Music and Creativity in Healthcare Settings

Does Music Matter?

Hilary Moss

• Publisher: Routledge
• Year: 2021
• eBook ISBN: 9781000380309
• Edition: 1
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

Through a series of vivid case studies, Music and Creativity in Healthcare Settings: Does Music Matter? documents the ways in which music brings humanity to sterile healthcare spaces, and its significance for people dealing with major illness. It also considers the notion of the arts as a vessel to explore humanitarian questions surrounding serious illness, namely what it is to be human. Overarching themes include: taking control; security and safety; listening; the normalization of the environment; being an individual; expressing emotion; transcendence and hope and expressing the inexpressible.

With an emphasis on service user narratives, chapters are enriched with examples of good practice using music in healthcare. Furthermore, a focus on aesthetic deprivation contributes to debates on the intrinsic and instrumental value of music and the arts in modern society. This concise study will be a valuable source of inspiration for care givers and service users in the health sector; it will also appeal to scholars and researchers in the areas of Music medicine and music Therapy, and the Medical Humanities.

1 Listening

When I began working as a hospital musician, I felt like a fish out of water. The world of performing, creating, rehearsing and practising every nuance of a piece of music was replaced with a different sound world – beeps, machines, loud speaker announcements, the sound of staff walking fast up and down the ward, conversations at the nurses station, laughter, serious discussions, the sound of wheels – wheelchairs, trolley beds, supplies being transferred, linen and bins carts and hospital food trolleys. The sounds of tears, pain, grieving. The sounds of televisions that no-one was listening to, family visits, the busy atrium where 2,000 staff and 4,000 service users passed through every morning. Occasionally the sound of loud voices complaining, arguments between family members, abuse shouted at reception staff. The sound of emergency sirens as the ambulance approached emergency rooms, the helicopter occasionally landing on the H-pad, the grass being mown, the electronic numbering system calling the next service user into phlebotomy or the outpatient clinic, the sound of MRI scanners, x-ray machines, staff discussions in corridors or fast, efficient footsteps.

The sound world of hospital is often chaotic, noisy and disjointed. The sound world of the 15-piece swing band, in which I played trombone, is ordered and systematic. Everything fits together, resolves together, the peaks and troughs are journeyed through together. The Glen Miller band in online clip 1 exemplifies the ordered, systematic and highly sophisticated sound of 15 musicians playing together. The musicians are listening, anticipating the other players moves and perfectly synchronising their breathing, physical, cognitive and emotional reactions in order to play together in the same style, appropriate dynamic range and intensity.

Listen and watch online 1.1: Glenn Miller Orchestra, In the Mood www.youtube.com/watch?v=UgkadSCPtbU

This chapter will explore the need for careful listening by artists and health providers to fully assess and provide what service users want and need. This may involve curbing a tendency to programme music programmes without fully consulting service users. The chapter contends that musicians are expert listeners and can offer reflection on clinical listening. The predominance of participative music-making (to the exclusion of simply listening to music) is also noted with a brief review of some of the benefits of music listening for health and well-being.

As a hospital music therapist, I regularly attended ward rounds, team meetings and clinical case review meetings. Sometimes the multi-disciplinary team felt as connected as the Glen Miller band, at other times the team was disjointed and unconnected, rarely meeting, communicating or listening. Even functional healthcare teams can find it a challenge to find time for genuine communication or reflection. In my experience, healthcare teams can often be disjointed, communication can be poor and overall performance suffers. My role as a music therapist was often viewed as adjunct to the core team, and my involvement in the team thus would feel disjointed. A visiting music therapist, offering a group programme for clients in a nursing home, for example, can feel very disconnected from the team. The power balance between professionals was often overt, and ‘lower’ staff deferred to the opinion of the chiefs of the team. A music ensemble also has a hierarchy but even those with very few notes to play commit to their contribution, and this is understood as crucial to the whole rather than dispensable or of secondary importance to another.

Before my hospital life, I spent my time training to be a musician. This time included listening to Beethoven symphonies and playing long low notes to warm up on my trombone for 20 minutes before performance or practice. Once I started work in a hospital, such quiet attention to detail was replaced with highly efficient meetings, typically 5–10 minutes of key information exchange between busy clinical staff. The intense concentration required at an orchestral rehearsal was replaced by the intense focus given to a family meeting, a clinical review meeting or a planning meeting for a new design section of the building. The language of the arts that I was steeped in, such as describing, reflecting, illuminating, quoting, was replaced with scientific lab tests, statistical results and formulae that I did not understand.

Working as a clinical music therapist was a journey from the arts to science and back again. For those who work at the intersection between arts and health, there is a new language to be learned, a cultural shift that takes place. Without this mutual understanding, creative, original and helpful arts projects in healthcare environments cannot happen. In my experience, science and the humanities do not exist in an ‘either/or’ situation and the split between these worlds in current society is artificial and unhelpful (Roche et al. 2018). Engel’s biopsychosocial model of medicine went a long way towards repairing the artificial split between aspects of our health, but the role of the arts in healthcare remains considered as a dispensable luxury, the icing on the cake, inessential but nice if you have time or energy to bother with adding it to the healthcare environment (Engel 1977; Edgar and Pattison 2006).

What has become apparent to me, as a musician, music therapist and manager of arts and health programmes in a large city hospital, is that the most important thing is listening.

Failure to listen in healthcare settings

Listening is a buzz word in health service delivery. In 2013 one of the biggest failures in UK NHS care was revealed. Between 400 and 1,200 service users died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire (Campbell 2013). A report published on 6 February 2013 (the fifth report into the scandal) revealed the horrifying evidence, and ‘Mid Staffs’ became a byword for a lack of NHS care at its most negligent (Francis 2013). It is often described as the worst hospital care scandal of recent times. In 2013 Sir Ian Kennedy, the chairman of the Healthcare Commission and the regulator of NHS care standards at the time, said it was the most shocking scandal he had investigated (Lancet 2014).

The failure of care in the Mid Staffordshire scandal was arguably a failure of listening. Robert Francis QC, author of the 2013 report, stated that: ‘(the Trust Board) did not listen sufficiently to its patients and staff… in part the consequence of allowing a focus on reaching national access targets, achieving financial balance at the cost of delivering acceptable standards of care’ (Francis 2013). Criticism was made of the institutional management and culture, which ascribed more weight to positive information than information raising cause for concern, punished whistleblowers and failed to act when informed of issues that required action.

In recent years, the NHS has regularly stipulated the need for listening to be a core element of good healthcare and this is reflected in many national health policies in this century. A 2013 white paper by NHS Wales, for example, stipulates the need for listening to become ‘a planned activity’ and several national policy documents have focused in recent years on listening and positive communication in order to reduce complaints and improve service user experience of health care delivery (Williams 2013).

Musicians are expert listeners

As a musician, I am steeped in the art of listening. From a young age, musicians practise for hours, listening intently to learn to play better. They take apart large sections of music to rework miniscule phrases, even individual notes. The musician returns to problematic sections and hones in on significant moments. They switch from detailed listening to listening to the overall direction of the music. When a musician plays with others in an ensemble, they listen intently to several lines of music at once and attend to the music of others.

Orchestral musicians listen to optimise delivery of their part of the music. By listening they can shape their own contribution to match perfectly and complement the other sounds – the dynamics, the timing, the shape of the phrase for example. They also listen to ensure that the sound of their instrument contributes to the music as a whole. Figure 1.1 shows a typical trombone part for an orchestral player. As a trombonist, I often spend large amounts of rehearsal time counting bars of rest! Nonetheless, this acute listening to long sections before the loud, dramatic entry of the brass, is crucial in making my small part count.

Figure 1.1Typical trombone part in an orchestra

If a health service team are not listening to each other, how can they make their contribution fit in the overall whole? If they are not listening to the service user and their family, how can they meet their needs effectively? And if a music therapist or other adjunct therapist is not integrated as part of the clinical team, attending discussions, family meetings and case reviews, how can their contribution be relevant and helpful to the overall case? Performance and optimum care must surely suffer. Is it possible that a music therapist in the clinical team can offer something particularly useful with regards to listening?

Mowat and colleagues contend that there are three types of listening in healthcare organisations: (1) listening to obtain information to optimize service delivery; (2) listening to obtain information that helps understand the relationship between the person and the organization and (3) listening for its own sake without an external objective. In the third type of listening, there is no purpose for listening, the listener is not trying to achieve something, but rather allowing the person to tell their story for their own well-being (Mowat et al. 2013). However, listening is complex. Professional skills such as accurate listening are neither visible nor easy to measure. Clinicians are taught to listen rigorously as part of their education and training, for example the ‘golden minute’ in consultations where doctors are encouraged to allow a service user at least a minute to say what they want (Beckman and Frankel 1984; Awdish and Berry 2017; Coope 2020). Listening is a position, a stance, an attitude, a choice, not a passive act (Stickley and Freshwater 2006). It is a craft that can be developed through supervised practice. Service users tend to be more dissatisfied with poor communication than any other part of their care, a fact which warrants attention during clinical training (Mallett and Dougherty 2000; Keatings et al. 2002).

Music therapists have time to listen

One of the luxuries of working as a music therapist in a hospital setting is time. I have time to spend an hour with my client, listening, offering opportunities for self-expression, validation of identity and offering support. It is a privileged position in a busy health service environment. Stickley and Freshwater observe that in the rush of modern health care practice, there is arguably little encouragement or time for self-reflection in nursing (Stickley and Freshwater 2006). Music, however, affords a unique opportunity for listening. The very crux of music therapy is to say to the client, through music, ‘I am listening to you’. The music we play can validate the individuality of the person who chooses it, but even in non-verbal musical exchanges music therapists can acknowledge the communication by attuning to the music the person offers. We use three specific musical techniques to achieve this: mirroring, matching and dialoguing. In each of these the emphasis is on attuning to the client’s music, creating a musical exchange and reflecting back to the client what they are communicating through the music.

As a teacher of student music therapists, I emphasise the importance of active listening. A common mistake in music therapy is to start to play music for a client before the client has a chance to express themselves or make a choice. For example, we might offer a client a choice of instruments and they might choose to play a drum. Even if the therapist waits for the client to play first, they routinely jump in too quickly and start to play with them. Better to wait and listen and only join in when you have something useful to say. If two people improvising is a non-verbal conversation, then the therapist is taking over in this instance, being supportive but over eager. The client is saying on their drum ‘I want to say something’ but the therapist is leaping in, saying ‘Great, yes, let’s talk. What do you want to say? Is it this? Or that? Can I help?’. We often overwhelm the unique expression of the client whose voice is drowned out by the music therapist’s eagerness to perform!

Time and again I have found it more beneficial to wait, listen and pause before responding. One of two things can happen. First, the client will say more about themselves. They might change instrument, intensity or pace. They may surprise the therapist. They are free to bring their own voice on the drum into the room. The second possibility is that they will not say more, but the therapist, by listening says ‘I am listening and when I play I will try to support you to say more, but I will be careful not to drown you out’.

The following two online examples demonstrate music therapists Rebecca O’Connor and Bill Ahessy improvising with clients who find verbal communication extremely difficult. Both examples are highly...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Figures
• List of online files
• Foreword
• Acknowledgements
• Introduction
• 1 Listening
• 2 Self-expression: Telling my story
• 3 Dissonance: When music doesn’t work
• 4 Excellence: Music matters in the healthcare environment
• 5 Polyphony: Issues of professionalism and working as a team
• Final thoughts
• Index