Case study 4: Using archive film to develop an accelerated form of EBCD

For many EBCD project teams, filming patient interviews is one of the most exciting parts of the project. But it is also resource-intensive, putting EBCD out of reach for some sites. Aware that they were gathering similar types of information, the researchers behind Healthtalk began collaborating with the EBCD developers to see whether their film library could be used to produce an accelerated version of EBCD.

‘For Healthtalk, we interview people on video or audio talking about their health experiences,’ explains Louise Locock, Director of Applied Research at the Health Experiences Research Group, University of Oxford. ‘Our idea was that we could short-circuit the EBCD process by showing video interviews selected from a sample of those filmed around the country.’

With funding from National Institute for Health Research, the researchers identified about 40 films and rolled the approach out in two pathways (lung cancer and intensive care) at two different sites: Royal Berkshire Hospital and the Royal Brompton and Harefield hospitals. The projects interviewed staff as usual and used films produced in Oxford from a re-analysis of their interview archive. Patients did not become involved until the patient event itself, where they saw the film for the first time. This was then also shown at the staff event before the projects moved, fairly quickly, on to the co-design phase.

There were some initial reservations about whether staff would engage as strongly with the process if the film did not include patients from their own service. Researchers were also unsure whether the material would be sufficiently similar to resonate with patients’ experiences locally. But their fears were unfounded, explains Louise: ‘The evaluation found that the accelerated approach worked as well as the standard approach, but at less than half the cost.’

She continues: ‘The staff seemed to engage perfectly well and the film still produced profound emotion. One staff member said “This is the best thing I’ve done in my whole career.” In some cases it seems to have had the positive effect of helping staff feel less threatened or defensive. Among patients, there was some feedback that the film content was more negative than their own experiences. But this didn’t seem to affect the discussions that flowed from the trigger film.’

One concern was that the patients themselves may have missed out on the positive experience of sharing their experience on film, but for some projects this compromise may be worth making. ‘The findings show that where you can use the archived film, it cuts the time and costs substantially,’ says Louise. ‘This is especially the case once you’ve completed the first project and have made the film, as you can keep reusing it.’

The effectiveness of the archive trigger films is partly down to the fact that common issues often arise within patient experience. ‘Themes like compassion, kindness, information, practical support, involvement of families arise time and time again: the Picker Institute’s principles of patient-centred care don’t come from nowhere,’ says Louise. ‘The role of the patient interviews is to make those principles come alive, to humanise them, and to prompt action.’

Both the trigger films and the ensuing discussions help to bring people’s experience to light and then create the outcomes they want to see. But this research shows that the trigger film is just that: a mechanism to spark things off, explains Louise: ‘Before the accelerated EBCD project, I was very hung up about the film itself within EBCD, but what I’ve come to realise is that it’s those face-to-face encounters – watching the film together and then asking “What shall we do about it?” that’s transformative. It breaks the ice and puts people into a different space, helping them see things through each other’s eyes.’

The team has received funding to make more trigger films on young people with depression; carers of people with dementia; autism; and ethnic minority mental health. These and other trigger films for service improvement can be found on the Healthtalk website.

Health Research Health Services and Delivery Research Programme funding acknowledgement

This project was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 10/1009/14).

Department of Health disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

Learning points

• The independent evaluation found that the accelerated EBCD produced the same benefits for half the cost and in half the time.
• In order to initiate discussion, the trigger film does not have to focus rigorously on the same circumstances that the patients in the service experience. Even if the patients disagree with what the film shows, this in itself may spark the debate.
• Facilitators may find the first couple of months of the project very intensive as even without having to conduct patient interviews, they still have to carry out staff interviews.
• The project timescale can be reduced from 12 months to 6 months, but allow a little more time if you can.