#413 James O’ Donovan from CHIC: Why the Future of Healthcare Starts with Community Health Workers

23:42James O'Donovan:The models will vary depending on the individual country, but typically they might receive some initial training. And then they may get some supervision following on from that, and they may get some equipment and supplies. But again, that's not guaranteed. Sheik is trying to change that and say, look, there are best practice guidelines published by WHO. There's eight of them in terms of you should be fulfilling these and making sure that you're not seeing community health workers as volunteers or as an afterthought they're basically a pivotal role of like delivering care in um communities um so chic is innovating in in lots of different ways and the way chic is made up is that we're a field catalyst and a coalition with multiple different member and ally organizations so the member organizations can include organizations like living goods or last mile health big providers who are present in countries such as Liberia, Ghana, Kenya, etc.

24:40James O'Donovan:And they support the governments and also the community health workers. The community health workers will be affiliated typically to the government and to that organization. But Sheik really came together to think about, okay, how do we share best practices globally? So if something amazing is going on in Malawi, for example, how could we learn from those best practices and bring that into other countries as well? and also we believe in like collective action so how do we leverage collective voice and amazing things that are being done to drive these big ambitious policy changes so we've got three main arms to the organization we have the research arm which i head up and we really try to generate and drive either primary care research or pull together existing research in things like meta-analyses or systematic reviews and give that evidence to policy makers or important funders Now, the second arm is the policy arm.

25:35James O'Donovan:So again, trying to enact policy change. And then the third is the activate arm. So leveraging in-country networks of community health workers to elevate their voices. So importantly, things like we shouldn't be having conversations about community health workers without them at the table. And that's why Dickson, one of my community health worker colleagues, was a co-host on the podcast that we ran. And again, talking about innovation, to my knowledge that's the first time a community health worker has co-hosted or hosted a podcast which is again really important because so many of his colleagues then would listen to that and think okay dixon has done this and they can probably relate much better to dixon than they can to me of course and so that sort of triad or triptych is really important to actually shifting changes, it's not good enough to have just great research.

26:27James O'Donovan:It can't just sit in a journal. It needs to get into the hands of the policymakers and the decision makers. But then equally to have the sustained grassroots level movement, you need the people who you're trying to affect change for to be part of that and have ownership of it. And that's where the community health workers are so pivotal. And so ultimately, I guess the goal is to have national or international unions of community health workers i mean you've got international unions of midwives nurses like we always say why yeah community health workers absolutely so yeah the work is being spearheaded by an amazing team um we have fantastic colleagues um dr madeline ballard is ceo and um she and the team have been recognized with the rue prize which is a really prestigious award from ihme university of washington and and then also the skull prize for social innovation so for any listeners who are interest in innovative forward-thinking models in either community care or global health which equally can apply across sectors um i would say yeah have a look at the chic website the website is join chic um and uh you'd be very welcome to either join as allies or if you are working in

27:38Dr. James O’Donovan:this space as members so um yeah it's funny as you're talking the innovation being communication and all that sorts of stuff it's like you can feel the the venn diagram the the youtube circle i can feel it encroaching that we can easily easily bring that in and talk about how disseminating those messages through youtube is obviously an innovation but before we do so community health workers you've clearly identified their value in the in in health care in these settings now the podcast that we produced with you guys was about data so what's the situation currently why is data important and what is essentially the health tech innovation here with data and how is that why should everyone know and why should everyone care about that we

28:38James O'Donovan:can kind of unpick all those parts of the questions, I guess, to set the scene for listeners who aren't familiar with this. We ran a podcast series, which your team helped us pull together and record and film. And we looked at the role of data in community health worker programs. We had five key parts of the episode, setting the scene, looking at participatory co-design and involvement. Third was about data and digital, and it was about data quality. And then we applied all of those things through the lens of antimicrobial resistance and partnered up with the Fleming Initiative to really showcase how data and at primary care level with community health workers is having an impact through the lens of antimicrobial resistance, which is obviously a major international problem.

29:22James O'Donovan:And so I think one of the things that we have to think about, the current problem is that data and data systems are very fragmented um and we don't always necessarily a capture the data and b when it is captured we're not maybe leveraging it in the best ways possible to

29:41Dr. James O’Donovan:gain new insights um and when you say that james just paint the picture of like a very realistic version of this like a community health worker on the ground what are they actually doing like what does that lack of data capture in inverted commas actually i'd say the most very basic level

29:56James O'Donovan:If we were to look at maybe the worst case scenario, it would be a community health worker still using pen and paper to go house to house and record data about who is in the household and what kind of illnesses people are suffering from within that household. Then they might go back to a health center and upload it, maybe to a database, but we're still not sure. It could just be filed away in filing cabinets. And obviously that comes with whole sorts of problems. And data accuracy, who's recording the data? Are people just not at the household at the time? And things like, if it's raining, is the paper going to get destroyed?

30:33James O'Donovan:And then you're not going to be able to file it. And then does it just sit in the cabinet and doesn't get used? Things have become more sophisticated over time. And there are examples of best practices now where community health workers have mobile phones with digital tools. And there's people who are doing amazing work in this space on this. So groups like Dimagi and Medic, who are members of Cheek. But they will go and collect data on the mobile phones. that will go to a central electronic health system. And then there'll be people who will analyze that and try to identify important trends. So community health workers are pivotal to this because they're the ones going house to house, collecting the data.

31:08James O'Donovan:And so the whole episode on data quality is really incitably important. And I guess, again, to peel back, I don't want to go down into too much of like the granular detail, but when we think about data, I think most people might assume it's about community health workers going house to house, collecting data on things like TB, malaria, et cetera. But actually there's that more macro picture as data about the community health workers themselves, like who are this workforce? And that's like very, very important to know for things like health systems, planning, funding, knowing where the gaps are in the workforce.

31:40James O'Donovan:And again, that kind of translates over into the NHS. I mean, we're having conversations about the 10 year NHS plan and shortages of doctors who are potentially leaving the system and how do we plug those gaps of course so i think you can't make decisions about a health system without knowing about your health workforce and that all comes down to having good quality data that you can trust rely on and utilize and leverage in in dynamic ways well it's funny as well as you're

32:07Dr. James O’Donovan:talking i'm thinking of like the scale of this yeah right as well yeah because this the fragmentation is one thing but it's so it's so fragmented amongst so many i mean how many community health workers are there it's a great question that's what we still need to work towards like a database

32:24James O'Donovan:of community health works like who is a community health worker where are they located there's i estimate there's millions um it's in the millions and that's the thing millions of community health

32:34Dr. James O’Donovan:workers seeing a multiple of that 100 200 like a multiple of that patients you think about all of the all of the insights that are locked up into that data and even if we're collecting the most rudimentary data the insights and therefore the impact that can be created and it's funny and this is what i mean about in in the western world where we're you know there's medical journals that are splitting hairs on the nanomoles of this versus this and and and you know what's the number needed to treat if that like it's yes okay that there is obviously value in that and then when you think about my god if we can if we can equip 10 million community health workers with the ability to just figure out whether flucloxycylin versus amoxicillin is a good idea or whatever it is like all of a

33:22James O'Donovan:sudden and the ripple effect is massive like you don't even have to uh train 10 million community health workers my argument would be you could train one community health worker who will reach like 200 households and the ripple effect from that is huge plus the community embeddedness means that when you train one community health worker they will train other community health workers this they're not isolationists they don't work in silos they work as like a real strong community unit. And so there's huge potential for this. But I would also say community health workers ultimately are the bedrock of most good primary healthcare systems.

33:56James O'Donovan:And the thing that has kind of unified us all globally have been major events such as pandemics. So COVID-19, Ebola, et cetera. These are things that don't respect boundaries at all, But the people who are going door to door, finding out where that zero patient case is, are the community health workers. They're putting themselves in harm's way. They're going into the community to places that are very rural and remote that traditional healthcare systems don't necessarily reach. So they will travel by boat, canoe, motorbike. They will basically go. And one of the organizations is called Last Mile Health because they go to the last mile to reach that patient.

34:37And so from an equity perspective, they're so pivotal and vital, but also from a global health security perspective and health security perspective, they are pivotal.

34:51James O'Donovan:And I think it's really important to know about them that way as well.

34:56Dr. James O’Donovan:You can very easily then make quite an obvious and clear economic argument for big Western economies to invest in this. Because if the next four or five pandemics are, well, if the information about when and how and potentially how to prevent the next four or five pandemics is locked away in those insights, then there's an obvious and clear, as I say, economic argument to really funding this work. because quite right if if there's half a million community health workers that are canoeing across various terrain to get to houses that we're unsure you know unsure how else to get to and within there is where the next thing starts like how how are we going to figure this out unless we have this data at scale it seems urgent and important yeah it's hugely urgent it's like so

35:58James O'Donovan:important and i think um unless we have the data we can't make very wise investments or decisions but also unless we have organizations like chic who are pulling together people from different disciplines different geographies um and importantly different tactics so the policy space the research space etc you can't really move that needle which is a tough needle to move But in terms of your point to cost effectiveness, we have thought about that as a coalition. And we just finished a suite of five papers looking at the cost and cost effectiveness of community health workers across various disease verticals.

36:37James O'Donovan:So things like HIV, TB, malaria, NCDs, non-communicable diseases, NTDs, neglected tropical diseases, and maternal and child health. And then what we call vertical or horizontal programs. So meaning not just those siloed approaches, which some community health workers may just focus on, say, just maternal and child health, but those who look at everything. And the emerging evidence from all of the papers that have been published during the past 10 years is that community health workers are highly cost effective. And importantly, when we looked at the HIV, TB, and malaria paper, so the infectious diseases, which again, HIV doesn't respect geographic boundaries, we found that they were cost effective when compared to alternative service delivery models, most commonly facility-based care, meaning that they are more cost effective than delivering care in health centers.

37:27James O'Donovan:so yes you're getting better outcomes and most likely in terms of health outcomes but cost outcomes especially to the payer like the governments or the funders who are funding

37:38Dr. James O’Donovan:this work they're a really great model one of the things that was um actually very impressive when we were recording was the the number of and i would say quality of organizations that um are involved in this stuff like it comes to you know tracy comes to mind from the gates Foundation and things like that so clearly there is a lot of attention on this and a lot of organizations are wanting to be part so you mentioned it there is you mentioned Sheik as essentially bringing those organizations together is that is that your role in this then?

38:15James O'Donovan:Exactly and I think it's something that before Sheik existed people might have thought it wasn't possible because when you're working in any space there can be a sense of resistance to change but also competition and not wanting to collaborate and maybe because of limited funding parts or mandates or just this sort of protectionist view but actually ultimately we're all kind of working towards the same goal and what we've been able to achieve even in the last sort of two or three years has been so much more than we would have if we were working alone on this problem. And there has been benefits across organizations because you share learnings.

38:56James O'Donovan:And I host a monthly research call where I have dozens and dozens of researchers or heads of monitoring, learning, evaluation who are on the call. And we work on both collaborative projects, but also there's opportunities for those organizations to share their research and their best practice and learnings and it's that kind of rapid iteration and sharing practical sharing of lessons that they can move this needle forward um but yeah it's interesting i think people are working in this space like you know tracy mcneill is at gates foundation but she was previously at babylon and i think um there's so much that hopefully the listeners can be taking away from this um and this could be applied to various different fields such as digital health for example but even

39:38Dr. James O’Donovan:pharmaceutical medicine etc yeah 100 yeah when i recorded with ali he name checked her specifically um which just goes to show the caliber of the type of people that are involved in this stuff the last episode that you guys recorded was on antimicrobial resistance can you join the dots as to again like not that we have to really show the importance of this because it's obvious and clear but this does have i mean it's not dramatic to say existential because it is antimicrobial resistance is existential for humans it is coming it is something that we're constantly having to innovate against and again coming back to innovation yeah um rather than tech necessarily but innovation yeah it kind of draws all of this together right so join the dots for me for community health workers and antimicrobial resistance yeah sure so antimicrobial resistance

40:32James O'Donovan:is basically a major crisis and it's a major crisis that's playing out like right in front of our eyes as we speak um but it maybe doesn't get the attention it deserves or needs because it's a slow burner um people don't necessarily see it it's not like a house is burning right in front of you, even though it kind of is.

40:54Dr. James O’Donovan:It's the reason nobody buys insurance, by the way. It's the same psychological glitch that we have.

41:00James O'Donovan:But to kind of put it into numbers, by 2050, antimicrobial resistance will play a role in just over about 8 million deaths, which is an increase by about 75 % from the deaths in 2021. So 8 million people by 2050 will die from antimicrobial resistance and we're kind of like we are running out of time

41:22Dr. James O’Donovan:and so you know it's funny james actually just interrupt sorry it's funny when when saying those stats um saying those stats when in the next room i've got a seven month old it's very hard yeah it's terrifying that hits very very hard actually because i can only a few months ago i can listen to those stats and be like oh okay something needs to be done that actually feels viscerally quite different to me now that you've just yeah it's really terrifying

41:49James O'Donovan:and so when you do go to the gp and the gp is saying no i'm not going to give you antibiotics for probably what is a viral upper respiratory tract infection there's a there is a reason for that um but it is terrifying when you think of the next generation i mean even our generation though like all being well if you know our health holds out we'll still be alive in the year 2050 And if we're in hospital, a very basic infection, so you have cellulitis, it won't respond or a urinary tract infection. And so, yeah, it's terrifying. And that's why you need a whole house approach to tackling this. A little bit like how SHEIK have pulled together various members and allies and partners to tackle this big problem of fair pay for community health workers.

42:36James O'Donovan:The Fleming Initiative have brought together multiple different actors to tackle this big problem of antimicrobial resistance. And we felt there were a lot of synergies between the two organizations, which is why we wanted to partner on this podcast work. But to answer your question about why data is so important, especially through the lens of community health workers, again, community health workers are going door to door. Sometimes they're giving antibiotics out to these households. You need to make sure people are completing courses of antibiotics. if someone stops the antibiotics early because they start to feel well then that's a breeding ground for antimicrobial resistance in these remote rural communities again we think that the first case of Ebola started in a very rural community in West Africa and so you need to make sure we're doing stuff at the community level that's informed by the community health workers they have the training they also have the authority to try and encourage behaviour change at community level And so that's interesting.

43:37Dr. James O’Donovan:That's the, that's the other interesting point.

43:39James O'Donovan:And I think that's the other key thing. Like, you know, we can have all the best science and we can have all these amazing innovations, but ultimately we need to understand behavior change. And so Fleming initiative are working with behavioral scientists and they're working with people who used to work in the nudge unit to think about, okay, people probably know that they need to finish a full course of antibiotics or people don't necessarily need antibiotics, but how do you change that behavior change? So when someone goes into the GP, they're not going to be pressuring the GP to ask for antibiotics, for example.

44:12Dr. James O’Donovan:This is so interesting, James. This is so interesting because this is this is sort of my thesis. And this is an incomplete thought that I'll try and explain as I'm thinking about it. But this is my thesis around and I've got a cold at the minute, so I'm a little bit brain foggy. But AI freeing us up to be more human and also us being behind in researching the value of humans. in healthcare where you've got a one-to-one relationship of a community health worker in a rural setting in Africa that's canoed up to a house to give you advice and information. There's a lot baked into that in a human-to-human way.

44:49Dr. James O’Donovan:Like that person has made that amount of effort to go to you. So you like that there must be, it's not researched, I don't know, but there must be some level of accountability that you take individually more so because that person has made that effort because there's a real human to human relationship there and you know think about how that plays out in the western world like you know i've got i've got friends in in my friendship group a very very diverse friendship group you know like we've all got some aunties in our friendship group where you do what they say like if one of those aunties has said you do something you you absolutely will do it if they're they're telling you to go inside you go in inside so are you finishing your dinner finishing that but like again there's something baked into that that i Like, I want technology to free us up to be more human.

45:35Dr. James O’Donovan:And I think there's actually so many insights that are locked up in there that I think is fascinating.

45:40James O'Donovan:And I agree. And I think if community health workers have that inherent respect in their communities, and so they're much more likely to command and respect and people are much more likely to listen to them. And again, it would free up their time if they didn't have to sit down and maybe analyze some of the data, but they were given the insights as to, OK, you need to go to this region or this place because it looks like there could be an outbreak here. It would just make their work so much more efficient and effective. So yeah, I don't think, I guess there's a concern that with some jobs, AI could technically replace it.

46:15James O'Donovan:But this space, I think it's more about enhancing and freeing up that time for those relational interactions and forming those really strong bonds that ultimately can deliver behaviour change.

46:28Dr. James O’Donovan:Changing tax slightly then. One thing that we talked about, I talked about that Venn diagram, that the YouTube circle has been encroaching on this conversation for quite some time. And there's a big space in the middle that obviously part of what we're doing today, even, and this will turn up on YouTube, is education. And we're trying to educate more people on this. We're trying to make people more aware that more, that awareness hopefully brings in more funding, more people that want to work in this industry and therefore impact, etc. you've obviously done this not only in the global health setting but you've personally built a youtube channel as well and that's no mean feat and you're one of the most followed clinicians at least um in the country in the world potentially um and you've done that educating people globally at large about loads of different topics um so it seems like education is something that is deep within you it's a purpose deep within you you've been part of the academic system throughout your career and still are um it's clearly something that you enjoy and that you like doing i'm interested because we've seen the rise of youtube we've had karen rajan on this podcast and i've done an event with him and all that sort of stuff again myth busting and building youtube following and you know this this notion of youtube being a public health service being arguably the modern clinician the modern orator we're no longer on our soapbox in the town square but this is the digital version and public health england going down this is somewhat replacing it but we have bad actors we have a lot of different things like the youtube health shelf is trying to comment so there's a there's a lot baked into this question slash comment but talk to me about your youtube channel why you've done it and i guess what do you see where is youtube and youtubers and clinicians talking where is where is that in medicine does that fit neatly into public health

48:38James O'Donovan:it's a great question i think we could talk we could have a whole another conversation just going down the whole youtube i think we should by the way yeah i think there's so many fascinating insights um and yeah education is so important to me um just because i think you need to have that kind of pivotal understanding of certain spaces in order to have informed discussions and so it's an ongoing joke between me and my wife that she said please do no more degrees um because you know i've done like the medical degree the phd which was technically in education and um i just finished an mba in health care but i would argue that each of those has taught me like it's having a language as a skill and so if you were in a boardroom you understand what is meant by like profit and loss sheets you understand what is meant by vcs etc and equally when you're in a room full of researchers you understand what's meant by a p-value um and you can talk about basic statistical tests so i would never claim to be a total expert in any one of these areas but i feel more converse and able to have these these discussions with people um i think in terms of education in the youtube sense um i started it off very much as like a channel to help support medical students when i was at medical school so you would read in textbooks about signs so like roswing sign etc or murphy sign and it would be a text-based description but i thought okay crissitis yeah murphy sign exactly yeah but i was thinking like what the belly button one yeah well the gray turners is the gray turners with the bruising etc colon sign so we did all of these videos and um it helped to bring to life like very dull stuff in textbooks um but then i didn't have time and youtube's one of those things you just have to commit to it and be very consistent It's a slow burn.

50:28James O'Donovan:You can blow up overnight and have millions of subscribers by posting short form content, for example. But for me, it was always very much about, okay, what is needed and where is there a gap in the space and how can I just fill this in an interesting way? So I left the channel for several years. And then when I went back to general practice, I think I found myself just getting slightly frustrated in the sense that you'd see 15, 20, how many patients a day. and you would often answer the same questions but you also felt rushed in terms of you'd have to safety net because gp is inherently risky you like don't have access to a ct scan around the corner like you might in a and e and so you'd have to safety net heavily but in a short time limited appointment you just couldn't do that very well and also patients will only take in maybe 10 % of the conversation, they'll listen to, is there a major problem?

51:25James O'Donovan:Yes or no. But then when you start to say, you should visit this website, you should check out this patient information leaflet, often they won't remember that. I know that myself because I've been a patient. I don't remember what's happened during a conversation that's lasted for 15 minutes, obviously because I'm probably anxious going into the consultation as well. So for me, YouTube felt like a great way to reach more people with common questions that were coming in every single day to the clinic, but also do a good job of it because I wasn't rushed giving them sort of piecemeal information and missing bits.

51:55James O'Donovan:I could really thoroughly research topics in depth and then I could put together a really structured sort of calm way of delivering things but then also add in supplementary resources to the description box. And also you could do this in different languages, you could add in non-English patient information leaflets, etc. So from an equity perspective I also felt it was really important um and so it just kind of grew organically from that um and more and more people would start to watch these videos and i was making videos on really diverse topics so the conventional wisdom is pick a niche and just really own that niche so just do for example women's health or just do dermatology and i do see huge value in that and i know if you wanted to just grow a very traditional youtube channel in another space that would be a way to do things but for me it was always always about what do i see in clinic what do i did i find interesting today and how can i make a video on that trying to articulate that to more people and just over time it's grown organically through um search function or people finding it through suggested videos um and so where is youtube going well when i started taking this more seriously like three or four years ago, it still was a very nascent and underexplored space.

53:11James O'Donovan:And you felt like you were pioneering the space in some ways, which in some ways can feel exciting. But in the space of healthcare, that can also be daunting because if you're a relatively junior clinician and you're trying to do something slightly innovative or different, you can be met with some resistance, be it from colleagues, but also yourself. You might have imposter syndrome or you might think, I need to make sure this information I'm putting out into the public domain is 100 % accurate.

53:39Dr. James O’Donovan:And as a clinician, there's always someone more senior that knows a little bit more than you. Exactly. Or someone that's more well-researched or more quoted in publications.

53:48James O'Donovan:And also there's the danger of people misinterpreting what you say. And so, for example, if you were to talk about potential signs and symptoms of bowel cancer, and you mention you could have bleeding from the back passage as one potential sign, Sure, you can. But also that can happen in more common benign conditions like hemorrhoids, for example. And so you always are balancing this act of trying to communicate concerning signs effectively, but not then sending everyone into a mass state of panic. And then thinking about does everyone then land up in the GP surgery and you've just overwhelmed an already stretched healthcare system.

54:22James O'Donovan:So you're trying to do something good, but you're also trying to make sure that's balanced and thoughtful. And it's why you just can't rush the content creation process from a healthcare perspective. And so when I was doing this about four years ago, I was one of the only clinicians who was trying to put out patient facing educational material. And I think that's a really important point to make because most of my other colleagues were kind of doing the more what I describe as influencer style stuff. So talking about day in the life or talking about what we do. And I think that's great from like a creative perspective.

54:55James O'Donovan:But I was trying to do something slightly more different as in public health education. And so I was fortuitously was actually listening to a podcast. It was Musty's podcast, actually. And he had Susan Thomas on. And I remember distinctly the day I was, it was April and I was driving down to a placement in palliative care in Sunderland. And I was listening to this podcast and Susan was just talking about her career, how she'd spent time at KPMG. So she's obviously an old age consultant before and went to do an MBA, went to KPMG and then started to work for Google Health. And she said, I really want to hear from people who are interested in YouTube, making patient education content.

55:37James O'Donovan:And also, she said, importantly, global health. And I remember just thinking, wow, I need to get in touch with her. I thought she might not reply. You know, she's such a high flyer and she probably won't reply to me if I just send a cold outreach.

55:51Dr. James O’Donovan:Head of Google Health in the UK. Yeah.

55:53James O'Donovan:So I ended up getting to the placement and I had about three minutes left of the podcast. And normally I would just pause and just go into the placement. But I have to finish this. It's so good. And the whole day I was thinking, oh, look, I really should try to reach out to her. So I got home that evening, sent her a message on Twitter at the time. Wow. She replied within 10 minutes and said, yeah, we need to connect. Let me know if you want to grab a coffee. And so I remember going down in June. I had a day off work and I went down to London and went to Google offices, met with Susan. We spoke about the whole YouTube stuff.

56:30James O'Donovan:And at the time I was concerned about authoritative content. How do you elevate authoritative content on the platform? And how do you make sure those people who are actually practicing licensed physicians could adhere to some sort of best practice? So if you think about clinical work, you've got mice guidelines or you've got rural college guidelines. But in the digital health space on YouTube, you don't have those guidelines. And I always thought that's really odd because ultimately YouTube is the ultimate public health communication platform. You're reaching millions of people globally, but also the potential for harm could be significant based on that, just in terms of pure numbers.

57:09James O'Donovan:and so the fact there were no guidelines in terms of how do you create good content that is safe was really concerning to me to be honest so that kind of set me off on this path of working with um susan and her team and vishal varani at youtube health um to work with academy of medical colleges to develop this uh guideline in terms of how to best produce educational content by healthcare professionals on social media. And so the first version of that guideline was released in May 2023. And that went on to help inform what is called the health shelf. So on YouTube now, when you type in pancreatitis, for example, you'll see a little bar at the top that says from trusted health sources.

57:51James O'Donovan:And that can either be institutions like the NHS, or it can be individual licensed clinicians who sign up to this best practice agreement and say, look, I'll adhere to these best practice guidelines. You submit your GMC number. And so, you know, you have to make sure you're doing things right. Otherwise you'll get pulled up in front of the GMC. And I think that's been a big step in kind of making sure that the space is a bit more regulated. And also there's best practices that are being shared. And I'll say Vishal is doing an incredible job at YouTube Health. He's really like bringing, again, talking about complex, big problems and bringing together multiple people.

58:30James O'Donovan:That's exactly what Vishal's done. He's brought together dozens and dozens of clinician creators now from all different disciplines, but also importantly, public health bodies, Department of Health and Social Care, medical charities. And we have meetings where we'll go and we'll all be in one room sharing best practices, lessons learned. And so I think the space has moved rapidly in terms of where it's going. That was the thesis for my MBA final year project. And specifically, I was looking at how do clinician creators who are now having these sizable platforms. I mean, you talked about Curran.

59:07James O'Donovan:Curran's got millions and millions of followers, probably millions of views per day on his videos. and how do you position or how they position themselves as business owners which i think is really important to consider because ultimately positioning yourself as a business owner will help you to scale and i think scale is important because if it's just you behind the camera absolutely everything script writing production etc you're limited by that rate limiting step but if you actually establish yourself as a business could you if you're a successful creator who's got a powerful voice, scale to have a team behind you.

59:46James O'Donovan:And ultimately that could reach more people and you could do a better job at communicating effectively. Either you have great video producers, editors, et cetera. And as part of that project, we basically ran a survey of clinical creators and we asked them various questions such as how much time are you dedicating to clinical content creation? And also how much time are you dedicating to your clinical work, but also looking at the use of AI in content creation And we found that 80 % of clinicians have integrated AI in some way into their workflows, which again brings up lots of various different questions and potential ethical quandaries.

1:00:23James O'Donovan:But we could talk about this forever. And there's so many insights I've gained from this survey. But then I also, it was a mixed methods approach. So I had great interviews with some clinicians across the UK and the US who were active on YouTube and various other social media platforms and trying to understand what are their aspirations for the next five and 10 years? And do they still see themselves working in this space? because I think people who aren't familiar with how YouTube works from the content production side might just see that 60-second short-form video or that 10-minute long-form explainer and think, oh, that was really good.

1:01:05James O'Donovan:And it might have only taken them a couple of minutes to film. But actually, this kind of work takes like hours and hours and hours. And it's a recipe for burnout if you're still trying to keep working clinically, which most of the creators are doing. Very few clinical creators are doing this as like a full-time job. They're not like traditional influencers. And so thinking about how do we safeguard and protect clinical creators from burnout is really important. But also it's important for YouTube and Google to know about this because ultimately they rely on the clinical creators to upload content regularly and keep people coming back to the platform.

1:01:42Dr. James O’Donovan:It's one of, if not the most searchable things now.

1:01:44James O'Donovan:Yeah, so there were 2 billion health-related searches in the UK alone in 2021. That's the UK alone in 2021. I know by 2025.

1:01:54Dr. James O’Donovan:Wow, and that was five years ago. Yeah, it'll be huge now.

1:01:57James O'Donovan:And it's the second most searched platform after Google for health-related queries. And so as a search function, YouTube is huge. And I kind of saw this like years ago because, again, this is where I think being active clinically for me is important because I knew people were coming into clinic and asking me questions. And then I would say, well, where did you hear this from? Because some of it was like really in-depth information that you would expect a member of the lay public not necessarily to know. And so I watched a video on YouTube or I watched a video on TikTok or Instagram. Some of it was really good.

1:02:31James O'Donovan:And it was amazing that I think it's great that patients are empowered because we can have more of a conversation that is patient-led and that's what we should always aspire to. but there were occasions that I was having patients come in and they'd heard misinformation or disinformation on the social media platform and it was concerning and I could see it happening and yeah it's kind of what's inspired me to go down this so I think YouTube for me is about being a fantastic public health tool and public health platform and how do we make sure that we kind of safeguard it but also make sure that the people who are contributing to it and that's clinicians or it's also you know people with lived experiences so patients have a really good experience in doing that um and so yeah i think it's uh it's a really exciting space to be involved

1:03:24Dr. James O’Donovan:i love that i i love the element that those creating need protecting yeah because they're the ones that are sacrificing their privacy their time all sorts in order to put themselves out there create those videos for the benefit of the public for the benefit of the platform for the benefit of quite a lot of other people rather than themselves and yes there is a business model behind it but just on that business model behind it i think what you said is really interesting about teaching them to be business owners because that's what it is and looking at that youtube revenue as all the sponsorship revenue is exactly that revenue that fits into a pnl great podcast mr beast that i listened to i can't it might have been his diary ceo one it might have been a different one but um no i think it was i think he did one with lex friedman but anyway he was saying on there that um and it you know saying it as if it as if it's ridiculous he's like most of the money that i make on videos i just spend on other videos and that being some like revelationary comment that sounds ridiculous like yeah i'm pretty much betting the house like 80 of what i make i'm just spending on the next video which sounds incredibly cavalier and ridiculous until you realize no hold on a minute this guy is actually running a multi multi multi million media and production company that just runs 20 margins yeah which is completely normal like that's completely normal it's completely normal to spend 80 of what you earn on a on your costs that is completely normal it's just that in youtube that's not considered the right thing because you're an individual creator that then thinks that that's the money that you then have not that's the money that you then spend 80 of to have what is a very comfortable by the way 20 % margin like we aim between an 18 and 30 % margin as a as a comms business that's market average that's normal that's just what sort of what we're going for um it's just not the done thing and therefore it limits the impact that you can have um which I think is a fascinating fascinating thing that um we should actually talk about actually because I've got some ideas around

1:05:32James O'Donovan:that but James now you've got a head yeah and it's a it's a really interesting insight I think just on that final point I think yeah when I asked people in that survey have you had any formal business training at all, the majority of clinician graders said no. And so I think it's again about reframing what is possible and how could you run an effective business? And we don't get taught that at medical school. But I do think it's important because the way that the NHS run, obviously we need to think about how to deliver excellent clinical care, but you can't have that conversation without understanding like basic fiscal principles and basic business management principles.

1:06:07James O'Donovan:And the decisions that are being taken in terms of like an executive level, you need to understand how business is being run and it's why often many of the chief executives of hospitals have had you know business experience in the past and so i think clinicians have massive massive value to add to it but it's about empowering them and thinking about this isn't just a youtube channel for example this is maybe a media house and you're delivering like massive value through this so we can talk about this another time and pick it up because there's so much to cover on it um i think we should i think we should but listen it's been an absolute pleasure

1:06:39Dr. James O’Donovan:James thank you so much for coming on I know you've got a shoot so I'm going to keep you but one final thing if people want to find the YouTube channel or they want to get in touch with you what's the best way for them to do so?

1:06:49James O'Donovan:They can find me on LinkedIn and I typically reply to every message I get on LinkedIn and then also YouTube it's they just search Dr O'Donovan but it's spelled doctor as in the full spelling D-O-C-T-O-R and then O'Donovan and yeah they can find me there and hopefully they might find some value on the channel or find a video that if they're in need of it sometime it will help them.

1:07:12Dr. James O’Donovan:You're a very modest and a very humble man James that you will find what you're looking for there if you're looking for inspiration, education or value. So I can promise you that. James it's been a pleasure, thanks so much for joining me.

1:07:23James O'Donovan:Thanks James, I appreciate it and thanks for your time.

1:07:36Dr. James O’Donovan:follow me on all of my social media so you don't miss out on any of the latest health tech content.