December 4, 2020 • 43 mins
This week we are speaking with Trystan Hawkins from the Chelsea and Westminster Hospital in London.
Trystan is the Art Director and Patient Environment Director and works for the Hospital charity known as CW+.
Trystan is responsible for leading the vision for arts and design for CW+ in order to provide a first-class environment for everyone using the hospital.
In our conversation we discuss:
- The value of evidence-based design and how that impacts patient experience.
- Paediatric patient distraction techniques that the hospital has employed.
- How art has the ability to foster patient wellbeing and relationships.
You can find details of CW+'s design principals here.
Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Face Coverings. THANK YOU!
Thinking of Oscar website and contact details can be found here.
Follow us on Twitter here or Instagram here.
Theme Music - ‘Mountain’
–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast artwork thanks to The Podcast Design Experts
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Trystan Hawkins (00:00):
Develope this intervention called The Zoo and
basically its this screen on thewall, it runs all the time.
Every time I look at it, I seesomething new and I've seen it
dozens of times, but it'sbasically moving animal
portraits. These verybeautifully filmed, slightly
slowed down portraits ofanimals, just moving looking at
(00:22):
the viewer. There's about, Ithink there's about an hour and
a half of content. So we've donea study in terms of looking at
the impact of this and we've gota randomised control trial
running at the moment. We'retaking bloods. Before we had
this intervention, it could beup to seven minutes to take
bloods with this interventionthat's dropped to under three
(00:44):
minutes. There's also been, thisas a clinician reported study
before we've done the randomisedcontrolled trial, there's an 87%
reduction in perception of pain.
David (01:08):
Hello, and welcome to the Not Mini Adults Podcast,
Pioneers for Children's HealthCare and Well Being. This is
Episode 11 of season 2. My nameis David Cole and once again,
I'm joined by my wife, Hannah.
Together we are the co foundersof UK children's charity,
Thinking of Oscar. This week,we're speaking with Trystan
Hawkins from the Chelsea andWestminster Hospital in London.
(01:28):
Trystan is the Art Director andPatient Environment Director and
works with a hospital charityknown as CW plus. Trystan is
responsible for leading thevision for Arts and Design for
CW plus, in order to provide afirst class environment for
everyone using the hospital. Inour conversation we discuss the
value of evidence based designand how that impacts patient
(01:51):
experience. As well aspaediatric patient distraction
techniques that the hospital hasemployed. Finally, how art has
the ability to foster patientwell being and relationships. We
had such a fascinatingconversation with Trystan, and
we hope you enjoy and take awayas much from it as we did.
(02:30):
Trystan, Hi, thank you so muchfor joining us on the Not Mini
Adults podcast.
Trystan Hawkins (02:35):
Hello, yes, it's a pleasure to be here.
Thank you for inviting me.
David (02:38):
Well, we were delighted to have you on and I think the
the conversation that we'regoing to have today is going to
be slightly different to some ofthe ones that we've had
previously. There's definitethemes that go through our
podcasts and I guess patientexperiences is one of them.
Obviously, so important when itcomes to children and children
being in that kind ofenvironment of a hospital
(02:59):
setting. So you know whatabsolutely, you know, delve into
that and understand what you'redoing in Chelsea and
Westminster. But maybe if youcould start as we as we tend to
do just talk a little bit aboutyourself and how you've got to
be doing what you're doing andwhat that involves, please.
Trystan Hawkins (03:16):
You know, I'd love to. So my kind of education
was fairly kind of unusual. So Iactually didn't go to school for
much my childhood. We livedabroad, we lived in France, then
Scotland and we kind of werequite nomadic as a family. So my
kind of career path has beenquite random. I really interest
(03:38):
in the kind of environment and Ispent quite a number of years
working with horses. Soactually, my plan was to be a
professional eventer of ridinghorses and also training horses.
I did that for about three yearsuntil I was I think 17. Then I
was kind of really gripped bygoing into medicine and in
(03:59):
particular Veterinary Science.
So that was my plan. But I hadabsolutely no qualification. So
I went to ,I think it was aTechnical College, that's what
it was called then and startedtrying to get the different
qualifications that I needed togo to university, which was a
real challenge. In that kind ofprocessI decided that actually
wasn't very academic. I havequite severe dyslexia. So that
(04:19):
was a real challenge at thattime because it wasn't really
recognised. So I went into thearts, which again, I had a real
interest in so went to artcollege, did an AMA in
filmmaking, actually in Berlin.
Then came back to the UK and wasquite kind of socially engaged.
(04:40):
So I was kind of working withGreenpeace and Friends of the
Earth and organisations likethat and was interested in terms
of how you could use the arts tobe kind of socially engaged. So
then I worked with young peopleat risk, worked with big people
with disabilities, but trying towork within the mainstream. So
really what I was doing wastrying to work with groups that
(05:02):
might have been excluded fromworking within mainstream arts.
At that time, that was quiteunusual work. Now it's very
commonplace, but this was kindof in the late 80s, early 90s.
So that kind of led me toworking more mainstream within
the visual arts, which is reallywhy I've been working since that
time. So of leading artsorganisations working across art
(05:24):
forms often. I had a job in inCambridge, which was running an
Art Centre and as part of thatwe did a major capital
development around the centreand that got me really
interested in built environmentin terms of architecture, and
how spaces made people feel. Aspart of kind of leading the
programme at our centre, whichis called Wising Arts, we did a
(05:46):
lot of collaborations with kindof science and research that was
taking place in what's calledsilicon fen, you know, in and
around Cambridge. One of thoseprojects was working with
Papworth Hospital and we had aan artist called Jordan Baseman,
who is doing a moving imagebased project looking at people
that are having hearttransplants. As part of that
(06:07):
process, I spent a lot of timekind of shadowing him, working
with him within an operatingtheatre environment. Which was
really challenging because Ithink me like a lot of people,
you know, when you go into thehospital, that they've quite
unnerving spaces, you know, justthings like the lighting or the
smells, the wayfinding, thecolours and that really struck
(06:27):
me because I was doing this workwith the commission for
architecture in the builtenvironment in terms of creating
a fantastic new Art Centre. Thengoing to these hospitals are
pretty awful and made me feelreally uneasy. So that kind of
really started an interest in interms of built environment in
terms of how that can affectpeople. In particular, around
(06:49):
kind of healthcare buildings. Sofollowing on from that job in
Cambridge, I went down to thesouthwest to work on a major new
development of new hospitals inExeter, Plymouth, Devonport and
Truro. So that was reallylooking at how we could kind of
maximise design, as well asintegrating the arts. But to be
honest, most of the work that Iwas doing was around design. So
(07:11):
things like colour, lighting andacoustics, those things that
often don't get factored intoprojects within the NHS. Then
from that, I went back intomainstream art, so I was running
the Royal Academy of Arts in inBristol, a really old
organisation with big collectionand 130 academicians. Then was
approached about the work atChelsea. So Chelsea is a
(07:33):
fascinating environment in termsof its work within arts and
health, it has a real trackrecord, but in terms of its role
within healthcare it is one ofthe first hospitals to be set up
in the UK. So it's over 300years old, it opened, I think,
in 1719. So it's one of thefirst charity run hospitals to
(07:53):
be established in the capital,London.It was then called the
Westminster Hospital. n In thelate 80s, they were looking to
kind of consolidate a number ofhospitals onto the site that we
currently occupy. So that was abrand new hospital, it was quite
forward thinking. They had areally great team of architects
(08:15):
that worked on it calledSheppard Robson. They developed
a building, which opened in1993, which was kind of really
pushing the envelope. So whenyou go into the space, even
today, it feels very differentto a lot of hospitals, it's very
light, it's very airy. But oneof the things that they wanted
to consider in terms ofdeveloping this space, where you
could open any internal windowand get fresh air. It's got a
(08:36):
very kind of sophisticated airhandling system, which was also
very sustainable in that it wasbringing in air from the
outdoors into the central atriumwithout using a lot of
mechanical engineering. So thebuilding is kind of flooded with
light, big open spaces. Theother really important thing was
(08:56):
that they kind of thought aboutartwork, you know, as they were
building the new building. Sothere were huge sculptures built
into the foundations and there'sover 2000 works of arts, you
know, within the clinical areas,but also within the atrium
space.
David (09:14):
One of the things that I was doing the research was that
I am right in saying that thehospital has museum status.
Trystan Hawkins (09:21):
We used to have museum status. So when I joined,
we spent quite a lot of timebecoming an accredited museum.
You know,and as a curator, Ithought that was fantastic. I
was coming from my previous job,which was also a museum and I
was thinking well hang on, we'vegot over 600 works in storage,
which because we were a museum,it was really complex to
deaccession those we couldn'tjust sell them or dispose of
(09:42):
them. We had to go for a reallylong process and we were
spending huge amount of time andmoney being a museum and I
thought well hang on, you know,we're here that our primary
function is around a hospitalIt's about the experience of pat
ents, families and the staff woring for us. Was this the Less us
of resources? I think the othr thing I was interested in was
e have a collection. You kno, we've got some really valua
(10:05):
le works within that collecton, which may be great back i
the late 80s, or 90s. But nowwe're quite tired and how we m
ght look at the collection aan asset, which we obviously in
est in good art, we show it, butthen perhaps, when that's serve
its purpose, we monetize it,and we sell it. So we've droppe
the museum status, we still looafter the collection t
(10:26):
museum standards. But for me,hat was really important. It's
bout the primary function isround, optimising the patie
t experience of peopleusing the hospital and hospita
s change. Every years somethingchanges, you know, the space th
t we might have thought waskind of sacrosanct and wasn't
onna change, you know, in 1months time that will need to
(10:47):
change because the building ian evolving organism. I t
ink the other thing is, we'reeally constrained with the f
otprint, we're located in an ara which house prices are very
David (10:58):
I'm glad you mentioned that, because I was gonna say,
igh, you know, the surroundingandscape around the hospi
al is quite fixed. So we can't rally extend beyond the current
arameters of the buildingfor anyone that's listening,
that doesn't actually realisewhere the Chelsea and
Westminster hospital is inLondon, it's in a, you know,
(11:18):
middle of London in a very, Iguess, sought after district, as
it were. Lots of residential andeverything else nearby a
football stadium, as wediscussed and everything else.
So yes, the ability to add asmuch change, I guess, as, as you
have in the last kind of 300years, not you personally but at
(11:40):
the hospital in itself. To tryand maintain that kind of modern
day attire, and to really lookat, you know, what your patients
are needing now and be able togive them that environment, I
think is, you know, it is areally great story in itself.
With everything that we'veeverybody that we've spoken to
(12:04):
it's, it's that kind ofserendipity as to what brought
you to the hospital and whatyou're doing now, which I think
is really interesting. So canyou give us an overview as to
what your role is and how that'sworking? The the kind of patien
experience element to it please
Trystan Hawkins (12:23):
Yeah, no, absolutely. So I kind of have
two roles. So when I joined CWPlus, I work for CW Plus, which
is a charity that exists forChelsea and Westminster
hospital. So essentially, we'reone team, but I'm paid for by
the charity. So my role is asArts Director, so we have a big
arts collection, we have over2000 works. But then we also, I
(12:49):
kind of have sort of two jobtitles, because I thought
sometimes when I'm using ArtsDirector within an NHS
environment. Why have you got anArts director? so I'm also
Director of PatientEnvironments, and I'll use those
two titles in different waysfrom talking to an arts audience
or a health health audience. SoI guess most of my work really
is as Director of PatientEnvironment. What that means is
(13:13):
how we can really maximise theexperience for people coming in.
That's often through the builtenvironment. So, you know, a lot
of the work that we're doing isdriven by capital schemes. But I
think we will also kind ofquestion, you know, looking from
the outside in terms of, youknow, the NHS may have been
delivering a service in aparticular way for, say, 20
years. Why is that? So, youknow, one of the things I love
(13:37):
about my job is when we'reworking on a new project and
perhaps I can give someexamples. So, you know, for the
past four years, we've beenleading a programme around
critical care. So that's beenaround a new neonatal intensive
care unit and an adult intensivecare unit. So as part of that
process, we were able to say,look, let's look at what's out
there in terms of what'savailable within the UK, but
(14:00):
also what's available within theworld. So really not being
constrained by parameters thatmight usually happen on an NHS
project where, you know, there'sa set of standards that we build
things to in the NHS. They'vegot hospital building notes, and
they're kind of laid down by theDepartment of Health in terms
of, you know, the veryfunctional elements of the
(14:21):
building space. What that needsto look and feel like. You know,
I think there's a lot oflearning, which takes some time
perhaps to filter into that wayof working. So a lot of my role
is really questioning andlooking at best practice
elsewhere and then trying totranslate that into something
that can work within the NHS.
The other thing that I'm reallymindful of within everything
(14:42):
that we're doing is the costbenefits. So, you know, we know
that things like Arts and Designare extremely valuable within
healthcare settings, but often alot of the reason those things
aren't happening is because theycost more money. Whereas in
reality, you know, my experienceis that sometimes they don't
cost any more money. It's justabout being careful and perhaps
(15:03):
taking more time and weavingthat into the whole design
process.
Hannah (15:11):
How do you prove out that cost benefit part of your
work?
Trystan Hawkins (15:17):
So that that is a challenge? I wouldn't say we
always get it right. So if we'relooking at say something like,
one of the things that I'mreally focused on is noise. So
noise in hospitals. So, youknow, something that struck me
when I go into hospital is hownoisy they are, the effect that
that noise can have on people.
But then you can think well,hang on, I'm actually going to
(15:40):
measure the cost benefit benefitof that where you're probably
not, you know, there is researchthat has shown that over a
certain number of decibels,staff are more likely to make
mistakes. There's a study donein Boston, back in 2013, which
looked at what level, the staffstart making mistakes and the
noise level is actually quitelow. I think it's around 38
(16:02):
decibels, which is, is notparticularly noisy. So to
actually measure that within theNHS would be, I think, very
impractical, it wouldn't be aneasy thing to do. But I know
that that is a reality that, ina noisy, busy environment,
people are more likely to makemistakes. That will have a knock
(16:23):
on effect in terms of cost, interms of, perhaps people being
given the wrong medicines ormaking mistakes, which could
then have an impact in terms ofmitigation or whatever. So I
think the most tangible exampleof cost benefit for me at the
moment would be you know, wherewe're able to do things more
quickly. We've got a greatproject we've been doing in our
(16:45):
paediatric AME. So that was aproject that we did a couple of
years ago. So we redeveloped thewhole department. It's one of
the largest agencies in London,runs from the front of the
hospitals to the back. So it'sabout 800 metres long, it's
vast, really beautiful. Withinthat we've got a dedicated
paediatric area with 16,treatment cubicles. We've
(17:08):
designed those so that they'rereally flexible. So we can do
things like we can adjust thelighting levels, this bespoke
music. So we've got eightdifferent playlists that you can
just press a button. That kindof immediately kind of creates a
different sound, within thatspace, you can change the volume
level. But one of the one of themost exciting things is we've
(17:29):
got this thing called the Zoo,which is essentially it's a
portrait screen. Roughly, I'mtrying to think of dimensions,
probably about 40 centimetres by120 centimetres. When we were
doing consultation for theproject, so I mean, that's the
other thing is we're reallydemocratic in terms of the way
(17:50):
that we develop things. So wejust spend time in a space. So
typically, that means, you know,I might put scrubs on I'll do
shifts, I spend different timesof the week working in the space
and just trying to understandwhat are the what are the
problems. When I was doing thatwork, you know, we were talking
to the children and young peopleabout what they would like.
Harry Potter was kind of all ofthe rage at that time. One of
(18:13):
the things you know, that kidswere saying was that they'd love
to help with the moving HarryPotter portraits. The other
thing I noticed was that oftenwhen painful or unpleasant
things were happening, you know,like taking blood, or even
taking blood blood pressure.
Doctors were getting theirphones out and finally got a
(18:36):
video on YouTube to show thekids to act as a distraction
while they were doing things. Ifwe could build that into the
environment, that would bereally, really strong. So we've
developed this interventioncalled the Zoo, and basically it
says this screen on the wall, itruns all the time. Every time I
look at it, I see something new.
I've seen it dozens of times,but it's basically moving animal
(18:58):
portraits. These verybeautifully filmed, slightly
slowed down portraits ofanimals, just moving looking at
the viewer. There's about Ithink there's about an hour and
a half of content. So we've donea study in terms of looking at
the impact of this and we've gota randomised control trial
running at the moment that we'retaking bloods. Before we have
(19:21):
this intervention, it could beup to seven minutes to take
bloods with the interventionthat's dropped to under three
minutes. There's also beenmissing as a clinician reported
study before we've done therandomised controlled trial,
there's an 87% reduction inperception of pain. So if we're
going back to what is the costbenefit, the cost benefit is the
(19:43):
time we're saving. So we're ableto take bloods more quickly. So
we are the halving the timearguably. I think the other
thing is that the distractionthat could be caused by siblings
or parents, that there's been ahuge benefit there as well in
terms of focusing them onsomething else, other than
what's happening to them. Soit's something that we are still
(20:03):
working on. But that wasprobably one of the most
tangible examples that I couldgive you at the moment.
Hannah (20:27):
I suppose you don't have to? Well, you need to correct my
assumption. But I was thinking,you don't have to pull out the
cost benefit for absolutelyeverything you do, because you
can build credibility throughthat. Then other initiatives
that you do that might be harderto, like the noise example that
you cited, or everything thatyou described about, even with
the noise piece. My examples arecoming from children, but it'd
(20:49):
be for any patient, if you'regetting some decent sleep, then
it's understood that supportsyour healing process, all your
anxiety levels. So the impact ofreduced noise on the patients is
significant in a different waythan the impact of noise from
the clinical side. Buteverything else that you
described in the building spaceto do with the other senses, so
(21:13):
lights or smells, how you makepeople feel. I can see that
there's so much there that it isintangible, but for the end to
end patient experience fromarrival to departure. Positive
changes there could could impactthem in many ways.
Trystan Hawkins (21:34):
No, absolutely.
I mean, we have other projects,which we're working on, which
have been kind of built withthat in mind in terms of looking
at cost benefits. So with thenew neonatal intensive care
unit, which has just opened, Imean, we're not completely open
yet. So two thirds of it isopen. There's another third
that's still being built. There,we really focused on the quality
(21:55):
of the environment for neonates.
So, you know, looking at theimportance of natural light,
again, of noise levels, so we'vekind of optimised that whole
environment. We've measured whatthe environment was like before,
so we understand what it waslike in terms of light, levels
in terms of noise, temperature,air quality. Then over the next
(22:16):
couple of years, we'll bemeasuring the change and then
looking at what was actuallyhappening to those babies, how
are things different now? I'mpretty confident that we'll see
a change for the better. But wedon't know that yet.
Hannah (22:29):
You talked about being one team. I'm curious about with
everything that you've beendescribing how you work with
your. You're employed by thecharity, but you're working hand
in hand with colleagues in thehospital? Can you describe that
dynamic for us, please?
Trystan Hawkins (22:44):
Yeah, I mean, I think the first thing to say is,
you know, we have a fantasticteam at Chelsea. I think people
are really open to differentways of working. When I was
thinking of taking the job, Icame down and met, you know,
different people. That was oneof the key attractions to work
there was, you know, we've got apretty unusual team. So we will
often come up with some quitewacky ideas, and there's a real
(23:08):
openness to kind of, toexperiment, to try new ways of
working. So I think, you know,the way that I work is very, you
know, we've kind of very handson, getting to know as many
different people of buildingrelationships. Which could be
with a, you know, yesterday Iwas with the Chief Executive for
the hospital. Im in in regularcontact with her but equally
(23:31):
with reporters or the healthcareassistants. So yeah, I find
nothing better than putting onscrubs. Just immersing yourself
in an environment because peoplewill talk to you in a different
way. I think that that's beenreally good. I think in terms of
building respect and peopleunderstanding what we're doing.
I think the other thing is, theartists and designers that we're
(23:53):
working with, that's one of thekey qualities that I look for in
them is that they're really goodcommunicators. Some of the ideas
that we're working with might bequite kind of the higher end of
contemporary art, but of findinga way of presenting that to
people that may not be asexperienced of that world and
they may not go to galleries. Sofor me that is the most
(24:15):
successful way of working.
Certainly in terms of the teamthat I work with, in terms of
the people that we're bringingin, that's a key quality. I
think the other thing is time,you know, it takes time to build
relationships and of allowingfor that within projects. You
know, give you an example we'reworking with an artist, British
artist called Isaac Julian. Hedoes, you know, absolutely
(24:36):
stunning video installations.
His work is quite challenging.
It's quite political. Itprobably took about four years
to develop a piece with himwhich would work within the
hospital. It's within theatrium. It's a big five screen,
installation of moving image. Itkind of runs continuous. I was
(24:58):
kind of slightly unsure as tohow that would work within the
environment, but it's beenreally well received and people
love it. I think you have tohave a piece like that which
could be by, you know, an artistwho's exhibiting internationally
quite cutting edge work withinthat kind of environment is
absolutely fantastic. So I thinkof educating people to different
(25:22):
ways of working. Equally,sometimes, you know, it doesn't
go as planned, it goes wrong. Sowe're doing a lot of work with
new technology. That doesn'talways work. But I think again,
that's part of the process.
We've been working with virtualreality for probably about two
years now. We've got about fourdifferent projects and so far,
(25:45):
one of those has worked. Ithink, yeah, that's acceptable.
It's part of the way we work. Wekind of factor that in. The
other thing we're looking at isrobots. So we're working with
robotic pets. So we have anintervention called Parow, which
is intervention developed inJapan. It's a furry seal works
(26:06):
particularly well with kind ofpaediatrics and older patients.
Then we have another robotcalled Miro. That's been less
successful. But we're workingwith the team that have
developed that in terms of howcan we learn from that and
modify it. I think this is justpart of working with those
technologies that, you know,things like VR headsets, you
(26:28):
know, the VR headsets areavailable last year compared to
now so different in terms ofbattery life or connectivity. So
that's a part of our work andthat comes under an umbrella of
programming called the FutureHospital.
David (26:42):
So I was going to ask about the part one of the
strands, I guess, of the charityis the CW innovation. So you're
doing a lot around innovation? Imean, you just described a
couple of elements to it there.
But how, I guess, how did thatcome about? What have you, what
have you learnt through that?
Trystan Hawkins (27:00):
So in terms of CW and innovation, you know, I
have a standard work within myprogramme, which is called
Future Hospital. That's reallylooking at how we can use new
and emerging technologies withina healthcare environment. So one
of the components of that I'vementioned already, which is
about understanding environment.
So as part of understanding theenvironment, we've developed
four different sensors. So we'relooking at air quality,
(27:22):
temperature, noise, and light.
So those sensors didn't existand we worked with companies to
develop a series of sensors,which are cloud based. We're
measuring those environmentalfactors every five seconds,
building up a profile of aspace. So the the aim with that
(27:43):
work is it gives us a reallyuseful tool in terms of, we can
In terms of sharing, you'vepublished some design standards
be using it within our hospital.
But the ambition is that thiscan be something which is shared
more widely within everyhospital. So I think certainly,
in terms of some of the workthat we're doing around new
technology, it's aboutinitiating, it's about testing,
it's about building an evidencebase, which we can then share.
So project like the Zoo, which Imentioned, you know, we are now
(28:05):
sharing that with otherhospitals. We'll make sure it
works, and then offer that freeof charge. So we're not charging
for that work. We have anotherinitiative which comes under
that umbrella, which is calledRelaxed Digital, and it's again
moving image base work. We hae 60 hours of content and then d
fferent types of playlits for different types of enviro
(28:28):
ments. We offer that contenfree of charge to either
HS, hospitals or environments.
've lost my train of thought,'m sorry.
(28:49):
as well. So a white paper arounddesign standards, which I've,
you know, which I've lookedthrough and it's fascinating. I
think, you know, some of thethings that you've talked about
today are covered in it, butit's a, you know, it's a great
kind of blueprint to give toanyone that's either looking to
tweak the facilities thatthey've got, or, you know,
there's actually quite a few newchildren's hospitals that are
(29:12):
looking to be built or are beingbuilt in and around Europe in
the in the coming years.
Yeah, absolutely. You know, wedevelop the the design
standards, initially just towork within our own teams. So
one of the things that we foundwas happening was, you know,
the states teams or facilitatorswill be working on a project,
(29:32):
you know, sometimes we wouldn'tfind out about them until quite
late along, you know, that kindof process. So he's already
agreeing a set of standardswithin the organisation that we
work to, you know, somethinglike Wayfinding you know, is
often quite bad in a hospital.
So how can we just haveconsistency in terms of fonts
that in use, size of signs, thatkind of stuff. So the the design
(29:53):
standards really look ateverything that goes into a
built environment. There's astandard that our organisation
works to, but you know, we arenow sharing that more widely.
The other thing is, it's notstatic. So it is changing all
the time, you know, we will hearnew things, so on our existing
design standards, We're doingmore work on is around acoustics
(30:14):
and learning from that. As alsonew materials become available,
those can be kind of woven intoit. So we share that work,
there's a group called theNational Performance Advisory
Group within the NHS. We're partof that and this is a way that
we can kind of disseminate thatlearning quite quickly. I think
the other thing is that we havea range of different partners,
(30:38):
you know, that we're workingwith. So for example, the work
around acoustics we've workedour tean for many years now and
also Fosters. So how we can kindof share some of that
opportunity we have that perhapsothers don't have. Within that
we also have internationalpartners that we're working
with. So particularly aroundsome of the work we're doing
(31:00):
with new technology, we've gotpartners in Japan, China and
South Korea. So it can be a wayof kind of disseminating things
that are happeninginternationally as well.
Hannah (31:14):
Does the scope of the work that you're doing involve.
I'm thinking with patientexperience, it might involve the
participation of patients in artactively producing art or being
creative themselves? Or is thatthe remit of a different part of
the organisation?
Trystan Hawkins (31:33):
No, so we have a, we've got kind of three
strands to our work. So we haveone, which is around the
collection, and, you know, kindof crudely as about pictures on
walls. We've got FutureHospitals, which is around
technology, and then anotherone, which is called Arts For
All. So this is aroundparticipation. So we have a team
of artists who are coming inevery day, I mean, obviously at
(31:55):
the moment, we're still kind ofin COVID. So that's been
challenging. But normally,you're more or less every day of
the week, we would havesomething happening in terms of
participation with a range ofdifferent patients from children
through to older people. Interms of approach that's also
very broad. So yeah, one end ofthe spectrum we've got. Dogs
(32:19):
that we bring in, so we havekind of petting dogs that will
come in. Gardening through todigital projects with patients
making music, at bedside. Sothat is a really, really
important part of our work isaround process and engaging with
patients. Often it's withpatients that are with us for a
longer period of time. So that'sreally important in terms of
(32:41):
their rehabilitation, but alsojust kind of socialisation,
whether that's with an externalperson coming in or with other
patients. So for example, youknow, some of our ward areas
have a six bedded bay. Oftenwhat we will be doing is a
collaborative piece, which isengaging with those six patients
that are sharing the same spacetogether. Because that will then
(33:04):
have huge benefits when theartist leaves in terms of at
least they might know the nameof the person next to them, I'll
know a bit more, but it willhave started a conversation,
which might not other wise bethere. I think the other really
important part of that is itgives the staff skills which
they can use in different ways.
So that kind of softer side ofnursing, which is around
(33:24):
understanding people, you know,talking with them, you know,
getting to know the families.
Which sometimes depending on theenvironment, there isn't a time
to do that. So I think ways thatwe can help with that it's
really important.
Hannah (33:41):
I can understand that COVID could easily have
inhibited and made it extremelydifficult for you to continue
that level of service over thelast few months. Has there been
examples where it's created anew opportunity? Or is it simply
been challenging times?
Trystan Hawkins (33:59):
Yeah, I mean, you know, COVID has been hugely
challenging. But I think, youknow, for me, one of the really
positive things that I've seencome out of this is, you know, a
sense of community in terms ofwithin the hospital. I think
also within within the widercommunity of people just looking
out for each other. For us,practically we've had to change
the ways that we're working. Sowith the participant troup work,
(34:22):
we've developed a virtual strandof that works. It's called
Virtual Connections. So it's ourartists creating work which
exists online that patients canaccess, but equally doing things
which are remote. So you know,one of the things that you know,
we've been doing since June islive performances for patients
(34:46):
in the hospital so we'll have amusician who is in their home.
Ee will go into the ward areawe'll put on the PPE and then we
will facilitate an interactionbetween an artist who is remote
and that patient. So, you know,one of the sessions I did a
couple of months ago is with apatient who had COVID. He was
coming out the other end beingwith us for 100 days. He was
(35:10):
quite lonely. He didn't reallyhave any friends. He didn't have
any family. He didn't have asmartphone. So, you know, his
life was incredibly boring. Hewas getting better, which was
fantastic. But for him to beable to have that connection
with the outside world was soimportant. With some of our
paediatric patients, we'velinked him with San Diego Zoo.
(35:33):
So we have a live stream fromSan Diego Zoo into the
paediatric areas. So it's not atwo way feed, but in terms of
live content coming into thatenvironment. So things like
that, I think, you know, withinCOVID have been really positive.
I think also in terms of newthinking, for example, like with
(35:54):
our outpatient clinics, youknow, 70% of those are now being
delivered virtually throughSkype or zoom or whatever. Yeah,
which is brilliant, because thatcan carry on, it just means that
the hospital can run moreefficiently. It's a better use
of people's time.
David (36:11):
I've just got a couple more questions. One of which is
what kind of feedback have youhad from children? You know,
specifically around I mean,something that we have, you
know, done quite a lot of workaround is that distraction
elements, is trying to make, youknow, procedures a little bit
easier for children. Last week,we were talking to someone that
(36:31):
was Evelyn, who's doing a lot ofwork around VR, and looking to
bring that in. But, you know,specifically around the Zoo
project, or, you know, any ofthe other kind of interactive
elements or distractionelements, what kind of feedback
have you have you received fromeither the children or indeed
the parents as well?
Trystan Hawkins (36:54):
Yes, I mean, I think, you know, I mentioned
already that, you know, our workis really driven by the people
that we're working with. So it'saround finding appropriate ways
that you can engage with them.
So we use kind of the formalgroups that exist within
hospitals, you know, patient,public engagement teams, but a
lot of our work is just aboutspending time in a treatment
(37:15):
area or waiting room and justtalking to people. Sometimes we
use questionnaires, but oftenit's about just talking to
people, but also just observingthe situation. So I think, you
know, we're trying to makespaces as unfrightening as we
can, we're trying to make themas domestic as we can. You know,
if we just go back to the A&Eproject. The really simple thing
(37:37):
that the first meeting I hadwith the architects, when we
were developing that the newunit. I said, Well, what are the
acoustic properties for thesetreatment rooms, and they'd like
to blank and said, well, therearen't any. So we, the charity
paid for ceiling tiles that hada property in terms of absorbing
(37:59):
sound. Ee were able to reducenoise levels throughout the
whole A&E by 28%. So youknow,when kids are coming into
that A&E it feels very quiet,we've got the different
distractions within the space.
We've also given them controlover some things within that
space things like the light,we've got music, we've also got
(38:23):
virtual reality that we're usingwithin paediatric A&E as well.
So that's a tool which isavailable. So I think really,
it's about giving people controland allowing them to make some
choices. The feedback that weget, you know, is always
positive. Otherwise, we wouldn'tbe doing it. Occasionally, you
know, we have had, you know,perhaps some negative feedback
(38:45):
about some artwork. Obviously,then we've changed that. I think
the other thing is alsorecognising that, you know, you
may do something and then, youknow, it doesn't finish, you
need to keep looking after that.
So an example would be, we'vegot an area for relatives,
which, you know, it's where theyhad bad news. We've learned from
(39:06):
people using that space in termsof how it made them feel. One of
the things that came back was,you know, it wasn't warm enough,
the air handling was too cold.
So how can we physically warm upthat space, but also kind of
learn from the way that peoplehave been in that environment
and make it better? So, youknow, I think, as an
(39:27):
organisation, we never finishedprojects, we always go back and
change them and redevelop them.
I think that's really importantwith technology that, you know,
I've seen some really greatprojects around the country. But
then after 12 months, they breakand then, you know, the states
team don't have the client tofix them. That is a reality of
working within the NHS. So wetake that responsibility in
(39:49):
terms of looking after thingsand replacing things when they
get broken or tired ordecommissioning them. So I think
it's really important to thinkabout decommissioning when
you're working on these thesetypes of projects.
David (40:04):
Justin, thank you so much, I think you've opened our
eyes to, you know, so manydifferent kind of facets and
even as you were justdescribing. Thinking about how
the longevity of, you know,technology that you put in to
into a system or, you know, intoa paediatric unit, or whatever
it might be. But also, you know,as a charity, we're looking to
(40:25):
bring, you know, the future ofhealth care to children. I think
when people look at that, theconnotation is that it's always
going to be technology, it'salways going to be, you know,
the latest and greatest, and,you know, the singing and
dancing, whatever it might be,but actually, there are so many
different elements to that. It'sthe latest research, it's the
latest evidence, it's, you know,as you describe just the
(40:47):
artistic elements of it, tryingto think how best to look after
the patients and what they needand everything else. I think,
you know, for us, it's been afascinating conversation and
something that you know, we'llthink about when we're looking
at some of the projects thatwe're going to be doing into the
future. The final question thatwe ask everyone that comes on
the podcast, is, if you had amagic wand, and you could do
(41:11):
anything, when it comes to childhealth, what would that be?
Trystan Hawkins (41:17):
So I think, you know, for me, it would be
focused around giving children,young people, some control or an
element of control over theenvironment that they're in. You
know, I think a lot of thethings that we're doing are
really simple and there not,perhaps that expensive either.
So I think the building incontrol. So for me it would be
(41:38):
around the environment thatthose children are in simple
things like, you know.
Somewhere, they can charge thephone, somewhere where they can
dim the lights. Yeah, I thinkwould be fairly key to me.
David (41:53):
Perfect. Thank you, Trystan. Thank you so much for
your time, you know, we reallyappreciate it and good luck with
all the work that you're doing.
Trystan Hawkins (42:00):
Great. Thank you very much.
David (42:03):
Thank you so much for joining us once again on the Not
Mini Adults and a big thank youto Trystan Hawkins for joining
us this week. Details ofThinking of Oscar and also the
work that Tristan is doing withCW plus will be in the show
notes. If you know someone thatyou think that we should be
talking to, or a topic thatyou'd like us to cover on the
podcast then please do get intouch. Next week is the final
(42:24):
episode of season two before wetake some time off for Christmas
and then resume again in the newyear. We're really excited about
our final conversation, whichwill be with Dr. Todd Ponsky
from the Cincinnati Children'sHospital. Dr. Ponsky is a
paediatric surgeon, but alsoDirector of Clinical growth and
transformation at syndicates. Inhis own words, he focuses on
(42:45):
trying to find the leastinvasive way to solve a child's
medical problem. We really hopeyou can join us again next week.
Develope this intervention called The Zoo and
basically its this screen on thewall, it runs all the time.
Every time I look at it, I seesomething new and I've seen it
dozens of times, but it'sbasically moving animal
portraits. These verybeautifully filmed, slightly
slowed down portraits ofanimals, just moving looking at
(00:22):
the viewer. There's about, Ithink there's about an hour and
a half of content. So we've donea study in terms of looking at
the impact of this and we've gota randomised control trial
running at the moment. We'retaking bloods. Before we had
this intervention, it could beup to seven minutes to take
bloods with this interventionthat's dropped to under three
(00:44):
minutes. There's also been, thisas a clinician reported study
before we've done the randomisedcontrolled trial, there's an 87%
reduction in perception of pain.
David (01:08):
Hello, and welcome to the Not Mini Adults Podcast,
Pioneers for Children's HealthCare and Well Being. This is
Episode 11 of season 2. My nameis David Cole and once again,
I'm joined by my wife, Hannah.
Together we are the co foundersof UK children's charity,
Thinking of Oscar. This week,we're speaking with Trystan
Hawkins from the Chelsea andWestminster Hospital in London.
(01:28):
Trystan is the Art Director andPatient Environment Director and
works with a hospital charityknown as CW plus. Trystan is
responsible for leading thevision for Arts and Design for
CW plus, in order to provide afirst class environment for
everyone using the hospital. Inour conversation we discuss the
value of evidence based designand how that impacts patient
(01:51):
experience. As well aspaediatric patient distraction
techniques that the hospital hasemployed. Finally, how art has
the ability to foster patientwell being and relationships. We
had such a fascinatingconversation with Trystan, and
we hope you enjoy and take awayas much from it as we did.
(02:30):
Trystan, Hi, thank you so muchfor joining us on the Not Mini
Adults podcast.
Trystan Hawkins (02:35):
Hello, yes, it's a pleasure to be here.
Thank you for inviting me.
David (02:38):
Well, we were delighted to have you on and I think the
the conversation that we'regoing to have today is going to
be slightly different to some ofthe ones that we've had
previously. There's definitethemes that go through our
podcasts and I guess patientexperiences is one of them.
Obviously, so important when itcomes to children and children
being in that kind ofenvironment of a hospital
(02:59):
setting. So you know whatabsolutely, you know, delve into
that and understand what you'redoing in Chelsea and
Westminster. But maybe if youcould start as we as we tend to
do just talk a little bit aboutyourself and how you've got to
be doing what you're doing andwhat that involves, please.
Trystan Hawkins (03:16):
You know, I'd love to. So my kind of education
was fairly kind of unusual. So Iactually didn't go to school for
much my childhood. We livedabroad, we lived in France, then
Scotland and we kind of werequite nomadic as a family. So my
kind of career path has beenquite random. I really interest
(03:38):
in the kind of environment and Ispent quite a number of years
working with horses. Soactually, my plan was to be a
professional eventer of ridinghorses and also training horses.
I did that for about three yearsuntil I was I think 17. Then I
was kind of really gripped bygoing into medicine and in
(03:59):
particular Veterinary Science.
So that was my plan. But I hadabsolutely no qualification. So
I went to ,I think it was aTechnical College, that's what
it was called then and startedtrying to get the different
qualifications that I needed togo to university, which was a
real challenge. In that kind ofprocessI decided that actually
wasn't very academic. I havequite severe dyslexia. So that
(04:19):
was a real challenge at thattime because it wasn't really
recognised. So I went into thearts, which again, I had a real
interest in so went to artcollege, did an AMA in
filmmaking, actually in Berlin.
Then came back to the UK and wasquite kind of socially engaged.
(04:40):
So I was kind of working withGreenpeace and Friends of the
Earth and organisations likethat and was interested in terms
of how you could use the arts tobe kind of socially engaged. So
then I worked with young peopleat risk, worked with big people
with disabilities, but trying towork within the mainstream. So
really what I was doing wastrying to work with groups that
(05:02):
might have been excluded fromworking within mainstream arts.
At that time, that was quiteunusual work. Now it's very
commonplace, but this was kindof in the late 80s, early 90s.
So that kind of led me toworking more mainstream within
the visual arts, which is reallywhy I've been working since that
time. So of leading artsorganisations working across art
(05:24):
forms often. I had a job in inCambridge, which was running an
Art Centre and as part of thatwe did a major capital
development around the centreand that got me really
interested in built environmentin terms of architecture, and
how spaces made people feel. Aspart of kind of leading the
programme at our centre, whichis called Wising Arts, we did a
(05:46):
lot of collaborations with kindof science and research that was
taking place in what's calledsilicon fen, you know, in and
around Cambridge. One of thoseprojects was working with
Papworth Hospital and we had aan artist called Jordan Baseman,
who is doing a moving imagebased project looking at people
that are having hearttransplants. As part of that
(06:07):
process, I spent a lot of timekind of shadowing him, working
with him within an operatingtheatre environment. Which was
really challenging because Ithink me like a lot of people,
you know, when you go into thehospital, that they've quite
unnerving spaces, you know, justthings like the lighting or the
smells, the wayfinding, thecolours and that really struck
(06:27):
me because I was doing this workwith the commission for
architecture in the builtenvironment in terms of creating
a fantastic new Art Centre. Thengoing to these hospitals are
pretty awful and made me feelreally uneasy. So that kind of
really started an interest in interms of built environment in
terms of how that can affectpeople. In particular, around
(06:49):
kind of healthcare buildings. Sofollowing on from that job in
Cambridge, I went down to thesouthwest to work on a major new
development of new hospitals inExeter, Plymouth, Devonport and
Truro. So that was reallylooking at how we could kind of
maximise design, as well asintegrating the arts. But to be
honest, most of the work that Iwas doing was around design. So
(07:11):
things like colour, lighting andacoustics, those things that
often don't get factored intoprojects within the NHS. Then
from that, I went back intomainstream art, so I was running
the Royal Academy of Arts in inBristol, a really old
organisation with big collectionand 130 academicians. Then was
approached about the work atChelsea. So Chelsea is a
(07:33):
fascinating environment in termsof its work within arts and
health, it has a real trackrecord, but in terms of its role
within healthcare it is one ofthe first hospitals to be set up
in the UK. So it's over 300years old, it opened, I think,
in 1719. So it's one of thefirst charity run hospitals to
(07:53):
be established in the capital,London.It was then called the
Westminster Hospital. n In thelate 80s, they were looking to
kind of consolidate a number ofhospitals onto the site that we
currently occupy. So that was abrand new hospital, it was quite
forward thinking. They had areally great team of architects
(08:15):
that worked on it calledSheppard Robson. They developed
a building, which opened in1993, which was kind of really
pushing the envelope. So whenyou go into the space, even
today, it feels very differentto a lot of hospitals, it's very
light, it's very airy. But oneof the things that they wanted
to consider in terms ofdeveloping this space, where you
could open any internal windowand get fresh air. It's got a
(08:36):
very kind of sophisticated airhandling system, which was also
very sustainable in that it wasbringing in air from the
outdoors into the central atriumwithout using a lot of
mechanical engineering. So thebuilding is kind of flooded with
light, big open spaces. Theother really important thing was
(08:56):
that they kind of thought aboutartwork, you know, as they were
building the new building. Sothere were huge sculptures built
into the foundations and there'sover 2000 works of arts, you
know, within the clinical areas,but also within the atrium
space.
David (09:14):
One of the things that I was doing the research was that
I am right in saying that thehospital has museum status.
Trystan Hawkins (09:21):
We used to have museum status. So when I joined,
we spent quite a lot of timebecoming an accredited museum.
You know,and as a curator, Ithought that was fantastic. I
was coming from my previous job,which was also a museum and I
was thinking well hang on, we'vegot over 600 works in storage,
which because we were a museum,it was really complex to
deaccession those we couldn'tjust sell them or dispose of
(09:42):
them. We had to go for a reallylong process and we were
spending huge amount of time andmoney being a museum and I
thought well hang on, you know,we're here that our primary
function is around a hospitalIt's about the experience of pat
ents, families and the staff woring for us. Was this the Less us
of resources? I think the othr thing I was interested in was
e have a collection. You kno, we've got some really valua
(10:05):
le works within that collecton, which may be great back i
the late 80s, or 90s. But nowwe're quite tired and how we m
ght look at the collection aan asset, which we obviously in
est in good art, we show it, butthen perhaps, when that's serve
its purpose, we monetize it,and we sell it. So we've droppe
the museum status, we still looafter the collection t
(10:26):
museum standards. But for me,hat was really important. It's
bout the primary function isround, optimising the patie
t experience of peopleusing the hospital and hospita
s change. Every years somethingchanges, you know, the space th
t we might have thought waskind of sacrosanct and wasn't
onna change, you know, in 1months time that will need to
(10:47):
change because the building ian evolving organism. I t
ink the other thing is, we'reeally constrained with the f
otprint, we're located in an ara which house prices are very
David (10:58):
I'm glad you mentioned that, because I was gonna say,
igh, you know, the surroundingandscape around the hospi
al is quite fixed. So we can't rally extend beyond the current
arameters of the buildingfor anyone that's listening,
that doesn't actually realisewhere the Chelsea and
Westminster hospital is inLondon, it's in a, you know,
(11:18):
middle of London in a very, Iguess, sought after district, as
it were. Lots of residential andeverything else nearby a
football stadium, as wediscussed and everything else.
So yes, the ability to add asmuch change, I guess, as, as you
have in the last kind of 300years, not you personally but at
(11:40):
the hospital in itself. To tryand maintain that kind of modern
day attire, and to really lookat, you know, what your patients
are needing now and be able togive them that environment, I
think is, you know, it is areally great story in itself.
With everything that we'veeverybody that we've spoken to
(12:04):
it's, it's that kind ofserendipity as to what brought
you to the hospital and whatyou're doing now, which I think
is really interesting. So canyou give us an overview as to
what your role is and how that'sworking? The the kind of patien
experience element to it please
Trystan Hawkins (12:23):
Yeah, no, absolutely. So I kind of have
two roles. So when I joined CWPlus, I work for CW Plus, which
is a charity that exists forChelsea and Westminster
hospital. So essentially, we'reone team, but I'm paid for by
the charity. So my role is asArts Director, so we have a big
arts collection, we have over2000 works. But then we also, I
(12:49):
kind of have sort of two jobtitles, because I thought
sometimes when I'm using ArtsDirector within an NHS
environment. Why have you got anArts director? so I'm also
Director of PatientEnvironments, and I'll use those
two titles in different waysfrom talking to an arts audience
or a health health audience. SoI guess most of my work really
is as Director of PatientEnvironment. What that means is
(13:13):
how we can really maximise theexperience for people coming in.
That's often through the builtenvironment. So, you know, a lot
of the work that we're doing isdriven by capital schemes. But I
think we will also kind ofquestion, you know, looking from
the outside in terms of, youknow, the NHS may have been
delivering a service in aparticular way for, say, 20
years. Why is that? So, youknow, one of the things I love
(13:37):
about my job is when we'reworking on a new project and
perhaps I can give someexamples. So, you know, for the
past four years, we've beenleading a programme around
critical care. So that's beenaround a new neonatal intensive
care unit and an adult intensivecare unit. So as part of that
process, we were able to say,look, let's look at what's out
there in terms of what'savailable within the UK, but
(14:00):
also what's available within theworld. So really not being
constrained by parameters thatmight usually happen on an NHS
project where, you know, there'sa set of standards that we build
things to in the NHS. They'vegot hospital building notes, and
they're kind of laid down by theDepartment of Health in terms
of, you know, the veryfunctional elements of the
(14:21):
building space. What that needsto look and feel like. You know,
I think there's a lot oflearning, which takes some time
perhaps to filter into that wayof working. So a lot of my role
is really questioning andlooking at best practice
elsewhere and then trying totranslate that into something
that can work within the NHS.
The other thing that I'm reallymindful of within everything
(14:42):
that we're doing is the costbenefits. So, you know, we know
that things like Arts and Designare extremely valuable within
healthcare settings, but often alot of the reason those things
aren't happening is because theycost more money. Whereas in
reality, you know, my experienceis that sometimes they don't
cost any more money. It's justabout being careful and perhaps
(15:03):
taking more time and weavingthat into the whole design
process.
Hannah (15:11):
How do you prove out that cost benefit part of your
work?
Trystan Hawkins (15:17):
So that that is a challenge? I wouldn't say we
always get it right. So if we'relooking at say something like,
one of the things that I'mreally focused on is noise. So
noise in hospitals. So, youknow, something that struck me
when I go into hospital is hownoisy they are, the effect that
that noise can have on people.
But then you can think well,hang on, I'm actually going to
(15:40):
measure the cost benefit benefitof that where you're probably
not, you know, there is researchthat has shown that over a
certain number of decibels,staff are more likely to make
mistakes. There's a study donein Boston, back in 2013, which
looked at what level, the staffstart making mistakes and the
noise level is actually quitelow. I think it's around 38
(16:02):
decibels, which is, is notparticularly noisy. So to
actually measure that within theNHS would be, I think, very
impractical, it wouldn't be aneasy thing to do. But I know
that that is a reality that, ina noisy, busy environment,
people are more likely to makemistakes. That will have a knock
(16:23):
on effect in terms of cost, interms of, perhaps people being
given the wrong medicines ormaking mistakes, which could
then have an impact in terms ofmitigation or whatever. So I
think the most tangible exampleof cost benefit for me at the
moment would be you know, wherewe're able to do things more
quickly. We've got a greatproject we've been doing in our
(16:45):
paediatric AME. So that was aproject that we did a couple of
years ago. So we redeveloped thewhole department. It's one of
the largest agencies in London,runs from the front of the
hospitals to the back. So it'sabout 800 metres long, it's
vast, really beautiful. Withinthat we've got a dedicated
paediatric area with 16,treatment cubicles. We've
(17:08):
designed those so that they'rereally flexible. So we can do
things like we can adjust thelighting levels, this bespoke
music. So we've got eightdifferent playlists that you can
just press a button. That kindof immediately kind of creates a
different sound, within thatspace, you can change the volume
level. But one of the one of themost exciting things is we've
(17:29):
got this thing called the Zoo,which is essentially it's a
portrait screen. Roughly, I'mtrying to think of dimensions,
probably about 40 centimetres by120 centimetres. When we were
doing consultation for theproject, so I mean, that's the
other thing is we're reallydemocratic in terms of the way
(17:50):
that we develop things. So wejust spend time in a space. So
typically, that means, you know,I might put scrubs on I'll do
shifts, I spend different timesof the week working in the space
and just trying to understandwhat are the what are the
problems. When I was doing thatwork, you know, we were talking
to the children and young peopleabout what they would like.
Harry Potter was kind of all ofthe rage at that time. One of
(18:13):
the things you know, that kidswere saying was that they'd love
to help with the moving HarryPotter portraits. The other
thing I noticed was that oftenwhen painful or unpleasant
things were happening, you know,like taking blood, or even
taking blood blood pressure.
Doctors were getting theirphones out and finally got a
(18:36):
video on YouTube to show thekids to act as a distraction
while they were doing things. Ifwe could build that into the
environment, that would bereally, really strong. So we've
developed this interventioncalled the Zoo, and basically it
says this screen on the wall, itruns all the time. Every time I
look at it, I see something new.
I've seen it dozens of times,but it's basically moving animal
(18:58):
portraits. These verybeautifully filmed, slightly
slowed down portraits ofanimals, just moving looking at
the viewer. There's about Ithink there's about an hour and
a half of content. So we've donea study in terms of looking at
the impact of this and we've gota randomised control trial
running at the moment that we'retaking bloods. Before we have
(19:21):
this intervention, it could beup to seven minutes to take
bloods with the interventionthat's dropped to under three
minutes. There's also beenmissing as a clinician reported
study before we've done therandomised controlled trial,
there's an 87% reduction inperception of pain. So if we're
going back to what is the costbenefit, the cost benefit is the
(19:43):
time we're saving. So we're ableto take bloods more quickly. So
we are the halving the timearguably. I think the other
thing is that the distractionthat could be caused by siblings
or parents, that there's been ahuge benefit there as well in
terms of focusing them onsomething else, other than
what's happening to them. Soit's something that we are still
(20:03):
working on. But that wasprobably one of the most
tangible examples that I couldgive you at the moment.
Hannah (20:27):
I suppose you don't have to? Well, you need to correct my
assumption. But I was thinking,you don't have to pull out the
cost benefit for absolutelyeverything you do, because you
can build credibility throughthat. Then other initiatives
that you do that might be harderto, like the noise example that
you cited, or everything thatyou described about, even with
the noise piece. My examples arecoming from children, but it'd
(20:49):
be for any patient, if you'regetting some decent sleep, then
it's understood that supportsyour healing process, all your
anxiety levels. So the impact ofreduced noise on the patients is
significant in a different waythan the impact of noise from
the clinical side. Buteverything else that you
described in the building spaceto do with the other senses, so
(21:13):
lights or smells, how you makepeople feel. I can see that
there's so much there that it isintangible, but for the end to
end patient experience fromarrival to departure. Positive
changes there could could impactthem in many ways.
Trystan Hawkins (21:34):
No, absolutely.
I mean, we have other projects,which we're working on, which
have been kind of built withthat in mind in terms of looking
at cost benefits. So with thenew neonatal intensive care
unit, which has just opened, Imean, we're not completely open
yet. So two thirds of it isopen. There's another third
that's still being built. There,we really focused on the quality
(21:55):
of the environment for neonates.
So, you know, looking at theimportance of natural light,
again, of noise levels, so we'vekind of optimised that whole
environment. We've measured whatthe environment was like before,
so we understand what it waslike in terms of light, levels
in terms of noise, temperature,air quality. Then over the next
(22:16):
couple of years, we'll bemeasuring the change and then
looking at what was actuallyhappening to those babies, how
are things different now? I'mpretty confident that we'll see
a change for the better. But wedon't know that yet.
Hannah (22:29):
You talked about being one team. I'm curious about with
everything that you've beendescribing how you work with
your. You're employed by thecharity, but you're working hand
in hand with colleagues in thehospital? Can you describe that
dynamic for us, please?
Trystan Hawkins (22:44):
Yeah, I mean, I think the first thing to say is,
you know, we have a fantasticteam at Chelsea. I think people
are really open to differentways of working. When I was
thinking of taking the job, Icame down and met, you know,
different people. That was oneof the key attractions to work
there was, you know, we've got apretty unusual team. So we will
often come up with some quitewacky ideas, and there's a real
(23:08):
openness to kind of, toexperiment, to try new ways of
working. So I think, you know,the way that I work is very, you
know, we've kind of very handson, getting to know as many
different people of buildingrelationships. Which could be
with a, you know, yesterday Iwas with the Chief Executive for
the hospital. Im in in regularcontact with her but equally
(23:31):
with reporters or the healthcareassistants. So yeah, I find
nothing better than putting onscrubs. Just immersing yourself
in an environment because peoplewill talk to you in a different
way. I think that that's beenreally good. I think in terms of
building respect and peopleunderstanding what we're doing.
I think the other thing is, theartists and designers that we're
(23:53):
working with, that's one of thekey qualities that I look for in
them is that they're really goodcommunicators. Some of the ideas
that we're working with might bequite kind of the higher end of
contemporary art, but of findinga way of presenting that to
people that may not be asexperienced of that world and
they may not go to galleries. Sofor me that is the most
(24:15):
successful way of working.
Certainly in terms of the teamthat I work with, in terms of
the people that we're bringingin, that's a key quality. I
think the other thing is time,you know, it takes time to build
relationships and of allowingfor that within projects. You
know, give you an example we'reworking with an artist, British
artist called Isaac Julian. Hedoes, you know, absolutely
(24:36):
stunning video installations.
His work is quite challenging.
It's quite political. Itprobably took about four years
to develop a piece with himwhich would work within the
hospital. It's within theatrium. It's a big five screen,
installation of moving image. Itkind of runs continuous. I was
(24:58):
kind of slightly unsure as tohow that would work within the
environment, but it's beenreally well received and people
love it. I think you have tohave a piece like that which
could be by, you know, an artistwho's exhibiting internationally
quite cutting edge work withinthat kind of environment is
absolutely fantastic. So I thinkof educating people to different
(25:22):
ways of working. Equally,sometimes, you know, it doesn't
go as planned, it goes wrong. Sowe're doing a lot of work with
new technology. That doesn'talways work. But I think again,
that's part of the process.
We've been working with virtualreality for probably about two
years now. We've got about fourdifferent projects and so far,
(25:45):
one of those has worked. Ithink, yeah, that's acceptable.
It's part of the way we work. Wekind of factor that in. The
other thing we're looking at isrobots. So we're working with
robotic pets. So we have anintervention called Parow, which
is intervention developed inJapan. It's a furry seal works
(26:06):
particularly well with kind ofpaediatrics and older patients.
Then we have another robotcalled Miro. That's been less
successful. But we're workingwith the team that have
developed that in terms of howcan we learn from that and
modify it. I think this is justpart of working with those
technologies that, you know,things like VR headsets, you
(26:28):
know, the VR headsets areavailable last year compared to
now so different in terms ofbattery life or connectivity. So
that's a part of our work andthat comes under an umbrella of
programming called the FutureHospital.
David (26:42):
So I was going to ask about the part one of the
strands, I guess, of the charityis the CW innovation. So you're
doing a lot around innovation? Imean, you just described a
couple of elements to it there.
But how, I guess, how did thatcome about? What have you, what
have you learnt through that?
Trystan Hawkins (27:00):
So in terms of CW and innovation, you know, I
have a standard work within myprogramme, which is called
Future Hospital. That's reallylooking at how we can use new
and emerging technologies withina healthcare environment. So one
of the components of that I'vementioned already, which is
about understanding environment.
So as part of understanding theenvironment, we've developed
four different sensors. So we'relooking at air quality,
(27:22):
temperature, noise, and light.
So those sensors didn't existand we worked with companies to
develop a series of sensors,which are cloud based. We're
measuring those environmentalfactors every five seconds,
building up a profile of aspace. So the the aim with that
(27:43):
work is it gives us a reallyuseful tool in terms of, we can
In terms of sharing, you'vepublished some design standards
be using it within our hospital.
But the ambition is that thiscan be something which is shared
more widely within everyhospital. So I think certainly,
in terms of some of the workthat we're doing around new
technology, it's aboutinitiating, it's about testing,
it's about building an evidencebase, which we can then share.
So project like the Zoo, which Imentioned, you know, we are now
(28:05):
sharing that with otherhospitals. We'll make sure it
works, and then offer that freeof charge. So we're not charging
for that work. We have anotherinitiative which comes under
that umbrella, which is calledRelaxed Digital, and it's again
moving image base work. We hae 60 hours of content and then d
fferent types of playlits for different types of enviro
(28:28):
ments. We offer that contenfree of charge to either
HS, hospitals or environments.
've lost my train of thought,'m sorry.
(28:49):
as well. So a white paper arounddesign standards, which I've,
you know, which I've lookedthrough and it's fascinating. I
think, you know, some of thethings that you've talked about
today are covered in it, butit's a, you know, it's a great
kind of blueprint to give toanyone that's either looking to
tweak the facilities thatthey've got, or, you know,
there's actually quite a few newchildren's hospitals that are
(29:12):
looking to be built or are beingbuilt in and around Europe in
the in the coming years.
Yeah, absolutely. You know, wedevelop the the design
standards, initially just towork within our own teams. So
one of the things that we foundwas happening was, you know,
the states teams or facilitatorswill be working on a project,
(29:32):
you know, sometimes we wouldn'tfind out about them until quite
late along, you know, that kindof process. So he's already
agreeing a set of standardswithin the organisation that we
work to, you know, somethinglike Wayfinding you know, is
often quite bad in a hospital.
So how can we just haveconsistency in terms of fonts
that in use, size of signs, thatkind of stuff. So the the design
(29:53):
standards really look ateverything that goes into a
built environment. There's astandard that our organisation
works to, but you know, we arenow sharing that more widely.
The other thing is, it's notstatic. So it is changing all
the time, you know, we will hearnew things, so on our existing
design standards, We're doingmore work on is around acoustics
(30:14):
and learning from that. As alsonew materials become available,
those can be kind of woven intoit. So we share that work,
there's a group called theNational Performance Advisory
Group within the NHS. We're partof that and this is a way that
we can kind of disseminate thatlearning quite quickly. I think
the other thing is that we havea range of different partners,
(30:38):
you know, that we're workingwith. So for example, the work
around acoustics we've workedour tean for many years now and
also Fosters. So how we can kindof share some of that
opportunity we have that perhapsothers don't have. Within that
we also have internationalpartners that we're working
with. So particularly aroundsome of the work we're doing
(31:00):
with new technology, we've gotpartners in Japan, China and
South Korea. So it can be a wayof kind of disseminating things
that are happeninginternationally as well.
Hannah (31:14):
Does the scope of the work that you're doing involve.
I'm thinking with patientexperience, it might involve the
participation of patients in artactively producing art or being
creative themselves? Or is thatthe remit of a different part of
the organisation?
Trystan Hawkins (31:33):
No, so we have a, we've got kind of three
strands to our work. So we haveone, which is around the
collection, and, you know, kindof crudely as about pictures on
walls. We've got FutureHospitals, which is around
technology, and then anotherone, which is called Arts For
All. So this is aroundparticipation. So we have a team
of artists who are coming inevery day, I mean, obviously at
(31:55):
the moment, we're still kind ofin COVID. So that's been
challenging. But normally,you're more or less every day of
the week, we would havesomething happening in terms of
participation with a range ofdifferent patients from children
through to older people. Interms of approach that's also
very broad. So yeah, one end ofthe spectrum we've got. Dogs
(32:19):
that we bring in, so we havekind of petting dogs that will
come in. Gardening through todigital projects with patients
making music, at bedside. Sothat is a really, really
important part of our work isaround process and engaging with
patients. Often it's withpatients that are with us for a
longer period of time. So that'sreally important in terms of
(32:41):
their rehabilitation, but alsojust kind of socialisation,
whether that's with an externalperson coming in or with other
patients. So for example, youknow, some of our ward areas
have a six bedded bay. Oftenwhat we will be doing is a
collaborative piece, which isengaging with those six patients
that are sharing the same spacetogether. Because that will then
(33:04):
have huge benefits when theartist leaves in terms of at
least they might know the nameof the person next to them, I'll
know a bit more, but it willhave started a conversation,
which might not other wise bethere. I think the other really
important part of that is itgives the staff skills which
they can use in different ways.
So that kind of softer side ofnursing, which is around
(33:24):
understanding people, you know,talking with them, you know,
getting to know the families.
Which sometimes depending on theenvironment, there isn't a time
to do that. So I think ways thatwe can help with that it's
really important.
Hannah (33:41):
I can understand that COVID could easily have
inhibited and made it extremelydifficult for you to continue
that level of service over thelast few months. Has there been
examples where it's created anew opportunity? Or is it simply
been challenging times?
Trystan Hawkins (33:59):
Yeah, I mean, you know, COVID has been hugely
challenging. But I think, youknow, for me, one of the really
positive things that I've seencome out of this is, you know, a
sense of community in terms ofwithin the hospital. I think
also within within the widercommunity of people just looking
out for each other. For us,practically we've had to change
the ways that we're working. Sowith the participant troup work,
(34:22):
we've developed a virtual strandof that works. It's called
Virtual Connections. So it's ourartists creating work which
exists online that patients canaccess, but equally doing things
which are remote. So you know,one of the things that you know,
we've been doing since June islive performances for patients
(34:46):
in the hospital so we'll have amusician who is in their home.
Ee will go into the ward areawe'll put on the PPE and then we
will facilitate an interactionbetween an artist who is remote
and that patient. So, you know,one of the sessions I did a
couple of months ago is with apatient who had COVID. He was
coming out the other end beingwith us for 100 days. He was
(35:10):
quite lonely. He didn't reallyhave any friends. He didn't have
any family. He didn't have asmartphone. So, you know, his
life was incredibly boring. Hewas getting better, which was
fantastic. But for him to beable to have that connection
with the outside world was soimportant. With some of our
paediatric patients, we'velinked him with San Diego Zoo.
(35:33):
So we have a live stream fromSan Diego Zoo into the
paediatric areas. So it's not atwo way feed, but in terms of
live content coming into thatenvironment. So things like
that, I think, you know, withinCOVID have been really positive.
I think also in terms of newthinking, for example, like with
(35:54):
our outpatient clinics, youknow, 70% of those are now being
delivered virtually throughSkype or zoom or whatever. Yeah,
which is brilliant, because thatcan carry on, it just means that
the hospital can run moreefficiently. It's a better use
of people's time.
David (36:11):
I've just got a couple more questions. One of which is
what kind of feedback have youhad from children? You know,
specifically around I mean,something that we have, you
know, done quite a lot of workaround is that distraction
elements, is trying to make, youknow, procedures a little bit
easier for children. Last week,we were talking to someone that
(36:31):
was Evelyn, who's doing a lot ofwork around VR, and looking to
bring that in. But, you know,specifically around the Zoo
project, or, you know, any ofthe other kind of interactive
elements or distractionelements, what kind of feedback
have you have you received fromeither the children or indeed
the parents as well?
Trystan Hawkins (36:54):
Yes, I mean, I think, you know, I mentioned
already that, you know, our workis really driven by the people
that we're working with. So it'saround finding appropriate ways
that you can engage with them.
So we use kind of the formalgroups that exist within
hospitals, you know, patient,public engagement teams, but a
lot of our work is just aboutspending time in a treatment
(37:15):
area or waiting room and justtalking to people. Sometimes we
use questionnaires, but oftenit's about just talking to
people, but also just observingthe situation. So I think, you
know, we're trying to makespaces as unfrightening as we
can, we're trying to make themas domestic as we can. You know,
if we just go back to the A&Eproject. The really simple thing
(37:37):
that the first meeting I hadwith the architects, when we
were developing that the newunit. I said, Well, what are the
acoustic properties for thesetreatment rooms, and they'd like
to blank and said, well, therearen't any. So we, the charity
paid for ceiling tiles that hada property in terms of absorbing
(37:59):
sound. Ee were able to reducenoise levels throughout the
whole A&E by 28%. So youknow,when kids are coming into
that A&E it feels very quiet,we've got the different
distractions within the space.
We've also given them controlover some things within that
space things like the light,we've got music, we've also got
(38:23):
virtual reality that we're usingwithin paediatric A&E as well.
So that's a tool which isavailable. So I think really,
it's about giving people controland allowing them to make some
choices. The feedback that weget, you know, is always
positive. Otherwise, we wouldn'tbe doing it. Occasionally, you
know, we have had, you know,perhaps some negative feedback
(38:45):
about some artwork. Obviously,then we've changed that. I think
the other thing is alsorecognising that, you know, you
may do something and then, youknow, it doesn't finish, you
need to keep looking after that.
So an example would be, we'vegot an area for relatives,
which, you know, it's where theyhad bad news. We've learned from
(39:06):
people using that space in termsof how it made them feel. One of
the things that came back was,you know, it wasn't warm enough,
the air handling was too cold.
So how can we physically warm upthat space, but also kind of
learn from the way that peoplehave been in that environment
and make it better? So, youknow, I think, as an
(39:27):
organisation, we never finishedprojects, we always go back and
change them and redevelop them.
I think that's really importantwith technology that, you know,
I've seen some really greatprojects around the country. But
then after 12 months, they breakand then, you know, the states
team don't have the client tofix them. That is a reality of
working within the NHS. So wetake that responsibility in
(39:49):
terms of looking after thingsand replacing things when they
get broken or tired ordecommissioning them. So I think
it's really important to thinkabout decommissioning when
you're working on these thesetypes of projects.
David (40:04):
Justin, thank you so much, I think you've opened our
eyes to, you know, so manydifferent kind of facets and
even as you were justdescribing. Thinking about how
the longevity of, you know,technology that you put in to
into a system or, you know, intoa paediatric unit, or whatever
it might be. But also, you know,as a charity, we're looking to
(40:25):
bring, you know, the future ofhealth care to children. I think
when people look at that, theconnotation is that it's always
going to be technology, it'salways going to be, you know,
the latest and greatest, and,you know, the singing and
dancing, whatever it might be,but actually, there are so many
different elements to that. It'sthe latest research, it's the
latest evidence, it's, you know,as you describe just the
(40:47):
artistic elements of it, tryingto think how best to look after
the patients and what they needand everything else. I think,
you know, for us, it's been afascinating conversation and
something that you know, we'llthink about when we're looking
at some of the projects thatwe're going to be doing into the
future. The final question thatwe ask everyone that comes on
the podcast, is, if you had amagic wand, and you could do
(41:11):
anything, when it comes to childhealth, what would that be?
Trystan Hawkins (41:17):
So I think, you know, for me, it would be
focused around giving children,young people, some control or an
element of control over theenvironment that they're in. You
know, I think a lot of thethings that we're doing are
really simple and there not,perhaps that expensive either.
So I think the building incontrol. So for me it would be
(41:38):
around the environment thatthose children are in simple
things like, you know.
Somewhere, they can charge thephone, somewhere where they can
dim the lights. Yeah, I thinkwould be fairly key to me.
David (41:53):
Perfect. Thank you, Trystan. Thank you so much for
your time, you know, we reallyappreciate it and good luck with
all the work that you're doing.
Trystan Hawkins (42:00):
Great. Thank you very much.
David (42:03):
Thank you so much for joining us once again on the Not
Mini Adults and a big thank youto Trystan Hawkins for joining
us this week. Details ofThinking of Oscar and also the
work that Tristan is doing withCW plus will be in the show
notes. If you know someone thatyou think that we should be
talking to, or a topic thatyou'd like us to cover on the
podcast then please do get intouch. Next week is the final
(42:24):
episode of season two before wetake some time off for Christmas
and then resume again in the newyear. We're really excited about
our final conversation, whichwill be with Dr. Todd Ponsky
from the Cincinnati Children'sHospital. Dr. Ponsky is a
paediatric surgeon, but alsoDirector of Clinical growth and
transformation at syndicates. Inhis own words, he focuses on
(42:45):
trying to find the leastinvasive way to solve a child's
medical problem. We really hopeyou can join us again next week.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.