with the Brooklyn Parkinson Group, leads classes around the world for people with Parkinson’s disease and trains other teachers in the Dance for PD approach.

Lisa Wong, MD, pediatrician, musician, cofounder and associate codirector of Arts and Humanities Initiative at Harvard Medical School and the Boston Arts Consortium for Health (BACH), and past president of the Longwood Symphony (http://longwoodsymphony.org/), an orchestra composed of health care providers, advocates for the combination of the arts, medicine, and community service.

Bill Cleveland, forum facilitator, and Gay Hanna, who served as a consultant for the GIA Arts in Medicine Initiative, opened the discussion by reviewing highlights from the arts-in-medicine literature review. Next, forum participants addressed three designated questions. The key points from the discussion are described below.

Question 1. How can funders support the development of the diverse, quality creative workforce needed to sustain the integration of the arts into medicine?

Forum participants discussed this question from three points of view: workforce training needed for artists to be integrated into medicine, workplace development supporting the continuum of care from clinical to community, and the importance of creating a sustainable scope of work for artists in medicine.

Workforce Training

Leventhal led the opening discussion by sharing how Dance for PD builds its workforce. He explained that after years of trial and error, Dance for PD developed a four-stage training for its artists. These stages include an online course and graded assessment that are prerequisites for their training program. If accepted, a candidate must participate in a two- to three-day workshop to learn the basics of the program and return later for a three-day advanced professional development workshop. The final stage of this certification process requires the submission of additional coursework and assessments as well as a video of the candidate artist teaching a class for people with Parkinson’s disease. Eighty percent of the videos submitted are returned with feedback and a request that the candidate resubmit. From this training and certification program, Dance for PD has built an international workforce of teaching artists to work with people with Parkinson’s disease and their care partners.

Forum participants discussed how artists training in medicine might be related to artists training in education. Lambert sees a clear need for professionalization, with a scope of practice to set the skills needed for artists to be integrated into the medical environment like they have been integrated into education. Several funders pointed to the importance of working with traditional and folk arts, especially as a means of helping individuals from communities associated with those art forms navigate the world of medicine. Funders further stated that although accreditation and training are needed, the perspective of this work must be holistic. Erik Takeshita, Bush Foundation, suggested, “It is certainly a ‘both/and’ situation where we need to be mindful of unintended consequences. There are other pathways we need to recognize before settling on a limited set of certifications and training models.”

Workplace Development

Funders shared the importance of using arts-in-medicine services to build bridges from inside the clinical setting back into communities for continuing an individual’s healing process and contributing to preventive health activities. Jamie Hand, ArtPlace America, reported that ArtPlace is exploring a place-based framework to support arts in public health as a way of connecting what we know about individual impacts to how we scale up for community impact. Several of the thought leaders and funders emphasized throughout the discussion that the medical community must be linked back to the larger community because that is where healing and continuum of care take place.

To further explain the importance of expanding the health care workplace, Sara Kass, MD, consultant to the National Endowment for the Arts (NEA) Creative Forces initiative, reminded forum participants that when a patient leaves the health care system, their journey to healing does not stop. “Each community and patient is different,” Kass noted, “We need to understand what works in each community for each patient.” She added, “The health care community is not necessarily putting these two sides of healing lives together at this time. As that does happen, health care will inherently change in our society.” Forum funders concurred that there is an acute need to look beyond the hospital setting into the larger community to find places where the arts can and do play an important part in healing and preventive health.

Scope of Services

Participants who attended the pre-forum tour at the UF Health Shands Arts in Medicine program spoke of the understanding they gained about the role of artists in medicine through their experience of watching these artists work in Shands’s public spaces and clinical wards. They felt that knowing what was being asked of artists in the health care environment is especially important to avoid putting them in the position of doing things outside their realm of expertise. Lambert and Wong emphasized that the critical nature of establishing scope of work for artists in health care speaks to the importance of training the people who are training the artists, and training the people who work with the artists. Funders reinforced these concepts by pointing out the need of knowing the right artist for each situation. They felt that the key questions were, What change needs to be effected? What is the environment? How can the artist’s intervention best effect the change needed for the specific environment?

Using the Creative Forces: NEA Military Healing Network as a model, Bill O’Brien, senior advisor for Creative Forces, shared that artists are seen by every patient as healers within the clinical setting and as connectors to the greater community. He suggested that funders think of themselves as change agents to help identify a place for health care organizations within cultural systems. This strategic leadership will help build a better understanding about what kind of arts workforce is needed to develop arts services within health care institutions. This work will also help build connections from clinical to community settings to cultivate opportunities for arts interventions to sustain arts-based wellness pursuits after treatments conclude. Funders agreed that the military and veterans’ services are a conducive environment to explore how to develop the scope of work and the skill sets needed by artists to work inside clinical settings while bridging to the larger community.

Summary

Summary points for funder consideration include the following:

  • Workforce training: the need for professionalization of artists and arts administrators working in medicine through training and certification programs where appropriate, but not to the exclusion of utilizing traditional arts and artists as healers and promoters of preventive health.
  • Workplace development: the need to build the workplace for arts in medicine from within the clinical setting outward to bridge into the community at large, where the healing process continues; and the need for prevention and wellness efforts to grow in importance.
  • Scope of work: the need to ensure that the scope of work is clearly established for artists in medicine, with skill set development that supports excellence in service delivery that positively affects quality care for people in clinical settings.

Question 2. How can funders best engage the health care community to establish the arts as an enduring feature of effective medical practice?

To address how to best establish the arts as an essential feature of effective medical practice, forum participants focused on understanding partnership development between the arts and medicine providers and their clinical issues.

Pre-Forum Tour to UF Health Shands Arts in Medicine Program, Gainesville, Florida

To support discussion at the forum, many of the participants had the opportunity to visit the University of Florida’s exemplary Shands Arts in Medicine program in Gainesville. This program was founded twenty-five years ago by a nurse, who is also a painter, Mary Rockwood Lane, RN; a pediatric oncologist and poet, John Graham-Pole, MD; and an enlightened hospital CEO, Richard Gaintner, MD, who established the program’s first endowment in part with his own funding. This trio of health care experts spawned one of the most robust arts-in-medicine programs in the world. Tina Mullen, director, Shands Arts in Medicine, University of Florida, and Jill Sonke, director, Center for Arts in Medicine, University of Florida, led the tour, which showcased how the arts are integrated into every aspect of the health care facilities and operations. Resident artists in music and visual arts shared how they work with both patients and staff in public spaces and at the bedside. Situated in rural north Florida, Shands Arts in Medicine is exemplary in using technology to bring their work to people isolated in their homes, as well as in bringing arts-in-medicine research and practice deeply into the university’s academic life. For more information, see http://artsinmedicine.ufhealth.org/programs/.

The Need for Arts-in-Medicine Partnerships to Address Measurable Clinical Issues

Several forum participants began the discussion by recommending that health care providers first experience how arts can work to enhance care in profound ways. There was consensus that artists and arts organizations interested in working in health care should ask their health care associates about their needs and how artists might help. Funders concurred that in the case of arts in medicine, the arts are in service of the medical community. Lambert discussed a model where the starting point was the health care institution with an integrated team of health care professionals, which included artists and arts administrators. This integrated team together determined the important quality care issue to be addressed. Once the issue and how it would be measured was identified, the arts-in-medicine program could play a substantial role in the research and development of more effective health care protocols. Funders explored the need for arts-in-medicine programs to be positioned to serve their clinical communities in clear and measurable ways that are mutually agreed upon by the integrated health care teams.

Jill Sonke, University of Florida Center for Arts in Medicine and UF Health Shands Arts in Medicine, shared an example of a research project funded by the NEA using live music to improve care for adult patients in emergency rooms. She explained that findings to date show significant reductions in pain medication administration among patients who receive an intervention of live preferential music by a professional artist in residence. This arts-in-medicine research is using standard clinical measurement instruments to show improvement in care and reduction in costs.

Impressed by this research project, funders wondered about additional opportunities. Specifically, How much research is needed to prove the effectiveness of arts in medicine? Who is doing this research now? They also asked, How can the role of academia help broaden support for arts in medicine by building an evidence base for its interventions? Lambert responded from the point of view of academia that there is no consistent form of measurement for either program evaluation or research protocols that would enable a comprehensive evidence base to be built. She believes that research networks are forming organically through the work of the NEA and others, and that more work could be accomplished by focusing support from funders on pilot and longitudinal research studies. Both Lambert and Basting asked funders to work toward supporting measurements that capture the unique capacity of arts to improve quality care. Funders agreed that research in arts in medicine is a critical area in need of support because it is the underlying foundation upon which the arts can be successfully integrated.

The Need for Arts-in-Medicine Partnerships to Market Results of Improved Quality of Care and Lower Costs

Participants agreed that arts-in-medicine programs produce cost savings for hospitals and insurers and improve the quality of life of patients, staff, and family. Basting queried, “How can we get to the point where the arts are actually prescribed?” Wong answered that the role of the funder could be as a convener, bringing together locally health care administrators and physicians with artists to advocate for arts in medicine’s cost savings and ability to improve quality of care, as well as to identify the barriers to growing arts in medicine. Funders expressed consensus that marketing the successes of the arts in medicine in solving clinical issues is key in partnership development.

Funders’ Key Role in Catalyzing Arts-in-Medicine Partnerships

Funders suggested facilitating arts-in-medicine partnerships via instructions to grant recipients on using their funding. It was also suggested that private funder leadership can be enhanced by using state and local arts agencies. Beth Bienvenu, accessibility director at the NEA, noted that several agencies already have arts-in-health programs as funding areas. She pointed to a community-of-practice consortium of forty state arts agencies brought together through funding from the NEA and Aroha Philanthropies by the National Center for Creative Aging to build capacity for artists and arts organizations to serve older Americans. This consortium is developing and sharing artist training, partnership developments, and funding criteria. Funders continued in their discussion to identify ways that they could bridge between arts, health, and community service partners though their capacities to advocate, convene, and fund, which are crucial elements in building the infrastructure for the arts in medicine.

Summary

Summary points include concurrence from funders that

  • arts-in-medicine programs need to be developed through interdisciplinary health care partnerships to impact measurable clinical issues,
  • funders need to be directive in helping partnerships develop common measurements and find ways to market the cost savings of arts interventions, and
  • funders have the capacity to be catalysts in creating communities of practice between arts-in-medicine partners to build a sustainable infrastructure.

Question 3. What kind of framework needs to be developed to empower next steps on the local level, and how can funders play a catalytic role?

In reflecting upon their experiences over their time spent together during the forum and the tour of UF Health Shands Arts in Medicine program, several funders shared questions that they intended to explore within their local communities; others offered general suggestions for the group’s consideration in regard to funding challenges and opportunities. General discussion about local funding included developing partnership incentives, exploratory seed grant programs, and leveraging incremental investments.

Partnership Incentives

Funders expressed interest in providing incentives for partnership development, especially between artists and health care institutions as well as related businesses. Troyd Geist, North Dakota Council on the Arts, explained how a $2,000 apprenticeship, funded with NEA money, led to their integrative, statewide Art for Life Program. Several funders added that even small amounts of funding can support building this kind of infrastructure. Funders also noted a need to create a marketplace for arts and health care providers where programs and services can grow and have a life of their own.

Basting reinforced this thinking, saying that artists are transformational, and innovation speaks to the artists’ process itself; if a conducive environment is nurtured through incentivized partnerships, innovations will evolve that serve both individuals and their communities. Funders shared the desire to look across the continuum of care by starting with health and wellness in community settings, then moving into arts in medicine located in clinical settings; this would result in innovative partnerships that link existing infrastructure of community arts organizations directly to the clinical environments.

Exploratory Seed Grants

Several of the thought leaders suggested that to have a major impact, funders should first fund partnership in exploration or discovery phases to ensure that the arts programs are following current trends in person-centered care, and that data from programs are collected using existing medical measurement systems. It was suggested that funders should move into supporting longitudinal research work once the exploratory phase and baseline data collection are complete.

Funders could start small; then if a failure happens, it can be rectified and a better, larger version can come into being. Several forum participants pointed to the importance of finding a key clinical issue and working with an integrated clinical team to help solve it. It was suggested that this method of funding could be a solid way to nurture the arts-in-medicine ecosystem by engaging all partners in a sequential cycle of program service.

Leveraging Incremental Investments

On the topic of scale, funders noted that arts funding is usually small compared to health funding, and there was concern that arts funders might be buried by this dynamic. Tanuja Bahal, SV Creates, explained her finding that small arts grants can have a huge impact in large health care systems. Bahal added that the arts bring a new lens to medical care in the diverse communities that her organization’s work serves. Others agreed that leveraging arts funding to support arts in medicine could catalyze greater support from health care institutions and related funders.

Leventhal mentioned the importance of technology to reduce cost and build programs to scale. He shared his experience of making small investments in technology that have had a huge footprint and impact in health care program services. Jennie Smith-Peers, National Center for Creative Aging, supported Leventhal’s claim, by reporting on her organization’s work on creative caregiving through an online guide. Funders concluded with discussion about how to leverage funder partnerships between the arts and medicine incrementally. They emphasized the importance of health care funding partners accompanying art funders on this learning journey, and in this way leveraging partnerships to move the funding protocols from “nice to have” to “must have.”

Summary

In summary, there are many entry points with multiple ways for funders to support the growth and development of arts-in-medicine programs locally:

  • Funders need to take a leap toward small exploratory partnership grants and build incrementally.
  • For funders to find the innovators and breakthrough people locally is key. Technology is additionally important to broadening impact and lowering costs.
  • At its core, arts funders need to be catalytic in leveraging resources and investing for the long term through health care funding partnerships to develop research, program services, and a sustaining infrastructure.

Conclusions

There is an opportunity for arts funders to catalyze sustainable partnerships between the arts and medicine services to address the critical health care issues of our day. Participants at the forum included thought leaders in arts in medicine and representatives from private philanthropies, public sector funders on the state and national levels, and leading arts service organizations. This convergence of perspectives produced concurrence that forty years of pioneering work has developed a foundation for building infrastructure to support the professionalization of the arts workforce to sustain partnerships integrated into clinical settings.

Under the continued leadership of the GIA membership, additional national convenings, educational opportunities through webinars and conference sessions, and state and local issues forums can be implemented. And with the newly formed National Organization for Arts in Health (NOAH), a national arts service organization, networking and educational opportunities can be provided on an ongoing basis to grow this emerging field of practice. A combination of strategic leadership will enable the development of a workforce of artists based on excellence and authenticity in service of their communities; strong, effective arts and health care partnerships; and, finally, sufficient exploratory funding that will make arts in medicine an enduring feature of medical practice for the twenty-first century.


Gay Hanna, PhD, MFA, is president of Hanna Merrill, Inc., and visiting faculty of the Arts Management Program at George Mason University.

Lorie Lewis, MA, is a research associate for Hanna Merrill, Inc. Judy Rollins, PhD, RN, is president of Rollins & Associates and faculty of Georgetown University School of Medicine.

NOTES

  1. Gay Hanna with Judy Rollins and Lorie Lewis, “Arts in Medicine Literature Review,” Grantmakers in the Arts, 2017, https://www.giarts.org/sites/default/files/2017-02-Arts-Medicine-Literature-Review.pdf.
  2. For more information about the Arts in Healthcare Management program at the University of Oregon, see https://aad.uoregon.edu/programs/degrees/graduate/areas-of-concentration.
  3. Patricia Dewey Lambert, ed. Managing Arts Programs in Healthcare (London: Routledge, 2016).