The Center For Health Design
Why does this study matter?
We know from previous research (and from the human experience) that art affects us. We also know that long wait times have a negative impact on our healthcare experience and how we perceive the quality of care. Healthcare organizations invest a great deal in artwork in their facilities, and there is a lot of curiosity (and some research) around how the content of art affects healthcare outcomes like waiting. However, up until this 2020 study, no one has taken an empirical look at the effect of the size of the art.
How was the study done?
Researchers used an online photo survey with 83 college student participants to investigate the effect of art size in an exam room. Images in the survey showed a photo of a typical exam room with either no art (as a control), or a small, medium, or large landscape scene on the wall (all the same scene) above an exam table. Two possible scenarios were given: a 10-minute wait or a 45-minute wait for the physician. In the survey, participants were asked to imagine that they were seeing the physician for a post-knee-surgery outpatient visit, and randomly given one of the eight possible combinations of art size and wait time. The survey outcome measures included positive distraction, perceived spaciousness, anxiety, response to the clinic, and physician competence. Researchers used both quantitative and qualitative analysis of the data.
So what do we learn from the study?
Results show that the size of the art had a significant effect on most of the outcomes evaluated. The large and medium images were rated significantly higher than the blank wall for quality of care and comfort. Compared to all other options, participants felt the large image would provide the most positive distraction, and more positive feelings about the clinic and the physician’s qualifications. (Image size did not appear to affect anxiety or perceived spaciousness.)
It’s no surprise that participants in the 10-minute-wait scenario gave more positive ratings overall than those in the 45-minute-wait scenario – regardless of image size. But what may be surprising is a potential “buffer” effect: the larger art seemed to offset some of the negative experience of the 45-minute wait. (This trend approached statistical significance, but would need more research to see if the trend holds true.)
The authors found that a mismatch in art-size-to-wall-space (e.g., small art with a lot of blank wall space around it) was linked to negative ratings of the environment and of the physician. They discuss the “canonical-size effect” – or “fit” of the art in the space, and how people have an aesthetic preference for images that seem in line with our understanding of actual physical size.
Can we say the results are definitive?
While this study helps to widen the lens on art in healthcare, there are still many questions left to explore. This survey was given to mostly white, suburban, female, college students. More research is needed to understand the effect of art size for more diverse groups.
The biggest issue with this study is the importance placed on human perception of art size – when ironically, no human was physically in the space. As the authors note, simulation through photo surveys can be a valid research strategy. However, it is unclear if the researchers were actually measuring the effect of art size, when participants were not experiencing the art in its actual size and proximity to themselves. Consider the experience of sitting on an exam table, within inches of art on the wall (especially the large image, which represented an 80.3” x 53.3” piece of art), and how that differs from the experience of looking at a photo of an exam room with art.
What’s the takeaway?
This study shows evidence that when it comes to art, size matters. Larger art that covers at least 60% of the visible wall space appears to make the exam room more pleasant, perhaps improving the overall perception of care. Large art may even help to combat the negative experience of a long wait for the doctor. As the authors suggest, the study should be replicated in situ to see if the findings hold true.
Devlin, A. S., Anderson, A., Hession-Kunz, S., Kelly, M., Noble, L., & Zou, A. (2020). Magnitude matters: Art image size and waiting time impact perceived quality of care. HERD: Health Environments Research & Design Journal, 13(3), 140–153. https://doi.org/10.1177/1937586719892602
Our slidecasts are an outcome of the popular Research Matters presentations at the annual Healthcare Design Expo & Conference. Our research team picks papers that have some significance to the healthcare design community and distill the study down into a 5-minute summary of how the study was done, what was learned, the limitations and the takeaway. The slidecasts bring research to you in digestible format. Just five minutes, and you’ll know more.
As a part of The Center's research team, Melissa focuses her efforts on grant-funded research initiatives, as well as supporting ongoing work of The Center, such as the Affiliate+ program, the Knowledge Repository, and the Evidence Based Design Accreditation and Certification (EDAC) program. She examines the impact of the built environment on health through the development of conceptual models that link design and outcomes and by evaluating the effects of evidence-based design innovations and by disseminating research findings through tools, presentations, and publications.
Melissa was previously a senior design researcher for Davis Partnership Architects and prior to that she served as a researcher with the OMNI Institute and the Center for Children, Youth & Environments at the University of Colorado. With a background in both architecture and social science, Melissa describes her research style as “boots on the ground with a knack for rigor.”
Melissa graduated from Cornell University with a Masters of Science, Applied Research in Environmental Psychology and received her Bachelors of Environmental Design, Emphasis in Architecture from University of Colorado, Boulder.