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Lights, camera, action: the creative approach to behavioural change

In conversation with Dr Tapas Mukherjee, Respiratory Registrar and Education and Leadership Fellow, Leicester Royal Infirmary

Tuesday, July 7, 2015

  • Noticing a lack of engagement by healthcare professionals with asthma management guidelines, Tapas explored how social media could transform practice.
  • His video featuring him singing about asthma management guidelines has become a multi-award-winning  YouTube hit.
  • The project has since featured on ITV, NBC, The Times and Time Magazine – and new films are in the pipeline.

What inspired you to make your first educational video about acute asthma management?

Tapas: A combination of things really. Back in 2012, I was working in the acute admissions unit at Glenfield Hospital [an NHS Trust on the outskirts of Leicester and a specialist centre for coronary care and respiratory diseases] when Ruth Green the lead consultant for Asthma at the Trust and I were doing a ward round. We noticed lots of basic things were consistently omitted during clerk-ins by junior doctors and nurses such as peak flow charts, or X-rays were being over-requested. Ruth was particularly annoyed as she had written the Trust’s Asthma Management Guidelines and clearly they were not being followed!

I decided to see why people didn’t follow them by trying to locate them myself and quickly realised that our hospital systems were not optimised for finding documents easily. Whilst I understood the importance of having written policies for everything (I even rewrote and updated the Trust’s Asthma Guidelines with Ruth during this time) I recognised it was more natural for my generation to check things on their mobiles. The Trust’s guidelines were not on the internet, but the BTS ones were! This formed the basis of turning to social media to publicise the BTS Guidelines for Asthma and at the same time making them appealing to the young nurses and doctors of the Trust.

Breakfast at Glenfield - The Educational Music Video about ACUTE ASTHMA MANAGEMENT

How did you end up singing in the video? And what was it like to make?

Tapas: The idea of singing the guidelines appealed to me because I have grown up admiring people who can sing – I particularly like Frank Sinatra’s and Dean Martin’s voices and if I could be re-born I’d quite like to be in the Rat Pack! However, in my time there were some massive songs that everyone knew and loved, and Breakfast at Tiffany’s was one of them. However, when I asked people to sing it in front of a camera suddenly everyone was less keen!

So in the end I used my team of juniors from the acute medical unit at Glenfield Hospital as actors and I became the singer. Getting ‘buy in’ from Ruth Green and Jonathan Bennett, two consultants at Glenfield, made things a lot easier. We didn’t need any special equipment – I just used the video camera on my mobile phone and video editing software on my laptop. However, I still had to film most of it outside the hospital around parts of Leicester, looking around to make sure I wasn’t about to get ridiculed by passing teenagers!

And what has been the response to the video?

Tapas: Reassuringly positive, to the extent that people are now willing to fund new productions (albeit ones that are professionally filmed – not just using my mobile!).

The BBC were great, they filmed us for the live midday local news and also the evening news, and about one year later I did a radio slot for BBC West Midlands, but the film was also highlighted on other news sources include ITV, NBC, The Times and even Time Magazine.

Of course media attention alone may not have been enough to convince the medical world of naysayers at the time, so winning various awards was a huge boost to the credibility of the work. To date it’s won the 2012 British Thoracic Society Award for Respiratory Education Innovation, The 2013 Network Casebook Prize for Innovation, a 2014 Regional Innovation Fund award from NHS England, and now the latest video has picked up the 2015 NHS Acorn Innovation Prize – even though it hasn’t been released yet!

I’d like to think that the massive positive reaction to this was one of the factors that helped University Hospitals of Leicester change its rather outdated attitude toward social media. When I first made the video it couldn’t be viewed in the hospital because YouTube was banned, but fortunately that’s no longer the case.

2012

winner

of British Thoracic Society Award for Respiratory Education Innovation

winner

So why do you think this particular project has been recognised as an example of innovation? Have there been any quantifiable behavioural changes that you think it has helped to achieve?

Tapas: Great question! I once read that 99% of YouTube videos don’t get more than 1,000 views, yet this one has generated nearly 80,000 to date since it was published in April 2012, even though it’s aimed at doctors and nurses and not the general public.

I think the honest answer is most NHS videos are really dull. A dull video is an insult to the viewer, whereas when done correctly, video can be a hugely rewarding material to use for learning. You can’t just film a senior doctor talking about a really heavy subject sitting at a desk staring at a camera – who wants to watch that?!

I think we owe it to our staff and the public to make more effort when it comes to presenting information to them. For example, you wouldn’t expect a car maker to tell you about their latest model from behind a desk – we have come to expect mini-movie quality productions instead. Why is it any different when life-saving information is involved?

You’ve recently filmed a second video project – can you tell us about that?

We filmed a second video based on the National Review of Asthma Deaths Report authored by Mark Levy. Again the report has some really startling facts in it about deaths from over using blue inhalers but it hasn’t been communicated clearly to the public yet.

I am hoping to really take the public by storm when we release this one. In fact I am meeting Mark Levy this month (July) to discuss our strategy for releasing it. We are aiming big – over 500,000 views, with a robust evaluation to measure the impact it has too...hence the delay in release!

78,197*

views

on YouTube of ‘Breakfast at Glenfield’ video on asthma guidelines

*on 7 July 2015

How has it been different from making the first video?

It’s been a slow process now that everyone is on board with the idea, because it means everyone becomes a director and wants scenes done their way! Being awarded money from NHS England was a massive motivator, but it also means that the expectations are now higher.

Fortunately I have learnt a lot from it. Enough to convince me that making a third video is a reality. I have learnt some hard lessons from making this video and it was physically really tough working in the day and filming at evenings and weekends. Having said that, the dedication from everyone involved has been magnificent. I have to give a shout out to the great acting and dancing skills of my medical team – Dr Josie Hanson, Dr Jamanda Liddicott and occupational therapist Rakhee Pau, and the camera work of James Williams was pretty good too – better than using a mobile phone!

Why do you think the medium of video films on social media has worked so well in this context?

I grew up with films, they have had a huge influence on me. I therefore understand that films can change how you act and think. Proving that I can do the same with medical films will be a challenge, but I am confident that I can always make something that makes people stop and think...and hopefully feel strongly enough about to share with others, because that’s how social media films work.

Do you think you are a naturally creative person or was this a step outside of your comfort zone?

I know I am creative but this isn’t always a gift! My mind wanders and I come up with several ideas a day, most of which I don’t have time to think about or develop further which frustrates me. Fortunately Health Education East Midlands have agreed to me dropping my clinical commitments to 50% from August and the Trust have employed me to create safety videos for them for the other 50% which means that I can at least channel some creative thinking into that. I’m also completing a Masters in Medical Education which has really made me think about how we learn and how to make my teaching more effective for the next one.

What do you think can be done to encourage others to be more creative and innovative in the NHS?

I feel that the current training for doctors is very linear with consultancy and getting a CCT [Certificates of Completion of Training] being the only long-term goal. In the short term, going to work in the NHS simply means getting ‘TTOs’ [a patient discharge form] done on time for most juniors, and a mad rush against time to see patients for everyone else.

I fear that by doing this we are losing a generation of leaders, managers, innovators and superstars in general because they either end up getting fed up with the current training and are poached by industry, or any expectations of being creative get hammered out of them for fear of not becoming a consultant. I think getting a CCT is important, but it shouldn’t be a person’s only goal in life.

A dull video is an insult to the viewer, whereas when done correctly, video can be a hugely rewarding material to use for learning… I think we owe it to our staff and the public to make more effort when it comes to presenting information to them
Dr Tapas Mukherjee

What would your advice be to a potential innovator?

I’m not sure I’m an innovator myself yet, but I would say if you really want something you have to be prepared to listen to everyone around you trying to tell you it’s a bad idea, day after day. Once you get past this, be prepared to listen to another round of people tell you there is no money for your idea. And once you get past that, you’ll have to listen to people telling you it’s too ambitious for you to do. Listen to all of these things, take what you want from it, and do it anyway. Otherwise you’ll never know if you were right.

Any future plans for further creative projects?

Yes! As I mentioned, Health Education East Midlands and University Hospitals of Leicester have allowed me to reduce my clinical training to 50% from next year which means I’ll be making videos for the other 50%. I’ve been employed by the Trust to make safety videos for them, and I’ll be working with Professor of Public Health Derek Ward at University of Derby to plan evaluations for the videos I create.

It sounds very exciting – we’re really looking forward to see what happens next. Thanks for your time!

Thank you too. We should have more to say in a year’s time – watch this space!