storytelling: the why and the how - ihi home...
TRANSCRIPT
11/25/2014
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Storytelling: The Why and the HowMartha Donovan Hayward
Alide Chase
Helen Haskell
Cody Mullen
Session: L20
December 7, 2014
1pm-4:30pm
These presenters have
nothing to disclose
Session Objectives
1. Describe the role of stories in accelerating change and
improvement
2. Develop a powerful case for integrating stories into their
setting
3. Describe the most effective story formats for different
audiences
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StorytellingMartha Donovan Hayward, IHI
None of these presenters have
anything to disclose
IHI National Forum
December 7, 2013
The Soul Doctor and the Jazz Singer4
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What is your story?
What story(ies) are told in your family?
What do they say about the culture of your family?
What influence do they have on you?
Notes for 3 – Share for 3 mins each (15)
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Purpose
Why?
Where?
When?
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Why
Connect to process
Connect the heart
Engage patients and staff
Return to ‘why’
Demonstrate meaning
Model safe vulnerability
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Where
Clinical interaction – one on one – deep listeningSaves time
Provides vital information
Builds trust
Team InteractionProvides focus and meaning to process
Engages hearts and minds
Enhances improvement
LeadershipInspires
Models meaning in work
Offers a reference point
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When
Opening board meetings
Staff meetings
New Hires
Website
You Tube
Training/teaching
All Staff – parking lot to physical therapy
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“The real voyage of discovery
consists not in seeking new landscapes
but in having new eyes.”
- Marcel Proust
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Brené Brown
“Maybe stories are just
data with a soul”
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Serious Safety Event Rate: One View
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Nu
mb
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of
Eve
nts
Rolling 12-month Serious Safety Events expressed per 10,000 adjusted patient days
SSER August 2008: 0.41
Average Days between events: 14 days (CY08 Sept YTD)
19 days (CY07)
37 days (CY06)
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John L.
9/27/2008
HAI
Baby C.
10/13/2008
Delay in TreatmentRalph H.
9/12/2008
FallHarold C.
10/5/2008
Fall
George P.
11/07/2008
Fall
Roberta A.
10/13/2008
Fall
Tom D.
1/29/08
Delay in Treatment
Tammy F.
11/17/2008
Post Procedure Death
Juanita D.
10/25/2008
Fall Baby D.
11/1/2008
Wrong Pt. Procedure
Donald C.
9/26/2008
Delay in
Treatment
James A.
9/06/2008
Delay in Diagnosis
Frank H.
10/03/2008
Delay in Treatment
Joe E.
9/23/2008
Wrong Site Surgery
Johnny R.
10/08/2008
Delay in Diagnosis.
Another View of the Same Data
for the Last 3 Months
Herman D.
/17/2008
Retained Foreign Obj.
Mark G.
11/17/2008
Fall
John G.
10/03/2008
Delay in Treatment
Nick S.
1/4/2008
Delay in Dx
Serious Safety Event Rate: One View
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0.25
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0.75
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Nu
mb
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of
Eve
nts
Rolling 12-month Serious Safety Events expressed per 10,000 adjusted patient days
SSER August 2008: 0.41
Average Days between events: 14 days (CY08 Sept YTD)
19 days (CY07)
37 days (CY06)
Safety Behavior Training Begins
Employee Training Ends
Medical Staff Training Ends
John L.
9/27/2008
HAI
Baby C.
10/13/2008
Delay in TreatmentRalph H.
9/12/2008
FallHarold C.
10/5/2008
Fall
George P.
11/07/2008
Fall
Roberta A.
10/13/2008
Fall
Tom D.
1/29/08
Delay in Treatment
Tammy F.
11/17/2008
Post Procedure Death
Juanita D.
10/25/2008
Fall Baby D.
11/1/2008
Wrong Pt. Procedure
Donald C.
9/26/2008
Delay in
Treatment
James A.
9/06/2008
Delay in Diagnosis
Frank H.
10/03/2008
Delay in Treatment
Joe E.
9/23/2008
Wrong Site Surgery
Johnny R.
10/08/2008
Delay in Diagnosis.
Herman D.
/17/2008
Retained Foreign Obj.
Mark G.
11/17/2008
Fall
John G.
10/03/2008
Delay in Treatment
Nick S.
1/4/2008
Delay in Dx
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https://docs.google.com/file/d/
0BzlFJ7NBvg6BZ1JtRkFtZjZ4
SnM/edit?usp=drive_web&pli
=1
Lewis
Blackman1985-2000
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Healthy 15-year-old develops severe upper abdominal
pain while on NSAID and narcotic pain regimen following
elective surgery
Nurses and residents fail to act upon increasing signs of
instability, including 24 hours with no urine output and four
hours with no BP
Four days post-op, Lewis dies. Autopsy shows a giant
duodenal ulcer and 2.8 liters of blood and gastric
secretions in the peritoneal cavity
Lewis Blackman
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If you want to serve, you need to
begin with the stories.—President Bill Clinton
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What is your story?
What are your needs?
What are your desires?
What are your interests?
What matters to you?
Listening
TeachingWithPatient Stories
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Know your goals
Know your audience
Frame positively
Use two or three main ideas to illustrate
your point
Discuss the take-away message in terms
of positive change
Telling a story well
Morrise, L and Stevens KJ. Training Patient and Family Storytellers and Patient and Family
Faculty. Perm J 2013 Summer;17(3): e142-145
What are the lessons?
What needs did you identify?
What positive changes have resulted?
Completing the story
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Bridge theory and practice
Create a connection with the “other”
Create paths to improvement
May offer insights into situations the learner has not yet experienced
Offer the end user’s perspective on the healthcare system
Provide multiple perspectives for assessing the same set of circumstances
Provide a foundation for learning and practice
Patient Stories…
1. Patient Care: Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
2. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
3. Practice-Based Learning and Improvement: Demonstrate the ability to investigate and evaluate one’s care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning.
Core Competencies for HC Professionals
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4. Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
5. Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
6. Systems-Based Practice: Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal healthcare.
Core Competencies for HC Professionals
7. Interprofessional Collaboration: Demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care.
8. Personal and Professional Development: Demonstrate the qualities required to sustain lifelong personal and professional growth.
Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88, 1088–1094.
Johnson, J.K., Haskell, H., & Barach, P., eds.(2015). Case Studies in Patient Safety: Foundations for Core Competencies. Jones & Bartlett: New York.
Core Competencies for HC Professionals
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The Data
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Beyond the Story
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In the end…
Stories are not about one patient
but about
- The global experience of healthcare
- The commonalities of the patient experience
- The need to finish the story
- The lessons we carry in our hearts
…the plural of anecdote is data
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How to Use Stories to Catalyze Change and Focus Quality ImprovementAlide ChaseAlide Chase, Consulting LLC
Retired, SVP Quality and Service
This presenter has
nothing to disclose
The science of storytelling
A factwrapped in a story is 22times more memorable- Jerome Bruner, Cognitive Psychologist
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Benefits of storytelling: Accelerating Performance
My story about stories
Old way:Used data, %’s, charts to motivate
New way:Use stories, lives saved, use of public story to motivate
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Recipe – Sharing Stories
Know your audience
Make it Stick – The Principles of Stickiness
� Simple: it’s about prioritizing
� Unexpected: it grabs people’s attention
� Concrete: easier to remember
� Credible: from outside sources or within
� Emotional: people care about people
� Stories: put knowledge into framework
For an idea to stick, for it to be useful and lasting, it has to make the audience:
• Pay attention
• Understand and remember it
• Agree / believe
• Care
• Be able to act on it
• Use emotional range
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Elements of Story
A good beginningsets stage, gives context, engages curiosity, produces empathy
Vibrant middlespecific time, place, mood, color, texture, sound
A strong endmoral revealed through resolution, brings understanding
How to Find Stories
Gather a new story
Use your own experience
Borrow someone else’s experience or storyGo to external sources
• Pulse Magazine : http://pulsemagazine.org/
• NYT video stories http://www.nytimes.com/interactive/2009/09/10/health/Patient_Voices.html
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Results
Significant
reduction in
readmission rates
across our
organization
Catalyzing Change
Video Ethnography
+
Patient & family, staff,
physician engagement
+
Additional dataImprovement
Efforts
Video Example
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Power of observation and shadowing
“What people say, what people do, and what they say they do are entirely different things.”
- Margaret Mead
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A picture is worth a thousand words
911 was often the only
phone number given Sometimes, many
phone numbers
were given
97% of patients
received discharge
instructions, but …
Over half of the
discharge instructions
did not specify who to
call at Kaiser
Permanente if
patients needed help.
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“No data
without stories
and no stories
without data.”— Lisbeth Schorr, Senior Fellow, Center for the Study of
Social Policy and Lecturer in Social Medicine
at Harvard University
Why Stories Matter
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Tool to help you plan your story
Key message (Insight, Opportunity, HMW?)
Audience
Desired Action
Benefit to Audience to Act
Key Supporting Quote(s) / Observation(s)
• What strategies have been successful for you in
sharing stories in your organization?
• What challenges have you faced in sharing
stories in your organization?
• What tools or resources have you used to support
your storytelling efforts?
• What do you need to share MORE stories in your
meetings, your improvement work and to further
mobilize your teams and your organization
Discussion
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Actions you can take
� Go to the front lines of care ready to
learn something new. Bring a video
camera if possible (and remember to
consent/authorize if you are digitally recording a story).
� Read our toolkit and share with
others: http://kpcmi.org/ethnography/video-
ethnography-tool-kit.pdf
� Integrate one or more of the methods
we discuss today, use tools we shared
today, and share stories at your next
quality meeting.
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26 Years in 200 Words
It is said, twins know each other, we know each others pain and needs before other’s do. I’m not sure if that is true but I also don’t know what it is like not being a twin. My name is Cody Mullen and my twin is Seth. Our birth was an adventure, at least that is what I was told, as we were born dead. Thankfully the doctors fixed that but Seth now has Cerebral Palsy. I love my brother but growing up I was quickly thrown into the healthcare world on a weekly basis. My dad jokes that my brother gave me my career but it is no longer a joke, it’s the truth. I’m wrapping up my PhD in Health Policy and Services Research. This truth has come into even a clearer picture the past 6 months. Above and beyond the medical needs of Cerebral Palsy, Seth has become ill. We have seen more doctors for him this past 6 months than I will see this decade, last count was 30 outpatient visits, 9 ER visits, and 3 inpatient admissions but yet no answers and more importantly no health improvement. As difficult as the last 6 months have been for my family, we are not alone. Several families are wondering if their loved one will have the much desired answers on this next healthcare visit, will this be the closure to this journey, or are answers even out there? As great as a healthcare system we have in America yet the practice of medicine is not always clear. As researchers determine ways to get these answers quicker, we need to ensure patients and families are involved in the search for answers and not feel like a pin cushions. Patient centered care should and is not simply a research concept I learn about in the classroom but a way of practice. Will you join me in my fight to ensure patient center care is not just a research concept but the way care is delivered in every corner of the planet?
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The Story of TwinsCody Mullen
500 words
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Reflection
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Telling Your Story
“Stories not only teach us how to act-they inspire us to act.”
“Stories allow us to express our values not as abstract principles, but as lived experiences, they have the power to move others.”
- Marshall Ganz
Public Story
“Why you sought to lead allows others insight into your values, why you have chosen to act on them in this way, what they can expect from you, what they can learn from you.”
Marshal Ganz
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3 Elements of Public Story
Story of Self
Story of Us
Story of Now
Story of Self
From your own life
Challenges you face
Choices you made
Satisfactions/frustrations
What you learned
What experiences taught you about yourself
Events that shaped you values/beliefs
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Exercise: Your story of self
Write your story of self that ties to your current work and passiono 20 minutes
Share your story at tableo 30 minutes
Story of Us
Us: “Shared identity”
We are all part of multiple “us’s”o families, faiths, cultures, orgs, communities, nations
Mutual goals
Mutual experiences
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Exercise - Theoretical Case
Define the “us” you hope to move
Define the Us whom you hope to call to join you
Establish potential shared values, beliefs, experiences
Develop a single sentence for simulation experience
o 5 mins
Practice an engagement conversation – creating “us”
o 20 mins.
Story of Now
Urgency
Address a real problem
Invitation of join
Call to hopeful action
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Linking
Story of self, us, now into single public narrative
Adaption story for different audiences
Learning a process, generating narrative to fit the challenge.