What is Explain My Procedure?
Explain my Procedure (EMP) creates animations explaining medical and surgical procedures to support patient understanding and consent. Animations are about five minutes long, cover the key GMC areas for valid consent, and are available in multiple languages to increase equality and inclusion. They are hosted on a web-platform that can be embedded into any patient pathway.
How did it come about?
The idea for EMP was prompted by a patient complaint. A Bengali patient had a coronary angiogram and suffered an arterial complication that required surgical repair. Arterial injury is a recognised complication and was mentioned in the consent form, signed 30 minutes before the procedure. But the patient could not have known this because the form was in English, which he didn't speak - he spoke Sylheti.
His wife complained. They accepted an apology, but I thought 'sorry' was not enough. Little provision was made for language and literacy barriers, particularly in the urgent setting. Consent had become somewhat tokenistic, did nothing to properly empower patients and left us legally exposed. EMP sought to tackle these problems.
The idea for animations instead of written information was prompted by an airline safety video. It was an engaging cartoon, with characters from all cultures and backgrounds. Everyone on the plane was transfixed, but no one reached for the safety leaflet in the seat in front of them when they were asked to. Expectations are changing. People are often more engaged by animation than the written word.
What was your first animation and how did the project grow?
It took four months of my free time to make the first animation on angioplasty. It was tricky, because complex concepts like risk, benefit, death and survival needed simple and disarming solutions.
The first video was offered to 20 patients, and it transformed their understanding (Heart 2019). Five years on, EMP has several thousand animations, in multiple languages, covering different specialties and serving more than 100 clinical services or research studies.
It now takes about one week to produce a new animation from transcript. A team of doctors, animators and medical translators work with an amazing patient and public panel, delivering content to an award-winning web-platform that can be customised to any hospital or doctor.
Click the image below to see an example video on the EMP website:
![Still from an animation showing a patient being prepped for general anaesthetic]()
Why do you think EMP is needed?
Central to informed consent is good communication. This can be hampered by language and educational barriers, time pressure, complexity around benefit and risk, and incomplete consideration of alternative options.
EMP animations help overcome these obstacles. They do not replace a doctor's duty to inform or individualise the consent discussion, but they do provide general background information. The web-platform allows the animations to be seamlessly woven into the patient pathway, providing upstream information to prompt questions.
Instead of using valuable face-to-face time recycling the same information about a procedure, we can focus on what matters. It changes the interaction, empowers patients and supports safer decision-making.
How important is it to have multiple languages?
Inclusivity was a priority for EMP from the start. Animation is actually a universal language and conveys, perhaps, 70% of the meaning. Multilanguage voiceovers support the images and started with English, Polish, Hindi, Bengali and Turkish, as these are commonly spoken in NE London.
Arabic was added and Nepalese, to serve the Gurkha community of Kent. Tamil, Gujurati, Punjabi and Urdu and subtitles for the hard-of-hearing are coming, which will broaden accessibility across the UK.
Is an initiative like this easy to build with AI?
No. We don't use AI because it's still so error-prone. A single word or strange phrase can lose patient trust. EMP has a team of bilingual translators who are all medically trained, which ensures accuracy and fluency.
It's a lot of work but the team enjoy being part of something that helps serve their own communities. Dr Indra Joshi, former director of AI for NHSX, summarised
things perfectly at the HSJ awards in 2019 when she said, "it reduces health inequalities, I think it really empowers the patient."
Is EMP the same as digital consent?
Not quite. Replacing a paper consent form with a digital one is simple, albeit surprisingly costly, but not a consent solution unless it is combined with high quality, patient-centred information. EMP complements digital consent - it is not an alternative - and supports both analogue (paper) and digital approaches.
Patients are often less likely to complain in the event of a complication if they are in control of, and own, their decisions.
What's the impact of poor communication on consent?
Failure to inform before consent is not only a failure of good medical practice, it's one of the most common causes of litigation. It costs the NHS more than £60 million each year in uncontested settled claims - a bill that rose sharply after the 2015 Supreme Court Montgomery judgment, which changed the way courts considered the extent to which consent was fully informed.
An NHS Resolution analysis of claims (QJM 2020) showed that following Montgomery, there was a four-fold increase of claims where failure to obtain informed consent was pleaded. This exposed the clear shortfalls of how clinical consent was interpreted legally and a need to improve, and the development of EMP coincided with this need.
What impact has the initiative had?
The impact was immediate and surprising. EMP, together with Barts Health, where the tool was first implemented, won the HSJ Award for Digitising Patient Services in 2019. EMP went on to win the BMJ Digital Award in 2020 and the Aneurin Bevan Award in the same year.
The concept's face value was clear, but I was keen to test whether it actually made a difference in practice. Several quality improvement projects followed, where patient understanding of their procedure, the benefits, risks and alternatives (four key GMC domains) were assessed in a consecutive series of patients before and after introducing EMP into practice.
Multiple studies showed similar results - an increase in complete understanding from about 30% to 80% across each of the four domains.
Did this increased understanding translate into other benefits?
Yes. In a subsequent analysis of about 40,000 patients undergoing ten cardiac procedures over four years, the introduction of EMP was associated with a 70% reduction in complaints and serious incidents of failure to inform before consent (QJM 2021).
Patients are often less likely to complain in the event of a complication if they are in control of, and own, their decisions. A separate study found that upstreaming animations before diagnostic procedures also reduced 'do not attend' rates by 56%.
![MDU app]()
What response has there been from those who've used it?
Junior doctors often say how the multilanguage options transform an impossible dialogue into a simple one. But the greatest reward has been the feedback from patients. I recall one patient who was awaiting a high-risk procedure saying, "For the first time I feel in control of what is happening to me," after using EMP from her hospital bed.
I am always impressed when a patient declines a procedure after watching an animation - not because they are terrified, but because they finally understand the trade-off between risk and benefit. They frame this in terms of their symptoms and alternative options, and feel empowered to say no. Declining treatment may be appropriate - a position that can be reviewed later if needed.
Are there any situations where it's particularly effective?
The increase in understanding has been replicated across many different specialties, but one situation where we saw a dramatic impact on understanding risk - a ten-fold improvement - was in the urgent clinical setting, where patients were transferred from one hospital to another for an emergency procedure (Heart 2020).
Since treatment is unplanned, the gap in understanding is greater. The challenge is one of time - often only 24 hours between admission with chest pain and transfer for urgent angiography, for example. EMP had a big effect in this urgent setting without delaying treatment.
Why do you think this hasn't come about before, or elsewhere?
Video animation is, of course, not new. But few specifically support consent, and many provide only partial information. Others exist to sell a service or product, which can reduce trust. Few videos are in multiple languages.
It takes work, clinical and consent expertise and patient input to fulfil all these requirements. EMP is run by doctors and allied healthcare staff, and the team use the animations in practice themselves, which keeps them relevant and updated to reflect what is needed.
The patient is also front and centre. The team tries to understand what patients find difficult to understand, and this is built into each new animation from the start.
Failure to inform before consent is not only a failure of good medical practice, it's one of the most common causes of litigation.
Do you feel there's still more to do?
Certainly. There are always more procedures and languages to cover, and the service could be offered more widely around the UK and abroad.
Staff education is also an opportunity. Many hospitals already use their subscription to educate junior staff. EMP Education is a new platform, which combines animations, clinical scenarios and certification. It was released last year.
Can individual doctors subscribe or is it just hospitals?
Most subscribers are hospital departments, but there is an increasing demand from individual doctors - many of whom work independently. Personal websites hosting animations are great for amplifying what independent doctors offer in an accessible way.
What challenges lie ahead - and how can other healthcare professionals help?
EMP has been showcased by the GMC (GMC 2022), the Patient Safety Commissioner (PSC 2024) and is now endorsed by the Personalised Care Institute (PCI 2022) and several national societies. But there is no advertising or sales team, and new users find EMP by word of mouth and publications.
This has the benefit of connecting enthusiasts, but it probably limits reach. If help is needed, it's really about spreading the word and encouraging individual clinicians and hospital managers to get in touch via the EMP website. Education and communication around consent should be seen as a necessity, rather than a luxury.
Professor David Wald
David is a professor of cardiology, working at St Bartholomew's Hospital in London. He trained in Oxford, London, Southampton and New York, and has been a clinical academic for over 20 years. He founded Explain my Procedure in 2019.
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