Abstract
The Arts & Medicine Institute at Cleveland Clinic, Cleveland, Ohio, is a comprehensive initiative providing patients, caregivers, and visitors with ample opportunity to engage with the arts for improved health and well-being. Started in 2008, the Institute seeks to enhance the lives of individuals through creative and evidence-based use of therapeutic, performance, and visual arts.
Francois Bethoux, MD, medical director of the Institute and a physiatrist in the Mellen Center for Multiple Sclerosis Treatment and Research at Cleveland Clinic, said he personally has an interest in any treatment or intervention that can improve the way a person feels and functions in their daily life. He stated, “I strongly believe—based on my clinical experience, scientific evidence and patient stories gathered at Cleveland Clinic and around the world—that exposure to the arts can help with the experience, well-being, and healing process of people who are confronted with health issues, including when they are hospitalized for testing or treatment.” Bethoux added, “The Arts & Medicine Institute is designed to weave the therapeutic power of the arts into the fabric of Cleveland Clinic, as an integral part of our Patients First approach to medical care.”
Specific programs at the Institute include: an extensive artwork collection displayed in and around Cleveland Clinic buildings throughout the country; therapeutic arts such as art and music therapy; musical performances in public areas by professional musicians, volunteer musicians, and local and visiting arts organizations; educational events; and a program for people with cognitive impairment called Art in the Afternoon. “Our initiatives beneficially impact our patients in both inpatient and outpatient settings, their loved ones, and our caregivers,” Bethoux said.
Maria Jukic, executive director, stated that the Arts & Medicine Institute has a lot of ground to cover at Cleveland Clinic, which had 7.14 million outpatient visits and 220,059 acute admissions in 2016, and also has nearly 50,000 employees, 10 regional hospitals, one affiliate hospital, 18 full-service family health centers, and three health and wellness centers. Jukic said, “Giving people a moment of respite or reflection through music or art provides patients and families with common ground upon which they can talk, laugh, discuss, share their feelings and process their situation.”
Jukic shared specific examples of how the programs offered through the Institute are impacting patients. She commented, “One day, there was a 1960s folk band playing in the main lobby, as part of our performing arts program. A patient with a terminal cancer diagnosis was being wheeled through Cleveland Clinic's lobby by his wife. He was so excited to hear the music that he and his wife went up to his room where he changed his clothes, put on his hat and boots and returned to the lobby to dance. Still attached to his IV pole, he and his wife danced to the music. We later learned that the patient wanted to do two things again before he died: ride his motorcycle and dance with his wife. We gave him the opportunity to fulfill one of those wishes.”
The performing arts program includes about 600 performances per year throughout Cleveland Clinic's main campus and in several regional hospitals. “With hundreds of musical performances per year, and our extensive visual art program, we are touching thousands of patients' and families' lives every day,” Jukic said.
Jukic shared another example of the benefits of programming for a patient: “We have 13 highly trained art and music therapists on staff at the Clinic who interact directly with nearly 16,000 people per year. These therapists see patients for pain, depression, stress, anxiety, coping issues, etc. One patient with a terminal illness was struggling to come to terms with his condition. A music therapist slowly engaged him, and eventually discovered that the patient had been a musician. He and the music therapist worked together regularly during his final weeks, and he and his wife shared music and memories. He was able to laugh and enjoy, and he wrote a song with the therapist that conveyed his feelings. These examples that I share are just the stories we hear about. In fact, we can't begin to know all of the ways in which our Institute is impacting individuals, families and employees.”
Health Benefits of the Arts
Bethoux commented on his main area of clinical practice and research, which is the rehabilitation of people with multiple sclerosis (MS): “About nine years ago, I was approached by a music therapist, who asked if I was interested in using a neurologic music therapy technique called Rhythmic Auditory Stimulation (RAS) in people with MS to improve their gait. Several research studies later, we now have evidence that rhythmic music can improve the gait pattern of MS patients, and changes the pattern of brain activation when these patients perform imagery of walking in an MRI scanner.”
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Bethoux shared other examples of how music therapy benefits patients' functionality and health: • “Our research manager, Lisa Gallagher MA, MT-BC, also recently completed a randomized clinical trial of music therapy for patients hospitalized after elective orthopedic surgery. This study showed immediate improvement of pain, anxiety, overall mood, and nausea after music sessions, and these findings were submitted for publication; • We have also recently published the results of studies in palliative medicine including a retrospective study of over 290 palliative medicine patients where findings included significant immediate improvement of patient-reported and therapist-rated outcomes; and a survey of 50 family members of patients receiving palliative medicine or hospice care showed that over 80% of the family members found music therapy to be helpful to the patients and to themselves, and all respondents recommended that the patient receive further music therapy.”
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Joanne Cohen, executive director and curator of Cleveland Clinic's Art Program, talked about the health benefits of their impressive art collection. She commented, “Fine art has become an integral part of the Cleveland Clinic experience. The art collection and arts programming adds a key component to our medical surroundings, infusing them with life, humanity and experiences people might not otherwise have an opportunity to encounter.”
The interest in art at Cleveland Clinic is not new, and in fact dates back to its inception in the 1920s, according to Cohen, who said the current art collection is comprised of more than 6000 works of art, as well as thousands of art posters installed throughout Cleveland Clinic's 32 million square feet of facilities in Ohio, Florida, Las Vegas, and Toronto. Art is acquired from local, national, and international artists, and the collection features work by artists from more than 60 countries.
Cohen stated, “Thousands of people see parts of the art collection every day, so as curators we adopt a patient-centered curatorial practice and think about the specific demographics and needs of a particular area or department and what might be most appropriate. Since we treat patients from over 100 countries, we acquire art that will resonate to our broad audience, and we look for work that represents diversity and the global nature of our world.” She added, “Specifically, we collect work by artists who deal with the human condition and spirit. We are also interested in artists that address concepts such as collaboration and innovation, which are both cornerstones of Cleveland Clinic.”
Cleveland Clinic artwork contributes to the healing environment in significant ways. Cohen said, “We receive many patient testimonials about the impact of the art on the patient experience. If interacting with the art results in an easier time for our visitors, whether as a welcome distraction or by providing a moment of levity, it is a win–win for our patients and caregivers. We carefully install art on our inpatient floors to inspire patients to leave their rooms and walk and explore as part of the healing process.”
A 2012 research study of visitors to Cleveland Clinic found that contemporary art in public spaces had positive effects on mood, stress, comfort level, and overall patient satisfaction. 4 Of the patients staying at Cleveland Clinic for two to three days, 91% said that artwork improved their mood. Cohen said, “Thanks to these results, a second phase of research is being conducted around inpatient responses.” She added, “Our mission with respect to the art is to enrich, inspire and enhance the environment for our patients, visitors, employees and the community and create a healing atmosphere. We are, and hope to remain, an essential part of the organization.”
Conclusion
Utilization of services provided through the Arts & Medicine Institute has steadily and significantly increased throughout the years, as has awareness of the Institute's presence from people around the globe. Bethoux commented, “We provide informal mentoring by regularly talking to and encouraging colleagues from other healthcare institutions and organizations, students, and individuals interested in our overall concept of arts and medicine. We also look for opportunities to share our story at conferences and meetings.” Due to this increasing demand and interest, the Institute recently started a consulting service that offers several options to receive specialized attention. “Groups can visit Cleveland Clinic for a presentation and tour, and members of our team travel to various settings to provide more detailed consulting and implementation services,” Bethoux said.
Both Bethoux and Jukic agreed that one of the strengths of the Institute is that it receives strong support from Cleveland Clinic leadership. Jukic stated, “We have learned from our colleagues around the country who work in arts and health that what differentiates our program is that everything (visual art, therapies, music, performance, and research) is housed under one roof and that we are supported from the highest levels of our organization.”
Plans are in the works to expand services within the Cleveland Clinic Health System, including initiatives targeting community-dwelling individuals with chronic health issues, to help them maintain and enhance their well-being and quality of life. Jukic commented, “We hope to be able to grow and expand, in order to touch more patients' lives, their family members, and our own employees and physicians. There's a lot of room to grow. I am most excited about the impact we can make for individual patients and their families. Taking that to the next level is to continue to answer the question, ‘Can the arts help people achieve and maintain health and wellness?’ We at the Institute believe the arts play a significant role in the health and wellness of individuals and communities, and we would like to continue to play a part in helping answer that question.” ■
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