My attention was recently drawn to this article published in the Journal of Patient Safety (March 2010 – Volume 6 – Issue 1 – pp 5-14)
Story Power: The Secret Weapon is authored by Dennis Quaid, Julie Thao and Charles Denham all of whom have very personal experience of harm in the healthcare context in the USA.
The article proposes story power as: “… an untapped vehicle to inform, equip, and challenge leaders to drive change that can save lives, save money, and build value in communities”
It reviews storytelling best practices from industry to complement findings from a direct survey of hospital safety leaders who presented a video story to hospital personnel. The video captured the story of the death of a child from failed communication and teamwork.
Interviews of safety leaders at 675 hospitals who had presented the video to hospital staff revealed that more than 90% of the respondents strongly recommended use of the video by other organisations as a tool to reduce harm to patients. 363 organisations showed it to more than 100 viewers. 276 institutions reported that between 50 and 100 people viewed the video at each institution. Of the 675 organisations that presented the video, 84.9% believe that it either saved lives or positively affected patients. Respondents from 205 hospitals believed that more than 50 patients had been positively impacted by changes in care inspired by viewing the video.
The article concludes that health care leaders have much to learn from storytelling practices from other industries, such as film and business, that they can apply to driving patient safety and improving the care they deliver. However, the article suggests that in order to realise these benefits leaders must “face the fear of reputational and financial risk that transparency through storytelling will create when they honestly address shortfalls that cause harm to the patients they serve”. The article also strongly proposes that leaders must become personally engaged in the action by activating their teams using stories as weapons against the fears that pose barriers to improvement of preventable harm.
It won’t surprise you to learn that I agree with these conclusions but in recent weeks as we have been testing and discussing our own approach to story-telling, we have met some challenge in this regard.
Isn’t the job hard enough already without further “criticism” from people like me who don’t really understand what it is like “out there”? What about the hundreds of thousands of encounters with health professionals everyday that have good, safe outcomes – why don’t we concentrate on those instead of a small number of tragic but ultimately relatively rare events? And what about the healthcare professionals – harm events have an impact on staff as well as patients so who will tell those stories?
Hearing stories of error and failure still seems to evoke feelings of guilt and blame and we have on occasion been accused of simply adding to this culture through the stories we tell.
All these challenges warrant some attention in my view.
For those of us who are steeped in safety and quality work (many of us not working in frontline delivery roles of course) it is time to address some of these issues and we hope through PATIENTSTORIES to provide a forum for the debate.
Over the next month we will be raising these questions in our blogs and in new on-line content. We hope you will join the discussion.
Mitzi Blennerhassett says
I agree – patient narratives are a powerful teaching tool. They should be used throughout medical education at all levels. How can there be improvement and change if there is no acknowledgement of harm? Patient narratives are one aspect of user involvement. They enable staff to see the patient experience from another perspective. They can then understand the effect of their attitudes and actions on patients. Patient narratives also enable staff to examine their own feelings and realise that, instead of emotional detachment for self protection, good communication skills could allow them to meet patients’ needs – offer a branch. It’s not necessary not jump in the pond, any more than it is to become hardened and blinkered.
Patient narratives are key to improving the patient experience and can open the door to compassion in health care. Enhanced job satisfaction will surely follow. I think they should be integral to any communication skills course and mandatory reading as part of lifelong learning.
Although I may seem to have vested interests, any royalties from my book, Nothing Personal, disturbing undercurrents in cancer care, Radcliffe Publishing, will mean reduction of my state benefits and I will be much worse off financially. Even so, I wrote it for use in medical education and am pleased to report it was a winner of the Medical Journalists’ Association Open Book Awards 2009 and has received acclaim in medical journals. Not only a patient narrative, it has discussion sections throughout looking at what needed to change, with references for better practice and was given as a prize by the Royal College of Nursing 2009.