For a communications team the thought of letting a TV crew behind the scenes could be daunting. How would you manage it and what would be the benefits? This guest post shares some fascinating insight on just that.
by Laura Skaithe-Knight
NUH was the ‘hospital’ featured in the third series of the award-winning BBC Two documentary series, ‘Hospital’. Broadcast over six weeks from March through to May this year, NUH staff and patients found themselves making the local, national and international headlines, with each episode attracting an average of 2 million viewers. Nottingham was the first city to bring the award-winning documentary out of London, with Series 3 receiving more viewers of all of the series to date.
As you might imagine, taking part in such a high profile and detailed documentary series was something that took a lot of time, effort and input to achieve. As we were about to find out, making 360 minutes of prime time TV is an all or nothing commitment. Before the documentary hit the screens, NUH staff were directly involved with the producers for around 12 months working together to bring the stories to the screen.
The ethos behind ‘Hospital’ is to go behind the headlines and show a true picture of how NHS clinicians and managers interact to provide the best possible care to patients and their families. NUH strives to be a leader of openness and transparency and ‘Hospital’ was one the ways we could demonstrate this; and it certainly didn’t shy away from the challenges and issues we face day-to-day. Label1, the production company who film ‘Hospital’ for the BBC, worked with the Trust Board and senior leadership team initially to reach agreement on taking part. Our reasons for going ahead were very closely aligned to what the producers were trying to achieve – and that was to show the work of the talented and dedicated NHS staff who 24/7 provide the best possible care, under all circumstances.
Staff engagement was a key factor in our decision-making process; we would never have been able to show 2 million plus people behind the scenes of NUH using other methods of communication. That said, as you would expect any Board to do, the NUH Trust Board very carefully weighed up risks of taking part in a documentary that would give cameras unprecedented access to our hospitals during what turned out to be the busiest and most difficult winter on record.
Filming took place over eight weeks in January and February with up to 30 production staff following staff and patients throughout the working week (24/7) across our two main hospitals sites. The producers assured us that we would very quickly forget that the cameras were there, and this was exactly what happened. The crews were always clear that the focus was always on capturing what was happening, not getting in the way of what was happening, and this is exactly what happened too.
There was a determination in Series 3 to go beyond the walls of our hospitals and show how the wider health and social care system functions. And I’m pleased that Series 3 successfully achieved this, not least in episode 5 which almost exclusively focused on showing the ‘back door’ challenges, notably around discharge delays, which is a subject never far away from the media headlines. Being able to show and explain some of the complexities involved in these processes was a significant achievement, and only possible thanks to the involvement and buy-in from many of our system partners, including Nottingham City Council, and of course patients, families and staff who consented to sharing their stories.
We had very strict protocols agreed which meant that filming would be stopped in the event that it was compromising safe and effective care. Filming could only take place where the patients and relatives agreed in advance; there were a number of robust safeguards put in place which meant that at any point patients or staff could change their minds. The producers worked closely with the clinicians responsible for the patient’s care to ensure that filming was appropriate and sensitively managed.
To some extent, the success of Series 3 of ‘Hospital’ was not down to the careful research and planning; it was all about the timing. Filming started on 2 January when it was already becoming apparent that NUH, along with the rest of the NHS and social care, was experiencing a sustained period of unprecedented demand. Having worked in Comms in the NHS for over 14 years, this winter was undoubtedly the most difficult of my career. This was the theme than ran throughout all six episodes. The stories that unfolded as a result were, in most cases, different to the ones that we and the producers had envisaged which was another learning point. You can plan for many months but ultimately what comes through the doors and the events of the 8-week filming period dictated the final footage, whether we liked it or not.
Our clinicians were heavily involved in the editing and post production, via viewings of the ‘draft’ episodes as they were ready, ensuring that the collaboration between NUH and the series producers continued right through to the day of broadcast and that scripts, voiceovers and commentary were accurate. This process wasn’t about censoring or editing out what we felt the viewers should not see or what at times made uncomfortable viewing. It was about extending our duty of care to the patients and families featured, ensuring the patient stories and aspects highlighted were factual and balanced by providing technical and clinical input to ensure accuracy and clarity. I think this process is part of the reason why ‘Hospital’ is so well respected and true to life.
The feedback from staff, patients, local community and our health and social care partners as each episode was broadcast was just tremendous; it was overwhelmingly positive and the support for our staff and patients in each episode was unlike anything we have ever experienced before. People were stopped in the street, in the supermarket and even on the bus and thanked for the work they do. Many still are! Our staff received ‘fan’ mail and we received presents from well-wishes for many of the patients who featured. There was a palpable sense of pride as staff came into work on Wednesday morning, following the broadcast the night before. We laughed, we cried and we cheered as we saw colleagues in each episode; we all learned something new about NUH. ‘Hospital’ put NUH right back into the heart of the local community. It showed the world what ‘team NUH’ is made of, put Nottingham and the East Midlands on the map, and showed we can very much punch our weight on the national stage and aren’t afraid to do so.
I have described to my team on many occasions over the last few months – “if we can do ‘Hospital’, we can do anything” and this is so very true.
Some headlines of what we achieved through ‘Hospital’ include:
· 150% increase in clicks from Facebook recruitment posts to live jobs (throughout broadcast period)
· 20,000 visits to new dedicated recruitment pages on NUH website
· 400 people attended NUH recruitment event during ‘Hospital’
· Nurse retention has improved significantly
· NUH social media accounts extended their reach and impact by over 100% on Facebook and 2million Twitter impressions
· Top trending topic for Episode 1, top 5 for Episodes 2 & 3 and top 10 for whole series
· Twitter followers increased by circa 4K February-July during ‘Hospital’ period and aftermath
· Significant increase in the number of spontaneous positive comments about the series, with patient experience tweets more than double normal levels
· In this period, there were 40% fewer complaints in our Surgery Division and patients were more understanding of the pressures the Trust faced, with our teams finding it helpful to refer to the programme in their conversations with patients and families.
· A stakeholder survey showed that after the series, 78% felt they had a greater awareness of challenges facing the NHS, 53% a better understanding of the NHS and 53% a greater appreciation of the skills and expertise of NUH and NHS staff
Knowing what I know now, would I do it again or advise others to do so? Yes. For one thing, there are so many more stories that we have to tell and so many services that deserve to be featured both in Nottingham and across the wider NHS. But overall my reason for saying “yes” is because when we asked staff what they felt the impact of the series had been, 81% said it had created a better understanding of NHS. And that is the most important thing in the year we celebrate the 70th birthday of this country’s most precious institution.
I’d boil my main learning points down to these:
• Get the contract right (access agreement, consent protocols etc)
• Know what you can influence and what you can’t
• Be clear what you want to get out of it (every Trust will be different)
• Relationships and trust are key (between NUH, BBC2 and Label1)
• Establish very clear ‘red line’ areas early on in the process
• Who you would want to feature and who is chosen may be very different!
• Get the Communications Team and support ‘set-up’ right (this is for some a ‘once in a career’ experience for comms teams/ comms professionals)
• Viewing panels (multi-disciplinary) critical to the end product
• Regular briefings to Executive Team, Board & system partners
• The experience has put NUH back into the heart of the local community
• Immense pride in ‘Team NUH'
Many months on, people are still talking about ‘Hospital.’ That is surely a tribute to the quality of the programme, our fantastic patients and our exceptional staff. This is what we describe as the ‘Hospital’ experience
Laura Skaife-Knight is Director of Communications at Nottingham University Hospitals NHS Trust (NUH)
image via The Library of Virginia