Supporting Healthcare Professionals Through Covid-19: Understanding How Arts-based Methods Can Support Non-verbal Communication
Lead Research Organisation:
Queen Mary University of London
Department Name: Sch of Medicine & Dentistry
Abstract
Effective, clear and compassionate verbal and non-verbal communication has been shown to be essential to good patient care, as well as part of an efficient and cost-effective healthcare system (McDonald, 2016). Since the Covid-19 outbreak, communication between patients and healthcare professionals has altered, with healthcare professionals facing new challenges: adapting to the
introduction of widespread use of Personal Protective Equipment (PPE), video-call consultations, social distancing and limited physical touch. Healthcare professionals have described the impact of wearing PPE as isolating, exhausting and impeding communication, articulating the urgent need for research in this area which has been reiterated by proactive requests for support from institutions such as University College of London Hospitals (UCLH).
Through Clod Ensemble's Performing Medicine programme WILLSON (Principal Investigator) provides sector-leading interventions in healthcare education using performative techniques from non-verbal artistic disciplines, such as dance and physical theatre, to enable healthcare professionals to gain a deeper understanding of how they communicate non-verbally. These techniques have been proven to enhance self-care and communication with patients and colleagues (Osman et al., 2018). This proposed research programme of interviews and workshops will investigate the impact of arts-based interventions on the training and support of healthcare professionals and medical students with regard to the non-verbal communication challenges presented by Covid-19. Undertaken by a unique, multidisciplinary partnership between arts organisations, NHS trusts and academics who have been collaborating for decades, this project will create, test, scale and disseminate online and in-person resources to support healthcare
professionals and medical students.
introduction of widespread use of Personal Protective Equipment (PPE), video-call consultations, social distancing and limited physical touch. Healthcare professionals have described the impact of wearing PPE as isolating, exhausting and impeding communication, articulating the urgent need for research in this area which has been reiterated by proactive requests for support from institutions such as University College of London Hospitals (UCLH).
Through Clod Ensemble's Performing Medicine programme WILLSON (Principal Investigator) provides sector-leading interventions in healthcare education using performative techniques from non-verbal artistic disciplines, such as dance and physical theatre, to enable healthcare professionals to gain a deeper understanding of how they communicate non-verbally. These techniques have been proven to enhance self-care and communication with patients and colleagues (Osman et al., 2018). This proposed research programme of interviews and workshops will investigate the impact of arts-based interventions on the training and support of healthcare professionals and medical students with regard to the non-verbal communication challenges presented by Covid-19. Undertaken by a unique, multidisciplinary partnership between arts organisations, NHS trusts and academics who have been collaborating for decades, this project will create, test, scale and disseminate online and in-person resources to support healthcare
professionals and medical students.
| Description | Overall the project has highlighted the importance of verbal and non-verbal communication in healthcare, and demonstrated the value of interdisciplinary research projects in the fields of arts and health to respond to critical issues such as the Covid-19 pandemic. The first phase of our project adds to the existing body of research demonstrating that healthcare staff have been extremely affected by the pandemic, offering unique insight into specific challenges around verbal and non-verbal communication. We highlighted the ways in which these factors impacted the care that staff gave their patients and the impact that these barriers had on their wellbeing. These were not all new challenges with many staff acknowledging that the pandemic had exposed existing longer-term problems which, had these been addressed, could have left staff feeling more prepared and minimised the extent of Covid-19's impact. In response, we created a series of 'creative encounters' that aimed to support staff wellbeing, develop verbal and non-verbal communication skills, and encourage reflection. Our programme of activities was designed through a multidisciplinary approach - getting an understanding of the needs and challenges on the ground from healthcare staff, as well as gaining a rounded perspective of artists' experiences during the pandemic and the components that make up their work. This was foundational to creating a programme that was engaging and effective. Our interventions reached 170 healthcare professionals and medical students, and offered staff brand new opportunities to engage with the arts. While this is fewer than stated in our original proposal, our delivery was impacted by the ongoing pandemic, restrictions, high staff workloads and strikes. We successfully piloted a new model of training intervention, delivering in-situ. Activities included workshops, one-to-one coaching and film screenings, all of which created opportunities for short, unexpected encounters to address the constrained nature of the working environment following the pandemic. While the original thinking behind this was to accommodate staff's busy schedules, we found that this approach of being on wards was effective in getting staff to take breaks and facilitated the transfer of skills learnt outside of the session. This model has been especially interesting for the Emergency Department and for teams that expressed feeling excluded from training opportunities. With 100% of participants finding the sessions 'easy to attend' (73% 'very easy'), our research has revealed a question for future projects around the accessibility of training programmes. The project has strengthened and created new relationships with our partner sites. We have worked with new teams and staff members who have spoken positively about the project and expressed the desire to continue the work and to collaborate in the future. There was a renewed interest in creative training opportunities from both managers and staff, who identified low morale across the NHS as well as training fatigue due to time pressures and the politics of 'resilience'. We found that the arts can counterbalance the target-based culture of mandatory training, help to increase engagement of wellbeing initiatives and offer personalised support to leave staff feeling listened to and cared for. |
| Exploitation Route | Through design, the skills and strategies learnt in each activity were made to be easily implemented by staff and be shared with colleagues to support staff wellbeing and improve the quality of the care they offer patients. The programme as a whole encourages introducing creative outlets into the working day, encouraging staff to try new experiences, reconnect with others and develop their critical thinking skills by engaging with the arts. We hope our outcomes demonstrate the effectiveness of this and encourage policy makers, medical schools and funders in NHS Trusts to invest in the arts and recognise their wider application. Our findings have highlighted the impact of verbal and non-verbal communication, and the environment on care and wellbeing in healthcare settings which all merit further research. Our project itself serves as guidance on how to run interdisciplinary projects and reveals learnings of running an in-situ training programme for healthcare staff on hospital wards. |
| Sectors | Communities and Social Services/Policy,Education,Healthcare |
| Description | Our findings from phase one (interviews with healthcare professionals and medical students) and phase two (creative workshops with artists) were used to inform the design of our intervention. This altered the original plan from traditional half-day or day-long educational workshops to a series of shorter, in-situ activities which were effective in being able to offer immediate and responsive solutions to the present challenges being experienced. 96% of participants found the sessions to be useful. The top themes that our activities spoke to, as identified by respondents overall, were; 1) stress relief and self-care, 2) enabled me to take a break, 3) taught me practical skills, 4) play, fun, randomness, 5) communication with colleagues and patients. Our activities re-energised staff through facilitating breaks, fostering social support, and the teaching of new communication skills and self-care strategies. In analysing our feedback forms, we found that 92% of respondents expected to use the skills and strategies that they had encountered in their work. In a 3-month follow-up interview we were told that participants continued to use the techniques learnt in their work, demonstrating that our methods potentially have a sustainable long-term impact. It was also mentioned that staff felt that the personalised approach to training was helpful and that staff felt cared for which speaks to the importance of the theme of reconnection and ways in which institutions take care of their staff. These findings bring up crucial questions about the framing, methods and long-term impact of wellbeing interventions for the future. Within the project we hosted a lecture for 4th year medical students at Queen Mary University London. As part of this lecture about the project and its findings, we screened two of the short films curated to contemplate the themes of care, touch, intimacy. As part of the session we invited the directors of the films to be part of a Q&A panel with students. 88% of students found this useful and enjoyed watching the films & interacting with the artists. This format was effective and students felt it helped them to explore different perspectives, acknowledge the different experiences and boundaries of patients, and facilitate personal reflections on how they communicated with patients. Reflections included a new understanding of non-verbal communication in the ways it can comfort people and a greater awareness of their own body and physicality. The feedback from this session will influence the ongoing delivery that Performing Medicine delivers at the medical school and help us continue to explore new ways in which the arts can support medical education. The project also highlighted the need for greater support and training for artists working in hospitals and community health settings which is becoming more common. This includes tips for working in hospitals, insight on what it is like working in a clinical environment and learning how to adapt art-based approaches for a health audience to increase engagement. The artists in our creative workshops spoke about how the public turned to them during lockdowns for an outlet. While many found this fulfilling and reaffirmed the value of the arts, this also put a lot of pressure upon artists. As a result, we identified the importance for artists working in healthcare contexts to fully understand their role, and expressed the importance of adapting to the setting and implementing self-care practices in order to deliver sustainable care. These findings have informed Performing Medicine's work for example in improving how we work with and support our associate artists and freelancers. It has also allowed the research team to think critically about what the arts have to offer healthcare staff and develop how we engage with both the arts and health sector to communicate the value that the arts bring to health and social care. We have produced more outputs than originally planned, reallocating the time and budget left over from the missing delivery to new outputs. Our data has helped to build a conceptualisation of what non-verbals and embodiment means in a healthcare setting, and set up for further investigation in this area. We have begun to create a non-verbal framework to define these terms and explore the way in which the experience of being a healthcare professional is embodied and affected by the environment with hopes to continue to explore this area in further research. Our findings from Communicating through Covid will build upon Performing Medicines knowledge and experience in this area, and be supported by a literature review. The aim of this framework is to support practical application through identifying strategies to help develop non-verbal skills, and create a shared language and understanding to facilitate the embedding of the framework into future healthcare education and training curricula. The framework will deconstruct the elements of non-verbal communication, outline the ways each element can be approached and taught, and how they can be applied in healthcare. |
| First Year Of Impact | 2022 |
| Sector | Healthcare |
| Impact Types | Cultural,Policy & public services |
| Description | Creative Health Quality Framework |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| Description | (AH/V015877/1) Follow-on: Communicating through Covid in General Practice |
| Amount | £99,913 (GBP) |
| Funding ID | AH/X010481/1 |
| Organisation | Arts & Humanities Research Council (AHRC) |
| Sector | Public |
| Country | United Kingdom |
| Start | 05/2023 |
| End | 02/2024 |
| Description | Blog posts |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | 3 blog posts can be found on the Performing Medicine website which outline our findings and process up to delivery |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://performingmedicine.com/blog/ctc-understanding-the-challenges/ |
| Description | Building Better Healthcare |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Featured in an article in Building Better Healthcare (April 2021), which has 168k web users; 14,000 monthly visits, and a newsletter with a circulation of 5,400: https://www.buildingbetterhealthcare.com/news/article_page/Exploring_the_role_of_the_arts_in_supporting_frontline_NHS_staff_during_COVID_pandemic/175621 |
| Year(s) Of Engagement Activity | 2021 |
| Description | Care and Healing through Creativity Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Suzy Willson, "Performance as a tool for change", at Care and Healing through Creativity: contributions of arts to the healthcare sector, University of Cantabria, Centro Botin, 13th July 2021. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Catalyser |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Other audiences |
| Results and Impact | Performing Medicine was a part of Clod Ensemble's 'Catalyser', a 5-week intensive course for 20 young creatives in London. The Performing Medicine session shared an insight into our current work and the topic of interdisciplinarity between the arts and health sector. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Clinical Service Journal |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Communicating through Covid work will be at the heart of an article authored by Performing Medicine explaining how arts-based initiatives can support healthcare workers at a time of unprecedented levels of burnout and stress. This will appear as a double page feature in the Clinical Services Journal in May 2023. |
| Year(s) Of Engagement Activity | 2023 |
| Description | Culture Health and Wellbeing Alliance National Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Suzy Willson, panellist on "Mutual Support", at A Culture of Care: Culture Health and Wellbeing Alliance National Conference, 23rd April 2021 |
| Year(s) Of Engagement Activity | 2021 |
| Description | Dance Gazette |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Featured in Dance Gazette's October 2022 Issue 'Dance on Prescription', to promote the use of dance and movement in healthcare education and our response to Covid-19. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Flexchange at King's College London |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | Suzy Willson, 'Interdisciplinary Arts, Health, and Humanities Curriculum Development Workshop', Flexchange at King College London, 13th July 2022 |
| Year(s) Of Engagement Activity | 2022 |
| Description | GLOBE Conference |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Other audiences |
| Results and Impact | Suzy Willson, "Performing Medicine", GLOBE conference to a series of international academics, Queen Mary University of London, 6th September 2022 Through the GLOBE conference, we have connected with academics in Colombia and begun a partnership to help introduce arts-based methodologies and practices into the medical school Curriculum at Pontificia Universidad Javeriana Faculty of Medicine, Bogotá. PI Suzy Willson and the Performing Medicine visited Bogotá in Jan 2023 to begin this development. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Her Life Her Health |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | We have also had coverage in 'Her Life Her Health' in their Autumn 2021 issue, promoting the use of arts-based techniques to support mental health and wellbeing and highlighting the enormous pressure that Covid-19 has had on the workforce. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Peer Forum with Thijs de Blok |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Industry/Business |
| Results and Impact | Suzy Willson spoke at a Peer Forum alongside CEO Thijs de Blok, hosted by Mannaz, about the theme of increasing resilience (September 2022). At this forum Suzy spoke about the project as an example of how we're addressing resilience in healthcare staff. |
| Year(s) Of Engagement Activity | 2022 |
| Description | Public Events |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Public/other audiences |
| Results and Impact | The research team held three separate events in September 2022. The events provided an opportunity for the public to learn about the research project, experience the programme and talk to the artists. Two of the workshops were promoted to the general public and artists interested in the intersection of arts and health. The third was a private event created to share the project with the project partners, academics, and friends of Performing Medicine. This event also included a panel with Suzy Willson, Co-investigator Graham Easton, project partner Peter Jaye from Guy's and St Thomas' and Arundi Mahendran, Director for the Institute of Health Sciences Education (IHSE) at Queen Mary University of London. We saw 63 attendees over the 3 occasions. Special Guest Michael Rosen attended one of the public workshops and the private event to speak about his experience with Covid-19 and read from his bestselling book 'Many Different Kinds of Love'. Inspired by this event, he has created a film using the reading he shared which can be found on YouTube (https://youtu.be/ZsrSN-OCk8w). |
| Year(s) Of Engagement Activity | 2022 |
| Description | Radio 4 Guest on "Inside Health" |
| Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | In February 2021, we were invited to speak on Radio 4 "Inside Health" about our work leading up to this project. We have no specific figures about reach for this show but Radio 4 reaches 10.98 million listeners each week. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Social Care Today |
| Form Of Engagement Activity | A magazine, newsletter or online publication |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | We have had coverage in Social Care Today (Jan 2022) promoting the use of arts-based techniques to support mental health and wellbeing through the stress and demands of the Covid-19 pandemic. |
| Year(s) Of Engagement Activity | 2022 |
| URL | https://socialcare.today/2022/01/26/feature-social-care-workers-wellbeing-and-arts-based-techniques/ |
| Description | Telegraph News Article |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Featured in the Telegraph in March 2021, around how to cope wearing PPE |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://www.telegraph.co.uk/theatre/what-to-see/cope-strangeness-wearing-full-ppe-ask-puppeteer/ |
| Description | The Polyphony Blog Post |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | In June 2021 we published a blog post about touch in healthcare during the pandemic - in relation to our research project - for the Medical Humanities online journal The Polyphony, which was also shared via its Twitter page which has 8,798 followers. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://thepolyphony.org/2021/06/22/trusting-touch-during-covid-19/ |
| Description | University of East Anglia Presentation |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Postgraduate students |
| Results and Impact | Bella Eacott, "Practitioner mental health in the time of Covid-19 - role of medical humanities", University of East Anglia's conference, Tuesday 2nd November 2021 |
| Year(s) Of Engagement Activity | 2021 |
| Description | Vassar Presentation |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Undergraduate students |
| Results and Impact | Suzy Willson, Goldsmiths Vassar Media Studies Presentation, 30th November 2022 |
| Year(s) Of Engagement Activity | 2022 |