Creative connections

By Janet M. Cromer, RN  |  July 10, 2007

Elizabeth Gaufberg, MD, is an internist, psychiatrist, and medical educator. She is also the chair of the Cambridge Health Alliance (CHA) Arts in Healthcare Committee and an energetic advocate for integrating the staff's artistic talents into daily practice. CHA is an academic public-healthcare system with three hospitals and over 20 primary-care practices and school clinics serving diverse cultural and socioeconomic communities. Among its 4,000 employees are artists, writers, musicians, actors, storytellers, and dancers, and when the decision was made several years ago to integrate medical humanities into patient care and medical education, it was to these employees that the hospital naturally turned.

CHA's philosophy, according to Gaufberg, is to make real connections with patients in a human way: "Creative arts is a way to deepen the understanding and connection among staff that carries over to their patients," she says. At CHA, the staff and administrators who participate in the arts and humanities programs share a firm belief that the arts can play a strong role in the healing process.

A way to understand and connect
The CHA Employee Arts Initiative was originally funded by a $10,000 grant from the Society for the Arts in Healthcare (SAH) and Johnson & Johnson that was matched by the CHA administration. Once there was committed funding to sustain specific projects, the arts committee set up a simple grant-proposal process that required applicants to include plans for collecting assessment and follow-up data on projects. The criteria the committee uses to review proposals mirrors its convictions about what creative arts can and should contribute to a medical setting. Proposed projects need to have:

• artistic value
• potential to enhance empathy and tolerance
• healing potential for patients and families
• renewal potential for staff
• education potential

One of the early projects funded was proposed by Virginia Lane, a psychiatric RN and musician. Lane understood the value of using music as a therapeutic nursing intervention and proposed starting healing music groups for psychiatric inpatients. The grant she received paid for musical instruments that she now uses to give lessons to members of her group.

Many of the projects are designed to energize staff and have an inherent zest and spirit of renewal. Alberto Netto, a Portuguese interpreter at CHA and a well-known musician in Brazil, taught Brazilian percussion classes for CHA employees. Netto’s students brought down the house when they performed at the annual Employee Arts Gala. Gaufberg says one benefit of the humanities program is that employees get to know and appreciate each other, which leads to more effective communication and collaboration across disciplines.

The art of careful listening
The word auscultation means listening carefully, as to a heartbeat through a stethoscope. Auscultations is also the name of a creative-arts journal brimming with fiction, painting, photography, narrative reflection, and poetry, all produced by CHA employees. The themes of revitalization and empathy run throughout its pages, and the journal is an instrument through which employees listen to, marvel at, and celebrate the creativity of their coworkers.

"Auscultations is an inclusive, not exclusive, journal and provides recognition of just how much artistic talent and passion people have all across the CHA network."

Participation in the journal is open to every department of CHA, and Auscultations accepts one piece from each person who submits. Gaufberg explains that the journal is inclusive, not exclusive, and provides recognition of just how much artistic talent and passion people have all across the CHA network. Some content relates the personal experience of a trainee or healthcare provider. Other pieces showcase pursuits and interests of a contributor outside the hospital. When the latest issue of Auscultations is published each June, the whole hospital community gathers for readings by featured authors, an art exhibit, music and dance performances, and even a puppet show.

Gaufberg says the goals of Auscultations are to:

• encourage employees to express themselves creatively
• share aspects of their personal and professional lives in ways that deepen relationships
• enhance caregiver empathy for patients, co-workers, and themselves
• energize employees in their work with patients and give a renewed sense of meaning

The special wall for kids
The art made by CHA employees is highly visible in the hospital lobbies and corridors. There is even a dedicated employee art gallery, overseen by Jenny Lee Olsen, medical librarian and artist, located on the second floor of the ambulatory building. However, one of the largest creations in the hospital was made by CHA artists for a private and deserving audience. The Wall of Respect for Kids mural is located in the community room of the adolescent assessment unit at the Somerville Hospital campus, which provides acute psychiatric care for youths age 12 to 19.

Ilse Stryjewski, artist and creative director of marketing and business development, says the entire process was a collaboration between artists, patients, and staff on the unit. Stryjewski, who was the main organizer and artist on the project, says a "village" made the mural possible. Teresa Forestell, RN, MSN, nurse manager, asked young patients to recommend subjects for her to portray. They came up with sports themes, music, and introspective images that Stryjewski sketched. Then patients and staff voted on 20 scenes to include, and the artists got to work. All of the CHA artists who worked on the mural volunteered their time on lunch breaks, evenings, and Saturdays. Stryjewski credits Ron Aron, administrator for the adolescent psych unit, for administration support and unit staff with helping the artists feel safe and comfortable in an unfamiliar environment.

Stryjewski contrasts her usual experience of painting in solitude with the lively give and take she had with young patients in their community room. "I was monitored constantly and had constant feedback from the kids," she recalls. That collaboration appears clearly in the 5-by-18-foot mural that depicts adolescents playing basketball, skateboarding, listening to and making music, studying, and interacting with peers and supportive adults. The bright, jewel-toned colors combine with a panorama of healthy activities to give an overall tone of optimism to the mural. However, Stryjewski emphasizes that the planners deliberately included pictures of somber, contemplative kids, too, so patients could relate to the mural as being true to their own experience. Responses from patients and staff have been very favorable, with kids on the secure unit describing the mural as very welcoming.

"The planners deliberately included pictures of somber, contemplative kids so patients could relate to the mural as being true to their own experience."

Stryjewski is an accomplished artist whose large-format paintings and photographs of flowers are often exhibited at CHA. The paintings generate guest-book notations from patients verifying that the beauty cheers and inspires them. "There is a healing aspect to art that patients recognize," says Stryjewski. "By sharing with them, I help them feel better in a nonmedical way."

Reflecting on personal experience
Gaufberg also directs the Medical Humanities Initiative, funded by the Kenneth B. Schwartz Center. Amending the familiar adage that says the purpose of education is to make the strange familiar, she says, "The task of education is to make the familiar strange." It is important, she emphasizes, to develop new perspectives on things we assume or take for granted, and points out that this is one function of art and literature. To encourage this, Gaufberg routinely incorporates reflective writing when working with Harvard Medical School students and CHA residents. In a psychosocial seminar, for instance, students bring in an object or work of literature or art piece that communicates something about their personal experience in a professional role, or relates to a part of their inner self that is at risk of being forgotten as they advance. These objects trigger a discussion about issues that are important to participants, and the empathy developed among them can carry over to contact with patients.

Understanding the personal history and experience of illness is compounded when healthcare providers work with patients from other countries. The Postcards from Home collaborative art project, for instance, matched eight medical students with a patient who had migrated from Brazil, Guatemala, Haiti, Lithuania, India, or Puerto Rico. Each pair made a retablo box holding photographs, pictures, words, and objects depicting the patient's personal narrative. These collage works were later displayed at a reception for patients, families, and medical students.

Cambridge Health Alliance strives to be a humanistic, relationship-centered hospital system. With compassion as its central value and medical humanities as its principal means of nurturing understanding and personal connection, CHA staff and trainees are truly attending to the human experience of their patients.

This is the third of a three-part series on medical humanities in the Greater Boston area. Janet Cromer is a freelance writer and regular contributor to On Call. She received the Will Solimene Award for Excellence in Medical Communication for her On Call article "Drawing Out the Best in People" (September 2005), which described the work being done at the Boston Institute for Arts Therapy.