Maria Jukic: There’s a program in medical humanities where the medical students interact with the arts in different ways, going to the art museum and learning about observation techniques, learning about artists working in the community and collaborating with them. The point of this is that the medical students are learning that the arts offer them a deeper way of understanding themselves, patients, communities, and the health of all three. Jo Reed: That was Maria Jukic. She’s the executive director of the Arts and Medicine Institute at Cleveland Clinic. And this is Art Works, the weekly podcast produced at the National Endowment for the Arts. I’m Josephine Reed. The latest edition of NEA Arts is devoted to art and health. While thinking about ideas for a story, I ran across a white paper that examined the impact of the arts on healing in Cleveland, Ohio. Released earlier this year by the Community Partnership for Arts and Culture, or CPAC, “Creative Minds in Medicine: A Cleveland Creative Intersection” was a revelation. It presented six case studies of programs that embraced the arts in their healing practices. And it demonstrated in quite specific ways the ameliorative powers of the arts-- for patients, their families, and for medical practitioners. The case studies examined in “Creative Minds in Medicine” cast a wide net, from training medical students and the significant advantages of art therapy, to the comfort of architectural design in hospices, to the Arts and Medicine Institute at the Cleveland Clinic, whose arts programming and commitment to treating the whole patient defines the cutting edge of the work being done at this intersection of art and medicine. Maria Jukic and CPAC director Tom Schorgl sat down with me to discuss the various ways the lively Cleveland arts community has joined forces with the city’s medical innovators. We particularly focused on the extensive and extraordinary arts and healing programming available at Cleveland Clinic. An edited version of this conversation was posted for NEA Arts online but there is a lot to say about this. So what follows is a longer, more detailed conversation with Tom and Maria about healing and the arts in Cleveland, Ohio. I’m gonna begin with you, Tom, if you don’t mind. Tell me why the Community Partnership for Arts and Culture decided to do a white paper about arts and medicine. What motivated it? And why don’t you just describe just a little bit about what you do at CPAC before we launch into this. Tom Schorgl: We’re an art services organization. We were founded in 1997 by the Cleveland and the George Gund Foundations, and our core competencies are in research-- what’s the intersection between arts and culture and education, arts and culture and community development, arts and culture and health and human services? We do economic impact studies, marketing analysis for the arts in cultural sector—and when I use that word, I’m talking about artist and all sorts of different slices of arts and cultural organizations. Public policy is very important. Policy drives programs and policy can drive funding also. So we work with municipal and county governments to assist them when it comes to the integration of arts and culture in their strategic plans. And then the third thing is, helping individual artists and arts and cultural organizations improve their business practices. Jo Reed: Okay, great. Now, what prompted the white paper? Tom Schorgl: Well, we know a lot about arts and culture, but we knew a little bit about arts, culture and health and human services. So, we started the white paper and the more we did research, the more we found that was very exciting and from our particular point of view, began to better define and articulate two of Cleveland’s very important assets-- health, medicine, human services in arts and culture. Jo Reed: I think it’s fair to say that art really has been part of the healing process since the time of Ancient Greece. But something clearly shifted because I think we look at medicine and often it seems colder, more distant, more dehumanizing. And that’s why, perhaps, this is a time to begin to re-examine the place of arts in healing, because something happened. It kind of fell out of favor. Maria Jukic: You know, it’s interesting that you bring that up because our Chairwoman, Dr. Iva Fattorini, who’s chair of our Arts and Medicine Institute, one of her favorite ways to describe what we’re trying to do is to rehumanize medicine and we have all benefited from the growth and acceptance of technology in medicine and in healing, but that has also coincided perhaps with a need to rehumanize the medical experience, the hospital experience. So I agree, you’re right, that the time seems to have come that the pendulum is swinging. You know, we’ve really gotten a handle on technology, and scientific interventions, and now we’re looking at using the arts and culture to rehumanize the experience. Jo Reed: Okay, I want to be very, very clear about something. We are not just talking about the aesthetic value of art, however significant aesthetics are. What you’re talking about is an evidence based approach to how art contributes to healing and that you can see significant definable differences in patients after exposure to arts programming in the hospital. Maria Jukic: Yes, that’s correct. The use of the arts in healing-- at least at the Arts and Medicine Institute, we believe that it contributes to the experience, and that is the visual arts, the aesthetics, but we also have a performing arts program. Then, we practice and investigate the use of the arts in healing. And right now, our main areas are music therapy and art therapy, and how do those interactions with patients, how do they benefit those patients? And we have many research studies going on with that. And related to the visual art program, we recently did a survey of our former patients to see how they experienced and interpreted the art. And 91 percent of patients who had spent several days in the hospital said that it improved their hospital experience and with the music, 94 percent said that is improved their experience of the hospital. Tom Schorgl: I would add that there’s a qualitative and a quantitative elements when it comes to arts and culture from our perspective. And when you look at the qualitative, it is something that helps patients and their families adjust to medical situations or health situations that are sometimes difficult to adjust to. But the quantitative is also equally important, and that I think goes back to what Maria said. There’s research that shows that music therapy has a profound effect on pain relief, particularly when it is compared to pharmacological applications and some of those studies show that the pharmacological approach can be very expensive and sometimes, unfortunately, it can be addictive, whereas music therapy in terms of pain reduction is not as expensive and it’s okay to be addicted to music. Jo Reed: Exactly. You know, it’s very interesting that you bring that up because as I was reading about this, it’s exactly that that made my eyes pop open. Because of course, qualitatively, it makes sense and I’m a fan of that and yes, that’s what I want when I’m in a hospital. But when I read that, actually, art can lessen the amount of drugs for pain that a patient takes, I thought that was just an extraordinary finding. Tom Schorgl: Well, again, Cleveland is the center for lots of arts and cultural breakthroughs, and individual artists as well as hospitals and the health professionals that make Cleveland their home. And it helps to define Cleveland as a unique community. Every community has different assets and in this case it’s a defining type of collaboration between arts and culture that Cleveland has to offer. Jo Reed: Tell me a little bit about the Cleveland Clinic’s Arts and Medicine Institute, Maria. Maria Jukic: Sure. Well, what we like to say is that the thread of appreciation of arts and music goes all the way back to the founding of Cleveland Clinic. You know in those days, in 1921, the physicians were also kind of Renaissance people who were in the arts and in music, so there was a tradition of having visual arts, there was a tradition of employee and physician choirs and orchestras, and there were drama groups and poetry societies. So there’s a thread throughout Cleveland Clinic’s history, and you know, in the last 20 years or so with the development of the buildings of Cleveland Clinic, there was really an attention to the design and the architecture and then the artwork that goes into those buildings. So there was a progression and appreciation of this. So in 2006, we developed a formal visual art program, where we had dedicated curators who worked with construction architects and designers placing artwork very intentionally, curating a collection, and then a few years later in 2008, with the history of the arts at Cleveland Clinic, with the success of the visual arts program, our chairwoman, as I mentioned, Dr. Fattorini, saw both a need and a set of resources in Cleveland that really could be utilized. And that was the arts and culture community in Cleveland. So the idea for having the Arts and Medicine Institute was born. And the second piece of that creation process is that Dr. Cosgrove, who is our CEO, he’s a real innovator and visionary himself, so he saw that bringing the arts and medicine together really does benefit the patient. So it was really a wonderful conglomeration of circumstance, of past successes and of the history of Cleveland Clinic and its view of arts as important to healing that all came together in 2008 under this Arts and Medicine Institute. Jo Reed: Well, tell us a little bit about the arts programming that you do at the Institute. Maria Jukic: Sure, gladly. Our main program areas are the visual art program and programming around that, and we have almost 6,000 now pieces in the collection, in the whole Cleveland Clinic Health System. And then we have music therapy and art therapy that are available throughout the main campus, as well as some of our regional hospitals. And there we have about five music therapists, five art therapists, working with all kinds of patient populations from inpatient children, pediatrics, to outpatient dialysis patients, with-- at the Cancer Institute, the Heart and Vascular Institute; really a wide range of therapeutic interventions for patients with art and music therapy. And then we have daily performances, as part of our performing arts program-- we have performances five days a week in five different locations now, at main campus. So that’s a very big part of our program that’s very visible to people. Tom Schorgl: I would also interject, and I hope my colleague will bear with me, is that Cleveland I think is also unique in the fact that it’s not one collaboration between a medical institution and the arts and cultural sector, but there are several collaborations that are taking place-- university hospitals, Metro hospital, the VA hospital, as well as a number of human service organizations that deal with homelessness, drug addiction, alcohol addiction-- are also a part of this unique collaboration and intersection. Jo Reed: Right, so the cultural institutions are stepping forward as well, they’re meeting the challenge, and I’m sure they’re very happy for it. Tom Schorgl: Yeah. From a very practical point of view, it puts individual artists and arts and culture organizations in front of potentially new audiences, not just patients, but workers in hospitals, doctors, the whole group of people that are part of a hospital system. So it’s very important and there’s great things that can be provided. The Cleveland Museum of Natural History has one of the largest collections of skeletons-- human skeletons-- in the world and so when it comes to medical practices, medical students can take advantage of that collection to see bone type and density, and those types of things, a hundred years ago compared to yesterday. Jo Reed: Yes, and we should mention that both the Cleveland Clinic and the Museum of Natural History are two of the six case studies you look at in “Creative Minds in Medicine.” Tell me about a couple of the others. Tom Schorgl: Well, I think one of the things that we saw that was very interesting was the design pieces that are part of these case studies. It had to do with the way the Hospice of the Western Reserve worked very closely with the architect that they hired to develop a space that was very, very sensitive to their mission, which is to help people at the end of their lives. And so, when you walk through this new facility, windows, natural lighting, are placed in the structure at very important angles. The colors that have been selected in terms of the walls, the carpet, all of those things, access for not only the hospice patients in terms of the whole facility, but also the patient’s family is taken into consideration. Also, it’s a green building. Again, it shows that design plays such a very important part of what takes place in terms of the arts, cultural sector and health and human services. A lot of people don’t understand that in many fascinating ways, arts and culture can be integrated and sometimes, it’s not obvious, but it is there. Maria Jukic: One of the other case studies is about humanizing medical training through interaction with the arts. So, at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University that’s based here at Cleveland Clinic, there’s a program in medical humanities where the medical students interact with the arts in different ways, going to the art museum and learning about observation techniques, learning about artists working in the community and collaborating with them, and working in the community with different arts organizations to get close to the patients, the future patients for these medical students. And there’s a Devising Healthy Communities project for the medical students. And the point of this is that the medical students are learning that the arts offer them a deeper way of understanding themselves, patients, communities, themselves and the health of all three. Jo Reed: Maria, I’m also fascinated by your art collection—almost 6,000 pieces. How did you amass such a collection and how do you choose, how do you curate your art? Maria Jukic: The short answer is very deliberately and methodically. We have a visual art program that’s headed by Joanne Cohen who is our executive director and curator so she manages the curation of the collection and as I mentioned, this has been going on for many years at Cleveland Clinic. There is an Aesthetics Committee that reviews works of art, we get a lot of donations from our supporters and from the community. So it is a professionalized responsibility to curate the collection as it is today. Tom Schorgl: I would also interject. In a former lifetime, I was curator for a museum and I was a director of a museum and I can say from that experience and those professional years in the museum world, it is a collection that rivals a number of museums in the United States in terms of its quality and its sensitivity in terms of how the works are collected not only for the patients and the patients’ family, but for the workers. Jo Reed: And is it true that the content of the art displayed matters in terms of its impact on the patient? Maria Jukic: Yes. We very intentionally look for pieces of work that can calm, can comfort, amuse or uplift the person interacting with the art. So, it’s a diverse collection. It includes both nature and landscapes, but also photography and prints and fine arts prints and sculptures. We have commissioned pieces, paintings. And the idea is to develop a diversity, a diverse collection that can really engage, uplift and inspire the person who’s interacting with the work. Jo Reed: Let me ask you this, are patients with certain diagnoses more likely to respond? Maria Jukic: That’s a very interesting question because in our recent survey that we did that I mentioned earlier, with our former patients who were on a patient panel, the patients who suffer from post-traumatic stress disorder, generalized anxiety, and breast cancer responded the most favorably to the visual arts, their interactions with the visual arts. So we have some evidence this time that there are certain diagnoses or experiences that patients are going through who respond in different ways. So that’s, I think, really the tip of the iceberg in us trying to figure out who and how people respond most favorably to the arts. Jo Reed: I just want to be clear—there are two separate strands going on. You have art therapists who work directly with patients, as well as artists who come in and perform at the clinic. These are two separate trajectories. Maria Jukic: Yeah, within the overall field of arts and medicine or arts and healthcare, there’s a whole spectrum of how artists and musicians interact with patients or in different healthcare settings. At Cleveland Clinic, we’ve found that the best model for us is that the music or art therapists are the ones who are close to the patient’s bedside, you know, perhaps in rehab centers or nursing homes, other environments. There are artists who work with the patients or musicians who come in and play for the patients. Tom Schorgl: I think that that’s an important point. Arts therapy—visual arts, dance, music—is a profession. And it is a profession that takes a lot of studying and time, both in terms of the therapies and the application of those therapies. And one of the things that I—again, from a public policy point of view, because that’s one of the things that CPAC looks at—we think that it’s time for the state of Ohio to license music therapists and art therapists because they find that their colleagues in other states do have licensure, and licensure helps give them more visibility and also helps to provide funding for those therapists, particularly when they’re working within the different types of Medicare and Medicaid programs. Jo Reed: Yeah, it legitimates them-- Tom Schorgl: That’s a better word. Jo Reed: --in a pretty fundamental way. Tom Schorgl: Yeah, yeah it does. Maria Jukic: On that note, I’d like to expand on the artists and musicians who work with us in the hospital. We talked earlier about patient bedside which is, you know, almost exclusively with the therapists but we have artists and musicians from the community who participate with us in arts and medicine programs. As Tom had mentioned about the Cleveland Institute of Art, we have now partnered with them for students in their portraiture class who are doing portraits of dialysis patients. This is a brand new program, we just started it this fall, and the idea there is to give some acknowledgment and some attention to patients undergoing dialysis treatment. This is young artists, you know, still in their formative learning years, participating with us. We also have a whole cadre of musicians in residence who are musicians from the community who come and perform in our lobbies and our public areas. We also have a creative storyteller who uses story and song with patients and with families, as well as we had a writer who did a program with our pediatric patients to help them write their stories or to create poems or stories. So artists and musicians in the community are also part of our programs in various ways. Jo Reed: We briefly mentioned the staff, but I’d like you both to talk about how the staff responds to the work that the artists and the art therapists are doing. Maria Jukic: I’ll talk in some generalities and then, you know, maybe in some specifics, but since we’ve been focused on bringing the arts into the hospital, what we know from our survey for the performing arts program-- employees are part of that survey-- how much they appreciate the music, the performances and much the same way that patients and families do. It’s a way to take a moment to rest, to think, to reenergize in order to go back and work with the patients. And we’re doing now a caregiver survey about employees and physicians, their reactions to the music. So, another thing that we do is we, by request, provide art therapy and music therapy activities to groups of caregivers for example, surgical nurses, so they’re even asking for some of the activities and interventions themselves. Tom Schorgl: I would add, in terms of individual artists who participate in these hospital programs, one of the things that artists, whether they’re performing or visual or literary artists, are always interested in is validation. Validation of what they do, as an artists. And when you see or you perform your work as an artist, in a setting that is not necessarily the typical setting, it does have an effect on artists, artists who we’ve talked to, is that, “I see my art in another dimension, in a dimension that is positive and it’s validating for me to have that experience.” Jo Reed: I mean, what an appreciative audience, no? Tom Schorgl: Right. Jo Reed: You put this white paper together, Tom. Tell me what surprised you about it. Tom Schorgl: I think that the breadth and depth of what was going on throughout Cleveland and Cuyahoga County, it was not a couple of programs but it was many programs, and they were programs that were not superficial, I think that’s clear when you look at Cleveland Clinic’s programs. They run the gamut from design, from therapies, research, and also assisting their staffs, their workers, in understanding how these therapies can be beneficial. So we started to see that it was broad and deep. I think the other thing for us, because the arts always seem to be in a situation where they have to justify their existence, was the effect of therapies when it came to a comparison to pharmacological therapies, art therapies versus pharmacological therapies and the whole research that’s being done behind music and pain relief, I think is quite significant. Jo Reed: Maria, you work at this every day. Is there something that still surprises you? Maria Jukic: What surprises me every day is really the positive interaction, the positive response that people have to our bringing the arts into the hospital. When you walk into a hospital, and in a moment, things can go from joy to sorrow, and in this environment, all of a sudden hear some music that might take you away for a moment from what you’re dealing with or thinking about, or a piece of art that can remind you of good times in the past or in the future. That experience with the arts and the surprise with which we, and I say we as an employee but we also as a patient, as a family member, when you experience the arts in this environment it takes on just a heightened level of positive reaction, I would say, and that’s what surprises me every day. It’s extraordinary. Jo Reed: I was really kind of intrigued to read that close to half the hospitals in the country have arts programming, including art therapy and musical performances. That was a very, very pleasant surprise. But what do you think the next steps are to integrate the arts into the remaining 55 percent of the hospitals? Tom Schorgl: You just entered my bailiwick in terms of future. <laughs> Jo Reed: I thought I was there! Tom Schorgl: Well, policy is a very important part of what we do at CPAC. Continue the research. It’s extremely important because research is one of those factors that also can have an impact on policy and we know policy drives programs. Communications—to increase the awareness of arts and cultural activities, and promote them publicly. Networking opportunities and collaborations for the practitioners of health care to work with artists and arts and cultural organizations. Funding, funding, funding. Funding is always an important part of any effort when it comes to improving and distributing and growing arts, health, and medicine in human services. And then the educational opportunities, to bolster the expertise of the work, of arts in the health fields. Jo Reed: And Maria, from somebody on the inside of art and medicine, that intersection, what do you think? Maria Jukic: In terms of how to spread the message, so to speak, I think exposure and evidence. What we’ve found, the more people see or experience it in different areas of the hospitals in different of our regional hospitals, in other healthcare institutions, when they’re exposed to the idea of arts in healthcare with the visual art program and how that can be done, from music to music therapy to art therapy to literature to dance. Once places, institutions, individuals, are exposed to it and experience it, then they want it for their patients, for their facility. So the exposure to it, we have found, really, it makes the idea blossom, so-- exposure. And the second is evidence, and this-- this is what we discussed about research. We need to be able to say things like what we’re able to say to you about how our patients experienced the artwork or the music or how does music therapy help decrease pain. We have to keep building the research and the analysis and the evidence for bringing the arts into healthcare environments. Jo Reed: I think it’s-- Tom Schorgl: I also-- Jo Reed: Go ahead, Tom. Tom Schorgl: I also think it’s important, and I’m not doing this because you’re with the NEA, but a great example of collaboration around this particular practice and intersection of the arts and cultural field and health and human services is what the NEA is doing in terms of the U.S. Department of Health and Human Services, the National Institute of Health, the Department of Education. Those send messages back to state governments and local governments that there’s clearly a national interest on the part of federal organizations to recognize the value of this and to advance it. So that plays an extremely important part when it comes to showing our colleagues in state government and local government the value of what federal government is doing through collaboration of arts, culture, and the sciences in health. <music> Jo Reed: That was Tom Schorgl. He’s director of the Community Partnership for Arts and Culture. And Maria Jukic, she’s executive director of the Arts and Medicine Institute at Cleveland Clinic. If you’re interested in the many ways the arts impact health, then check out the latest issue of NEA Arts. You can find it at arts.gov. You’ve been listening to Art Works, produced at the National Endowment for the Arts. The Art Works podcast is posted each Thursday at arts.gov. To find out how art works in communities across the country, keep checking the Art Works blog or follow us @NEAarts on Twitter. For the National Endowment for the Arts, I’m Josephine Reed. Thanks for listening.