The Culture of Possibility
My firm, Aesthetics Inc., has been involved with various aspects of the design of children’s hospitals for more than 20 years. When we recently were privileged to work with Children’s Hospitals and Clinics of Minnesota on a major expansion project, we had the opportunity to participate with—and learn from—visionary leaders during a project I believe has much to teach us all.
Originally hired to implement the hospital’s expansive arts program, my firm and I were also asked to assist the organization in a design leadership capacity.
With 332 patient beds, Children’s of Minnesota is one of the 10 largest pediatric organizations in the United States. Its expansion project includes two campuses, Minneapolis and St Paul. Minneapolis was largely completed in 2010, with new surgery and cardiovascular centers, renovated neonatal and pediatric intensive care units, and a new emergency department. The St. Paul renovation, completed this year, includes a new five-story patient tower, new operating rooms, an expanded emergency department, and a new epilepsy unit.
The culture of possibility
Hospitals are—as they should be—bastions of practical, pragmatic thinking. Because virtually every major decision can have profound consequences for patient health, fiscal soundness, staff engagement, and institutional identity, those decisions are generally weighed with great care and analytical rigor.
And at the same time, hospitals also represent some of the highest and most idealistic human aspirations: the healing of not just the body but also of the mind and the spirit; the renewal of hope; and service to others.
It is difficult for a healthcare organization’s leadership to stand in both of those modes of thinking at the same time, and to generate an organizational culture that honors the full expression of the idealistic impulse while remaining grounded in responsible operational practicalities.
When a healthcare organization successfully engages both of those aspects of its responsibilities, it creates what I call a “culture of possibility,” because it entertains breakthrough thinking about possibilities while harnessing that thinking to the practical constraints of what is actually possible. Such a culture carries an organization beyond the limitations of existing models and industry benchmarks to breakthroughs that shift the sense of what’s possible, creating new models and new benchmarks, setting new standards for everyone within its industry.
Children’s of Minnesota has created such a culture, and its new physical environment and the incorporation of the arts are a result of that culture at the same time as they are expressions of it. Its renovations have incorporated a major commitment to using the arts as an active participant in healing, and in communicating vital messages of empowerment, opportunity, generosity, and delight.
Arts, healing, and urban renewal
You don’t have to look far to see the combination of vision and pragmatism in the hospital’s recent makeover of its Minneapolis campus—you can start with the full title of the arts component: the Arts & Healing and Urban Renewal Project. Dr. Alan Goldbloom, the hospital’s president and CEO, explains, “Our healing mission includes not only patients and their families, but our community, too, and so we decided to launch an urban renewal effort unlike any other in the country through a unique collaboration with the local arts community.”
The original vision was particularly inspired by the former board chairman of Children’s of Minnesota, the late James Ryan, who had been a long-term supporter of the arts in the Twin Cities as well as a visionary leader at the hospital. He saw that the exceptionally robust arts institutions there offered a great opportunity for practical yet novel collaboration to serve the hospital’s young patients and their families, and he began inviting them into a process of co-creation to develop programming for the hospital.
Children’s of Minnesota convened and listened closely to an advisory task force of community members, including artists, arts patrons and donors, and representatives of several prominent arts institutions. It called on its architect for a design that welcomed the community rather than walling it out, and that amply supplemented the sparse green space to be found in the community (green space has been shown in many careful studies to improve the health, safety, and self-reliance of community members1).
Consistent with the theme of joining together with the best local resources, which recurs throughout this expansion in ways that will be described more fully, the Minneapolis architecture firm Ellerbe Becket performed the architectural design work at the Minneapolis campus, and the principal architect on the project was
Mic Johnson, a professor from the University of Minnesota’s College of Design who teaches graduate-level studio courses focused on design within the urban context. Johnson observes: “Qualities in material color, texture and density, rhythm and size of windows, building height, and open space became community issues rather than considerations of only those involved in developing the hospital. Rather than designing a singular sculpted object that could be placed in any urban context, Children’s of Minnesota is uniquely reflective of its place within the neighborhood, creating a unique healing place and transforming the relationship with the hospital.”
Community facilities were incorporated into the building’s design. For example, a healing garden with a climbable sculpture by Minnesota artists Dan and Lee Ross is located in a space that invites community children; a community art gallery, located alongside the second floor lobby, showcases exhibits from local arts organizations and youth groups; and a performance space in the main lobby is open to children and parents from the neighborhood, where they can join patients, siblings, and family members in viewing live performances by some of the hospital’s arts partners (performances also are broadcasted to patients’ rooms in Minneapolis and St. Paul).
A central paradigm
The astute business thinker Robert K. Cooper once observed, “There’s good, there’s great, and there’s possible. And just as the good is the enemy of the great, the great is the enemy of the possible.3” I believe that all of us hold certain views, or paradigms, about what constitutes good work and great work. Once we get an idea in our heads about the way things are or the way things should be, it takes a lot to change that idea. We might stretch it at the edges here and there, but the core understanding usually serves to rein in how broadly we think and how far we go. Our work may be good, very good, or even great—but is it stretching toward the edges of what’s possible?
One paradigm of children’s hospital design can be phrased first as a multipart question: How much fun should a hospitalized child be enabled to have? How much joy, delight, discovery, learning, and growth?
From the perspective of its culture of possibility, Children’s of Minnesota has answered those questions the only way it can: as much as possible. Not as much as is good or as much as is great—as much as is possible.
And how are the farther reaches of the possible approached? By finding ways. As another insightful business expert, Peter Block, once wrote, “The answer to how is yes.2”
Five major arts institutions provide programming
Following board chairman Ryan’s inspiration, Children’s of Minnesota has found ways. Perhaps most notably, it has forged partnerships with five major Twin Cities arts organizations to bring vibrant, innovative programming into its hospitals.
The live performances in the lobby area’s “Performance Place” theater are currently presented by the Children’s Theater Co., a Twin Cities institution since 1965. Soon two other organizations, COMPAS and the MacPhail Center for Music, also will offer live performances on the stage. COMPAS—which serves 600,000 people throughout Minnesota each year—also offers participative theater, music, and creative movement projects in flexibly designed playrooms and family areas within the hospital.
In addition to helping design the community art gallery mentioned, the Minneapolis Institute of Arts worked with the hospital’s child life development department to create “Art out of the Box,” a make-it-and-take-it project for patients and their siblings. A variety of art projects have been designed by drawing from artwork in the museum’s collection that engage children from preschool through high school, and a special gallery in the hospital cafeteria showcases two- and three-dimensional works by the children.
Music therapists from the MacPhail Center invite families into an ongoing music therapy experience using songs and sensory stimulation. The hospital also is focusing with MacPhail on applying music therapy on newborns with gastroschisis, and an evaluation will be conducted to determine whether that application of music therapy has significant impacts on reducing length of hospital stays, increasing weight gain, and supporting healthy growth and development.
COMPAS also will provide storytellers, musicians, and poets who visit patient rooms and interact with patients and others in family areas.
The bustling arts activity at Children’s of Minnesota adds up to far more than “positive distraction” from pain, tedium, and worry, although it is surely important and effective in that regard. It also offers the children, many of whom come from families of limited means (Medicaid accounts for 44% of the hospital’s revenue), a vision of a future enriched by the arts. To reinforce the children’s appreciation and enthusiasm, workshops, group experiences, and individual coaching will be offered by trained personnel from the participating arts organizations.
“While Children’s always seeks to effect physical cure, we also honor the larger journey taking place. The integration of the visual, performing, and literary arts and creative and educational play throughout the hospital provides children and families unique opportunities for healing and the unfolding of new gifts as a result of their experience with trauma or pain,” says Theresa Pesch, who is the hospital’s vice president of development and executive director of the hospital’s foundation.
This unique partnership between world-class arts organizations and a world-class pediatric facility grows from the hospital’s culture of possibility and creates new possibilities not just for the hospital itself but for everyone whose life intersects with it. It is a rare occasion when the art of “customer experience design” is fully congruent with a facility’s branding message.
Inspired by what they have observed, other major Twin Cities arts organizations are now offering to join with the hospital to add even more programming.
[SEE ADDITIONAL SIDEBARS BELOW]
Annette Ridenour is President of Aesthetics, Inc. She can be reached at firstname.lastname@example.org.
1Faber Taylor, A., Kuo, F., and Sullivan, W. “Views of nature and self-discipline: Evidence from inner-city children.” Journal of Environmental Psychology, Special Issue: Environment and Children, (2002) 22, 49-63; and Kuo, F., “The role of arboriculture in a healthy social ecology.” Journal of Arboriculture (2003) 29(3), 148-155.
2Cooper, Robert K. Get Out of Your Own Way: The 5 Keys to Surpassing Everyone’s Expectations (New York: Crown Books, 2006)
3Block, Peter. The Answer to How is Yes (San Francisco: Berret-Koehler, 2003)
Co-creation and generative space
Pat Grazzini, the deputy director of the Minneapolis Institute of Arts, is one of the arts organization leaders who worked with Children’s of Minnesota to formulate and implement the collaborations that so powerfully enrich the hospital’s healing environment. Her office is about a mile away from the hospital’s Minneapolis campus. “Many days when I’m driving to or from work,” she says, “I go by Children’s and I can’t help wondering what’s going on at that moment in ‘my’ hospital. I wonder how many children’s lives are being improved by things my organization helped create there. It’s a great feeling.”
I have written elsewhere about the evolving concept of “generative spaces”—healthcare facilities whose overall character promotes health and supports the flourishing of individuals, organizations, and communities. Because they fulfill such a crucial function, generative spaces become prized by those who engage with them: those people have a deep sense of stewardship for sustaining and improving the space.
When Grazzini says that she thinks of Children’s of Minnesota as “her” hospital, she is manifesting the most important aims of the generative space movement. The same is true when a community resident who has never had a child treated at Children’s of Minnesota refers to it as “my” or “our” hospital; or when an artist or donor comes to feel the same way. Of course, the hospital’s commitment to compassionate healing, so powerfully reinforced by its beautiful buildings and unique art and arts programming, is likely to strengthen the ties that patients, families, and visitors feel to the hospital.
For all the branding or reputational advantages to the hospital of such feelings of relationship and even psychological “ownership,” there is also the incalculable advantage of having people throughout the Twin Cities—and beyond—feel emotionally connected to their part in helping Children’s of Minnesota achieve its healing goals, today and in the future. They are invested in the hospital’s success for reasons that are at the same time pragmatic and idealistic, personal and civic-minded. They have become part of the culture of possibility that began with the hospital’s leadership and now extends far beyond it.
Original visual art from local artists
Research over the past 20 years has shown that it’s good to have art on the walls in a hospital, in hallways, and in patient rooms. Some have approached this in a pedestrian way, hanging posters or shopping from a standard catalog. The art is there—one more thing checked off the list—but there’s no real aspiration to greatness or to reaching toward the fullest possibilities of this very noticeable design element.
At Children’s of Minnesota, art doesn’t just hang on the walls; it’s embedded into every aspect of the experience of a patient, family member, or visitor, and it fully reinforces not just the hospital’s commitment to healing, to joy, and to discovery, but its linkage with the community and its highest aspirations. The Aesthet
ics Inc., team worked closely with the architectural team to design into the building the right color palette, patterns, and materials to appropriately display the hospital’s multidimensional art program.
Every item of artwork throughout the facility—a total of more than 400 pieces—is original, and all of them are created by Minnesota artists, most of whom are from the Twin Cities area. With guidance from my firm, a taskforce of hospital officials, patients, family members, and community members defined criteria for the art. We distributed a call for artists, and the taskforce screened more than 200 submissions to select 48 artists to make unique contributions consistent with the specific needs of the facility. These artists were not just “hired” or “retained”—they were “enlisted” in the hospital’s mission, encouraged to bring out their best, and empowered to put their own spirit into their work. The results shine through. Several of the artists themselves had been patients in children’s hospitals, and their special perspective is evident in their works.
There are things for children and adults to marvel at throughout the architects’ beautiful light-filled and open building. Three dioramas are recessed into the lobby floor; a light and sound installation in the skyway between the children’s specialty center and the hospital will invite visitors to stop and create music; many of the sculptures are interactive; a mobile in the atrium of the children’s specialty center is an ode to the overall theme of the arts program, “The Experience of Art Making is Healing.”
Since it’s not just viewing art, but also making art and experiencing art in many manifestations, that shape the “customer experience” at Children’s of Minnesota, the eight floors of the hospital’s Minneapolis campus are named for arts activities: acting, painting and drawing, music-making, sculpting, storytelling, dancing, and filmmaking. Artists were engaged to create designs for each area; the design concepts were reviewed and vetted with three teams: the community advisory committee, the healing environment committee made up of clinical staff from throughout the campus, and a special taskforce of the patient and family advisory committee.
Research and evaluation
“Evidence-based design” is a much-honored phrase today, as it should be. Many facilities are happy to make use of the findings that others have produced, and others commit to adding to the critical knowledge base about applications of the arts in healthcare, but in a culture of possibility, research and evaluation are essential—the places where good intentions and grand dreams are measured against their real-world impacts.
Children’s of Minnesota has committed to evaluate all of the elements of its arts programming, from interactive elements to visual art, to measure how they affect health outcomes and the overall quality of the healthcare experience for patients, families, and staff. Each of the programs has a research committee and sponsor that have written a proposal for evaluation that was submitted to the hospital’s institutional review board to ensure that the results achieve the level of quality that will allow them to be published in peer-reviewed journals.
These evaluations will not just help Children’s of Minnesota keep what’s best, improve what isn’t, and invent new kinds of possibilities; they will help healthcare organizations everywhere to use the arts more efficiently and more effectively. It’s another form of co-creation, with the entire healthcare sector.