Better Communication means Better Healthcare.
Dr Rachael Grimaldi is an anaesthetist based at The Royal Sussex County Hospital. She decided to try and solve a major problem when she heard the story of a critically ill patient who talked about his terror when he couldn’t understand what healthcare staff were saying to him through their personal protective equipment (face masks, visors and hoods).
Rachael was on maternity leave and stranded in the US because of COVID restrictions so she decided to put her time and energy into coming up with a solution that would benefit her frontline NHS colleagues and their patients. Rachael set to work on a series of flashcards with key messages. Within 72 hours, she had developed a free online resource in 10 languages and a read-aloud option for partially sighted or blind patients.
In this podcast, Rachael discusses Card Medic's development and her aspirations to remove communication barriers across all healthcare provision.
Phil Friend 0:08
Hello, everyone, it's Phil Friend once again with the Gear, Gadgets and Gizmos show. And today I'm delighted to say that we've got with us, Rachael Grimaldi. Now, Rachael will explain who she is in a second. But she's not one of our disabled colleagues. She's doing something that's a bit more sort of, is different. And I think very, very important. So, Rachael, good to see you welcome. How are you?
Rachael Grimaldi 0:33
Thank you. Thank you so much for having me. I'm really well, thank you, Phil, how are you?
Phil Friend 0:37
Good, good I'm very well too. Oh, yes. Now I know you're a doctor. So the fact that I'm very well is probably very good news. I'm not coming to see you professionally. But tell us a little bit about yourself, Rachael, you are a doctor. I mean, tell us a bit about your career and so on.
Rachael Grimaldi 0:54
Yeah, sure. So um, so I'm an anaesthetist by background. I work in the NHS, and I've been practising for over a decade. And in terms of my medical career so far, I've worn a few different hats during my anaesthetics. I also am the Associate Medical Director for the Brighton marathon. And I run the research group there as well. So those are kind of been my main medical background and experience and then also set up Card Medic, a year ago, which I think we're going to talk a bit about today.
Phil Friend 1:32
That's the plan. Card Medic is the product because on our show, we normally talk about an issue some gadget or something of that sort, usually that a disabled person has been using to overcome the barriers that their disability throws at them. What we're talking about here is Card Medic, which is something you've designed and implemented, I know with others, and you can explain that. But this is a really important product, it seems to me, tell us a little bit about it. How did it come about first, I mean, what led you to develop this very clever idea?
Rachael Grimaldi 2:03
That's very kind of you. Thank you. So while it was actually started last year, at the height of the pandemic or the first wave of the pandemic, I was on maternity leave visiting family in the states where I used to live and our flights cancelled seven times in the end. So we were there for nearly six months. And I was really desperate to do something to help my friends and colleagues across the NHS who were struggling to communicate with patients through PPE. And I actually read an article about a patient who'd been to intensive care with COVID. And who was terrified because he was unable to understand the healthcare staff through PPE. So I thought, you know, how are people overcoming this barrier? And what are people doing? They must be maybe writing notes on a piece of paper, or, you know, trying to sort of signal or mime and I wasn't really sure how people were managing and spoke to some friends and colleagues across the UK who said that this was an issue. So I thought, well, what about if I tried to create a tool to support that communication? So how about if I essentially replicated those conversations those little notes on a piece of paper, but put them on a website that was really easy to access. So with essentially from concept to launch, in 72 hours, we'd built the website Card Medic dot com, and then added a load of content, mostly based on my experience and anaesthetics and critical care. And we launched that. And the intention was just to share it with some friends. And someone said, you should join Twitter, which was a bit sceptical of I'm not a social media user normally. But we joined Twitter. And then within three weeks, we had 8000 users in 50 countries, and it just spread by word of mouth. And the feedback we've had during that time, will actually even within the first few days was, you know that this needs to stay around. It's a really useful tool, we need it after the pandemic because actually good communication, healthcare or barriers to good communication, healthcare has been a really long-standing issue. Outside the pandemic, the pandemics just serve to massively exacerbate it, and bring to light the health inequalities that 20% of the population suffer with who do have barriers to communication. So that's what we've been working on. And then over the course of the last nearly a year, we've had nearly 50,000 users in 120 countries and 16,000
Phil Friend 4:33
So who the users are the actual users of it?
Rachael Grimaldi 4:38
so the users are members of healthcare staff or health care or allied health care professionals. So you can go to the website, choose the topic you'd like to talk about or the app and choose a topic you'd like to talk about and show that the screen to the patient and then use that to guide the conversation or the clinical interaction. But we have actually had lots of patients and members of the public contact us through the media coverage that they've seen, or social media or the kind of when they've heard about on the radio or TV getting contacted and drop us an email to say, you know, can we have this in sign language? Or can you add this content to it. So actually, what we've built out with using feedback from patients and public and members of staff and carers, is to make sure that the content that we've got is like a one stop communication shop. So we're able to be really flexible at the bedside, so to speak, or at the point of caring for the patient. To make sure we've got language is multilingual, we've got read aloud for patients with visual impairment or who have literacy issues or who are too unwell to read. We've got sign language videos, which we're just about to launch and easy read with pictures, and then our integrated translation tool. So although it's supporting the staff delivering the care and the interaction, the idea is that the patients are also able to communicate back to the members of staff and answer all the questions as well and ask questions if they want to as well.
Phil Friend 6:07
So if I was going to see a doctor, in a hospital or clinic, I could first of all download the various topics that might relate to what I'm going for and kind of get used to what's going on there all set them up. So I can just go on, I'm thinking of people who have no speech, for example, or who have neurodiverse conditions may be learning disabilities of one sort or another. Deaf people, obviously, who use sign language, for example, it's possible for them to download this information and then use it themselves when they go and see the clinician, is it?
Rachael Grimaldi 6:41
Yeah, absolutely. So we've got our freemium model if you like. So the Card Medic Lite, where we've got, there's quite a bit of content on there already, that will have all the languages that we offer, the sign language videos, the easy read with pictures, the read aloud, it's got the content and the functionality. And anyone can sign up for that, all you need to do is just username, you know, email address, your name, username, etc. And then you verify it when you get sent your email address. And then you can access it all for free. So what you could do is if you knew about Card Medic, and you can download the app, or access the website, from your phone, or Kindle tablet, whatever, you can take it into your hospital, dentist, pharmacy, GP ambulance, kind of any healthcare setting. And if you know that the content is on there that you need, you can show it to the healthcare staff and ask them to use it to support the interaction with you. And then in terms of being able to access all the content, as well as some extra additional features. That's a subscription that we're looking at for healthcare settings to pay for.
Phil Friend 7:46
So let's have a little look at a typical example of somebody who has serious communication difficulties. We won't worry about why that is. But they're going to see their doctor about some blood tests that they've had, for example. And they're going to be given the results. And they need to talk about how what that means. And so, so what would be the process that you as the doctor, and some would go through, presumably before I arrived, but also when I'm with you what's How does it actually get used in real life?
Rachael Grimaldi 8:19
Yeah, that's a great question. So you know, as I mentioned, it can be used in any setting. And, you know, part of that is if you have accessed that and advanced the patient to kind of prepare yourself for your appointment, then having a read-through of the content will help you prepare a bit. But whoever you're going to see the doctor if it's for some blood test results, for example, if we've got the content on there, and if we don't, we can add custom content on there as well. Then we would make sure we've introduced ourselves there is a Hello, my name is card so we can introduce ourselves to the patient, explain who we are, what our job is where we're working to kind of set the scene and explain that we're here to talk about blood test results today. And then we would access the card or series of cards to do with blood test results. And then we can bring up the screen. So on the screen, we can show the patient the text, if you like the flashcard is kind of the way that we've worded it just because it's very simplistic, really clean and clear. It's just, it's just plain large text on a white background. Or we are looking at being able to change the different colours of the text and background to suit different people's needs. But it's essentially plain writing on a background with pictures if you need it. And you can either read that content yourself. It can be read aloud to you it can be you can change the language. And so it just helps support the clinician who's explaining the information to you to make sure that it's just simple and easy to understand free of jargon. And then every after every card, there's the ability to press the any questions card which takes you straight to the flashcard which asks We know we've given you a lot of information, there's a lot to understand and take on board. Especially as we were mentioning before this discussion, Phil, you know, people, it's stressful, it's anxiety-inducing going to see a healthcare professional. And we want to make sure we try and minimise that as much as possible, reduce any anxiety around not being understood or understanding what's being said. So we made sure in that that any questions card that we also make sure we give patients an opportunity to ask any questions at the end, whether they'd also like an interpreter present. And then into that, we are also going to be integrating additional patient communication tools, such as communication boards, and things like that designed by Speech, Language therapists and learning disability nurses who I've been working with, throughout this, they've been incredible. And so just to try and make sure that we give staff the best means to communicate with patients as possible, but also patients the best tools to try and communicate back. And if the conversation is kind of expanding beyond the cards, bit if you like, so if there's content that you're wanting to cover, that's not on there, then you can skip across to the notepad, which is basically a free text section where you can dictate your questions or answers, and it kind of auto transcribed, and then you can translate it. And we're working on building out the functionality of that. So it's a speech to text functionality to really allow those back and forth conversation. So it's not just a kind of one-way tool that staff can communicate with patients and vice versa.
Phil Friend 11:31
I mean, this is extraordinary. So you're, you're stuck in America, and two days later, you're all over Twitter and 8000 people know about you. It's quite extraordinary. I mean, this is I think COVID has been a really interesting experience in a positive way on some levels. I'm not wishing it on anybody, I wish it had never arrived. But we have developed and this idea of yours is, is totally brilliant, I suppose the big question that I think many people listening to us will be asking is, how available is it? I mean, is it in every GPS practice? I suspect not yet. But what's your plan there? Because clearly, this only really works. If it becomes a pretty standard piece of kit. I mean, when I go and see my doctor, he's got a stethoscope or she's wearing some bit of gear that I need. This almost needs to be in their pocket, doesn't it? It's kind of so how easy is it and how accessible is it across the health service now? And I know that's a bit unfair because it's very early days still, isn't it?
Rachael Grimaldi 12:38
Yeah, that's a really good question. So I think there's a lot that's tied up in that as a question and sort of lots of different avenues to explore. So there are 1000s of frontline healthcare staff across the NHS using it, not just the NHS, but across the UK and globally, that are using Card Medic just downloaded it and have run with it, which kind of ties into a separate point in terms of how easy is it to use, because it's really simplistic and intuitive, you can just pick it up and run with it, it doesn't require a lot of training, it's not costly for hospitals or GP surgeries to implement at all. It's such a simple tool that you don't really need any training on it. So it's very easy to use in terms of how many GP practices it in our dental practices or hospitals. Because we, you know, essentially wanted to get something out there for free, no barriers to entry, something that's just going to help in the pandemic, there was no login required, it was just out there for people to use. And that's been what's been happening for the best part of the last year, what we've done in the last I think about 10 days or so now have released our first commercial product if you like so we've got the Card Medic lite, which is our free version, which has got any card that you can access to do with emergencies that you'd want in an emergency setting is on there. So anyone can access it anytime, anywhere across the world for free. You just sign up name, email address, verify your email and you're ready to go. We've been speaking to different trusts across the UK, we're starting to speak to GP practices. But I think it's just about getting the message out there, that this is a tool that staff really want that patients really want and that it's really cost-effective. And we want to make it available like you said in everyone's digital pocket really. So it's just a go-to tool that's kind of a one-stop communication shop. You're not having to go to lots of different tools and apps and websites and pick up the phone to translators and because the reality the logistics of all of that is that it's expensive. It's time-consuming to organise. It doesn't always work. That there is legislation to make sure that we're providing information in a simple, easy to understand format for everybody. But because of budget constraints and time constraints, and you know, logistics and all sorts of things, it isn't always possible with the best will in the world to get that out there and to make it available. And so what we're trying to do is bridge that gap, and provide a really cost-effective solution that, that any health care professionals, allied health care professional in any healthcare setting in the community care homes, ambulances, dentists, pharmacies, hospitals can access at any time.
That's very, that's very helpful. So we've got a kind of a lite version, which is free to everybody. And that's mainly would be used in emergency type situations. But there's a much more detailed version which will be available through subscription, what's the penetration in the sense of how widely is it known? So, you know, when we think about the GP surgeries, or the dentists or the care home providers, how likely Am I to come across it, because they've heard of it,
The chances are, that your healthcare provider may have heard of it, but probably not at this stage, because it's still relatively early days. But we're hoping that once we've got our Beacons Site, that's all going to change. And that we're going to be really actively pushing it now because although you know like you said, we needed to generate revenue. And it's, you know, in order to sustain it, and to build out its functionality and all the features. actually a really big part of this, and something that's really close to my heart, as if this wasn't already close enough to my heart, but something I feel really passionate about is that this has a positive social impact, we reduce health inequalities, and we improve patient safety and quality of care. And in line with that, we are we've set up the Card Medic Foundation, which someone is running alongside this. And we're using the foundation to make sure that the money that we make from Card Medic that we put into the foundation to not just subsidise the use in low middle-income countries and humanitarian crises and refugee camps, but also that we are providing grants to to really help the local communities set up programmes and businesses that support healthcare in their countries. And that's something I feel really excited about. And we're also working with, we're about to start working with the step one foundation in Kakuma refugee camp in Kenya to do some of the translation work as well. So that's a really big part of what we're doing. It's very much not set up to intend to be a business, but it's rapidly evolved into that because of the feedback we've had. We thought this has got to become sustainable, but we wanted to also be a force for good and, you know, positive social impact in that way as well.
Phil Friend 17:52
So I guess there's a sort of final question really. There's us the public, my chums who listen to this, they're not in their millions, but you know, what would you want them to do? The people listening to you and me now, many of whom will be disabled people, of course, and their families and supporters and so on. What what's the call to action for them from you?
Rachael Grimaldi 18:22
There are two strands to that. Number one is that we want to make this the most useful and relevant tool possible for everybody. So for the staff who are delivering the care supporting the staff, we want to know what kind of content do they want on their end features? And the exact same goes for the patients who are on the receiving end of that we want to know what do you like about it? But more importantly, What don't you like about it? So what can we make better? Is there content on there that we don't have that you'd like to see? Are there features that you'd like to see are there you know, aspects of it You think I wish it did this but it doesn't or it would be great if it did that or I don't actually like this writing with that background or I don't like those pictures I prefer these pictures all those sorts of things really help us shape the best product it can be so feedback is the number one thing that we are absolutely you know we're really keen to hear feedback and there's the email is firstname.lastname@example.org that's really straightforward. Or you can just visit the website www.cardmedic.com and let there's the Contact Us page on there. So over on Twitter @cardmedic, so it'd be just drop us either which way drop us a note your thoughts feedback. We're always really interested in setting up meetings or focus groups to get people's thoughts. And then the other strand to that is if you know about it, and you like what you see. Then share it you know, share the idea when you go and see your healthcare professional or allied healthcare professional. Show them it as a tool you have you seen this? Have you heard of it? I actually really like it. Or could you speak to your boss about more the, you know, if you're going to the GP, the partners of the practice, or drop us a line and let us know we've been to this hospital, we've asked them would they use it. They're a patient experience teams at hospitals that we can speak to, or equality, diversity and inclusion teams that we can speak to. And if we know where you're going, and we know the places you're visiting, and you've asked for Card Medic to be used, then we can contact them on your behalf and say, we know that you have patients in your who live in your area that want us to you to be using this tool. So I think those are the two key things, feedback and, you know, spreading the word and then letting us know.
Phil Friend 20:42
Well, I guess the other thing is we kind of come to the end wrap up really if there's anybody listening to us who's got millions of pounds, and they want to invest in this brilliant idea, then I guess you're on? You know, you're available for discussion.
Rachael Grimaldi 20:59
Yeah, well, yes, absolutely.
Phil Friend 21:02
I was thinking more about the being serious, you know, the developments of this is clearly going to be expensive, and but also, you know, making it available to everybody. So we all hear about it. So an advertising budget doesn't come cheap, and all that sort of stuff. I'm really serious. If there are people listening to us who think this is a product worth investing in to make it available to all of us, then please, you know, do let Rachael know, I will, of course, put on all the links. One final question that always comes up with IT that I must ask you, I think I know the answer already. How secure is it? Is there data collection going on here? What about my privacy? Those sorts of questions.
Rachael Grimaldi 21:43
So there's no data collection. So where we've got Card Medic set up at the moment, the only thing that we collect is if you sign up for it, we've just got your email address, you know, on the system, and that's it. We don't store any personal or patient identifiable information. The conversations that take place on the integrator translation tool aren't stored. So nothing personal is stored at all. And it's all secure and encrypted and stored on Amazon cloud, as it is we've got NHS digital security clearance, and we comply with the clinical safety standards. But we've just kind of belt and braces done that. But yes, no, we don't store any personal information.
Phil Friend 22:26
That's great Well, I mean, I think that's that, you know, it is a concern that many people have. So it's reassuring to hear your response. Well, what can we say Rachael, other than that is the most interesting product, something that I think deserves to be very widely known by as many people as possible. It's clearly a force for good. Some good things have come out of COVID and I suspect this is one of them. So thank you very much, Rachael, for giving us your time, I will make sure that we post all the information about Card Medic on our sites. And who knows we might talk again about how we can help RIDC get the word out to so been brilliant talking to you. Thank you so much.
Rachael Grimaldi 23:11
I've really enjoyed it. Thank you so so much for your time and to your listeners as well. I'm very grateful.
Phil Friend 23:16
If you've got some gadgets or things that you use to overcome the difficulties that your disability may cause, please let me know and maybe we can arrange for you to appear on the show. My email address is email@example.com. Or you can contact me via the Research Institute for Disabled Consumers at www.ridc.org.uk and thanks for listening
Transcribed by https://otter.ai