Forgive yourself if you enter the five-story Pavilion at Paoli Hospital and mistake it for the skylighted atrium of a grand mall. The centerpiece space of the $145 million facility, which opened in July, radiates the warmth of a coffeehouse. It's as welcoming to extended families as it is to intimate conversations.
High above people whose thoughts are focused on some of life's most harrowing curveballs, eight towering chiffon mobiles sway with the circulating air. They range from 6 by 10 feet to 8 by 16 feet, and each displays two vertical, intersecting, archival-ink photographs of natural scenes: oak trees, ginkgo leaves, the colors of autumn-dyed trees reflected in water, pine needles, snow geese against a blue sky.
"You'll see people just sitting there, staring at them," says Lindsey Felch.
Felch is the art consultant who led the installation of an expansive collection of photographs and paintings throughout a building whose every angle was designed with patients and visitors in mind.
After cutting 120 works from the pool of art, she chose locations for the 408 remaining pieces. She spent 20 hours strolling through the blueprints, hours more walking the completed halls. Initially allotted $300,000 for the project - the Pavilion, whose mobiles were made by one photographer, had a separate budget - Felch finished with $50,000 to spare.
Such sums are modest considered alongside the premiums some collectors pay for art. And a growing body of research suggests that the resulting vibrancy has marked effects on patients, visitors, and staffers.
According to national surveys in 2004, 2007, and 2008, art in health-care facilities - hospitals, in particular - can reduce the length of hospital stays, need for medication, and number of complications. Coupled with increased staff retention, that means hospitals have more to gain from displayed art than better moods: Thoughtfully selected and exhibited images have measurable economic benefits.
While the therapeutic value of artistic activities is widely accepted, it's becoming clear that the mere display of paintings, murals, and sculptures (not a new development in hospitals) can have a similar effect on recovery.
"Think about how you feel in a certain environment," says Anita Boles, executive director of the Society for the Arts in Healthcare, a Washington nonprofit that helped conduct the surveys with Americans for the Arts and the Joint Commission on Accreditation of Healthcare Organizations. "Think about what makes you feel better, and what makes you feel less than better."
When Boles joined the society nearly three years ago, her father, a retired physician, said, "Congratulations. Now tell me in 30 seconds or less: What is arts in health care?"
"Good question," she replied. She called the members of the board and asked them to share their thoughts.
"I got 23 different explanations of what the field was. So we really recognize that in order to be able to talk outside of the field to other individuals, we have to have a strong definition of what arts in health care actually is, and why it's so important."
In the organization's 2004 study of how literary, performing, and visual arts and design figure in health-care programs, nearly half the 2,333 responding institutions had some sort of arts program, more than 70 percent of those in the form of permanent displays.
The supplementary 2007 study supported the findings and showed that the number of paid arts administrators had increased, as had the number of organizations funding programs from their operating budgets. It also found that diverse populations - Latino, African American, and white populations were the largest - benefited in nearly equal proportions.
A 2009 report on developments in the arts-in-health-care field acknowledges that much early research is "anecdote rich and data poor," particularly in assessing economic benefits, the subject of the 2008 survey.
The report cites Bill Ivey, former head of the National Endowment for the Arts and now director of Vanderbilt University's Curb Center for Art, Enterprise, and Public Policy, who called for more investment in cost-benefit analysis to support saving "potentially billions of dollars annually" through arts programs.
Though there may be a shortage of hard numbers, examples of the effects of health care's changing face are getting easier to find.
At the Perelman Center for Advanced Medicine, the University of Pennsylvania Health System's 500,000-square-foot outpatient-care facility on the former site of the Civic Center in University City, the glass-encased atrium soars more than six stories. Even on cloudy days, light cascades through the ceiling and walls.
Completed in 2008 and fully functional early last year, the Perelman in mid-September opened "Interplay," the first in a series of exhibitions designed to lend the atrium a subtle idea or atmosphere.
Marsha Moss, curator of "Interplay" in conjunction with the presenting Arts and Business Council of Greater Philadelphia, chose nine abstract sculptures by nine regional artists. She wanted to bring art to people who otherwise might not be exposed to it, and her choices carry "an undercurrent theme of rejuvenation, rebirth, something that would suggest that sense of hope."
Moss recalls sitting on a sofa beneath the suspended Orange Crush, by Warren Muller, to the right of the atrium entrance. A tangle of orange utilitarian objects - push brooms, clamps, a bicycle wheel, pointed lightbulbs - it's an enigma.
"You could sit there, as I did," Moss says, "and be invisible."
She eavesdropped as visitors discussed whether it even was art. People's reactions to the sculptures - three hang from the ceiling on the first level, and six stand on the mezzanine above the escalators - don't matter to her as much as the fact that people react.
Libby Harwitz, a longtime Center City resident who spent most of three days visiting a close friend, says she felt "a flush of beauty coming inside of me" each time she walked in.
She was an administrator in another local hospital for 13 years, and her husband is a physician. "He went out of his mind," Harwitz says, "because it's nothing he's ever seen before."
"I think the power of art in general, whether a person is well or ill or whatever - it's a distraction and a privilege to be able to be a part of it," she says. "People who go in there are overwhelmed, are frightened, are unknowing as to what their own situation is going to be. But here you are, experiencing this kind of elegance and beauty."
Laurence Salzmann, a photographer and filmmaker, was there to see a doctor on the day of the exhibition's opening reception. He knows several of the artists, and Moss invited him to join them that night.
"As an artist, I'm always interested in what art is hung in hospitals," he says, adding that "Interplay" includes works he calls "challenging," "high-end," and "inspiring."
Virtua Memorial Hospital in Mount Holly has showcased art for more than 20 years. David Flinker, who was chief of hematology and oncology, firmly believed that art was important in healing. He invited local artists to exhibit and offer their work for sale, producing eight to 10 shows a year.
Virtua's Pavilion Art Gallery now bears his name. "In our hospital," says Stephen Kolesk, the hospital's vice president and chief operating officer, "Flinker was well ahead of his time."
Notions of what constitutes health care, Kolesk says, have changed. While medication and quality of care still are integral, "healing is more than that, and I think hospitals and health systems are starting to realize there's all the other things [about which] 25 years ago we might have said, 'That's not really going to help,' [but now] we realize do help. People do get better faster because of things like art therapy or art that allows them to reflect about what's going on."
St. Jude Children's Research Hospital in Memphis keeps three to five artists busy all the time, says John Curran, director of design and construction. Its biomedical communications department has staff photographers who provide images at no extra cost.
Curran leads all renovations, and for nine years has managed the art program. The campus has 60,000 to 80,000 square feet of murals and at least 5,000 square feet of art and photography, age-specific for sections of the hospital designated for toddlers, tweens, and teenagers.
"I really believe that human beings for 5,000 years, 10,000 years, have brought art to their construction, and I think that's important," Curran says. "You can't just color walls and call it art. You have to bring art and artists, and then interpretation.
"Just about any program we do has an art budget in it. What we find is it really makes a hospital a lot less threatening when you come in the door. If you see a white wall in a hospital, it's not something that kids are used to. But you come in and you see art and painted walls, and the first impression is a lot more welcoming."
He and a team of artists and administrators discuss themes and scaled drawings of potential murals. Sophistication matters - toddlers are more likely to see low-lying paintings of cartoonish animals, while teens are more open to conceptual work - and so does style. Hallway art must be softer, to avoid hallucinations among anesthetized patients. Intensive-care units house impressionistic works - pleasing, but not detailed, images of forests, for example.
The hospital allots $150,000 annually for murals. If an interior-design team, Curran says, looks holistically at art availability throughout a facility during planning, "it can be done on a shoestring budget. It doesn't have to be expensive if you're doing some of the work yourself and it comes from your soul."
But even as the creation of healing gardens, exposure to bountiful natural light, and musical performances grows, exhibitions of visual art can face stigmatization.