This article was downloaded by: [Herb Fondevilla]On: 18 May 2015, At: 19:36Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Click for updates

Arts & Health: An International Journalfor Research, Policy and PracticePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rahe20

Student participation in arts in hospitalprojects in JapanHerbeth L. Fondevillaa & Yukari Iwataa

a School of Art and Design, University of Tsukuba, Tsukuba, JapanPublished online: 18 May 2015.

To cite this article: Herbeth L. Fondevilla & Yukari Iwata (2015): Student participation in artsin hospital projects in Japan, Arts & Health: An International Journal for Research, Policy andPractice, DOI: 10.1080/17533015.2015.1033435

To link to this article: http://dx.doi.org/10.1080/17533015.2015.1033435

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Student participation in arts in hospital projects in Japan

Herbeth L. Fondevilla* and Yukari Iwata

School of Art and Design, University of Tsukuba, Tsukuba, Japan

(Received 26 May 2014; accepted 20 March 2015)

The demand for less hostile and more humanitarian ways of caring for patients inhealth care institutions are becoming more widespread and accepted in Japan. In thecity of Tsukuba, student groups are leading the way in developing ways in makinghospital stays less stressful through arts programs. This paper is the result of directparticipation, observation, and assistance by the hospitals, medical staff, and studentswho are organize hands-on projects and interactive art sessions designed to servepatients directly. The Arts in Hospital program is a useful tool in engagingcommunity participation and communication among students and hospital staff.It provides a learning opportunity to students, and a creative outlet for patients onextended care. Active participation by students has a very positive impact on bygiving them practical outlets to exercise their creativity and knowledge, whilehospitals benefit through their service, which also cuts costs. Further research isneeded to identify the direct benefit to patients, and the future prospects of arts-basedhospital projects in Japan.

Keywords: visual arts; design; participant observation; interpretive

Introduction

The benefit of the creative arts to well-being has been widely documented and used byhospitals in Europe, the USA, Canada and Australia, and is backed by worldwide research(Ante et al., 2011; Camic, 2008; Coles, 1981; Lankston, Cusack, Fremantle, & Isles, 2010;Liikanen, 2003; Macnaughton, White, & Stacy, 2005; McQueen-Thomson & Ziguras,2002; Miles, 1994; Scher, 2000; Vennet, 2011; Wikoff, 2004). Integrating an arts programinto health facilities can reduce the anxiety and stress of patients and positively affect theirclinical outcomes, support the morale of their families and caregivers, alleviate tensionamong the hospital staff and enhance the quality of their service. In short, a well-developed hospital-wide arts program can significantly improve the hospital experiencefor everyone.

Arts in Hospitals have a long history in England, which began with the FoundlingHospital erected in the eighteenth century. Its first governor, William Hogarth decoratedits walls with art works donated by contemporary British artists, and in fact became knownas the first contemporary gallery of British Art (Harris, 2012). In the USA, hospital artprograms began in the 1960s from a movement by the Society of Arts in Healthcare (SAH)to hang pictures on sterile hospital walls (Lane, 2006). While the demand for humanitarianand more patient-centered hospitals have ushered changes in Europe, the USA, Canadaand Australia, Arts in Hospital initiatives in Japan are lesser known. There are manyattempts at bringing art into hospitals in Japan. However, most of these projects focused onarchitecture, installations and displays (Cooper, 1999), and it has only been in the past 10

q 2015 Taylor & Francis

*Corresponding author. Email: hlfondevilla@gmail.com

Arts and Health, 2015

http://dx.doi.org/10.1080/17533015.2015.1033435

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

years that more participatory and interactive Arts in Hospitals programs became widelyaccepted and practiced in healthcare facilities in Japan.

Art Meets Care, an annual conference began in 2006 as a way to increase knowledgeamong academics and practitioners (Tanpopo no Ie Foundation, 2006). It is interesting tonote that the Arts in Hospital movement in Japan is widely supported by the academe suchas the Kanazawa College of Art, and the School of Art and Design of the University ofTsukuba and nonprofit organizations such as “artsproject” in Kobe, Heart & Art Kuukan inSendai, and Hospital-based Kids Art Project in Kanagawa. Art that is participatory anddesigned to directly serve patients is slowly becoming part of every hospital in Japan.

Methods

This paper describes hospital art programs at the University of Tsukuba Hospital andTsukuba Medical Center, both located in Tsukuba city, Ibaraki prefecture in Japan, led byuniversity student groups Asparagus, Paprika, Frontier and Keyakids. It seeks to documentand study the different forms and activities Japanese hospitals are implementing to assistin patient care. Additionally, the study intends to highlight the importance of supportingArts in Hospital projects by showing its beneficial impacts through communityengagement and education.

The research for this study is based on current activities and happenings at theUniversity of Tsukuba and the University of Tsukuba Hospital. The authors are activesupporters and participants of this project, and the information gathered for this article arebased on primary sources such as interviews with patients and staff, as well as personalexperiences in handling and organizing the events as a faculty member of the university(Fondevilla) and as a former student and volunteer of Asparagus, and currently the artcoordinator of Tsukuba Medical Center (Iwata). Secondary sources are based fromarchived materials such as exhibitions, workshops, symposiums, and universitypublications on adp or “Art Design Produce.”

This study has several limitations. Though all projects were made in consultation withhospital staff and student groups, formal ways to evaluate the impact of the Arts inHospital projects are limited to survey results and interviews with hospital patients andstaff. Much evidence on the benefits of hospital arts programs remain to be anecdotal,which is the same in this study. However, the advantages of having Arts in Hospitalprograms should not be discounted. Arts practice is known to provide a medium for thecreation of personal meaning, and this process is invaluable to those who are experiencinghealth problems (McQueen-Thomson & Ziguras, 2002).

Student groups

In 2005, the School of Art and Design at the University of Tsukuba launched a programnamed adp or “Art Design Produce,” supported by the Ministry of Education, Culture,Sports, Science and Technology (MEXT).1 The program invites university studentsregardless of their field of study from their freshmen year to graduate school to engage increative machizukuri or community building projects. The students are tasked withorganizing themselves to conceptualize, plan and carry out projects that are centered oncommunity engagement, and receive academic credits in return. Student groups, organizedin 2008 and named Asparagus, Paprika and Frontier, concentrate on hospital arts.Asparagus organizes participatory expressive arts that involve physical and tactilestimulation such as mini-art workshops to children and older adults,2 while Paprika and

2 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Frontier are involved in non-participatory expressive arts such as product design (Avalon,2006). Though majority of the students are art majors, students from other disciplines alsoparticipate, such as the new group named Keyakids which was organized in 2013, andlargely composed of medicine and nursing students who organize the yearly event “YumeHanabi (Dream Fireworks)” for the children confined at the University of TsukubaHospital. However, members of Keyakids receive no academic credit, and their work is ona voluntary basis with financial support from the University of Tsukuba and the Universityof Tsukuba Hospital. The changes in arts practices outside of more traditional venues suchas galleries, museums, schools and studios express a worldwide shift that is becomingincreasingly participatory, and have given it a new identity and character different thanwhen audience engagement was mediated solely through artworks (Broderick, 2011),which young artists are now being exposed to through the program.

University of Tsukuba Hospital

The University of Tsukuba Hospital is an academic teaching hospital located in the city ofTsukuba, Ibaraki prefecture in Japan and was opened in October 1976, and as part of theUniversity of Tsukuba that was established in 1973. As one of the major teaching hospitalsin the country, the hospital is updated with the latest advances in medicine. The hospitalhas adopted a holistic approach to healthcare, one in which careful consideration to light,space and color in the hospital environment, as well as participative arts program is alsobeing supported and encouraged.

There is cooperation and community involvement in placing the artworks, anddeciding on which workshops or activities can be performed in the hospital. The localcommunity, especially the students and faculty of the University of Tsukuba, plays a vitalrole in volunteering and organizing arts programs that are both participatory and non-participatory. To answer the greater need in establishing a hospital arts program that isstable and sustainable, the University of Tsukuba Hospital has established an artscommittee, which is attended by doctors, nurses, professors, students, the hospital staff aswell as members of the community. The students are responsible for programming artworkshops and present their ideas to the committee for comments and suggestions, guidedby their professors who also volunteer their own time and create artworks to display in thehospital. In addition, the need to for an organized and committed arts program has led theway for the hospital to hire a hospital art coordinator in 2013, signaling the hospital’srealizations in the role of arts in health care.

Arts and design

Upon entering the newly constructed hospital building, patients and visitors willimmediately notice the differences from the previous construction. The new hospital hashigher ceilings that allow better air circulation, and large windows that let in natural light.One of the new installations that captures the attention of patients and visitors is the three-panel LCD display on the way to the elevators. The displays feature: an animated collageof doctors, nurses and hospital staff being interviewed by children, an aerial view of thecity of Tsukuba from the hospital rooftop at different times of the day and a video promoof the University of Tsukuba. Each video sequence runs for six minutes, and are loopedcontinuously. The video collage is a joint effort by design and multimedia students andtheir professors, while Fumiaki Murakami, a professor in the department of Arts & Design,created the aerial views. The animated collage introduces the patients and hospital visitors

Arts and Health 3

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

to the staff in an entertaining and informative way, by providing small materials such astheir hobbies, or weekend activities. The concept of the videos is to lessen the stresspatients feel before meeting their designated healthcare provider. The colorful stop-motion animation took almost 2 years to complete, and the installation of the panels wasfinanced by the university hospital. In the future, the arts committee hopes to create arevolving collection of videos to display in the panels that will showcase the work ofstudents, local artists, and professors (see Figure 1).

Another change in the newly constructed hospital building is the colorful pediatricward. With the aim of eliminating or reducing the stress and progressive deteriorationexperienced by hospitalized children, the pediatric ward is decorated with large murals ofpastel-colored trees and flying animals with the idea of bringing nature, specifically aforest, to the hospital. This theme mirrors the natural surroundings of Tsukuba, which islargely forested. The city itself is famous for its lush greenery and small wild animals thatroam its hiking and mountaineering paths. Named after Mt. Tsukuba, one of the sacredmountains of Japan, the murals hope to bring the outdoors within the walls of the hospital.Through the idea of subjective spatial perception, the reality of hospitalized children andtheir caregivers may be positively transformed through art, and the feeling of seclusion belessened (Ante et al., 2011).

According to Takaesu:

In order for the hospital to fulfill its function as a healing establishment, careful attention wasdedicated to selecting the most appropriate kinds of furniture, placement of chairs and desks,telephones, the vending machines, the color schemes in all the hospital facilities, equipment,etc. Thus, we focused on the problem of creating an environment where we could effectivelyprovide various therapeutic treatments for our patients. This approach may be said to be andextension of the subtle know-how associated with psychotherapy.

The ward is very spacious, and a playroom was constructed for the use of hospitalizedchildren, their parents and staff. In the same playroom, art students from the University ofTsukuba often hold short workshops on arts and crafts. Having the space where to engage inactivities usually done in school, home or community can be replicated is important formaintaining relationships between the children and their families (Wood et al., 2013). Theyoung patients are also responsible for writing their own name on the door of their wards, asa way for them to personalize their own space, and are encouraged to join the play activities.

Figure 1. Digital triptych at the University of Tsukuba Hospital. Photo by Daichi Konaka.

4 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Along the corridors of the hospital, colorful photographs of plants and trees, winningentries of a local contest sponsored by the Tsukuba Botanical Garden held every year, linethe walls. Large photographs of local people doing ordinary things such as baking bread orbuilding a house also decorate the hospital. Scenes that portray everyday life help toreassure the patients by portraying familiar scenes that they can relate to, and provide apoint of focus and humanize the hospital environment. On the fifth floor of the hallwayconnected to the old building, framed landscape oil paintings by the university art studentsare also displayed. The artworks were brought to the hospital for healing and meditativepurposes, knowing architecture and art can foster a better healing environment (Lane,2006). The hospital arts committee carefully curated the photographs and artworks thatdecorate the walls of the hospital, choosing those that are the most soothing, familiar orpleasing to the eye.

According to Wikoff:

Paintings that are challenging, confrontational, and emotionally charged may be ideal for agallery, but a hospital needs art that is calming, meditative, and uplifting. Some art will beselected, in part, for practical purposes – major symbols that can be used as landmarks to helppeople navigate the maze of hospital corridors. (2004, p. 8)

In the case of University of Tsukuba Hospital, the artworks serve as location markersbetween floors and wards, decorate the bare walls of the hospitals, and serve as a showcaseof student work and a window to the outside world for the hospital patients. The paintingsare replaced annually, and portray scenes from the Japanese countryside, which arefamiliar to most of the hospital patients.

On the second floor of the hospital, sho or Japanese calligraphy by the studentsdecorate the hallways. There was initially much contention in bringing calligraphy to hanginside the hospital, for it is often associated with funerals in Japan. But at the same time,sho is also used to celebrate festivals and joyful events such as birthdays, anniversaries,weddings and the changing of the seasons, and also is used to write traditional poetry.To emphasize the joyful and meditative aspects of calligraphy, the Arts in Hospitalcommittee decided to redecorate the hallway to resemble the interior of a traditionalJapanese house to serve as a background for the calligraphic scrolls and artworks.By changing the background of the artworks, the calligraphy now stands as reminder tojoyful events, bringing messages of hope and encouragement to the patients, their familiesand the hospital staff.

In early 2014, a landscape garden designed and created by landscape architecturemajors on the university was opened to the public. The students were given control overthe design and implementation of the project, with help and funding from the hospital artscommittee. Maintenance of the garden also rests on the students, professors and hospitalstaff who regularly trim the grass. The doctors in the hospital also find great comforttrimming the grass cutter between shifts, as it helps alleviate stress from their work.In addition, the garden serves as an exhibition space for students and faculty who createsculptures to complement the natural beauty of the garden (see Figure 2).

In a survey performed between May and June 2013, the majority of the patientsexpressed their preference for displays that involve natural scenery, such as the forestsof Tsukuba and the changing seasons. Many also expressed interest in the activities andexhibitions by the students, and have even requested for an “art map” of the hospital.The results of this study support the growing interest in the roles of the arts incontributing to the health and wellness of the patients, as well as cater to their interests(see Figure 3).

Arts and Health 5

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Patient-centered workshops and activities

The university hospital has also allotted a hallway that now serves as the Asparagusmembers’ headquarters, nicknamed SOH (seeds of humanity) by the students. It alsoserves as an activity area for projects that are being carried out by the group, a gallery ofpast activities, and exhibition area for the Artist in Hospital program by the hospital anduniversity. One of the projects that were held in SOH was the Giant Board Game Week.Aimed to encourage participation and provide an enjoyable activity for child patients, thestudents transformed SOH into a board game by pre-marking the floor with circles andarrows that lead to a goal. Next, the children were asked to assign simple tasks or questionswhen the player, who also serves as the token, lands on a certain space, such as namingcountries or holding the hand of the nearest person. The students also provided a large,blow-up dice that the children can cast to move ahead in the game. The activity washelpful in encouraging creativity in the participants, and gave them an opportunity to playand interact with other patients and staff in a fun, and non-threatening manner (see

Figure 3. Infographic on Arts in Hospital at the University of Tsukuba.

Figure 2. The hospital garden designed and created by students. It also serves as an outdoor galleryof student and professors’ artworks. Shown here is a sculpture by Prof. Yuko Ono.

6 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Figure 4). In addition, the games served as a form of therapy, as the children areencouraged to use their imagination, build up excitement, and immediately release itwhenever the dice reveals a number, or when the game itself has finished.

Another popular project was Hikari no Yume Tsubomi (Orbs Filled with Light),which Asparagus jointly developed with other student groups, government officialsand employees, Circle (or the University of Tsukuba Fireworks Appreciation Club)and the university Debate Club. In this activity, the students asked the child patients todesign their own fireworks. The students then commissioned a pyrotechnics companyto recreate the illustrations into live fireworks, which were set off and displayed in thenight sky as the culminating event of the annual university festival. The childrenalso made “dream orbs,” battery-operated light up bulbs covered in gauze withstenciled designs, which the children made with their siblings and parents. The lightswere then used to decorate the bus that went around the university that carried thechildren, their families and hospital staff to the fireworks viewing venue (University ofTsukuba, Art Design Produce 2012, 2012, 2012). The activity was so successful andpopular that a new student group was created to handle the event, named Keyakids (seeFigure 5).

Since the university hospital is an acute medical facility, the importance of having anart program that can help alleviate patients’ stress has become a significant part in the careof their well-being. Studies show that patients who are exposed to natural scenery andartwork are less anxious, requested less pain medication and had quicker post-operative

Figure 5. An illustration by a patient commissioned into real fireworks. Photo by Keyakids.

Figure 4. Child patients play with Asparagus members on the giant boardgame. Photo byAsparagus.

Arts and Health 7

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

recovery times (Homicki & Joyce, 2004). In addition, children develop a more positivecoping response even when faced with life-threatening situations if their environment issupportive and more caring (Cowell, Heron, & Hockenberry, 2011).

The arts and crafts projects are not confined to the hospital. One of the Asparagusworkshops brought older adult participants outside to collect leaves which were then usedto make leaf prints (University of Tsukuba Art Design Produce 2011, 2011, 2011).Another project named Irodori Chousan Cafe (Colorful Butterfy Cafe) taught the olderadult patients to create butterfly clips (see Figure 6). This craft was intended to be morecomplicated in order for the patients to feel challenged and practice their coordinationskills. Comorebi (light filtered through tree leaves) brought the outdoors indoors, asparticipants cut, twisted and glued felt fabric together to create vines that were hung to bedisplayed on the glass walls of SOH. The shadows created by the craftwork appear to beleaves from outdoor, reflected on the floor of the gallery, creating the impression that thehalls are covered in leaves. The fact that nature can help alleviate and assist recovery is oneof the key concepts of this project. The patients were also encouraged to practicecoordination skills by making the felt fabric vines, communicate with the students andenjoy the beauty of their works (see Figure 7).

Artist in hospital

Similar to the concept of an artist in resident, this project invites creative persons to make aproposal that will be held at the University of Tsukuba Hospital. This includes plans forexhibitions, installations, workshops or even performances that can be fulfilled within onemonth, and can be achieved with a limited budget provided by the hospital. The residencyis open to all students of the University of Tsukuba. The program gives young artists thechance to engage in creative and challenging work within the hospital by providing theman exhibition space, as well as modest funds to complete their projects. The programstarted in 2008, with two residents, Haruka Ono and Jun Kitazawa. It was held again in2009, with three residents, Fumiharu Sato, Daichi Konaka, and Haruto Suzuki. In 2010, a“pucchidence” or short-term residency, was held (3 days, instead of the usual one month),and three student artists were invited to participate. This program also goes under theuniversity’s adp project, and is managed by Asparagus members, as some of the membersof Asparagus have a keen interest in arts management. In 2014, with funding from the

Figure 6. An older adult patient with her collection of butterfly pins. Photo by Asparagus.

8 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Agency for Cultural Affairs, the arts committee chose three artists to perform art-relatedactivities within the hospital. The Artist in Residence program will continue until the nextyear, as stipulated in the grant.

The program has successfully introduced artists to alternative ways of creating andpresenting art. The program has taught students of the powerful ways art can transformsmall community spaces, and it has influenced their work. Former residents Jun Kitazawaand Daichi Konaka have continued to create artworks based in local communities,including schools and hospitals and have been successful in finding appreciative audiencesand opportunities to exhibit all over Japan and overseas as well.

Cross-cultural projects

In September 2013, the University of Tsukuba held its first symposium on arts and health,inviting scholars from the University of East Anglia and Emma Jarvis, art coordinator of theNorfolk and Norwich University Hospitals. Because of its success, another symposiumwasheld in January 2014, gathering arts and health practitioners all over Japan. As the universityalso received support for further research into the role of arts in health from the Agency ofCultural Affairs as well as private grants, further cross-cultural projects were enacted inSeptember 2014. “Supernatural Garden” held at the Norfolk and Norwich UniversityHospital brought the Arts in Hospital project of the University of Tsukuba to England.3 Theline-up of activities included student works to be installed in the hospital outdoor garden,and installations and workshops by the professors, students and community artist DaichiKonaka. British artist John Shelley, who has close ties with Japan, participated by installinghis artworks along the hospital hallways. Student volunteers gathered by the Centre forJapanese Studies at the University of East Anglia lent support by helping with the

Figure 7. Comorebi, or sunlight filtered through the leaves of the trees. Patients enjoyed makingand watching the “leaves.” Photos by Asparagus.

Arts and Health 9

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

workshops, and participated in creating tapemurals around the hospital. One of the studentswho volunteered for theworkshops even remarked that hewould like to study Japanese afterworking with the Tsukuba arts in hospital staff (personal communication, September 14,2014). The hospital staff mentioned that even though one 45-year-old female patient “haddrips and wires coming out of her, she still joined in the fun.” The workshops not onlyinvolved the hospital patients, but also included the staff as well, who viewed the activitiesas a welcome break from their daily undertakings (see Figure 8). These activitiesdemonstrate great promise in the future of Arts in Hospital programs, as it will not onlyencourage further practice and research into the field, but can also be instrumental informing bilateral communications between institutions in Japan and overseas.

Tsukuba Medical Center

Tsukuba Medical Center was opened in 1985, the same year Tsukuba Science Expo washeld. Located near the University of Tsukuba, the hospital also benefits from the servicesof university student groups Asparagus, Paprika and Frontier. Tsukuba Medical center’sclose proximity to a landscaped city park, with ponds filled with koi, lend a greenenvironment to the hospital, and enables patients to readily experience nature. Thehospital’s focus is on changing small details in the way people interact with theirenvironment, as well as making useful improvements to serve their patients and theirfamilies.

The hospital works closely with university student groups Paprika and Frontier, andassists in creating a more comfortable environment through product and environmentaldesign. It has made several thoughtful changes such as the layout of furniture in theirwaiting rooms, the transformation of empty spaces into small gardens, the replacement ofplain signs by colorful ones and even replacing the non-slip mats that are placed under theplates and bowls that patients use during meals, which used to be plain and monochromaticinto a more cheerful design (see Figure 9). Efforts to make the environment in the hospitalmore friendly and comforting include offering creative channels that are reflected in thechanges in the hospital atmosphere. These beliefs lie in the supposition that everybody isan “artist,” and talent nor training is not necessary to appreciate the rewards of creativeexpression, and that these channels can reduce stress and reduce the trauma of hospitalvisits (Avalon, 2006). This is especially the case of Tsukuba Medical Center, which

Figure 8. Staff at the Norfolk and Norwich University Hospitals sport their “goblin” uniforms,from the “Goblins Everywhere” workshop. Photo by Daichi Konaka.

10 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

receives the largest number of patients transferred by ambulance in the city, and serves as atertiary emergency center for patients with serious medical conditions.

Projects by Paprika

The university student group Paprika, in coordination with the hospital administration andits art coordinator jointly developed and designed several projects to enhance the waitingareas of the hospital including (1) happatable (leaf-shaped table), which are small,colorful tables that also serve as decorative accents which the patients can move near theirseats to place their belongings on while they wait for their medical appointments or testresults (see Figure 10), (2) harumachi pockets, where the chairs in the waiting areas were

Figure 9. Team Paprika designed the non-slip mats that the hospital uses to serve food to patients.

Figure 10. These leaf-shaped tables were designed by Paprika to be useful and decorative at thesame time.

Arts and Health 11

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

fitted with cloth pockets containing brochures with short, illustrated introductions abouthospital staff, including the doctors and nurses (see Figure 11), (3) organdy curtains that letin natural light as well as maintain the patients’ and their visitors’ privacy in the waitinglounge and dining area (see Figure 12) and (4) redesigning waiting and dining rooms.

Two small waiting rooms were redesigned by Paprika, in careful consideration ofproviding a space for hospital patients and visitors to talk and interact. The first waitingroom that the students re-designed used organic shapes made of natural materials such aswood to divide the space. They also designed original furniture, which the hospital paid tohave custom-made. The choice of natural materials and warm, muted colors give the spacea relaxed and calming atmosphere, which is important to patients and caregivers increating a more comfortable environment.

One of the problems that the staff noticed is that many long-term hospital patients andtheir visitors often cut their own hair in the hospital bathrooms. With this problem in mind,the hospital commissioned Paprika to refurbish another waiting area, to serve not only as a

Figure 11. Patients and visitors can read about their doctor’s hobbies or their nurse’s favorite foodon the mini leaflets in the harumachi pockets.

Figure 12. Organdy curtains in the waiting/dining room let the light in while maintaining privacy.

12 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

place for patients and their families to communicate, but also as a temporary hair salon.Named Tsutsumare Salon (tsutsumare means to sit around in a circle in Japanese), theroom now serves as a waiting and activity area where people can sit around with each otherto talk and communicate. On one side of the wall is a mirror, as the hospital occasionallyemploys a barber to cut patients’ and their families’ hair. A survey form is placed in theroom, to invite participants to give suggestions on activities or workshops, which theywould like to see or participate in the hospital (see Figure 13).

Projects by Frontier

In the project Irodori no Mori (Colorful Forest), the students decorated the waitinghallway with felt fabric leaves, with a stretch of cloth printed with the blue sky with hot airballoons. In the middle were marked colorful numbers and shapes that represented meters,measurements to be used for the rehabilitation of patients (University of Tsukuba ArtDesign Produce 2011, 2011, 2011). One of staff members remarked that instead ofencouraging patients to walk a certain number of meters, they would instead tell theirpatients to walk towards the red or blue balloon, as each was marked with a correspondingdistance. The very simple task of replacing ordinary numbers with colorful visuals greatlyinspires the patients, and adds an element of fun to their rehabilitation.

Figure 13. At the Tsutsumare Salon, where the space and furniture were redesigned by universitystudent group Paprika.

Arts and Health 13

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Results

The beneficial effects of the Arts in Hospital project has greatly enhanced patientexperience at the University of Tsukuba Hospital and Tsukuba Medical Hospital and hascontributed towards the education of university students. The positive response of thepatients and hospital staff has led to increased exhibitions and projects, the creation of anew student group, Keyakids, additional financial support from the Japanese governmentthrough the Agency of Cultural Affairs, as well as international collaborations. The Artsin Hospital project at the University of Tsukuba is proof that cooperation betweeneducation and healthcare is possible, and must be considered especially in universityteaching hospitals or healthcare facilities that are in close proximity to educationalinstitutions.

Discussion

Many complex factors affect health and well-being, and as the level and quality andhealthcare improve, the need for less-quantifiable factors will also likely intensify.In Japan, healthcare is an important topic for policy discussions because of its agingpopulation and decreasing rates of childbirth. With longer periods of retirement also comeextended periods of care, as well as disability. There is much concern about the rising costsof pensions and medical care, especially at a time when strong family support for the olderadults is also decreasing (Martin, 1989). Needless to say, the need and interest for better,patient-centered healthcare is on the rise, and the government hospitals, as well as privatehospitals and clinics are supportive of practices that are increasingly more sensitive to theemotional and psychological needs of patients.

As university students largely lead the Arts in Hospital projects in Tsukuba, theactivities are heavily reliant on the revolving schedules of the students, and the hospitalssuffer a dearth of activities during busy seasons such as university examinations or lengthyvacation periods. Likewise, hiring a hospital art coordinator to promote and manage Artsin Hospital programs will bring a sense of order and make the presence of arts in healthcare facilities more stable and reliable. They can also forge new contacts with city officialsand community groups, as well as maintain the relationship between students, professorsand volunteers. Lastly, while Arts in Hospital projects in health care facilities in Japan arefinanced in-house, they should also consider financing their programs through charitablemeans or sponsorships whether corporate or private to help alleviate the costs and giveincentives to their workers and volunteers. The Arts in Hospital at the University ofTsukuba is a continuing project, as it is widely supported by the MEXT, and integratedinto the university curriculum. Additional support from the Agency for Cultural Affairshas enabled the project to expand by sponsoring field research, conferences and youngartists. Private funding has enabled the project to engage in cross-cultural activities.However, only the support from MEXT is stable, and the range of activities will becomelimited when additional support has ended. Where possible, the development of graduate-level studies and curricula, as well as support for formal ways of evaluating the effect ofarts on health with evidence, should also be encouraged.

Japan is still cautious in developing new policies or implementing hospital-wide Arts inHospital programs, but the new generation of hospital administrators is more willing toencourage patient-centered care using the arts. In addition, this kind of cooperation betweenuniversities and hospitals may be replicated in other countries, especially in hospitalsaffiliatedwith universities. The benefits of a project similar to theUniversity of Tsukuba arenumerous, and is mutually beneficial to all those who are willing to participate.

14 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Conclusion

The Arts in Hospital movement in Japan led by student groups are mutually beneficial topatients and students, as well as hospital staff, nurses and doctors. First, the students aregiven the responsibility to conceptualize and present their ideas to fellow students,professors and hospital staff. They are also given the freedom to develop ideas, performresearch and initialize dialogues with the patients, whether they are dealing with the olderadults or with children. These experiences teach lifelong skills in planning andorganization, as well as interpersonal relations that will be useful in their future careers.One student volunteer from Asparagus commented that she is glad for the opportunity toteach the arts to patients, for it will help her become a better doctor someday (personalcommunication, June 2013). The patients also enjoy the benefit of having an alternativeform of activity and distraction for their minds and bodies. They look forward to theworkshops and art activities as a way to break the monotony of their hospital stay, and areencouraged to talk and communicate to the students and nurses. They are also givenopportunities to be creative and are taught various crafts that are not normally part of atraditional hospital stay.

There is a strong case to be made in bringing more Arts in Hospital projects in Japan,and one important aspect of the Arts in Hospital projects in Tsukuba is how it hasmobilized the youth through community participation. Arts in Hospital projects provide acreative avenue for engaging the community through the arts by encouraging volunteerismand communication with other sectors of the public. It encourages the development ofgovernmental policies, enhancing health education, and improving the aestheticenvironment of hospitals and other healthcare settings. In the spirit of machizukuri orcommunity building, encouraging more health care facilities to adopt arts projects willgreatly contribute to the development of community engagement.

Arts in Hospital projects can also be used to assess the mental and physical health ofpatients, and can be used as an important information-gathering tool. This can beespecially useful for patients who are undergoing physical therapy, or for patients whohave difficulty speaking or communicating verbally. Drawing is known to assist memory,while the use of movement such as dance or yoga invites a patient to expand upon theirthoughts or feelings (Camic, 2008). Arts in Hospital programs have a promising future inJapan, especially if students, who will be the future of these activities, motivate them. It isimportant that the clinical atmospheres of health care facilities not overshadow theineffable character of Arts in Hospital projects, but rather maintain its stance as a way toprovide comfort, reduce anxiety and emphasize the role of the hospital as a place ofhealing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. You may view the adp archives at (in Japanese): http://info-d.geijutsu.tsukuba.ac.jp/,adp/index.html

2. You can find out more Asparagus and their activities through their Facebook page at (inJapanese): https://www.facebook.com/adp.asparagus

3. More information about the international activities of the Arts in Hospital project at theUniversity of Tsukuba can be viewed at: http://www.geijutsu.tsukuba.ac.jp/ ,artsinhospital/

Arts and Health 15

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

References

Ante, B., Gonzalez, R., Lopez, X., Peleteiro, C., Rodriguez, C., & Ruibal, N. (2011). Algo Mas DeColor. Terapia Habitacion De Hospital [A bit more color. Hospital room therapy]. Arte,Individuo y Sociedad, 23, 203–211.

Arts and Health. (2009). Editorial. Arts and Health, 1, 3–5. doi:10.1080/17533010802614627Avalon, A. (2006, March 23). Arts in new directions the development and application of a construct

that uses the arts to promote transformation and self-actualization in health care and education/therapy. FL: University of South Florida. http://scholarcommons.usf.edu/etd/2446

Broderick, S. (2011). Arts practices in unreasonable doubt? Reflections on understandings of artspractices in healthcare contexts. Arts & Health: An International Jounal for Research, Policyand Practice, 3, 95–109.

Camic, P. M. (2008). Playing in the mud: Health psychology, the arts and creative approaches tohealth care. Journal of Health Psychology, 13, 287–298. doi:10.1177/1359105307086698

Clift, S., Camic, P., & Daykin, N. (2010). The arts and global health inequities. Arts & Health: AnInternational Journal for Research, Policy and Practice, 2(1), 3–7.

Coles, P. (1981). Manchester Hospitals’ Art Project. London: Calouste Gulbekian Foundation.Cooper, G. (1999). The Arts in Health Care Kings Fund 1999. Retrieved from Coopergraham: http://

www.coopergraham.supanet.com/ArtJapHosp.htmlCowell, E., Heron, C., & Hockenberry, M. (2011). The impact of an arts program in a children’s

cancer and hematology center. Arts & Health: An International Journal for Research, Policyand Practice, 3, 173–181.

Hamilton, C., Hinks, S., & Petticrew, M. (2003). Arts for health: Still searching for the Holy Grail.Journal of Epidemiology and Commuity Health, 57, 401–402. doi:10.1136/jech.57.6.401

Harris, R. (2012, October 5). The Foundling Hospital. Retrieved from BBCHistory: http://www.bbc.co.uk/history/british/victorians/foundling_01.shtml

Homicki, B., & Joyce, E. (2004). Art illuminates patients’ experience at the Massachusetts GeneralHospital Cancer Center. The Oncologist, 9, 111–114. doi:10.1634/theoncologist.9-1-111

Iwasa, K. (1966). Hospitals in Japan: History and present situation. Medical Care, 4, 241–246.doi:10.1097/00005650-196610000-00009

Lane, M. R. (2006). Arts in health care: a new paradigm for holistic nursing practice. Journal ofHolistic Nursing, 24, 70–75. doi:10.1177/0898010105282465

Lankston, L., Cusack, P., Fremantle, C., & Isles, C. (2010). Visual art in hospitals: Case studies andreview of the evidence. Journal of the Royal Society of Medicine, 103, 490–499. doi:10.1258/jrsm.2010.100256

LelchukStaricoff, R., Duncan, J.,Wright,M., Loppert, S.,&Scott, J. (1992–2002).A study of the effectsof the visual and performing arts in healthcare. Retrieved from http://www.publicartonline.org.uk/resources/research/documents/ChelseaAndWestminsterResearchproject.pdf

Liikanen, H. -L. (2003, August 15). Art meets life- the arts in hospital initiative and culturalactivities in the everyday life and festivities of care units in Eastern Finland (p. 197). Helsinki:University of Helsinki.

Macnaughton, J., White, M., & Stacy, R. (2005). Researching the benefits of arts in health. HealthEducation, 105, 332–339. doi:10.1108/09654280510617169

Martin, L. G. (1989). The graying of Japan. Population Bulletin, 44, 3.McQueen-Thomson, D., & Ziguras, C. (2002, July). Promoting mental health and wellbeing through

community and cultural development: A review of literature focusing of community arts practice.Retrieved from http://www.vichealth.vic.gov.au/, /media/ProgramsandProjects/Publications/Attachments/Promoting%20Mental%20Health%20-%20Arts%20Participation.ashx

Melbourne, T. R. (2013, December 10). Arts at The Royal Children’s Hospital Melbourne. Retrievedfrom The Royal Children’s Hospital Melbourne: http://www.rch.org.au/arch/

Miles, M. F. (1994). Art in hospitals: Does it work? A survey of evaluation of arts projects in theNHS. Journal of Royal Society of Medicine, 87, 161–163.

Pasick, A. (2014, January 2). Japan is rapidly losing population – and half the world is about to joinit. Retrieved from Quartz: http://qz.com/162788/japan-is-rapidly-losing-population-and-half-the-world-is-about-to-join-it/

Scher, P. S. (2000). Research and evaluation of the exeter health care arts project. MedicalHumanities, 26, 71–78. doi:10.1136/mh.26.2.71

Takaesu, Y. (n.d.). The hospital as an artistic space: Dynamics of the therapeutic complex. Retrievedfrom Izumi Hospital: http://izumihospital1985.or.jp/english.html

16 H.L. Fondevilla and Y. Iwata

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015

Tanpopo no Ie Foundation. (2006, March 11). Art meets care. Retrieved from Art Meets Care: http://popo.or.jp/artmeetscare/about/about.html

University of Tsukuba Art Design Produce 2011. (2011). Art Design Produce 2011 ver. 07. Tsukuba:University of Tsukuba School of Art and Design.

University of Tsukuba, Art Design Produce 2012. (2012). adp12. Tsukuba: University of TsukubaSchool of Art and Design.

Vennet, R. v. (2011). Transforming the heathcare experience thorugh the arts. Arts & Health: AnInternational Journal for Research, Policy and Practice, 3, 185–186.

Wikoff, N. (2004, November). Monograph: Cultures of care: A study of arts programs in U.S.Hospitals. Monograph, 1–12, Americans for the Arts.

Wikstrom, B. -M. (2005). Communicating via expressive arts: The natural medium of self-expression for hospitalized children. Pediatric Nursing, 31, 480–485.

Wood, V., Curtis, S., Gesler, W., Spencer, I., Close, H., Mason, J., & Reilly, J. (2013, August).Creating “therapeutic landscapes” for mental health carers in inpatient settings: A dynamicperspective on permeability and inclusivity. Social Science & Medicine, 91, 1–8.

Arts and Health 17

Dow

nloa

ded

by [H

erb

Fond

evill

a] a

t 19:

36 1

8 M

ay 2

015