Beyond the Patient

Art and Creativity for Staff, Management, Executives and Organizational Change

by Deborah Koff-Chapin

Chapter 22 from Art Therapy in Healthcare, Edited by Cathy Malchiodi PhD, LPAT, LPCC, ATR-BC, REAT

When I first came upon the simple yet profound process of Touch Drawing (Koff-Chapin, 1996) in 1974, I was completing my years as an art student in New York City. Something deep had been stirring in me– a longing to find a more natural way to create and to tap the authentic roots and purpose of art. On the last day of my last year in school, I received a response to this subliminal search. I was helping a friend clean an ink plate in the print shop. Before wiping it with a paper towel, I playfully moved my fingertips upon it. As I lifted the towel off the inked plate, I saw lines that had been transferred to the underside by my touch. It was as if these marks had come directly from my fingertips onto the page. Amidst bursts of laughter, I created one drawing after another. They were a natural extension of my being, a record of each moment as it passed.

Although this experience had the appearance of childlike play, under the surface was something profound and powerful. Though I am sure that others have made marks on paper this way before, there was more to the experience that the physical act. I opened to something larger in those moments; with that opening came a sense that this simple process had a greater purpose than my personal use; it felt like I was receiving an impulse from a level of consciousness that was outside of time. I had a sense that this simple way of drawing could become a significant form of human expression in the future. I was receiving a gift that came with a responsibility. Somehow, I would have to share this process with the world.

That commitment to share Touch Drawing has continued deepen over the years. My approach has been like ‘Jonny Appleseed’– introducing the process, encouraging and supporting others to cultivate its application within their unique field of expertise. Koff-Chapin (2001) The unique qualities of Touch Drawing lend themselves to a great range of applications. The ease, directness, and speed with which images can be created inspires people who otherwise would be afraid to draw. I could have written a chapter for this book on the many ways Touch Drawing is being used with patients in healthcare settings; with people who have Parkinsons and their caregivers, rehabilitating from stroke, in treatment for cancer and Aids, in pain management, pregnancy education (Touch Drawing Stories), and grief counseling (Rogers, 2007). I even did Touch Drawing in the hospital myself, during contractions in my 32 hour labor. My experience of the pain was entirely different while drawing. Those were the easiest contractions of the whole birth!

But Touch Drawing has also found its way beyond the patient and into every level of the hospital organization; from executives to clinical and non-clinical staff, middle management, and community outreach. This dynamic development has unfolded out of a collaborative relationship with Kaiser Institute, a team of visionary medical consultants who work with hospitals around the U.S.. Through their potentiating work at executive levels, they have developed a vital network of people bringing transformative processes into every level of healthcare organizations. This chapter focuses on two ways Touch Drawing is being integrated into this work to help shape organizational culture: the process of creative expression and the power of visual images.

Creative Expression for Stress Relief, Renewal, Creativity and Intuition

There is widespread agreement that medical and support personnel who work in hospitals and healthcare organizations are often affected by stress (Fisher & Anderson, 2002). A variety of approaches have been used including mindfulness practice (Cohen-Katz et al, 2005), interventions for compassion fatigue (Figley, 1995), and positive psychology techniques (Seligman et al, 2005). Art therapy and the arts in healthcare have also been applied with healthcare workers and staff (Repar & Patton, 2007; Italia et al, 2008).

This first section offer examples of how the process of Touch Drawing is being used with clinical and non-clinical staff, middle management, medical school faculty and executive leadership. Combined with other creative processes and a sense of the sacred, these experiences are helping professionals cope with the inevitable stresses of any large organization. Participants gain a sense of renewed possibilities and access deeper capacities in their work. Through collegial collaborations, Touch Drawing has found its way into every level of the healthcare organization.  

Stress Relief and Renewal for Clinical Staff

Many professionals working in healthcare are with people in the most vulnerable and significant times in their lives. A close and open-hearted dynamic must occur in order for patients and family members to trust them and allow a collaborative “we” to occur. This is the precious part of the work. It is also what makes clinical staff vulnerable to burn out and compassion fatigue. The rising prevalence of fatigue in healthcare creates an imperative to intentionally resource strategies and practices that build caregiver resiliency, and develop the capacity to work from their heart. Resilient, renewed, and compassionate caregivers evoke healing potentials in the patient and their family.

Sandy Johnson* is the executive director of “mission and culture” at a faith-based community hospital. The hospital policy acknowledges that caregivers in every department create the healing environment. They can do that only to the degree of personal wholeness that they embody. Sandy has developed a program of monthly ‘Staff Renewal Retreats’ meant to re-connect them to the heart of their work and enlarge their connection to their own sense of life purpose and their work as a spiritual path. She designed the entire day to promote a sense of well being, through the organic and colorful way the space is created; the use of music and other sound healing modalities; and activities which center around story telling, generous listening, relaxation, creating a personal vision, and a closing blessing ceremony.

The visual art modality that she has chosen to use is Touch Drawing. Sandy describes what she witnesses as participants draw: “The employees get completely immersed in the creative expression of their joys, sorrows and dreams through touch; drawing with their fingers, hands and at times even feet. Often, someone experiences tears as deep feelings are evoked, or an awareness surfaces that was unconscious. One employee got in touch with deep-seated grief over an estranged relationship with a sibling that she said was impacting her at work. Within a week, she was able to create healing in that relationship. Another who had been considering quitting his job, found the courage to approach a co-worker and work out differences. This resulted in the employee choosing to stay at his job. Participants feel renewed and connected to their sense of calling and purpose. “ Sandy also uses this retreat modality with her hospital’s leadership team and is currently planning to open it up for physicians and the community.

The next step towards integration of any therapeutic creative process is to use it at the moment when it is most directly needed. Shemaya Blauer* is social worker who has personally practiced of Touch Drawing for many years. When she began working with as a hospice professional, she discovered how vital this form of expression was in helping her to integrate and release the intense experiences she found herself in. She describes one here: ”I was asked to be with a woman who was crying out to be held. I sat with her and entered a space somewhere between my body and hers. Afterwards, I needed to release the experience and find a way to return to myself. Even more important was to honor and explore what it touched within my soul. Those words that she spoke and cried were the same words that were my secret longing for years as a child and young adult. When I went home that night, I created a series of 12 Touch Drawings and titled them “Hold Me”. The drawings told the story of our sacred time together as she cried the yearning that I had, and allowed me to hold her in my heart, and find peace.”

Imagine if every hospital had a creative studio available for staff breaks. Rather than a having a coffee, sugary snack or cigarette, a nurse might create a drawing, move or write a poem. Soulful creative expression allows one to touch the sacred aspect of the work, and explore and integrate the deeper personal impact. This also provides a buoyancy and resiliency, something more than the typical form of self-care might provide.   

Healing the Clinical Leaders

Janet Nix* is Director of Learning in a faith-based regional healthcare system. One of the hospitals in this system had just gone through the second round of lay-offs in less than two years; the majority of layoffs were at the manager and director levels, leaving the middle management team demoralized. Janet offered a Touch Drawing workshop as a vehicle for healing. Every leader at the hospital was required to attend. They started out with a discussion about how to stay connected to the system’s mission despite all the chaos. A Sister from the community that sponsors the hospital co-lead the discussion with Janet. They facilitated a meditation that connected everyone at the heart, followed by the Touch Drawing experience.

Janet described what she witnessed that day. “I was impressed with how much everyone enjoyed Touch Drawing and the deep insights that came out. The Chief Nursing Officer remarked that no matter how hard she tried to change her color to a brighter one, it kept coming out black and gray, just like she was feeling. She knew she had to keep going to clear out that darkness before she could get to the color. One manager commented on how this process was a waste of her time and that she was too busy to be playing. This manager tends to be very negative on a day-to-day basis so I took the criticism with an open mind. In the afternoon session, this manager’s boss came up to me and said, “I don’t know what happened here this morning but Betty (the manager) is like a new person. She actually came up to me and asked if there was something she could do to help me!  She has never done that in the five years we have worked together.” The evaluations of the process were excellent reflecting the fact that participants felt refreshed after the experience.

Let’s Not Forget Non-Clinical Staff

In addition to the previously mentioned clinical challenges, layoffs occurred at the hospital where Nix was employed that dramatically affected the information management department. Word had spread about the positive impact of Touch Drawing when Janet used it with the clinical staff. Subsequently, she was asked if she could provide it for department staff that had survived the cuts. When she brought Touch Drawing to the group, participants were very open to the experience. Some were somber and went deep into their hearts as they drew; others found it to be a playful experience and a welcome release from their day-to-day pressures. They had fun with colors and found symbols emerging from the touch of their fingertips on paper. All came through the experience feeling uplifted and joyful. Many took their drawings back to their desks and hung them up. This experience served to support the staff as they regrouped and entered their next phase of challenges.

College of Nursing Faculty Access Their Creativity

The same hospital’s college of nursing was going through a transition of leadership. An outside consultant was brought in to be the interim chancellor and many faculty members were experiencing anxiety over the forthcoming changes. The interim leader wanted the faculty to be part of the change and contribute ideas; in contrast the previous leadership was perceived as controlling. Innovation had not been used in so long that it was hard to motivate the team to be creative. Through the Touch Drawing process and Janet Nix’s facilitation, the faculty found that the freedom of the process stimulated their creative juices. This sense of possibility and creativity unleashed much joy and fun. They decided to take a drawing from each person and make a collage to hang in their faculty lounge area. As they brought their drawings out from the personal realm to the community space, they were also able to share a vision for the future.

Executives and Physicians Cultivate Intuitive Abilities

Kaiser Institute has developed many innovative programs that challenge convention for hospital executives, upper management and physicians. One of these is the ‘Program in Intuition’, designed and directed by Kevin Kaiser*. It is based on the premise that intuition is an innate human capacity. Development of intuitive awareness can help anyone function more effectively in their personal and professional life. Imagine an emergency room physician, faced with the urgent need to make a decision that impacts the life of a patient. The ability to follow subtle cues and draw upon deeper resources could make the difference between life and death.

I was invited to join the faculty of this program, both as intuitive artist and facilitator of the drawing process. I suggested that we take a chance and introduce an application of Touch Drawing that I call ‘Inner Portraits’. In this process, individuals are paired up and do a series of drawings for each other. They do not draw what they see with their physical eyes; rather they draw from a felt sense or images that arise from within. When we met for our session, I set people up in pairs. As they stood facing each other I guided them through an attunement to one another’s presence. After a time of mutual openness, I suggested they let go of their judging mind, relax and create a series of Touch Drawings for their partner. If a symbolic image rose to their awareness, they should put it down on paper without trying to understand its connection to their partner or worrying about how well it was drawn. This was not a test of their drawing skill, but an opportunity to practice trusting their intuition.

They sat across the tables from each other, hands moving upon the paper, lifting one sheet off the board and laying a new one down until each had completed a series of drawings. They then looked through the drawings, exploring the associations the images might have for their partner. When participants shared their experience, there were many stories with surprising connections. One man had thought of a bear, but didn’t want to draw it because he didn’t know how. But he just couldn’t get it out of his mind, so he finally scribbled it on the page to get it out of his system. When looking through the drawings, his partner immediately recognized it, saying, “That is a bear. It’s my power animal!” The experience of having a person find deep recognition in something you have created for them is a graphic and hard-to-deny affirmation of the access we each have to something more than linear knowledge. Coming at the end of their yearlong Program in Intuition, this drawing experience provided undeniable confirmation and helped participants internalize this ability as part of their identity. This affirming experience of insight and connection could then be applied to understanding and awareness of others within the workplace.

The Power of Visual Images in the Shaping of Organizational Culture

As Leanne Kaiser Carlson* traverses the continent in her capacity as consultant to hospitals and healthcare organizations, she finds the healthcare setting at best has the look of a destination hotel or spa. She sees beautiful pictures, soothing colors and gorgeous sculptures. Yet little speaks to the spiritual essence of the people in the place and how they are growing and transforming. Leanne notes the purpose of art is more than decorative beauty. Art has the power to remind us who we are and draw us toward our potentials. The highest dimension of art is mythic. Myths are stories that explain the world and tell us who we are in relationship to it. They convey meaning and often provide the inspiration to step beyond our small lives and apparent limitations. It is through myths that people have understood the world since the beginning of time.”

Leanne focuses on harnessing the mythic power of art to move healthcare organizations toward their vision and mission. This is especially important now with so many clinicians, executives, and staff feeling disconnected from why they entered their profession and adrift in the chaos of change. “Art has the potential to help people become more whole when it speaks to what lies beyond the tasks and mechanics of medicine. It has the power to hold an image of what people or an organization can be in their highest expression. Art drawn from deeper levels enables patients to touch into the soul of the organization and viscerally feel the passion and purpose of those who work within it.

An artist working from “soul levels” can give form to potentials that people cannot articulate themselves. When a vision takes form in an artistic image, it becomes real in a way that is both evocative and concrete. The image creates a container that holds an originating impulse over time. Art contains a potency that can uniquely energize a vision and draw together executives, clinicians, staff, board members, donors and the people they serve.” Kaiser Institute’s work with healthcare organizations across the country is harnessing the power of art to help heal their culture and create the future.

One Image, Many Places

Another project of the Kaiser Institute that I have taken part in is their ‘Program in Philanthropy’. It brings together working teams from hospital foundations to expand their understanding of their foundation’s role is fostering philanthropy. This program encourages the development of projects that inspire generosity and enrich the hospital’s relationship to the greater community. My role at these working retreats is to act as a visual scribe. I call the process ‘Interpretive Touch Drawing’. I sit at the sidelines, listening to the heartfelt stories of generosity that have emerged from these hospitals. I internalize the thoughts, feelings and images, and translate them into form on the page through the touch of my fingertips. The speed of Touch Drawing allows me to keep pace with the stories, moving swiftly from one drawing to another during each session. Select drawings are later enhanced with color and made available for use by hospital foundation projects. The following is an example of how one of the drawings I created during a Program in Philanthropy retreat found its way to full integration into the life of a hospital and community. 

Barbara Fulton* is director of development at a non-profit critical access community hospital. She notes, “When we began our work several years ago with Leanne Kaiser Carlson, our community envisioned a future as the ‘most generous community’.  Leanne also introduced us to Deborah’s art and we immediately connected with the image entitled “Abundance” as a meaningful symbol of the generosity we wanted to foster. The energy of this particular image became very important to our team. We adopted it as the official symbol of our work. Deborah had an enlarged version produced for us in a beautiful silk wall hanging. When we would travel to community gatherings or presentations, we often brought along the silk version. As such, “Abundance” has inspired countless people along the way. One powerful image can go so much farther than an abstract discussion in reaching people’s emotion and releasing both ideas and the desire to act on them. 

Our generosity initiatives have sparked many new projects; our “charitable assets pillar” group, a time bank, exciting (and moving) connections between youth groups and various think tanks and strategic economic groups, the beginnings of community-wide “power of one” initiatives and many other results. The image has helped keep our “possibility thinking” flowing. It is the central image linking our many projects. We currently have the poster version of Abundance at our new experience-based destination health park called AL!VE. And the silk version is hanging in the lobby of our Administration office suite at the hospital. All employees, as well as visitors who come to meet with our executives, marketing department, and development office have the opportunity to see Abundance and be inspired by the image. “


Integrating Art into Executive Visioning and Strategic Planning

As a nurse, healthcare consultant and executive coach; Eileen Zorn* often partners with leaders from healthcare organizations that are in the midst of crisis, chaos and transition. Many of the situations in hold a sense of restriction, turbulence, scarcity, and a less than desirable future. Executives look to the visioning and strategic planning processes as means to navigate into a better place. Traditional strategic planning approaches are linear and analytical. Numbers and data drive the process. They do not allow for the expansiveness, creativity and innovation that a ‘whole brain’ attitude allows. Art can be a bridge between a traditional approach and one that holds deeper meaning and possibility. (Zorn, 2006)

Eileen was working with a faith-based community hospital that was in the midst of major challenges related to quality, service, and commitment to values and mission. They truly wanted to renew the original intentions of the founders. Eileen’s coaching role was to help them identify an approach that would evoke a more heart-based, innovative response. Based on the new CEO’s strong commitment to positive transformation, Eileen encouraged him to form a partnership with the Kaiser Institute to create a “visioning retreat”. The intention would be to launch a values-based organization that more consistently reflected their mission. I was invited to join Leanne Kaiser Carlson and Kevin Kaiser to help them set the stage for this transformation.

The executive team came together in a circle designed to foster collaboration, conversation and deep listening. I was sitting in the center of the circle, ready to draw. My board was rolled with fresh ink and a large stack of paper was by my side. After an introduction to the ‘intention’ of the session, the facilitators suggested the executive leaders to close their eyes and project forward three to five years, and imagining the best-case scenario for their organization. They were asked to imagine what this would look and feel like. They were guided in connecting these images with the mission and the original intention of the founders, which was ‘service to the community’. Each leader was given a period of silence to allow their minds to generate the possibility of a future filled with wellbeing and abundance for their organization. They imagined the form that the organization might take if it fully embraced its values. Then they were asked to open their eyes.  

One by one they described their visions. I listened intently, internalizing their images and translating them into form on paper. Each leader watched in awe as drawings reflecting their own hopes and dreams emerged from my fingertips. Visioning supported by artistic expression removed obstacles and released limitation, opening doors that launched a new phase for this hospital. The executives that collaborated in this experience were transformed through connecting with the deeper meaning of their work and their own personal mission for healthcare. They rediscovered and reaffirmed who they were as leaders and as human beings. Janet Nix, a director of organizational development at the time, shared her view of the experience and its impact: “It brought us together at a different level of consciousness – not only at the verbal level but also at the soul level. This experience connected us more deeply than any other time together. It was the foundation of the next two years of success and growth.“ ST MARY’S IMAGE

From the group of images that were created that day, five primary focus pieces were chosen. I developed the drawings with additional color to be used in a booklet that was given to all staff. In this way, the leadership team was able to convey, with pictures and words, how they had chosen to recommit to mission and meaning, and ‘reframe’ the future. Many of the managers chose to use individual images as part of their inspirations/devotions at the beginning of their meetings in an effort to keep the original core message of the vision alive. Many staff members hung prints of the images in their offices as a reminder of the values and possibilities that that they represented. The staff discussed ways in which the images could become potent reminders for all by printing them on cubicle curtains, scrubs or banners in the waiting rooms. From the initial visioning process emerged a new focus on serving the community, partnering with other providers, supporting staff, and creating healing environments for patients. The drawings played an essential role as touchstones to the possible future, holding the signature of what gave each person meaning within the context of their professional lives.

Universal Images, Personal Meaning

Over the years, as I continued to draw in the studio, the images evolved into more refined forms that express mythic and transpersonal levels. A selection of these images entered the lives of many people when I published them in the form of SoulCards. (Koff-Chapin, 1995, 2000). Without written meanings, people are encouraged to trust their own response to a chosen card and explore what it evokes in them. SoulCards have found their way into a range of healthcare settings; with patients as part of post-acute services, with chaplains as they assist people diagnosed with life-threatening illnesses, as well as in management team meetings. (

Cynda Rushton* is a professor of nursing and pediatrics at a major university hospital. As co-chair of the hospital’s Ethics Service Committee, she was responsible for designing a day-long retreat. At the opening, she invited members to select a SoulCard that represented healing for them. After some initial resistance, members chose diverse images from the array of cards. They then divided into pairs to share about themselves, their work and the meaning of healing through an exploration of their chosen card. Following this, each person in the pair introduced the other to the entire group. The introductions were deeply meaningful, going beyond the usual data disclosed in professional settings. At the closing of the retreat, several participants mentioned the impact of knowing each other differently and asked to keep their cards as a reminder of their work. The experience helped to deepen the retreat and to shift their interactions beyond mind to soul and heart.

Common Thread

What is the common thread in all these myriad stories? The power of soul-level art, both process and product, to help access a fuller range of our human capacities; communication, compassion, creativity, intuition, generosity, authenticity, a sense of wholeness and love. The potent emergence of the arts in healthcare in recent years could be somewhat surprising. But hospitals are places of birth, suffering, healing and death. No wonder these large technologically sophisticated institutions are now so attracted to the timeless, primal, mysterious human impulse for Art. Creativity fosters life.

*Note: Sandy Johnson RN, B.S. is Executive Director of Mission and Culture at San Joaquin Community Hospital in Bakersfield, California; Shemaya Blauer LCSW is a medical social worker at Providence ElderPlace in Portland, Oregon; Janet Nix, Ed.D. is System Director of Learning at Hospital Sisters Health System in Illinois and Wisconsin; Kevin Kaiser is Cofounder of Kaiser Institute in Brighton, Colorado; Leanne Kaiser Carlson MSHA is a Futurist with Kaiser Institute in Brighton, Colorado;

Barbara Fulton Ph.D is Director of Community and Organizational Development at

Hayes Green Beach Memorial Hospital in Charlotte, Michigan; Eileen Zorn MS, RN

is President & CEO Zorn Consulting Network (consultant to St Mary’s Medical Center in Apple Valley, California); Cynda Rushton PhD, RN, FAAN is Professor of Nursing and Pediatrics at Johns Hopkins University and core faculty at Berman Institute of Bioethics in Baltimore, Maryland.


Cohen-Katz, J., Wiley, S., Capuano, T., Baker, D., & Shapiro, S. (2005). The Effects of Mindfulness-based Stress Reduction on Nurse Stress and Burnout, Part II: A Quantitative and Qualitative Study. Holistic Nursing Practice, 19(1), 26-35.

Fisher P, & Anderson K. (2002). When Working Hurts: Stress, Burnout & Trauma in Human, Emergency, and Health Services. Victoria: Spectrum Press;

Italia, S., Favara-Scacco, C., Di Cataldo, A. and Russo, G. (2008), Evaluation and art therapy treatment of the burnout syndrome in oncology units. Psycho-Oncology, 17, 676–680.

Repar, P., & Patton, D. (2007). Stress Reduction for Nurses Through Arts-in-Medicine at the University of New Mexico Hospitals. Holistic Nursing Practice, 21(4), 182-186.

Seligman, M. E. P., Steen, T. A., Park, N. & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60 (5), 410-421.

Koff-Chapin, D. (1996). Drawing Out Your Soul: The Touch Drawing Handbook, The Center for Touch Drawing

Koff-Chapin, D. (2000). SoulCards® 1 The Center for Touch Drawing

Koff-Chapin, D. (1995). SoulCards® 2 The Center for Touch Drawing

Koff-Chapin, D (2001) Touch Drawing Facilitator Workbook, The, The Center for Touch Drawing

(multiple authors) Touch Drawing Stories and Uses, Touch Drawing Stories

(multiple authors) SoulCards Stories and Uses, SoulCards Stories

Earl Rogers 2007 The Art of Grief; The Use of Expressive Arts in a Grief Support Group, 153-176 Routeledge Press

Zorn, E (2006) Building the Bridge: Helping Nurse Leaders Find a Vision Though Art American Holistic Nursing Association Beginnings, Volume 26,3 28-29 

Hobson, D (2005) AHN INTERVIEW: 
Deborah Koff-Chapin Arts & Healing Network News

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