The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”

Episode 23: 'ART & DESIGN' with Trystan Hawkins

December 04, 2020 Season 2 Episode 11
The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”
Episode 23: 'ART & DESIGN' with Trystan Hawkins
Chapters
The Not Mini Adults Podcast - “Pioneers for Children’s Healthcare and Wellbeing”
Episode 23: 'ART & DESIGN' with Trystan Hawkins
Dec 04, 2020 Season 2 Episode 11

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

Show Notes Transcript

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

Trystan Hawkins:

Develope this intervention called The Zoo and basically its this screen on the wall, it runs all the time. Every time I look at it, I see something new and I've seen it dozens of times, but it's basically moving animal portraits. These very beautifully filmed, slightly slowed down portraits of animals, just moving looking at the viewer. There's about, I think there's about an hour and a half of content. So we've done a study in terms of looking at the impact of this and we've got a randomised control trial running at the moment. We're taking bloods. Before we had this intervention, it could be up to seven minutes to take bloods with this intervention that's dropped to under three minutes. There's also been, this as a clinician reported study before we've done the randomised controlled trial, there's an 87% reduction in perception of pain.

David:

Hello, and welcome to the Not Mini Adults Podcast, Pioneers for Children's Health Care and Well Being. This is Episode 11 of season 2. My name is David Cole and once again, I'm joined by my wife, Hannah. Together we are the co founders of UK children's charity, Thinking of Oscar. This week, we're speaking with Trystan Hawkins from the Chelsea and Westminster Hospital in London. Trystan is the Art Director and Patient Environment Director and works with a hospital charity known as CW plus. Trystan is responsible for leading the vision for Arts and Design for CW plus, 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. As well as paediatric patient distraction techniques that the hospital has employed. Finally, how art has the ability to foster patient well being and relationships. We had such a fascinating conversation with Trystan, and we hope you enjoy and take away as much from it as we did. Trystan, Hi, thank you so much for joining us on the Not Mini Adults podcast.

Trystan Hawkins:

Hello, yes, it's a pleasure to be here. Thank you for inviting me.

David:

Well, we were delighted to have you on and I think the the conversation that we're going to have today is going to be slightly different to some of the ones that we've had previously. There's definite themes that go through our podcasts and I guess patient experiences is one of them. Obviously, so important when it comes to children and children being in that kind of environment of a hospital setting. So you know what absolutely, you know, delve into that and understand what you're doing in Chelsea and Westminster. But maybe if you could start as we as we tend to do just talk a little bit about yourself and how you've got to be doing what you're doing and what that involves, please.

Trystan Hawkins:

You know, I'd love to. So my kind of education was fairly kind of unusual. So I actually didn't go to school for much my childhood. We lived abroad, we lived in France, then Scotland and we kind of were quite nomadic as a family. So my kind of career path has been quite random. I really interest in the kind of environment and I spent quite a number of years working with horses. So actually, my plan was to be a professional eventer of riding horses and also training horses. I did that for about three years until I was I think 17. Then I was kind of really gripped by going into medicine and in particular Veterinary Science. So that was my plan. But I had absolutely no qualification. So I went to ,I think it was a Technical College, that's what it was called then and started trying to get the different qualifications that I needed to go to university, which was a real challenge. In that kind of processI decided that actually wasn't very academic. I have quite severe dyslexia. So that was a real challenge at that time because it wasn't really recognised. So I went into the arts, which again, I had a real interest in so went to art college, did an AMA in filmmaking, actually in Berlin. Then came back to the UK and was quite kind of socially engaged. So I was kind of working with Greenpeace and Friends of the Earth and organisations like that and was interested in terms of how you could use the arts to be kind of socially engaged. So then I worked with young people at risk, worked with big people with disabilities, but trying to work within the mainstream. So really what I was doing was trying to work with groups that might have been excluded from working within mainstream arts. At that time, that was quite unusual work. Now it's very commonplace, but this was kind of in the late 80s, early 90s. So that kind of led me to working more mainstream within the visual arts, which is really why I've been working since that time. So of leading arts organisations working across art forms often. I had a job in in Cambridge, which was running an Art Centre and as part of that we did a major capital development around the centre and that got me really interested in built environment in terms of architecture, and how spaces made people feel. As part of kind of leading the programme at our centre, which is called Wising Arts, we did a lot of collaborations with kind of science and research that was taking place in what's called silicon fen, you know, in and around Cambridge. One of those projects was working with Papworth Hospital and we had a an artist called Jordan Baseman, who is doing a moving image based project looking at people that are having heart transplants. As part of that process, I spent a lot of time kind of shadowing him, working with him within an operating theatre environment. Which was really challenging because I think me like a lot of people, you know, when you go into the hospital, that they've quite unnerving spaces, you know, just things like the lighting or the smells, the wayfinding, the colours and that really struck me because I was doing this work with the commission for architecture in the built environment in terms of creating a fantastic new Art Centre. Then going to these hospitals are pretty awful and made me feel really uneasy. So that kind of really started an interest in in terms of built environment in terms of how that can affect people. In particular, around kind of healthcare buildings. So following on from that job in Cambridge, I went down to the southwest to work on a major new development of new hospitals in Exeter, Plymouth, Devonport and Truro. So that was really looking at how we could kind of maximise design, as well as integrating the arts. But to be honest, most of the work that I was doing was around design. So things like colour, lighting and acoustics, those things that often don't get factored into projects within the NHS. Then from that, I went back into mainstream art, so I was running the Royal Academy of Arts in in Bristol, a really old organisation with big collection and 130 academicians. Then was approached about the work at Chelsea. So Chelsea is a fascinating environment in terms of its work within arts and health, it has a real track record, but in terms of its role within healthcare it is one of the first hospitals to be set up in the UK. So it's over 300 years old, it opened, I think, in 1719. So it's one of the first charity run hospitals to be established in the capital, London.It was then called the Westminster Hospital. n In the late 80s, they were looking to kind of consolidate a number of hospitals onto the site that we currently occupy. So that was a brand new hospital, it was quite forward thinking. They had a really great team of architects that worked on it called Sheppard Robson. They developed a building, which opened in 1993, which was kind of really pushing the envelope. So when you go into the space, even today, it feels very different to a lot of hospitals, it's very light, it's very airy. But one of the things that they wanted to consider in terms of developing this space, where you could open any internal window and get fresh air. It's got a very kind of sophisticated air handling system, which was also very sustainable in that it was bringing in air from the outdoors into the central atrium without using a lot of mechanical engineering. So the building is kind of flooded with light, big open spaces. The other really important thing was that they kind of thought about artwork, you know, as they were building the new building. So there were huge sculptures built into the foundations and there's over 2000 works of arts, you know, within the clinical areas, but also within the atrium space.

David:

One of the things that I was doing the research was that I am right in saying that the hospital has museum status.

Trystan Hawkins:

We used to have museum status. So when I joined, we spent quite a lot of time becoming an accredited museum. You know,and as a curator, I thought that was fantastic. I was coming from my previous job, which was also a museum and I was thinking well hang on, we've got over 600 works in storage, which because we were a museum, it was really complex to deaccession those we couldn't just sell them or dispose of them. We had to go for a really long process and we were spending huge amount of time and money being a museum and I thought well hang on, you know, we're here that our primary function is around a hospital It's about the experience of pat ents, families and the staff wor ing for us. Was this the Less us of resources? I think the oth r thing I was interested in was e have a collection. You kno , we've got some really valua le works within that collect on, which may be great back i the late 80s, or 90s. But now we're quite tired and how we m ght look at the collection a an asset, which we obviously in est in good art, we show it, but then perhaps, when that's serve its purpose, we monetize it, and we sell it. So we've droppe the museum status, we still loo after the collection t museum standards. But for me, hat was really important. It's bout the primary function is round, optimising the patie t experience of people using the hospital and hospita s change. Every years something changes, you know, the space th t we might have thought was kind of sacrosanct and wasn't onna change, you know, in 1 months time that will need to change because the building i an evolving organism. I t ink the other thing is, we're eally constrained with the f otprint, we're located in an ar a which house prices are very

David:

I'm glad you mentioned that, because I was gonna say, igh, you know, the surrounding andscape around the hospi al is quite fixed. So we can't r ally extend beyond the current arameters of the building for anyone that's listening, that doesn't actually realise where the Chelsea and Westminster hospital is in London, it's in a, you know, middle of London in a very, I guess, sought after district, as it were. Lots of residential and everything else nearby a football stadium, as we discussed and everything else. So yes, the ability to add as much change, I guess, as, as you have in the last kind of 300 years, not you personally but at the hospital in itself. To try and maintain that kind of modern day attire, and to really look at, you know, what your patients are needing now and be able to give them that environment, I think is, you know, it is a really great story in itself. With everything that we've everybody that we've spoken to it's, it's that kind of serendipity as to what brought you to the hospital and what you're doing now, which I think is really interesting. So can you give us an overview as to what your role is and how that's working? The the kind of patien experience element to it please

Trystan Hawkins:

Yeah, no, absolutely. So I kind of have two roles. So when I joined CW Plus, I work for CW Plus, which is a charity that exists for Chelsea and Westminster hospital. So essentially, we're one team, but I'm paid for by the charity. So my role is as Arts Director, so we have a big arts collection, we have over 2000 works. But then we also, I kind of have sort of two job titles, because I thought sometimes when I'm using Arts Director within an NHS environment. Why have you got an Arts director? so I'm also Director of Patient Environments, and I'll use those two titles in different ways from talking to an arts audience or a health health audience. So I guess most of my work really is as Director of Patient Environment. What that means is how we can really maximise the experience for people coming in. That's often through the built environment. So, you know, a lot of the work that we're doing is driven by capital schemes. But I think we will also kind of question, you know, looking from the outside in terms of, you know, the NHS may have been delivering a service in a particular way for, say, 20 years. Why is that? So, you know, one of the things I love about my job is when we're working on a new project and perhaps I can give some examples. So, you know, for the past four years, we've been leading a programme around critical care. So that's been around a new neonatal intensive care unit and an adult intensive care 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's available within the UK, but also what's available within the world. So really not being constrained by parameters that might usually happen on an NHS project where, you know, there's a set of standards that we build things to in the NHS. They've got hospital building notes, and they're kind of laid down by the Department of Health in terms of, you know, the very functional elements of the building space. What that needs to look and feel like. You know, I think there's a lot of learning, which takes some time perhaps to filter into that way of working. So a lot of my role is really questioning and looking at best practice elsewhere and then trying to translate that into something that can work within the NHS. The other thing that I'm really mindful of within everything that we're doing is the cost benefits. So, you know, we know that things like Arts and Design are extremely valuable within healthcare settings, but often a lot of the reason those things aren't happening is because they cost more money. Whereas in reality, you know, my experience is that sometimes they don't cost any more money. It's just about being careful and perhaps taking more time and weaving that into the whole design process.

Hannah:

How do you prove out that cost benefit part of your work?

Trystan Hawkins:

So that that is a challenge? I wouldn't say we always get it right. So if we're looking at say something like, one of the things that I'm really focused on is noise. So noise in hospitals. So, you know, something that struck me when I go into hospital is how noisy they are, the effect that that noise can have on people. But then you can think well, hang on, I'm actually going to measure the cost benefit benefit of that where you're probably not, you know, there is research that has shown that over a certain number of decibels, staff are more likely to make mistakes. There's a study done in Boston, back in 2013, which looked at what level, the staff start making mistakes and the noise level is actually quite low. I think it's around 38 decibels, which is, is not particularly noisy. So to actually measure that within the NHS would be, I think, very impractical, it wouldn't be an easy thing to do. But I know that that is a reality that, in a noisy, busy environment, people are more likely to make mistakes. That will have a knock on effect in terms of cost, in terms of, perhaps people being given the wrong medicines or making mistakes, which could then have an impact in terms of mitigation or whatever. So I think the most tangible example of cost benefit for me at the moment would be you know, where we're able to do things more quickly. We've got a great project we've been doing in our paediatric AME. So that was a project that we did a couple of years ago. So we redeveloped the whole department. It's one of the largest agencies in London, runs from the front of the hospitals to the back. So it's about 800 metres long, it's vast, really beautiful. Within that we've got a dedicated paediatric area with 16, treatment cubicles. We've designed those so that they're really flexible. So we can do things like we can adjust the lighting levels, this bespoke music. So we've got eight different playlists that you can just press a button. That kind of immediately kind of creates a different sound, within that space, you can change the volume level. But one of the one of the most exciting things is we've got this thing called the Zoo, which is essentially it's a portrait screen. Roughly, I'm trying to think of dimensions, probably about 40 centimetres by 120 centimetres. When we were doing consultation for the project, so I mean, that's the other thing is we're really democratic in terms of the way that we develop things. So we just spend time in a space. So typically, that means, you know, I might put scrubs on I'll do shifts, I spend different times of the week working in the space and just trying to understand what are the what are the problems. When I was doing that work, you know, we were talking to the children and young people about what they would like. Harry Potter was kind of all of the rage at that time. One of the things you know, that kids were saying was that they'd love to help with the moving Harry Potter portraits. The other thing I noticed was that often when painful or unpleasant things were happening, you know, like taking blood, or even taking blood blood pressure. Doctors were getting their phones out and finally got a video on YouTube to show the kids to act as a distraction while they were doing things. If we could build that into the environment, that would be really, really strong. So we've developed this intervention called the Zoo, and basically it says this screen on the wall, it runs 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 portraits. These very beautifully filmed, slightly slowed down portraits of animals, just moving looking at the viewer. There's about I think there's about an hour and a half of content. So we've done a study in terms of looking at the impact of this and we've got a randomised control trial running at the moment that we're taking bloods. Before we have this intervention, it could be up to seven minutes to take bloods with the intervention that's dropped to under three minutes. There's also been missing as a clinician reported study before we've done the randomised controlled trial, there's an 87% reduction in perception of pain. So if we're going back to what is the cost benefit, the cost benefit is the time we're saving. So we're able to take bloods more quickly. So we are the halving the time arguably. I think the other thing is that the distraction that could be caused by siblings or parents, that there's been a huge benefit there as well in terms of focusing them on something else, other than what's happening to them. So it's something that we are still working on. But that was probably one of the most tangible examples that I could give you at the moment.

Hannah:

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 absolutely everything you do, because you can build credibility through that. Then other initiatives that you do that might be harder to, like the noise example that you cited, or everything that you described about, even with the noise piece. My examples are coming from children, but it'd be for any patient, if you're getting some decent sleep, then it's understood that supports your healing process, all your anxiety levels. So the impact of reduced noise on the patients is significant in a different way than the impact of noise from the clinical side. But everything else that you described in the building space to do with the other senses, so lights or smells, how you make people feel. I can see that there's so much there that it is intangible, but for the end to end patient experience from arrival to departure. Positive changes there could could impact them in many ways.

Trystan Hawkins:

No, absolutely. I mean, we have other projects, which we're working on, which have been kind of built with that in mind in terms of looking at cost benefits. So with the new neonatal intensive care unit, which has just opened, I mean, we're not completely open yet. So two thirds of it is open. There's another third that's still being built. There, we really focused on the quality of the environment for neonates. So, you know, looking at the importance of natural light, again, of noise levels, so we've kind of optimised that whole environment. We've measured what the environment was like before, so we understand what it was like in terms of light, levels in terms of noise, temperature, air quality. Then over the next couple of years, we'll be measuring the change and then looking at what was actually happening to those babies, how are things different now? I'm pretty confident that we'll see a change for the better. But we don't know that yet.

Hannah:

You talked about being one team. I'm curious about with everything that you've been describing how you work with your. You're employed by the charity, but you're working hand in hand with colleagues in the hospital? Can you describe that dynamic for us, please?

Trystan Hawkins:

Yeah, I mean, I think the first thing to say is, you know, we have a fantastic team at Chelsea. I think people are really open to different ways of working. When I was thinking of taking the job, I came down and met, you know, different people. That was one of the key attractions to work there was, you know, we've got a pretty unusual team. So we will often come up with some quite wacky ideas, and there's a real openness to kind of, to experiment, 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 hands on, getting to know as many different people of building relationships. Which could be with a, you know, yesterday I was with the Chief Executive for the hospital. Im in in regular contact with her but equally with reporters or the healthcare assistants. So yeah, I find nothing better than putting on scrubs. Just immersing yourself in an environment because people will talk to you in a different way. I think that that's been really good. I think in terms of building respect and people understanding what we're doing. I think the other thing is, the artists and designers that we're working with, that's one of the key qualities that I look for in them is that they're really good communicators. Some of the ideas that we're working with might be quite kind of the higher end of contemporary art, but of finding a way of presenting that to people that may not be as experienced of that world and they may not go to galleries. So for me that is the most successful way of working. Certainly in terms of the team that I work with, in terms of the people that we're bringing in, that's a key quality. I think the other thing is time, you know, it takes time to build relationships and of allowing for that within projects. You know, give you an example we're working with an artist, British artist called Isaac Julian. He does, you know, absolutely stunning video installations. His work is quite challenging. It's quite political. It probably took about four years to develop a piece with him which would work within the hospital. It's within the atrium. It's a big five screen, installation of moving image. It kind of runs continuous. I was kind of slightly unsure as to how that would work within the environment, but it's been really well received and people love it. I think you have to have a piece like that which could be by, you know, an artist who's exhibiting internationally quite cutting edge work within that kind of environment is absolutely fantastic. So I think of educating people to different ways of working. Equally, sometimes, you know, it doesn't go as planned, it goes wrong. So we're doing a lot of work with new technology. That doesn't always work. But I think again, that's part of the process. We've been working with virtual reality for probably about two years now. We've got about four different projects and so far, one of those has worked. I think, yeah, that's acceptable. It's part of the way we work. We kind of factor that in. The other thing we're looking at is robots. So we're working with robotic pets. So we have an intervention called Parow, which is intervention developed in Japan. It's a furry seal works particularly well with kind of paediatrics and older patients. Then we have another robot called Miro. That's been less successful. But we're working with the team that have developed that in terms of how can we learn from that and modify it. I think this is just part of working with those technologies that, you know, things like VR headsets, you know, the VR headsets are available last year compared to now so different in terms of battery life or connectivity. So that's a part of our work and that comes under an umbrella of programming called the Future Hospital.

David:

So I was going to ask about the part one of the strands, I guess, of the charity is the CW innovation. So you're doing a lot around innovation? I mean, you just described a couple of elements to it there. But how, I guess, how did that come about? What have you, what have you learnt through that?

Trystan Hawkins:

So in terms of CW and innovation, you know, I have a standard work within my programme, which is called Future Hospital. That's really looking at how we can use new and emerging technologies within a healthcare environment. So one of the components of that I've mentioned already, which is about understanding environment. So as part of understanding the environment, we've developed four different sensors. So we're looking at air quality, temperature, noise, and light. So those sensors didn't exist and we worked with companies to develop a series of sensors, which are cloud based. We're measuring those environmental factors every five seconds, building up a profile of a space. So the the aim with that work is it gives us a really useful tool in terms of, we can In terms of sharing, you've published some design standards be using it within our hospital. But the ambition is that this can be something which is shared more widely within every hospital. So I think certainly, in terms of some of the work that we're doing around new technology, it's about initiating, it's about testing, it's about building an evidence base, which we can then share. So project like the Zoo, which I mentioned, you know, we are now sharing that with other hospitals. We'll make sure it works, and then offer that free of charge. So we're not charging for that work. We have another initiative which comes under that umbrella, which is called Relaxed Digital, and it's again moving image base work. We ha e 60 hours of content and then d fferent types of playli ts for different types of enviro ments. We offer that conten free of charge to either HS, hospitals or environments. 've lost my train of thought, 'm sorry. as well. So a white paper around design standards, which I've, you know, which I've looked through and it's fascinating. I think, you know, some of the things that you've talked about today are covered in it, but it's a, you know, it's a great kind of blueprint to give to anyone that's either looking to tweak the facilities that they've got, or, you know, there's actually quite a few new children's hospitals that are looking to be built or are being built in and around Europe in the in the coming years. Yeah, absolutely. You know, we develop the the design standards, initially just to work within our own teams. So one of the things that we found was happening was, you know, the states teams or facilitators will be working on a project, you know, sometimes we wouldn't find out about them until quite late along, you know, that kind of process. So he's already agreeing a set of standards within the organisation that we work to, you know, something like Wayfinding you know, is often quite bad in a hospital. So how can we just have consistency in terms of fonts that in use, size of signs, that kind of stuff. So the the design standards really look at everything that goes into a built environment. There's a standard that our organisation works to, but you know, we are now sharing that more widely. The other thing is, it's not static. So it is changing all the time, you know, we will hear new things, so on our existing design standards, We're doing more work on is around acoustics and learning from that. As also new materials become available, those can be kind of woven into it. So we share that work, there's a group called the National Performance Advisory Group within the NHS. We're part of that and this is a way that we can kind of disseminate that learning quite quickly. I think the other thing is that we have a range of different partners, you know, that we're working with. So for example, the work around acoustics we've worked our tean for many years now and also Fosters. So how we can kind of share some of that opportunity we have that perhaps others don't have. Within that we also have international partners that we're working with. So particularly around some of the work we're doing with new technology, we've got partners in Japan, China and South Korea. So it can be a way of kind of disseminating things that are happening internationally as well.

Hannah:

Does the scope of the work that you're doing involve. I'm thinking with patient experience, it might involve the participation of patients in art actively producing art or being creative themselves? Or is that the remit of a different part of the organisation?

Trystan Hawkins:

No, so we have a, we've got kind of three strands to our work. So we have one, which is around the collection, and, you know, kind of crudely as about pictures on walls. We've got Future Hospitals, which is around technology, and then another one, which is called Arts For All. So this is around participation. So we have a team of artists who are coming in every day, I mean, obviously at the moment, we're still kind of in COVID. So that's been challenging. But normally, you're more or less every day of the week, we would have something happening in terms of participation with a range of different patients from children through to older people. In terms of approach that's also very broad. So yeah, one end of the spectrum we've got. Dogs that we bring in, so we have kind of petting dogs that will come in. Gardening through to digital projects with patients making music, at bedside. So that is a really, really important part of our work is around process and engaging with patients. Often it's with patients that are with us for a longer period of time. So that's really important in terms of their rehabilitation, but also just kind of socialisation, whether that's with an external person coming in or with other patients. So for example, you know, some of our ward areas have a six bedded bay. Often what we will be doing is a collaborative piece, which is engaging with those six patients that are sharing the same space together. Because that will then have huge benefits when the artist leaves in terms of at least they might know the name of the person next to them, I'll know a bit more, but it will have started a conversation, which might not other wise be there. I think the other really important part of that is it gives the staff skills which they can use in different ways. So that kind of softer side of nursing, which is around understanding people, you know, talking with them, you know, getting to know the families. Which sometimes depending on the environment, there isn't a time to do that. So I think ways that we can help with that it's really important.

Hannah:

I can understand that COVID could easily have inhibited and made it extremely difficult for you to continue that level of service over the last few months. Has there been examples where it's created a new opportunity? Or is it simply been challenging times?

Trystan Hawkins:

Yeah, I mean, you know, COVID has been hugely challenging. But I think, you know, for me, one of the really positive things that I've seen come out of this is, you know, a sense of community in terms of within the hospital. I think also within within the wider community of people just looking out for each other. For us, practically we've had to change the ways that we're working. So with the participant troup work, we've developed a virtual strand of that works. It's called Virtual Connections. So it's our artists creating work which exists online that patients can access, but equally doing things which are remote. So you know, one of the things that you know, we've been doing since June is live performances for patients in the hospital so we'll have a musician who is in their home. Ee will go into the ward area we'll put on the PPE and then we will facilitate an interaction between an artist who is remote and that patient. So, you know, one of the sessions I did a couple of months ago is with a patient who had COVID. He was coming out the other end being with us for 100 days. He was quite lonely. He didn't really have any friends. He didn't have any family. He didn't have a smartphone. So, you know, his life was incredibly boring. He was getting better, which was fantastic. But for him to be able to have that connection with the outside world was so important. With some of our paediatric patients, we've linked him with San Diego Zoo. So we have a live stream from San Diego Zoo into the paediatric areas. So it's not a two way feed, but in terms of live content coming into that environment. So things like that, I think, you know, within COVID have been really positive. I think also in terms of new thinking, for example, like with our outpatient clinics, you know, 70% of those are now being delivered virtually through Skype or zoom or whatever. Yeah, which is brilliant, because that can carry on, it just means that the hospital can run more efficiently. It's a better use of people's time.

David:

I've just got a couple more questions. One of which is what kind of feedback have you had from children? You know, specifically around I mean, something that we have, you know, done quite a lot of work around is that distraction elements, is trying to make, you know, procedures a little bit easier for children. Last week, we were talking to someone that was Evelyn, who's doing a lot of work around VR, and looking to bring that in. But, you know, specifically around the Zoo project, or, you know, any of the other kind of interactive elements or distraction elements, what kind of feedback have you have you received from either the children or indeed the parents as well?

Trystan Hawkins:

Yes, I mean, I think, you know, I mentioned already that, you know, our work is really driven by the people that we're working with. So it's around finding appropriate ways that you can engage with them. So we use kind of the formal groups that exist within hospitals, you know, patient, public engagement teams, but a lot of our work is just about spending time in a treatment area or waiting room and just talking to people. Sometimes we use questionnaires, but often it's about just talking to people, but also just observing the situation. So I think, you know, we're trying to make spaces as unfrightening as we can, we're trying to make them as domestic as we can. You know, if we just go back to the A&E project. The really simple thing that the first meeting I had with the architects, when we were developing that the new unit. I said, Well, what are the acoustic properties for these treatment rooms, and they'd like to blank and said, well, there aren't any. So we, the charity paid for ceiling tiles that had a property in terms of absorbing sound. Ee were able to reduce noise levels throughout the whole A&E by 28%. So you know,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 control over some things within that space things like the light, we've got music, we've also got virtual reality that we're using within paediatric A&E as well. So that's a tool which is available. So I think really, it's about giving people control and allowing them to make some choices. The feedback that we get, you know, is always positive. Otherwise, we wouldn't be doing it. Occasionally, you know, we have had, you know, perhaps some negative feedback about some artwork. Obviously, then we've changed that. I think the other thing is also recognising that, you know, you may do something and then, you know, it doesn't finish, you need to keep looking after that. So an example would be, we've got an area for relatives, which, you know, it's where they had bad news. We've learned from people using that space in terms of 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 up that space, but also kind of learn from the way that people have been in that environment and make it better? So, you know, I think, as an organisation, we never finished projects, we always go back and change them and redevelop them. I think that's really important with technology that, you know, I've seen some really great projects around the country. But then after 12 months, they break and then, you know, the states team don't have the client to fix them. That is a reality of working within the NHS. So we take that responsibility in terms of looking after things and replacing things when they get broken or tired or decommissioning them. So I think it's really important to think about decommissioning when you're working on these these types of projects.

David:

Justin, thank you so much, I think you've opened our eyes to, you know, so many different kind of facets and even as you were just describing. Thinking about how the longevity of, you know, technology that you put in to into a system or, you know, into a paediatric unit, or whatever it might be. But also, you know, as a charity, we're looking to bring, you know, the future of health care to children. I think when people look at that, the connotation is that it's always going to be technology, it's always 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's the latest research, it's the latest evidence, it's, you know, as you describe just the artistic elements of it, trying to think how best to look after the patients and what they need and everything else. I think, you know, for us, it's been a fascinating conversation and something that you know, we'll think about when we're looking at some of the projects that we're going to be doing into the future. The final question that we ask everyone that comes on the podcast, is, if you had a magic wand, and you could do anything, when it comes to child health, what would that be?

Trystan Hawkins:

So I think, you know, for me, it would be focused around giving children, young people, some control or an element of control over the environment that they're in. You know, I think a lot of the things that we're doing are really simple and there not, perhaps that expensive either. So I think the building in control. So for me it would be around the environment that those children are in simple things like, you know. Somewhere, they can charge the phone, somewhere where they can dim the lights. Yeah, I think would be fairly key to me.

David:

Perfect. Thank you, Trystan. Thank you so much for your time, you know, we really appreciate it and good luck with all the work that you're doing.

Trystan Hawkins:

Great. Thank you very much.

David:

Thank you so much for joining us once again on the Not Mini Adults and a big thank you to Trystan Hawkins for joining us this week. Details of Thinking of Oscar and also the work that Tristan is doing with CW plus will be in the show notes. If you know someone that you think that we should be talking to, or a topic that you'd like us to cover on the podcast then please do get in touch. Next week is the final episode of season two before we take some time off for Christmas and then resume again in the new year. We're really excited about our final conversation, which will be with Dr. Todd Ponsky from the Cincinnati Children's Hospital. Dr. Ponsky is a paediatric surgeon, but also Director of Clinical growth and transformation at syndicates. In his own words, he focuses on trying to find the least invasive way to solve a child's medical problem. We really hope you can join us again next week.