Case Study

University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) brings together a combined workforce of over 13,000 staff. The Trust delivers over 100 different clinical services across 10 different sites serving a core population of more than 500,000 people, which includes specialist services such as children’s services based within Bristol Royal Hospital for Children.

The Bristol Royal Hospital for Children (BRHC) provides a local service for Bristol children and a referral service for specialist care for families across the South West and nationally.

With the rise of the second Covid-19 wave in September 2020, our Matrons forum were worried that Christmas would need to be cancelled. The Virtual Christmas project took this challenge and developed a programme of Covid safe activities and entertainment to boost morale and provide bespoke opportunities for entertainment. By using a virtual approach, patients at the hospital could watch the same content as families at home and share in the fun together, which helped mitigate the sense of distance for .those families who were separated due to the infection control limit on one parent only at the bedside. Patients and siblings could share the experience wherever they were and whenever they chose which provided a connection and sense of community which might otherwise have been lost.

It also brought unexpected benefits in widening access to a much larger audience, and growing new skills for our staff and collaborators which we hope will allow this work to be continued into everyday practice.

The team contacted the performers and organisations who would usually visit the hospital during the festive season and asked who would be able to provide a virtual session that could be uploaded to a dedicated playlist on the hospital YouTube Channel, and a number were willing to work with us. We identified a range of activities that would offer variety to young people; story telling for all ages, craft activities, music and singing. We also introduced a competitive element, Bristol Children’s Hospital’s Got Talent, with the play team working on their individual wards with their ‘acts’ which were recorded on video and turned into a showcase for the week prior to Christmas. We also included a retelling of the Christmas story with stick puppets by a long stay patient in collaboration with our school team, and were able to move our Service of Light online in collaboration with our Palliative Care team. All inpatients also received a virtual visit from Santa on Christmas Day which was available through a QR code on their Christmas stocking.

In order to share what was happening, a poster and email campaign were designed and the play team used a generic QR code to link to the playlist on the Trust YouTube channel which was shared with all patients and families regularly. There was also a social media campaign, sharing each new activity and providing a direct link to watch the session.

Following the events we asked for feedback via Facebook and by way of a simple survey on Survey Monkey which explored what viewers felt about the content, how easy it was to access and how they had heard about the project.

Feedback was hugely positive and is summarised below:

• Content was able to reach a wider audience – our most popular had over 200 views which, in the majority of cases, is higher than the number that would have been able to participate in a face to face session.

• Content was open to all family members – not just those in the hospital – which meant that siblings at home could watch along at the same time or undertake the same activities and their share their experiences during phone and video calls. This allowed some families to feel more ‘together’ despite being far away.

• Content could be accessed as and when a patient wanted so no one risked missing out on a session due to being in therapy or having treatment. Favourite sessions could be played over and over again.

• Participants were happy to be able to continue what in some cases had become a tradition of supporting the hospital at Christmas. They could also receive feedback via the comments on the channel and via the Facebook page to hear how families had reacted to their work.

• CFSS staff enjoyed the opportunities to work more collaboratively and new skills and abilities were brought to the fore including film making and editing skills.

• Staff also felt that they were able to contribute, particularly through the Bristol Children’s Hospital’s Got Talent’ sessions which they felt boosted morale and allowed them to join in the fun but in a safe and appropriate way. (289)

Whilst we hope that face to face activity may be possible in 2021, we know we have created a solid foundation for a more hybrid solution to maintain all of the positives of providing virtual entertainment, not just for Christmas but also for preparation and distraction services to support patients all year round.

Following the evaluation results, we have booked our 2021 planning meeting for July 2021, 3 months earlier than usual, to start considering what the offer could be for Christmas 21 and ensure that we have more opportunities to consider our communication approach and widen engagement. The project has effectively formed a small activities coordination group which used the same approach to manage Easter activities and has also been looking at plans for the Summer holiday.

We anticipate that the ‘Bristol Children’s Hospital’s Got Talent’ programme will be repeated, perhaps every other year, and may also be able to become a hybrid event with a combination of live and recorded performances once this is permitted.

This project was created in incredibly short period of time, going from a blank sheet to a programme of 16 individual elements in the space of three months, showcasing the benefits of working collaboratively and of everyone pulling together to make something happen which initially seemed impossible. This work was in addition to other standard day to day duties but collaborators found the extra time and energy to make sure that our patients and families didn’t feel forgotten at Christmas, but the only thing they would catch as a result was an infectious Christmas grin.

Our feedback from the matron who chaired the original Matron’s meeting where Christmas was discussed said it all:

“I wanted to drop you a line to say a massive thank you for everything that you did to make Christmas a success. I know that this was a huge team effort, but you went above and beyond in leading and supporting the changes that we had to make this year – it is hugely appreciated.”

Key learning points include:

• Improving access for patients – wards were able to access additional devices to allow patients without the necessary tech to participate but it would be helpful to make it clearer that this is available.

• Earlier promotion of activities – we need to start planning earlier to avoid all of the content coming through in a rush in the last two weeks before Christmas – although this provided choice it made communication more challenging.

• Approach to promotion of the activities could be improved – reaching everyone is always challenging but again starting earlier and looking at where else we might encourage cascade communication, including staff such as housekeepers and HCA’s who built more social relationships with families, would be beneficial. One respondent suggested being able to sign up to an alert so that you know when new content has been posted and this is being explored.