Art is Medicine

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Steph Bayer, senior director of the Office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio. I'm very pleased to have with Maria Jukic. Maria, welcome to Studies in Empathy.

Maria Jukic: Thank you, Steph. It's great to be here.

Steph Bayer: Maria's a senior director for the Arts & Medicine Institute in the Office of Patient Experience at the Cleveland Clinic in Cleveland, Ohio. In her current role, Maria is working to enhance patient experience and promote healing through the arts. Maria also serves as city councilwoman for the City of Euclid, Ohio. Maria has been with the Cleveland Clinic for 20 years, first doing marketing and public relations at Euclid Hospital and with Arts & Medicine for the last 13 years. Wow, that's some background, Maria. Well done.

Maria Jukic: Thank you.

Steph Bayer: Hey, before we really get into it, I'm talking about Arts & Medicine, but I didn't define it. Do you want to maybe tell us first just what is Arts & Medicine at the Cleveland Clinic, what that entails, and then we'll get into our whole interview together?

Maria Jukic: Sure. So as you mentioned, I've been doing Arts & Medicine now at Cleveland Clinic for 13 years, and what I've discovered is that Arts & Medicine can be so many things. And it is so many things around the country and the world, depending on the location.

But we, at Cleveland Clinic, what our main program areas right now are art and music therapy, which are therapies with the patients at the bedside, performing arts program; pre-pandemic we had performances every weekday at main campus, as well as at some of the regional hospitals, totaling more than 600 performances per year. We also have a visual arts program that's in charge of the collection and the curation of the visual art. We do community programs. We do education, like artist talks or grand rounds or various things, which I'll tell you about as we move along. And then, we also do research, trying to research the impact of the arts on health and wellbeing. And just one more thing, I always forget about this, it's really music. Music is in so many places in medicine. Overhead music, using music for physical therapy, on the patient TVs, all of those things. That's just a little taste of Arts & Medicine.

Steph Bayer: So, your background is very diverse. What inspired you to pursue a role in Arts & Medicine, especially for the last several years?

Maria Jukic: Oh Steph, that's a good story because I didn't choose Arts & Medicine, Arts & Medicine chose me. As you mentioned, I've been at Cleveland Clinic for 20 years. At Euclid hospital, I was doing marketing and public relations, and then I went to law school, believe it or not. I'm actually a licensed attorney in the state of Ohio, which people in the field of arts and medicine, they kind of scratch their heads.

Steph Bayer: Well, we all have our misspent youth, right?

Maria Jukic: I went to law school mid-career, not necessarily practice law, but as part of nonprofit management. When I finished law school, I was networking and looking for a mission-driven organization or program or something, that was really important to me. Since I was already part of the Cleveland Clinic health system, I was talking to people both inside and outside. What was going on at Cleveland Clinic at the time, it was early in the former CEO, Dr. Cosgrove's, tenure. He was really like, a lot of energy, a lot of ideas. We were changing into the Institutes, the Office of Patient Experience was just created. There was this concept floating around about how to bring all the arts and cultural activities under one umbrella, which turned out to be the Arts & Medicine Institute.

I basically interviewed with the founding director of Arts & Medicine, and we hit it off and she brought me on board. So I didn't have arts and medicine experience, which people expect, but I had the internal Cleveland Clinic experience. And prior to that, my history, it was a lot of projects hitting the ground running, so I was a really good fit for helping a concept move forward. But the funny thing is, people expect me to have some kind of passion for arts and medicine or something, and I say, "You know what, guys? My claim to fame is playing the clarinet through elementary school and high school. And that's really about it." So when I joined this program, I described myself as being like Alice in Wonderland, like, "What is this field?" I had to learn all about it, about the performing arts and the visual arts and art therapy and music therapy, and really the whole concept of arts and health. It's been a great ride, but I really didn't choose it. It chose me and we've been growing together ever since.

Steph Bayer: And I love that you, clarinet playing aside, claim to not have a passion for arts and medicine, because I know you, and you do have a passion now. You have to start to claim that because it is from your soul and it is beautiful and it gets me excited about the work. Your approach is that there's a relationship between art and healing, and that's why this matters in a healthcare setting. Talk to me about what that relationship is to you.

Maria Jukic: You know, Steph, that's a big question, the arts and healing, We could spend a whole hour on that, and maybe we can sometime in the future. All of us, on a personal level, know that the arts can impact. When you turn on the radio, which, that dates me, but anyway, when you hear music, a lot of times it can uplift you and take you to a different place and remember things or get you dancing while you're trying to clean the house. Or sometimes if you're in an environment where you see artwork, you feel that there's some type of a connection, so we know that.

But in terms of some type of formality, last week I was at a conference, virtual, for the National Organization for Arts and Health. And one of the sessions was about the history of arts and health, art and healing. And that presenter took us way back, like to the cave drawings and Hippocrates. I don't know enough about that, but that's also super interesting. But where I can kind of start my understanding of arts and healing is that post World War I and World War II, in treating a lot of the veterans who came back with a lot of issues, which now we might describe as post traumatic stress, some of the care teams started using music to try to help the veterans. They found that was very helpful, and that led into the field of music therapy. And then, art therapy started also being used in that capacity, and it's really been growing ever since.

Now, our military is using art therapy for veterans. There's an institute called Neuroaesthetics. We are involved in a music medicine concept. The National Institutes of Health is doing research. The arts and healing can start with just an individual using the arts for healing. And it really expands to an actual marriage, recently, of arts and sciences related to research. When we started stuff, we did a search in the medical library, there were more than 4,000 research studies that either had art, music, art therapy, music therapy. It was overwhelming. And the implication there was that a lot of people are looking into it to really try to figure it out. So even in those 10 years or so since then, and we've done about 25 research studies just at Arts & Medicine, and many others are doing research with music therapy, art therapy, other things. And it's almost like the research is catching up to try to define how the arts really are helping in healing.

Steph Bayer: I love that. I love the history too. I wasn't aware of the origin story and I think that's great. You call it Arts & Medicine, but we talked about art and music therapists. Why is the term Art and Medicine important?

Maria Jukic: Oh my gosh, that's a good question. We actually had the honor and the challenge of naming the Institute when we first started. It's like, how do you bring all of these things? Because in researching arts, there's visual arts, there's performing arts, there's music. There's also culinary arts, there's literary arts. There are six to ten different arts that fall under arts, so we were like, "How do you capture all of that?" And really the only way is the word arts. Just alone.

And then, with medicine like Arts & Medicine. On the one hand, it kind of levels the playing field, because you're saying Arts & Medicine. It's in the same sentence, on the same plane, which only later did we appreciate that what it does. But also keeping it really simple, it leaves it broad because so many things can be counted in the arts. And then the practice of medicine is also broad, and in the last decade or so we're looking at health and wellbeing as part of medicine. So it was a simple way to convey a lot of ideas. It puts arts and medicine on the same plane and it leaves us a lot of room to do a lot of things under that umbrella.

Steph Bayer: I think it's a great name. I think you chose right.

Maria Jukic: Thank you.

Steph Bayer: When we talk about arts and the way that we've been able to help patients, that's really important. And you mentioned 4,000 research articles and beginning, so we know it's out there. But is it also available for caregivers like nurses and medical residents? Especially with COVID right now, we're seeing a lot of burnout. Are there ways that we can apply music therapy or art therapy to ourselves or is it just for patients?

Maria Jukic: That's a really good question, a really good point, and a lot of work done in that area of really supporting and encouraging caregivers, both at Cleveland Clinic and around the country. I'm sure you've seen through the pandemic, the use of music and collaborate artwork and things like that to give some space for the caregivers to just try to deal and get through the challenges that they're facing. So specifically, as I mentioned earlier, art and music therapy are two of our biggest programs.

Just to take a step back, art therapy and music therapy are actual professions where the therapists either have a bachelor's or a master's degree where they study their medium. The art therapists study all the different uses of art, and the music therapists study all the different uses of music, as well as physical and mental things. Physiology, and a whole bunch of other things that I forget. And then they have their national accrediting bodies where they become board certified in their field. So art and music therapy are like occupational and speech therapy in that vein, and a lot of times they work with patients for individual goals. But on a broader level, art and music can be used as therapeutic interventions in so many different ways, and it's really good.

At the Arts & Medicine, we have used art therapy specifically for caregivers. Early on in the pandemic, Steph, if you remember up on the rooftop, it was open for caregivers as a place of respite. Respite and centering and a step away from everything, all the challenges on the units. And we did a community art project where the caregivers were invited to decorate piece of art, which then became a collaborative project. That we called To Art as a Unit.

Steph Bayer: It was beautiful.

Maria Jukic: Mm-hmm (affirmative). That was one example of what we were able to do. But also our music therapists, they work in a lot of different specific units or hospitals. So they have connections in the areas where they work the most, and they maintained a connection with those teams and sent them musical telegrams, so to speak. Or did some fun videos that they were able to integrate the units, to give people a place to let off some steam.

And then we had a couple, I think they came to be known as virtual choirs. During the pandemic, all of the virtual choirs of different artists, or choruses or musicians, so we did that also. The music therapists in their different locations recorded songs that then even Dr. Mihaljevic, our CEO and president, sent to the whole 60,000 plus team of caregivers to try to uplift people. Those are just some examples of things that we had done and have done.

As things are leveling off, but still at a high level of pandemic challenge, we're doing things like team building with smaller groups of people with some art therapy techniques and an art therapist facilitator. Especially in the really hardest-hit units like respiratory therapy, emergency department, ICU, really trying to target smaller groups to do some individualized support.

Steph Bayer: That's amazing. And for anyone listening, I hope they take a chance and Google your virtual choirs. They bring tears to your eyes. I'm pretty dead inside and I still felt that. It was awesome. You guys are so talented. You mentioned in the beginning that not only do you do music and art, but you also bring in performances. I think you said over 600 the year before the pandemic hit. What are some of the performances that you've brought into the Cleveland Clinic? What does that look like?

Maria Jukic: Yeah, that is one really good way of engaging our community, especially pre-pandemic. Just some recent examples, in Cleveland, we're very close to University Circle, which has the Cleveland Orchestra there, the Cleveland Museum of Arts, the Cleveland Institute of Music, and some more which I'll get to in a second. In the last year and a half or so, the Cleveland Orchestra, especially when they weren't able to have live performances, they wanted to come back and give something to the caregivers. So we had a joint program called Healthcare Heroes, where last summer during the height of the pandemic, Cleveland Orchestra members came and did performances for our caregivers, both at main campus and at Hillcrest Hospital. And then they were here also this year, celebrating our centennial. So we had the Cleveland Orchestra.

I mentioned the Cleveland Institute of Music in the past. We've had students from CIM come and perform for us. Also locally, we have the Cleveland Orchestra Youth Orchestra. That's an elite youth orchestra affiliated with the Cleveland Orchestra, so they've been here to perform. Also, on the music thread, Oberlin College, it's about an hour or so away from main campus, and they have an excellent music program. They've been here to perform for us, as well as their summer program called Credo. Beck Center for the Arts, which is a big community arts organization on the west side of Cleveland, they perform for us annually during the holidays. Also Dancing Wheels, they're one of the founding dance companies for integrated dance, so wheelchair dancers and standing dancers, they've performed for us. Oh my gosh, and another good one was Baldwin Wallace, it's another local university, they have a music theater program and we've had their music theater majors come and perform for us. And you can imagine, these are on their way to Broadway or other music theater venues coming to perform for us.

So we've had a lot of performances based in the community. And I forgot to even mention that we have a core group of musicians and residents. There are about 15 local musicians who are both professors at CIM, Cleveland Institute of Music, or other local schools. A lot of them have, I don't know what they call it, their own studio where they teach students, and performers in the community. And they're really at the core of our performing arts program.

Steph Bayer: I'm lucky enough, my office is right by the entrance to main campus. And we have a defacto stage that kind of opened up when you walk in our main entrance and we would have the performances and I'm lucky enough to have taken advantage of lots of those over these last few years. I was so happy this summer when we were able to bring the orchestra back with masking and distancing and in a limited space. It was so great to see it back. It brings such life and beauty into a sometimes stressful place. Thank you for that work. Let's switch a little bit though, to some of the partnerships. I know that with the art and medicine team, you've developed really important community partnerships with groups such as the Alzheimer's Association, the Epilepsy Association, and there's been research that explores a connection between art and community health. Can you talk to me about this relationship and what it looks like here?

Maria Jukic: That is a very hot and important topic in the country today in general, just like how the arts can help in communities, both for expression within the community of different issues or challenges, but also in bringing together communities. It's very exciting. There are all kinds of initiatives nationwide to try to figure out how the arts can really help in community building and place-making, as they call it. In terms of Cleveland Clinic, we're involved as an organization, in a lot of local community organizations, programs, activities, et cetera, because that's who we're here for, for the patients and the community. So our arts programming related to the community involves presentations out in the community to teach people about how they can use the arts and health, but also, well, I'm going to take a little aside step and tell you about our HeRe We Arts™ program. It stands for Health, Resilience and Well-being through the Arts.

Steph Bayer: Oh, that's clever.

Maria Jukic: And we've been working on this now for about five years. And what we learned was that in Arts & Medicine, we got really good at knowing how to help patients, caregivers, families in the hospital setting. And we thought our patients, families, caregivers are coming from the community. So how can the arts impact people living in the community, to help them achieve health, wellbeing, and resilience? So we pivoted and created a program, an eight week arts-based health education program, for our community members with chronic health conditions. And a chronic health condition really ranges from weight to mental health, high blood pressure, cholesterol, arthritis. Chronic health conditions, what I say to people is almost all of us have some type of a chronic health condition, honestly and unfortunately, so that was our premise.

We've done about four different iterations of this research study, moving from overall, just how are people going to receive this idea of using the arts to teach health and wellbeing and as a tool for health and wellbeing? We've done the program at our Euclid Hospital location, at Stephanie Tubbs Jones location, in Akron, in Lakewood. And I might be forgetting one, but we're real in the community. And what we found, because we use measures, self-reported measures. And what we found was that there was improvement from week one when we started the program to week eight when we finished the program. And there was even improvement on these measures two months after, Steph, so people reported still kind of a buoyancy in health resilience and wellbeing two months after the program was completed.

Steph Bayer: Are you publishing on this? This is amazing.

Maria Jukic: We're working on publishing the first study, which was the patients self-reporting compared against themselves. And in the next stage of research, the idea is to compare it against something else. So we had embarked on a research study that compared the arts based health education, which is HeRe We Arts™, with a non-arts based traditional health education program. Same time, same place just using standard health education. We were just about to start our third cohort of that research study when the pandemic hit, and we weren't able to meet in person. But the early indications are that the arts is a really good way, as I said a minute ago, to teach about health, and as tools to achieve and maintain health. So we were headed in a really good direction, and the theory was so interesting to the National Endowment for the Arts that we received a grant for that research study.

Steph Bayer: Wow.

Maria Jukic: So there's a lot to do, Steph, in that topic about arts and community health. It's a huge field, a huge question. And I think for us healthcare, I think it's a piece of the puzzle of how we can all achieve and maintain our health and wellbeing at home, in the community, really paying attention to how we live in our daily lives, in our communities to stay healthy.

Steph Bayer: I love that holistic lens. That's great. So you just listed to me all of these wonderful reasons that arts matter. There's a lot of research on it, yet I know not all healthcare organizations are supporting and have the funding for these types of programs. So how does your team engage Cleveland Clinic as an organization, as well as donors, to support these efforts? And what advice can you offer to those that want to created it at their space?

Maria Jukic: So to the first part, what's interesting is that arts and healthcare and the support for arts and health care, actually kind of mirrors the whole concept of arts for healing. We know arts for healing is helpful. We know that intrinsically, individually, families, communities, schools, et cetera, we know all that. And it's similar for arts and healthcare. As a big concept, it feels like it doesn't have a lot of legs, but broken down to what do you really include in arts? Every hospital has art on the walls. Every hospital has music somewhere: elevator music, music in the gyms, music stations on TVs, access to music. That's what we found.

The Society for Arts and Healthcare, along with JCO, believe it or not, and I want to say National Endowment for the Arts, but maybe it was with Americans for the Arts, did a nationwide survey, and they found that a lot of hospitals do these piecemeal things. Art on the walls, music. More than a few half an art therapy presence or a music therapy presence, especially in the behavioral health units or in pediatrics, or in cancer. It's surprising that there's more than you might think going on in little places around the country. So that kind of brings me back to Cleveland Clinic. And Arts & Medicine, we didn't create it, what we did was we provided a home for it.

Steph Bayer: I like that.

Maria Jukic: Yeah. Cleveland Clinic, when we did a little bit of research, oh and I think we use this term sometimes when we talk about the history, arts is woven into the fabric of Cleveland Clinic. Our four founders, as we know, worked together as a unit, to work as a unit in World War I, and a lot of physicians at the time were really Renaissance people, who were both scientists and also musicians or artists or supporters of the museum or the orchestra. So their sensibility, now what we can find, also included arts, so there has been arts. Art on the walls. There has been the architecture, and idea towards architecture and design. There used to be orchestras. Cleveland Clinic orchestras. Cleveland Clinic bands. I think we found barbershop quartets. We found talent shows. We found theater. We found arts used in medical education.

And there were physicians who were treating musicians and artists in the Neurology Institute, in head and neck, for voice issues, orthopedics for dancers. There were physicians treating artists. There were physicians artists, physician musicians, the art program, music therapy we've had for 20 years in the Palliative Medicine Unit, art therapy we've had for 20 years in the behavioral health units, especially at Lutheran Hospital. We brought all of these things together. It was an acknowledgement, really of the elevation of importance of the arts in the conversation of Cleveland Clinic. I think now that arts in medicine has become part of the Cleveland Clinic brand, especially on a wider definition, looking at the architecture and the design and the visual arts, that's part of the Cleveland Clinic brand, and then the music.

Where were we yesterday? Oh yeah. Okay. Yesterday. There was a get to know some of our leaders and we were discussing different books. And one of the books that was discussed was about how industries try to make a moment of surprise for their customers, or in our case, our patients. And what we found is that the music and the arts, when someone comes in into Cleveland Clinic now, they are often surprised to find a classical violinist playing in the lobby in this beautifully designed space with the artwork, and it does create a moment for them. And that's really become part, I think, of the Cleveland Clinic brand. So we've seeped in, even though it was there even from the very beginning.

I feel like Arts & Medicine was given an opportunity, a seed that was planted and given some water and food to nurture. And it's like, build it and they will come. And we're still doing that, because the idea and the concept is so good and right, that when we plant a seed somewhere, for example, in one of our other regional hospitals, in terms of art and music therapy, it grows. And then the local, whether it be a hospital or a unit or an institute, it grows. That's kind of the case that's made, is build it and they will come. Then we layer on the research, so that we can speak the language of medicine and science. And then in terms of philanthropy, the philanthropic support is really what allows us to grow and to innovate. I think part of it again is because people internally know how beneficial the arts are, so a lot of time donors are happy to participate in this really kind of forward thinking important concept.

Steph Bayer: I love that. And you say you don't have passion for this work. Are you kidding me?

Maria Jukic: Oh, oh, Steph. I absolutely do now. Absolutely.

Steph Bayer: Oh, absolutely you do. And you're getting me excited about all the work, and what's to come in the future. And how we can incorporate, as you said, these moments of surprise in building empathy and building these empathetic moments for our patients and our community and helping. I love it. I'm so excited that we've got you and your talented team within our patient experience umbrella. So thank you for talking today. I'm really grateful.

Maria Jukic: Thank you, Steph. It's my pleasure. And I appreciate your kind of reflecting back my enthusiasm and passion.

Steph Bayer: It's contagious.

Maria Jukic: It is. I agree with you. Thanks for having me.

Steph Bayer: Absolutely. This concludes the Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcasts. Thank you for listening. Join us again soon.