ARTICLE IN PRESS

The Joint Commission Journal on Quality and Patient Safety 2017; ■■:■■–■■

A Scalable Program for Customized Patient

Education Videos
Ishani Ganguli, MD, MPH; Chrisanne Sikora, MAC; Briana Nestor, MA; Rachel Clark Sisodia, MD; Adam Licurse,
MD, MHS; Timothy G. Ferris, MD, MPH; Sandhya Rao, MD

Problem Definition: Patients must make sense of increasingly complex information to navigate their health and the health
care system, with limited opportunity to do so in clinical settings. Patient education videos may help to communicate key
information, but they are often impersonal and cumbersome to produce or update with new evidence. To address these limi-
tations, a program was developed to facilitate local video creation to deliver targeted information to patients.
Approach: The Patient Education Video Program was created at a large urban academic medical center. The medical di-
rector and two project managers worked with clinicians and patients to create and disseminate short, single-topic videos
organized by segments. The videos educated patients on clinical and service topics such as self-care for low back pain and
postoperative protocols. Videos were filmed and modified on a user-friendly mobile device application, then prescribed by
sharing a link to the online video platform. Video creators were engaged through a learning collaborative, a physician in-
centive program, and a residency elective in which trainees designed video-based care redesign projects.
Outcomes: The program was introduced to practice sites across 26 departments. Some 269 videos received 19,713 unique
views in a two-year period. In an operational survey, 1,034 (86.0%) of 1,203 viewer responses stated that a video helped
them understand their health, medical condition, or treatment plan.
Key Insights: A program to facilitate video creation and dissemination is feasible. Clinicians were most receptive to cre-
ating and using videos that addressed direct clinical or operational needs.

PROBLEM DEFINITION to use these videos to reduce medical errors and treatment
nonadherence through improved communication on complex
P atients must make sense of increasingly complex infor-
mation to navigate their health and health care. Many
patients prefer to do so with their physician’s help,1 but
issues,7,8 support self-care, improve patient experience, and
bolster clinician-patient relationships.
patients have limited time with their clinicians, and the in-
formation communicated is easily forgotten. 2 Patient
APPROACH
education through video, a medium that is adaptable to
varying levels of health and general literacy, is an increas- In 2014 we created the Massachusetts General Hospital
ingly popular approach to supplementing patient-clinician (MGH) Patient Education Video Program within the phy-
interactions.3 Compared to verbal or written communica- sicians organization of MGH, a large urban academic medical
tion, educational videos may better help patients retain center that employs 3,168 physicians. The video program
knowledge4–6 and improve outcomes.7,8 However, studies have was launched as part of the Partners HealthCare Popula-
shown that existing patient education videos on YouTube tion Health Management13 (PHM) strategy, which aimed
are of variable quality,9–11 and that even those created by health to improve care delivery and reduce costs for all patients re-
organizations do not consistently present safety and other ceiving care at the affiliated hospitals and community practice
key information.12 Furthermore, professionally made videos sites. The program was designed to complement other video
are costly and can take a long time to produce, cannot be programs14 at our institution, including a shared decision-
updated easily to reflect the latest evidence-based medi- making program,15 by offering new content areas along the
cine, and rarely feature the viewer’s own clinician. To address continuum of a patient’s journey through videos that local
patient education gaps in light of these challenges, we used clinicians and patients could easily create, modify, and pre-
an online video platform to support clinicians and patients scribe. The program team consisted of a medical director [first
in creating educational videos at a large academic medical I.G., then R.C.S.] and two project managers [C.S., B.N.]
center. Our goal was to demonstrate the feasibility of a scal- for a total approximate time commitment of 1.5 FTEs (full-
able video program in a clinical setting. Ultimately, we hoped time equivalents). This team worked with a Partners
HealthCare PHM clinical and administrative team that com-
municated with the video platform vendor and coordinated
video platform use across the health system.
1553-7250/$-see front matter
© 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.
This quality improvement work was exempted from
http://dx.doi.org/10.1016/j.jcjq.2017.05.009 Harvard Institutional Review Board oversight.
 ARTICLE IN PRESS
2 Ishani Ganguli, MD, MPH, et al Customized Patient Education Videos

Table 1. Video Definition Framework

Topic Domain
Clinical Service
Video Creator Description Examples Description Examples
Clinician Explanation of health or Opioid safety and pain contracts Explanation of a care Meet your inpatient team
(e.g., physician, illness concept, diagnosis, What to expect during your process or entity Meet your care manager
nurse, physical or management colonoscopy Introduction to care Discharge planning
therapist, Tracheostomy self-care setting or team What to expect in your
nutritionist) Stretches for low back pain members skilled nursing facility
How to administer insulin

Patient Experience with health or Getting a mammogram Explanation of a care How to use the online
illness concept, diagnosis, Reducing stigma around MRSA process or entity patient portal
or management infection About our patient family
advisory committee
MRSA, methicillin-resistant Staphylococcus aureus.

Content Development When filming was complete, each video was automatically up-
We (the program team) worked with clinicians or patients to loaded onto the platform and reviewed by the creator before
create short (5–10-minute) single-topic videos with segments being made available for wider use (Figure 1). Individual video
organized by questions or statement headings. The intended segments could be refilmed at any time after publication.
audience varied by video but usually included all patients at- Clinicians prescribed videos to patients by sharing a link to
tributed to a particular clinician or practice setting for whom the online platform through e-mail, text message, smart phrase–
the topic would be relevant. We selected topics that were facilitated insertion in electronic health record–generated patient
(1) frequently discussed with patients or otherwise salient to instructions, handouts modeled after prescription pad sheets
patient care, (2) aligned with institutional or broader priori- (Figure 2), embedment on practice or physician profile web-
ties, (3) amenable to standardization, and/or (4) well-suited sites, or social media including Twitter® and Facebook®. We
to a video format. We developed a framework for video-use also made the videos available on our online patient portal.
cases to organize and communicate the scope of topics (Table 1). Patients were able to access videos made by their primary care
The creators drafted scripts by drawing on clinical knowl- physician as well as the full library of videos created by clini-
edge and existing patient education materials; they could also cians in our health system. Patients could show the videos to
opt for an hour-long, individualized script-writing work- friends or family members by sharing the video web link.
shop with the program team in which we discussed the video
topic with the creator(s) and typed notes to facilitate script Clinician and Patient Engagement
development. Each script was then reviewed by the video We contacted quality improvement leaders in each of the
program’s medical director and one of our project manag- 26 departments and divisions at the hospital and the leaders
ers before undergoing peer clinical review by at least one of of allied health professions (for example, physical therapy, nu-
the creator’s practice colleagues as well as plain language review trition). We then met with interested groups to present program
by the institution’s patient and family learning center.14 The specifics and generate possible topics. As the program evolved,
review process, which took between 10 and 30 minutes, was we also engaged clinicians and administrators working across
usually completed within a week of script submission. departments on high-priority areas (for example, opioid safety,
care management for high-risk patients, palliative care enroll-
Video Creation and Dissemination ment, post-acute care) to find ways to incorporate video creation
The videos were filmed on a user-friendly mobile device ap- and dissemination into major quality improvement initiatives.
plication (vidscrip®) on an iPad® or iPhone®. The application We created and disseminated a manual with detailed in-
was free for clinicians to use on the basis of a five-year contract structions and best practices. We advertised the video program
between Partners HealthCare and the vendor, who required using our institution’s employee bulletin. Departments
an annual license fee. Video creators could download the ap- were invited to select the video program as their popula-
plication and film on their own or request support from the tion health management initiative to fulfill requirements of
video program. Filming took 30 to 60 minutes on average. We an institutionwide physician quality incentive program linked
encouraged filming in the creator’s office or another professional to clinical activity and achievement of performance targets.
environment without visible patient health information and The incentive program, which started in 2006, issues in-
offered several predesignated sites. Videos were filmed in English, centive payments twice a year to clinically active, nontrainee
as well as in Russian, Arabic, Chinese, Spanish, and Portuguese physicians for meeting each of three quality measures; con-
through our partnership with the hospital’s interpreter services. temporaneously with the video program, one of these
 ARTICLE IN PRESS
Volume ■■, No. ■■, ■■ 2017 3

Sample Video Screenshots Prescription Pad Template for Video Dissemination

a About Me
http://app.vidscrip.com/vidscrip/5726cb66a254a5897c3c5ec1

b Opioid Safety in Spanish

https://app.vidscrip.com/vidscrip/5833861bc08dc600051bae95

Figure 2: This image shows a sample prescription pad tem-

plate used to prescribe videos to patients.

We e-mailed all video creators on a quarterly basis to report

the usage metrics for their videos that were available through
the platform and to seek input on their successes and chal-
lenges with video delivery. We enrolled video creators in a
learning collaborative. Members of the collaborative re-
Figure 1: These images are screenshots of patient educa-
ceived occasional e-mails with information such as video
tion videos: (a) shows a video made by a physician that
introduces her to her existing and potential patients, and (b) platform application updates. We also invited them to large
shows a video about opioid safety that is presented in Spanish group presentations with moderated discussion on various
with the aid of an interpreter. aspects of video development, filming, and distribution.
Initially, patients were invited to create videos for the program
on the recommendation of their participating clinician. We
measures was required to involve an initiative through Part-
invited patient family advisory council members affiliated with
ners HealthCare PHM.13
a given practice site to join introductory meetings and to con-
We created a two-week elective in our internal medi-
tribute ideas and/or create videos. We also included patients
cine residency program, in which each trainee designed a
on our health system–wide Patient Engagement Committee
video-based care redesign project. A maximum of two resi-
in conversations about developing the video program.
dents could sign up for each of the 22 available two-week
blocks. During the elective, residents worked with the
clinicians and staff members at their continuity clinic site EVALUATION
to identify and address gaps in patient education or prac- Between October 10, 2015, and January 6, 2016, we ad-
tice operations by developing patient-facing videos. The ministered a two-item patient survey for the primary purpose
learning objectives were as follows: understanding the roles of informing operational decisions. The survey was
of various care team members, reviewing the literature on administered across all Partners HealthCare sites that were
topics in ambulatory medicine, and developing content suit- using vidscrip® and consisted of the following two items:
able for patients. Participating residents met regularly with 1. Do you find this video useful in helping you to under-
the video program’s medical director and a project stand your health, medical condition, or treatment plan?
manager—for a total of five to seven hours during the two- 2. Do you think it is important that health care provid-
week block—to develop, film, and review the videos. ers give programs like these to their patients?
 ARTICLE IN PRESS
4 Ishani Ganguli, MD, MPH, et al Customized Patient Education Videos

The survey was embedded on the video platform and offered The 10 hospitalized patients who were interviewed after
upon initiation of any video. Other patient and clinician-level viewing videos that introduced members of their teaching
evaluations were conducted on individual videos or video series. service clinical team reported that the videos were “engag-
For example, we performed semistructured interviews among ing” and useful to share with family members. Several required
a convenience sample of patients to evaluate a video pilot in prompts to watch the videos. One respondent reported that
which inpatient general medicine teaching service teams created the video caused her worry when she learned that the team
videos to introduce team members and their roles to patients. member with whom she had made a personal connection
We also evaluated videos for their impact on specific clin- was an intern rather than a higher-ranked physician.
ical and utilization outcomes, as in Tanguturi et al.’s prospective In the prospective trial of videos and other initiatives to reduce
trial to reduce readmission rates after percutaneous coronary readmission rates after percutaneous coronary intervention, the
intervention.16 For this trial, we worked with colleagues in car- multipronged approach was found to reduce readmission rates
diology to create videos featuring cardiology fellows explaining from 9.6% to 5.3% between 2011 and 2015.16
self-triage of chest discomfort and managing heart failure symp-
toms. Web links to the videos were included in written discharge
instructions as part of the multipronged intervention. For KEY INSIGHTS
another initiative, which was aimed at reducing surgical site We demonstrated the clinical and operational feasibility of a
infection rates following colorectal surgery, we co-created a series program to facilitate targeted video creation and dissemina-
of videos for patients to view prior to surgery and during their tion at a large academic medical center. Early evidence suggests
inpatient stay on the hospital’s closed-circuit television system,14 that the videos may contribute to larger population health goals
as well as after discharge (research in progress). The video such as reducing readmission rates.16 Our experience may be
program also encouraged and supported evaluation efforts led helpful to other clinicians and institutions, particularly given
by individual divisions or departments by offering usage metrics evidence that high-quality clinician-patient communication,
and other resources. and videos in particular, may improve patient knowledge, self-
management, and health outcomes.4–8
We found a tension between creating content that was
OUTCOMES broad enough to be generalized yet specific enough to be
We introduced the program to practices representing 26 de- useful to patients. For example, in a video on heart failure,
partments across the medical center. The 269 videos that we we could include content on the purpose of various stan-
created received a total of 77,255 “views” (defined as playing dard medications but had to ask patients to discuss specific
at least one video segment) and 19,713 “unique views” dosing and frequency with their own clinician. There was
(defined as a unique visitor to the video URL playing a video also a tension between ease in creating the videos—and, there-
one or more times) in a two-year period. The total number fore, scalability—and the demands of quality assurance. To
of views per video ranged from 2 to 9,301, and the videos this point, we discovered the value of engaging key stake-
were viewed for more than 615 hours cumulatively. Videos holders, including hospital leadership, to address and design
about kidney transplantation for potential donors and re- protocols for video-quality considerations such as informa-
cipients (9,301 views), preparing for a healthy trip overseas tion accuracy, consistency with existing patient education
(5,238 views), and introducing solid foods to infants (1,203 materials, patient safety and privacy, clinician professional-
views) were among the most highly viewed. ism, and video production values (that is, technical elements
Six (6/26, 23.1%) departments, comprising 179 physicians, of a film, such as lighting, decor, or sound that can be im-
selected the video program to fulfill their physician quality in- proved to enhance audience appeal). In the first few years
centive requirement. These physicians all earned a modest with the program, we found that several videos required up-
financial incentive by meeting the following prespecified criteria: dating, in particular videos on procedural topics (when clinical
(1) at least 10% of physicians in their department helped to protocols changed) and videos introducing personnel (when
make a video and (2) at least one clinical and one service video individuals left or joined a practice site). The updates could
was created per department. In addition, we launched the res- be prompted by the video program, the video creators, or
idency elective, and eight trainees participated in its inaugural by a third party who had observed that need.
year, filling 18.2% (8/44) of the available two-week slots. We found that clinicians were most receptive to creating
Among the 1,203 patients responding to the survey, 86.0% and using videos that addressed direct clinical or operation-
(1,034) reported that they found the video “useful in helping al needs—for example, a video capturing a urologist’s
you to understand your health, medical condition, or treat- instructions on post-vasectomy care, possibly reducing the
ment plan,” while 87.5% (1,053) reported that they thought time needed for this explanation during the office visit and
it was “important that health care providers give programs the likelihood of a post-visit phone call. Clinicians in spe-
like these to their patients.” It was not possible to ascertain cialties with lower patient demand seemed to be less receptive
from the platform how many unique viewers were offered to videos as visit-replacers (rather than visit-extenders), perhaps
the survey, so we were unable to calculate a response rate. due to volume-based payment incentives.
 ARTICLE IN PRESS
Volume ■■, No. ■■, ■■ 2017 5

Clinicians had a wide range of comfort with, and band- Manager/Editor, MassGeneral Hospital for Children, Boston. Rachel Clark
width for, video planning and filming: Some clinicians we worked Sisodia, MD, is Assistant Professor of Obstetrics Gynecology and Repro-
with took one or two days to create a video, while for others ductive Biology, Harvard Medical School, and Assistant Medical Director,
Massachusetts General Physicians Organization. Adam Licurse, MD, MHS,
the process required months or years along with repeated re- is Instructor of Medicine, Harvard Medical School, and Associate Medical
minders. Therefore, we learned to offer support commensurate Director, Center for Population Health, Partners HealthCare, Boston. Timothy
G. Ferris, MD, MPH, is Associate Professor of Medicine, Harvard Medical
to individual needs. We learned through solicited feedback and School, and Senior Vice President, Center for Population Health, Part-
direct observation that many clinicians struggled to incorpo- ners HealthCare. Sandhya K. Rao, MD, is Assistant Professor of Medicine,
rate video prescription into clinic work flow because they did Harvard Medical School, and Medical Director for Quality Improvement,
Massachusetts General Physicians Organization. Please address
not remember that the video was available or had difficulty correspondence to Ishani Ganguli, iganguli@partners.org.
accessing it at point of care. Therefore, we worked with video
creators to clarify the purpose, target audience, and work flow–
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Blum Patient and Family Learning Center; Jorge Rodriguez, Beth Israel
14. Massachusetts General Hospital. Maxwell and Eleanor Blum
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