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Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Research

Lifting the curtain on the emergency department crisis: a multi-method reception study of Larry Saves the Canadian Healthcare System

Published in: BMC Health Services Research | Issue 1/2024

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Abstract

Background

Despite growing evidence of the potential of arts-based modalities to translate knowledge and spark discussion on complex issues, applications to health policy are rare. This study explored the potential of a research-based theatrical video to increase public capacity and motivation to engage with the complex issues that make Emergency Department wait times such an intractable problem.

Methods

Larry Saves the Canadian Healthcare System is a digital musical micro-series developed from extensive research examining system-level causes of Emergency crowding and the ineffectiveness of prevailing approaches. We released individual episodes and a revised full-length version on YouTube, using organic promotion strategies and paid advertising. We used YouTube Analytics to track views, engagement and viewer demographics, and content-analyzed viewer comments. We also conducted five university-based screenings; 92 students completed questionnaires, rating Larry on 16 descriptors using a 7-point Likert scale.

Results

From June 2022 through May 2023, Larry garnered over 100,000 views (76,752 of the full-length version, 35,535 of episodes), 1329 likes, 2780 shares, and 139 comments. Views and watch time were higher among women and positively associated with age. Among YouTube comments, the predominating themes were praise for the video and criticism of the healthcare system. Many commenters applauded the show’s accuracy, humor, and/or resonance with their experience; several shared healthcare horror stories. Students overwhelmingly agreed with all positive and disagreed with all negative descriptors, and nearly unanimously deemed the video informative, thought-provoking, and entertaining. Most also affirmed that it had increased their knowledge, interest, and confidence to participate in discussions about healthcare issues. Neither gender, primary language, nor employment in healthcare predicted ratings, but graduate students and those 25+ years old evaluated the video most positively.

Discussion

These findings highlight the promise of research-informed musical satire to inform and invigorate discourse on an urgent health policy problem. Larry has reached tens of thousands of viewers, garnered excellent feedback, and received high student ratings. Further research should directly assess educational and behavioural outcomes and explore what facilitative strategies could maximize this knowledge translation product’s potential to foster informed, impactful policy dialogue.
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Literature
1.
go back to reference Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Shabanah HA, Anderson PD, Bernhard M, Bertini A, Gries A, Ferrandiz S, Kumar VA, Harjola V-P, Hogan B, Madsen B, Mason S, Öhlén G, Rainer T, Rathlev N, Revue E, Richardson D, Sattarian M, Schull MJ. International perspectives on emergency department crowding. Acad Emerg Med. 2011;18:1358–70.PubMedCrossRef Pines JM, Hilton JA, Weber EJ, Alkemade AJ, Shabanah HA, Anderson PD, Bernhard M, Bertini A, Gries A, Ferrandiz S, Kumar VA, Harjola V-P, Hogan B, Madsen B, Mason S, Öhlén G, Rainer T, Rathlev N, Revue E, Richardson D, Sattarian M, Schull MJ. International perspectives on emergency department crowding. Acad Emerg Med. 2011;18:1358–70.PubMedCrossRef
2.
go back to reference Canadian Institute for Health Information. How Canada compares: results from the Commonwealth Fund’s 2016 international health policy survey of adults in 11 countries. Ottawa: CIHI; 2017. Canadian Institute for Health Information. How Canada compares: results from the Commonwealth Fund’s 2016 international health policy survey of adults in 11 countries. Ottawa: CIHI; 2017.
3.
go back to reference Canadian Institute for Health Information. NACRS emergency department visits and length of stay, 2018-19. Ottawa: CIHI; 2019. Canadian Institute for Health Information. NACRS emergency department visits and length of stay, 2018-19. Ottawa: CIHI; 2019.
5.
go back to reference Kreindler SA, Aboud Z, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M. How do health systems address patient flow when services are misaligned with population needs? A qualitative study. Int J Health Policy Manag. 2022;11:1362–72.PubMed Kreindler SA, Aboud Z, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M. How do health systems address patient flow when services are misaligned with population needs? A qualitative study. Int J Health Policy Manag. 2022;11:1362–72.PubMed
6.
go back to reference Kreindler SA, Cui Y, Metge CJ, Raynard M. Patient characteristics associated with longer emergency department stay: a rapid review. Emerg Med J. 2016;33:194–9. Kreindler SA, Cui Y, Metge CJ, Raynard M. Patient characteristics associated with longer emergency department stay: a rapid review. Emerg Med J. 2016;33:194–9.
7.
go back to reference Martin D, Miller AP, Quesnel-Vallée A, Caron NR, Vissandjée B, Marchildon GP. Canada’s universal health-care system: achieving its potential. Lancet. 2018;391:1718–35.PubMedPubMedCentralCrossRef Martin D, Miller AP, Quesnel-Vallée A, Caron NR, Vissandjée B, Marchildon GP. Canada’s universal health-care system: achieving its potential. Lancet. 2018;391:1718–35.PubMedPubMedCentralCrossRef
8.
go back to reference Kreindler SA, Schull MJ, Rowe BH, Doupe MB, Metge CJ. Despite interventions, emergency flow stagnates in urban Western Canada. Healthc Pol. 2021;16(4):70–83. Kreindler SA, Schull MJ, Rowe BH, Doupe MB, Metge CJ. Despite interventions, emergency flow stagnates in urban Western Canada. Healthc Pol. 2021;16(4):70–83.
9.
go back to reference Lazar H, Lavis JN, Forest P-G, Church J. Paradigm freeze: why is it so hard to Reform Health-Care Policy in Canada? Montreal and Kingston: McGill-Queen’s University Press; 2013.CrossRef Lazar H, Lavis JN, Forest P-G, Church J. Paradigm freeze: why is it so hard to Reform Health-Care Policy in Canada? Montreal and Kingston: McGill-Queen’s University Press; 2013.CrossRef
10.
go back to reference Archibald MM, Caine V, Scott SD. The development of a classification schema for arts-based approaches to knowledge translation. Worldviews Evidence-Based Nurs. 2014;11:316–24.CrossRef Archibald MM, Caine V, Scott SD. The development of a classification schema for arts-based approaches to knowledge translation. Worldviews Evidence-Based Nurs. 2014;11:316–24.CrossRef
11.
go back to reference Boydell KM, Hodgins M, Gladstone BM, et al. Arts-based health research and academic legitimacy: transcending hegemonic conventions. Qual Res. 2016;16:681–700.CrossRef Boydell KM, Hodgins M, Gladstone BM, et al. Arts-based health research and academic legitimacy: transcending hegemonic conventions. Qual Res. 2016;16:681–700.CrossRef
12.
go back to reference Gonzalez de Armas A, Archibald M, Scott SD. Developing an inventory of ongoing/unpublished arts and narrative-based approaches as knowledge translation strategies in health care. Arts Heal. 2017;9:111–22.CrossRef Gonzalez de Armas A, Archibald M, Scott SD. Developing an inventory of ongoing/unpublished arts and narrative-based approaches as knowledge translation strategies in health care. Arts Heal. 2017;9:111–22.CrossRef
13.
go back to reference Boydell KKM, Gladstone BMB, Volpe T, Allemang B, Stasiulis E. The production and dissemination of knowledge: a scoping review of arts-based health research. Forum Qual Soc Res. 2012;13:32. Boydell KKM, Gladstone BMB, Volpe T, Allemang B, Stasiulis E. The production and dissemination of knowledge: a scoping review of arts-based health research. Forum Qual Soc Res. 2012;13:32.
14.
go back to reference Shen F, Han JA. Effectiveness of entertainment education in communicating health information: a systematic review. Asian J Commun. 2014;24:605–16.CrossRef Shen F, Han JA. Effectiveness of entertainment education in communicating health information: a systematic review. Asian J Commun. 2014;24:605–16.CrossRef
15.
go back to reference Perry M, Maffulli N, Willson S, Morrissey D. The effectiveness of arts-based interventions in medical education: a literature review. Med Educ. 2011;45:141–8.PubMedCrossRef Perry M, Maffulli N, Willson S, Morrissey D. The effectiveness of arts-based interventions in medical education: a literature review. Med Educ. 2011;45:141–8.PubMedCrossRef
16.
go back to reference Majid U, Kandasamy S. The rationales for and challenges with employing arts-based health services research (ABHSR): a qualitative systematic review of primary studies. Med Humanit. 2021;47:266–73.PubMedCrossRef Majid U, Kandasamy S. The rationales for and challenges with employing arts-based health services research (ABHSR): a qualitative systematic review of primary studies. Med Humanit. 2021;47:266–73.PubMedCrossRef
17.
go back to reference Hall A, Furlong B, Pike A, Logan G, Lawrence R, Ryan A, Etchegary H, Hennessey T, Toomey E. Using theatre as an arts-based knowledge translation strategy for health-related information: a scoping review protocol. BMJ Open. 2019;9:e032738.PubMedPubMedCentralCrossRef Hall A, Furlong B, Pike A, Logan G, Lawrence R, Ryan A, Etchegary H, Hennessey T, Toomey E. Using theatre as an arts-based knowledge translation strategy for health-related information: a scoping review protocol. BMJ Open. 2019;9:e032738.PubMedPubMedCentralCrossRef
18.
go back to reference Rieger K, Schultz ASH. Exploring arts-based knowledge translation: sharing research findings through performing the patterns, rehearsing the results, staging the synthesis. Worldviews Evidence-Based Nurs. 2014;11:133–9.CrossRef Rieger K, Schultz ASH. Exploring arts-based knowledge translation: sharing research findings through performing the patterns, rehearsing the results, staging the synthesis. Worldviews Evidence-Based Nurs. 2014;11:133–9.CrossRef
19.
go back to reference Bleuer J, Chin M, Sakamoto I. Why theatre-based research works? Psychological theories from behind the curtain. Qual Res Psychol. 2018;15:395–411.CrossRef Bleuer J, Chin M, Sakamoto I. Why theatre-based research works? Psychological theories from behind the curtain. Qual Res Psychol. 2018;15:395–411.CrossRef
20.
go back to reference Rossiter K, Kontos P, Colantonio A, Gilbert J, Gray J, Keightley M. Staging data: Theatre as a tool for analysis and knowledge transfer in health research. Soc Sci Med. 2008;66:130–46.PubMedCrossRef Rossiter K, Kontos P, Colantonio A, Gilbert J, Gray J, Keightley M. Staging data: Theatre as a tool for analysis and knowledge transfer in health research. Soc Sci Med. 2008;66:130–46.PubMedCrossRef
23.
go back to reference Gray J, Mitchell G. Considering aesthetics: bringing new awareness to patient safety culture in hospitals. In: Belliveau G, Lea GW, editors. Research-based theatre: an artistic methodology. Bristol, UK: Intellect; 2016. pp. 77–88.CrossRef Gray J, Mitchell G. Considering aesthetics: bringing new awareness to patient safety culture in hospitals. In: Belliveau G, Lea GW, editors. Research-based theatre: an artistic methodology. Bristol, UK: Intellect; 2016. pp. 77–88.CrossRef
24.
go back to reference Nisker J, Martin DK, Bluhm R, Daar AS. Theatre as a public engagement tool for health-policy development. Health Pol. 2006;78:258–71.CrossRef Nisker J, Martin DK, Bluhm R, Daar AS. Theatre as a public engagement tool for health-policy development. Health Pol. 2006;78:258–71.CrossRef
25.
go back to reference Cox SM, Kazubowski-Houstin M, Nisker J. Genetics on stage: public engagement in health policy development on preimplantation genetic diagnosis. Soc Sci Med. 2009;68:1472–80.PubMedCrossRef Cox SM, Kazubowski-Houstin M, Nisker J. Genetics on stage: public engagement in health policy development on preimplantation genetic diagnosis. Soc Sci Med. 2009;68:1472–80.PubMedCrossRef
26.
go back to reference Eakin J, Endicott M. Knowledge translation through research-based theatre. Healthc Policy. 2013;2(2):54–9. Eakin J, Endicott M. Knowledge translation through research-based theatre. Healthc Policy. 2013;2(2):54–9.
27.
go back to reference Bore ILK, Reid G. Laughing in the face of climate change? Satire as a device for engaging audiences in public debate. Sci Commun. 2014;36:454–78.CrossRef Bore ILK, Reid G. Laughing in the face of climate change? Satire as a device for engaging audiences in public debate. Sci Commun. 2014;36:454–78.CrossRef
28.
go back to reference Chattoo CB, Green-Barber L. An investigative journalist and a stand-up comic walk into a bar: the role of comedy in public engagement with environmental journalism. Journalism. 2018;2018:1–19. Chattoo CB, Green-Barber L. An investigative journalist and a stand-up comic walk into a bar: the role of comedy in public engagement with environmental journalism. Journalism. 2018;2018:1–19.
29.
go back to reference Snyder-Young D. Theatre of good intentions: challenges and hopes for theatre and social change. New York: Springer; 2013.CrossRef Snyder-Young D. Theatre of good intentions: challenges and hopes for theatre and social change. New York: Springer; 2013.CrossRef
30.
go back to reference Day A. Satire and dissent: interventions in contemporary political debate. Bloomington, IN: Indiana University Press; 2008. Day A. Satire and dissent: interventions in contemporary political debate. Bloomington, IN: Indiana University Press; 2008.
31.
go back to reference Hoffman LH, Thomson TL. The effect of television viewing on adolescents’ civic participation: political efficacy as a mediating mechanism. J Broadcast Electron Media. 2009;53:3–21.CrossRef Hoffman LH, Thomson TL. The effect of television viewing on adolescents’ civic participation: political efficacy as a mediating mechanism. J Broadcast Electron Media. 2009;53:3–21.CrossRef
32.
go back to reference Hoffman LH, Young DG. Satire, punch lines, and the nightly news: untangling media effects on political participation. Commun Res Reports. 2011;28:159–68.CrossRef Hoffman LH, Young DG. Satire, punch lines, and the nightly news: untangling media effects on political participation. Commun Res Reports. 2011;28:159–68.CrossRef
33.
go back to reference Feldman L, Borum Chattoo C. Comedy as a route to social change: the effects of satire and news on persuasion about Syrian refugees. Mass Commun Soc. 2019;22:277–300.CrossRef Feldman L, Borum Chattoo C. Comedy as a route to social change: the effects of satire and news on persuasion about Syrian refugees. Mass Commun Soc. 2019;22:277–300.CrossRef
34.
go back to reference Feldman L, Young DG. Late-night comedy as a gateway to traditional news: an analysis of time trends in news attention among late-night comedy viewers during the 2004 presidential primaries. Polit Commun. 2008;25:401–22.CrossRef Feldman L, Young DG. Late-night comedy as a gateway to traditional news: an analysis of time trends in news attention among late-night comedy viewers during the 2004 presidential primaries. Polit Commun. 2008;25:401–22.CrossRef
35.
go back to reference Xenos MA, Becker AB. Moments of Zen: effects of the daily show on information seeking and political learning. Polit Commun. 2009;26:317–32.CrossRef Xenos MA, Becker AB. Moments of Zen: effects of the daily show on information seeking and political learning. Polit Commun. 2009;26:317–32.CrossRef
36.
go back to reference Becker AB. Political humor as Democratic relief? The effects of exposure to comedy and straight news on trust and efficacy. Atl J Commun. 2011;19:235–50.CrossRef Becker AB. Political humor as Democratic relief? The effects of exposure to comedy and straight news on trust and efficacy. Atl J Commun. 2011;19:235–50.CrossRef
37.
go back to reference Beck JL, Belliveau G, Lea GW, Wager A. Delineating a spectrum of research-based theatre. Qual Inq. 2011;17:687–700.CrossRef Beck JL, Belliveau G, Lea GW, Wager A. Delineating a spectrum of research-based theatre. Qual Inq. 2011;17:687–700.CrossRef
38.
go back to reference Belliveau G, Lea GW. Research-based theatre: an artistic methodology. Bristol, UK: Intellect; 2016.CrossRef Belliveau G, Lea GW. Research-based theatre: an artistic methodology. Bristol, UK: Intellect; 2016.CrossRef
40.
go back to reference Nabi RL, Moyer-Guse E, Byrne S. All joking aside: a serious investigation into the persuasive effect of funny social issue messages. Communication Monogr. 2007;74:29–54.CrossRef Nabi RL, Moyer-Guse E, Byrne S. All joking aside: a serious investigation into the persuasive effect of funny social issue messages. Communication Monogr. 2007;74:29–54.CrossRef
41.
go back to reference Kreindler SA, Hastings S, Mallinson S, Brierley M, Birney A, Tarraf R, Winters S, Johnson K, Nicholson Goertzen L, Anwar MR, Aboud Z. The hard, relentless, never-ending work of focusing on discharge: a qualitative study of managers’ perspectives. J Health Org Manag. 2022;36:164–77.CrossRef Kreindler SA, Hastings S, Mallinson S, Brierley M, Birney A, Tarraf R, Winters S, Johnson K, Nicholson Goertzen L, Anwar MR, Aboud Z. The hard, relentless, never-ending work of focusing on discharge: a qualitative study of managers’ perspectives. J Health Org Manag. 2022;36:164–77.CrossRef
42.
go back to reference Kreindler SA, Star N, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M, Nicholson Goertzen L, Anwar MR, Aboud Z. Working against gravity: the uphill task of overcapacity management. Health Serv Insight. 2020;13:1–6. Kreindler SA, Star N, Hastings S, Winters S, Johnson K, Mallinson S, Brierley M, Nicholson Goertzen L, Anwar MR, Aboud Z. Working against gravity: the uphill task of overcapacity management. Health Serv Insight. 2020;13:1–6.
43.
go back to reference Kreindler SA. Larry Saves the Canadian Healthcare System: research-based musical satire goes digital. Manuscript under review. Kreindler SA. Larry Saves the Canadian Healthcare System: research-based musical satire goes digital. Manuscript under review.
46.
go back to reference Tschantz MC, Egelman S, Choi J, Weaver N, Friedland G. The accuracy of the demographic inferences shown on Google’s ad settings. WPES’18: Proceedings of the 2018 Workshop on Privacy in the Electronic Society. 2018:33–41. Tschantz MC, Egelman S, Choi J, Weaver N, Friedland G. The accuracy of the demographic inferences shown on Google’s ad settings. WPES’18: Proceedings of the 2018 Workshop on Privacy in the Electronic Society. 2018:33–41.
47.
go back to reference Schreier M. Qualitative content analysis. In: Flick U, editor. The SAGE handbook of qualitative data analysis. London: SAGE; 2014. pp. 170–83.CrossRef Schreier M. Qualitative content analysis. In: Flick U, editor. The SAGE handbook of qualitative data analysis. London: SAGE; 2014. pp. 170–83.CrossRef
49.
go back to reference D’Alessandro PR, Frager G, Theatre. An innovative teaching tool integrated into core undergraduate medical curriculum. Arts Health. 2014;6:191–204.CrossRef D’Alessandro PR, Frager G, Theatre. An innovative teaching tool integrated into core undergraduate medical curriculum. Arts Health. 2014;6:191–204.CrossRef
50.
go back to reference Schneider J. Evaluation of the impact on audiences of Inside out of mind, research-based theatre for Dementia carers. Arts Health. 2017;9:238–50.CrossRef Schneider J. Evaluation of the impact on audiences of Inside out of mind, research-based theatre for Dementia carers. Arts Health. 2017;9:238–50.CrossRef
51.
go back to reference Nichols J, Cox SM, Cook C, Lea GW, Belliveau G. Research-based theatre about veterans transitioning home: a mixed-methods evaluation of audience impacts. Soc Sci Med. 2022;292:e114578.CrossRef Nichols J, Cox SM, Cook C, Lea GW, Belliveau G. Research-based theatre about veterans transitioning home: a mixed-methods evaluation of audience impacts. Soc Sci Med. 2022;292:e114578.CrossRef
52.
go back to reference Shigematsu T, Lea GW, Cook C, Belliveau G. A spotlight on research-based theatre. Learn Landscapes. 2022;15:349–65.CrossRef Shigematsu T, Lea GW, Cook C, Belliveau G. A spotlight on research-based theatre. Learn Landscapes. 2022;15:349–65.CrossRef
53.
go back to reference Schneider J, Lowe S, Myers T, Scales K, Bailey S, Middleton J. A short report on knowledge exchange through research-based theatre: inside out of mind. Soc Sci Med. 2018;118:61–5.CrossRef Schneider J, Lowe S, Myers T, Scales K, Bailey S, Middleton J. A short report on knowledge exchange through research-based theatre: inside out of mind. Soc Sci Med. 2018;118:61–5.CrossRef
54.
go back to reference Cameron AW, Causey ST, Livingston JN, Brandon DT, Brinson LC, Floyd MWF. Fourth and a mile: using theater in comparison to workshop/lecture as an approach to educating African American men about Prostate cancer. World Med Heal Policy. 2012;4:47–69.CrossRef Cameron AW, Causey ST, Livingston JN, Brandon DT, Brinson LC, Floyd MWF. Fourth and a mile: using theater in comparison to workshop/lecture as an approach to educating African American men about Prostate cancer. World Med Heal Policy. 2012;4:47–69.CrossRef
Metadata
Title
Lifting the curtain on the emergency department crisis: a multi-method reception study of Larry Saves the Canadian Healthcare System
Publication date
01-12-2024
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-023-10512-9

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