Sketchnotes and Pictorials in Healthcare Bradford Teaching Hospitals FT

1. Sketchnotes and Pictorials in HealthcareBradford Teaching Hospitals FT …Because pictures tell a thousand words

2. An idea…born from frustration Just a burning ambition to use simplicity, inclusion, creativity and emotions to communicate in a more meaningful way & break down barriers

3. What I did • No artistic background, practiced (failed a lot!) • I started to do mind maps & learn techniques • Tried to engage with staff to be more “creative”

4. John’s Journey through virtual ward • Problem was: 1-2 referrals from A&E per month • What we did: Information, guidance & feedback. We created a pictorial guidance and story • Who we involved: A&E Team (Matron, Consultant) Lead Nurse, patient experience • Results: In 2 months – 80 referrals! • Patient safety: Treated from the safety of their home, less risk of deconditioning, right care, helped with patient flow

5. Family journey through NICU • Problem was: New parents were unsure, emotional & needed support • What we did: Shadowed NICU, spent time with new parents to get feedback and reviewed information • Who we involved: NICU team and parents • Results: Improved patient safety through information on what to expect, support options to help them & coping with their sick baby “So much better than loads of words. Looking at the pictures helps us to understand. It made some of my worries go away” • “I found the poster invaluable in the first few days on my sons admission” • “Loved the fact that it focused not just on our baby but from our perspectives too. It answered so many of my questions” “A brilliant orientation tool with lots of easy to understand information”

6. Safe Baby book • Problem was: Increased risk & high rate of sudden infant death (SID) amongst diverse community • What we did: Created a language friendly book for parents with new born babies to communicate information about how to prevent SIDs • Who we involved: Student Nurse, Lullaby Trust, Community Midwives & Matron • Results: Early results indicate patients fedback how useful it is, easy to understand and a good reminder. Going to be rolled out nationwide with the Royal College of Nursing • Patient safety: Reduce the risk of infant death, increase knowledge, keep babies safe and look after their wellbeing/health

7. Red Bag Pathway • Problem was: Improve patient experience & stay in hospital for care home residents; through the use of a red bag with all their personal belongings & essential medical/social information • What we did: As part of the role out, created a red bag pathway pictorial • Who we involved: CCGs, care homes, A&E and ward Nurses • Results: Pictorial used and shared across 100 care homes. Staff fed back it helped remind them of the process and what to include in the bag. • Patient safety: Better communication across services, better understanding of patient needs/history and improving patient experience through inclusion of personal items. Safety can be increased through patient bringing in their own slippers & reading glasses (Less risk of fall).

8. End PJ Paralysis • Problem was: There is so much literature and evidence to show how harmful prolonged bed rest can be • What we did: Created visual campaigns for End PJ Paralysis and “Stop gowning around” • Who we involved: Brian Dolan, Chief Nurse & several wards • Results: 70 day challenge: 3600+ up dressed and moving, reduced risk of deconditioning, improved patient experience and contributed towards the reduction in falls across the Trust (15% reduction) • Patient safety: Less risk of falls, less muscle damage and less deconditioning. Staff focused more on what the patient needs

9. Pressure Ulcers (PU) • Problem was: There was an increase in PU (especially G3) in the organisation and the TVN felt basic factors were not being followed • What we did: Used all the Trust guidance and national guidance to work with TVN to create PU pictorial to help remind busy staff of the basics of care. • Results: Alongside the PU improvement work, the Cat. 3 reduced by 24% over a 12 month period • Patient safety: Staff remembered the basics of care which helped reduce pressure ulcers. Visual reminder in ward areas improved safety through education and having basic standards to follow

10. Summary of our successes at Bradford (where pictorial were used) Increased proactive actions to aid early discharge which enables sick patients to be seen sooner (red2green campaign) Increased use of social activity to keep patients stimulated Increased recording of Expected Dates of Discharge – improving patient flow (SAFER) 3600+ up, dressed & moving 15% reduction in falls 24% reduction in pressure ulcers Improved patient experience • Increased awareness of “freedom to speak up” – more staff speaking up Improved teamwork across services – helped maintain safety Reinforced basic standards of care Reduced patient complaints (on Children’s ward) Better communication with diverse community Staff feedback on increased remembrance of processes

11. Sketchnotes Club: National Reach • Problem was: I wanted others to be able to create their own visual pictorials/reminders to use in their workplace • What we did: I set up a sketchnotes club where I teach, share and promote tips on how to create sketchnotes (these are simple visual reminders to reinforce key messages) • Results: Since starting it in September 2018: Over 150 people have attended my sessions Evaluation: 60% increase in confidence of staff creating sketchnotes Evaluation: 100% of staff recommended by session to others I have presented the club and my mission to over 500 staff Over 100 new sketchnotes shared with me from a wide range of staff Over 1400 members form part of the sketchnotes Twitter community

12. National Reach • Over 50 NHS organisations/national bodies using my pictorials • Organisations in Canada & New Zealand using them • Over 100 requests to use them across the country • Over 2000 retweets of my pictorials • 12 sketchnotes club sessions held across different organisations • 2 national campaigns supported (End PJ Paralysis and SAFER patient flow)

13. Pictures help Patients! • My mission from 2 years ago is coming to life! • Patient safety: Information is easier to remember • Patient safety: Education for patients & staff • Patient safety: Critical guidance is accessible • Patient safety: Communication between services improved • Patient safety: Emotive – reminds people of why we are here • Patient safety: Experience improves with clear guidance, information and consistent communication There is so much more to do with pictorials and sketchnotes! It costs nothing – just practice, will and persistence