PictoComm accessible communication tool

At a time when hospitals are facing increasing pressure to reduce overheads and work more efficiently, University Hospitals Coventry and Warwickshire NHS Trust contacted CDS to improve communication between staff and patients.


The objective

University Hospitals Coventry and Warwickshire NHS Trust recognised that several communication barriers existed between staff and patients. For example, some patients had learning difficulties whilst others had a limited understanding of the English language. In addition, patients who had suffered a stroke or were receiving treatment also experienced difficulty in communicating their basic needs. For the hospital, these barriers meant that frontline staff took longer to communicate with patients, and there was a growing reliance on translation services provided by the private sector.

At a time when hospitals are facing increasing pressure to reduce overheads and work more efficiently, University Hospitals Coventry and Warwickshire NHS Trust contacted CDS, a leading communication specialist, to explore ways to improve communication.

CDS has developed a range of accessible formats to help organisations to communicate with diverse audiences. A specialist service that combines bespoke illustrations with clear text, CDS Easy-Read is recognised as one of the market leaders in helping organisations make their information more accessible to more people.

Clients include the Office for Disability Issues, Department of Health and the Government Equalities Office. Whilst Easy Read was initially developed for people with learning disabilities, it is also used by people with low literacy skills, as well as those for whom English is not their first language.

How the objective was achieved

PictocommA team from University Hospitals Coventry and Warwickshire NHS Trust, including frontline medical staff and communication specialists, identified that the aid should initially focus on the basic needs of patients. The content was grouped into a number of sections: allergies, feelings, food and drink, actions, personal items and people. CDS’ designers and illustrators used experience gained over the last 10 years in accessible formats to develop a clear and style of illustration that would best communicate basic needs. Illustrations were used rather than photographs as they allowed total flexibility to recreate scenes and objects in a consistent and accessible style that could be tested, refined and would be universally understood.

In order to reduce the need for translation, it was agreed that words would be kept to a minimum. The pictures, therefore, had to speak for themselves. Where pictures were unable to clearly communicate the content/meaning – especially pertaining to drugs or family members – a decision was made to include translations from the top 10 most commonly spoken languages in the area.

During the development stage, CDS considered the size, format, durability, and navigation as well as the mechanism which would be used to hold together the proposed pictures cards.

An A5 size was chosen which allowed sufficient space to present the illustrations in an easily readable size. CDS recommended a screw device positioned at the top left corner to hold the picture cards together. Testing on the wards, however, concluded that this format wasn’t easy to use, particularly among the older audience who preferred a conventional book format. Following this feedback, CDS presented an alternative solution comprising of a ring binder with internal pages. Designed so that it could stand upright on the patient’s bedside table, as well as allow for additional pages to be inserted at a later date, this option was chosen as the preferred format.

As the picture cards would be used on a daily basis, it was important to use a hygienic material which offered durability and a long life. The material also had to be waterproof so hospital staff could wipe it clean. To meet these requirements, CDS recommended the use of polypropylene, a durable and robust printable plastic, as well as an anti-bacteria coating to prevent the spread of infections. Another benefit of polypropylene is that it can be recycled at the end of its life, under category 5, plastics. A matt finish was chosen, as it reduced reflections from the hospital’s artificial lighting, improving readability.

Coloured tabbed dividers were included to separate content into six distinct sections, enabling patients and staff to find relevant information quickly and easily.

Testing phase

PictocommAfter a few sample pages were produced, CDS presented a hard copy mock-up for University Hospitals Coventry and Warwickshire NHS Trust to test in several of its wards, including, adolescent, elderly as well as stroke and dementia units. The picture book was also presented to the hospital’s Patient’s Council (an advisory group consisting of medical professionals and volunteers) who endorsed the product with their full support.

CDS also ran independent testing sessions and surveyed 100 people from the following groups on their ability to understand each of the illustrations:

  • High school children
  • Members of a retired group
  • Employees from local businesses
  • Students from English as a Second Language Overseas Language (ESOL) course
  • Residents of a private care home

CDS also tested the picture book with a variety of community user groups including Grapevine Centre, which supports people with learning disabilities. The feedback generated from these sessions enabled CDS to refine the product.


The results from the survey showed that 92% of people were able to understand the illustrations. A further 95% agreed that the illustrations were clear and easy to understand.


PictoComm™ was officially launched on 9 June 2011 at the University Hospital. The event, provided an opportunity for University Hospitals Coventry and Warwickshire NHS Trust and CDS to showcase PictoComm™ to potential buyers and hospital staff.

The solution

University Hospitals Coventry and Warwickshire NHS Trust purchased 1,500 copies, enabling them to place a copy of the book at every patient’s bedside table.

After implementation, David Faulkner, a support worker in the University Hospitals Coventry and Warwickshire NHS Trust Fluoroscopy unit, said “This is a really helpful and useful tool, and so easy to use. All of the pictures speak for themselves. I can’t believe that this has not been done in this form before.”

Jonathan Astin, PictoComm™ Sales Manager said, “We were very keen to extend our knowledge and expertise in communicating with vulnerable groups to the health sector. With changing demographics it is becoming more and more important to improve communication between patients and hospital staff. We are committed to ensuring that everyone has access to information and is able to communicate. We look forward to working with other NHS Trusts and developing the PictoComm™ concept further to suit the needs of specialised departments.”

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We chose to make PictoComm™ available to everyone, thereby ensuring accessibility for all our patients.

Barbara Hay

Head of Equality and Diversity, UHCW NHS Trust