title: Unmasking quality: exploring meanings of health by doing art.
abstract: BACKGROUND
  Quality in healthcare has many potential meanings and interpretations. The case has been made for conceptualisations of quality that place more emphasis on describing quality and less on measuring it through structured, vertically oriented metrics. Through discussion of an interdisciplinary community arts project we explore and challenge the dominant reductionist meanings of quality in healthcare.
  
  
  CONCLUSIONS
  The model for structured participatory arts workshops such as ours is 'art as conversation'. In creating textile art works, women involved in the sewing workshops engaged at a personal level, developing confidence through sharing ideas, experiences and humour. Group discussions built on the self-assurance gained from doing craft work together and talking in a relaxed way with a common purpose, exploring the health themes which were the focus of the art. For example, working on a textile about vitamin D created a framework which stimulated the emergence of a common discourse about different cultural practices around 'going out in the sun'. These conversations have value as 'bridging work', between the culture of medicine, with its current emphasis on lifestyle change to prevent illness, and patients' life worlds. Such bridges allow for innovation and flexibility to reflect local public health needs and community concerns. They also enable us to view care from a horizontally oriented perspective, so that the interface in which social worlds and the biomedical model meet and interpenetrate is made visible. Through this interdisciplinary art project involving academics, health professionals and the local community we have become more sensitised to conceptualising one aspect of health care quality as ensuring a 'space for the story' in health care encounters. This space gives precedence to the patient narratives, but acknowledges the importance of enabling clinicians to have time to share stories about care.
authors.affiliation: Centre for Medical Education, Institute of Health Sciences Education, Queen Mary University of London, Room 2.10, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK. m.j.kelly@qmul.ac.uk.
authors.forename: Moira
authors.initials: M
authors.lastname: Kelly
authors.affiliation: University of Southampton, School of Health Sciences, Highfield, Building 67, Southampton, SO17 1BJ, UK. C.A.Rivas@soton.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Rivas
authors.affiliation: Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University London, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, UK. j.foell@qmul.ac.uk.
authors.forename: Jens
authors.initials: J
authors.lastname: Foell
authors.affiliation: Stitches in Time, Old Limehouse Town Hall, 646 Commercial Road, London, E14 7HA, UK. janet.llewellyn@blueyonder.co.uk.
authors.forename: Janet
authors.initials: J
authors.lastname: Llewellyn-Dunn
authors.affiliation: Stitches in Time, Old Limehouse Town Hall, 646 Commercial Road, London, E14 7HA, UK. mail@stitchesintime.org.uk.
authors.forename: Diana
authors.initials: D
authors.lastname: England
authors.affiliation: Stitches in Time, Old Limehouse Town Hall, 646 Commercial Road, London, E14 7HA, UK. anna@cocciacostumier.co.uk.
authors.forename: Anna
authors.initials: A
authors.lastname: Cocciadiferro
authors.affiliation: Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University London, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, UK. s.a.hull@qmul.ac.uk.
authors.forename: Sally
authors.initials: S
authors.lastname: Hull
mesh_terms: D000328:Adult; D001154:Art; D000529:Complementary Therapies; D005260:Female; D006262:Health; D006801:Humans; D062525:Narrative Therapy / Q000458:organization & administration; D011320:Primary Health Care / Q000379:methods; D016730:Program Development; D011787:Quality of Health Care; D013784:Textiles