As the Ebola virus lands closer to home, it has been disappointing to watch the hype, inaccuracies and blame circulating in various media on what continues as a yet-to-be controlled humanitarian and health crisis in West Africa. Those who have been aware of this evolving issue, such as many well-trained, conscientious infection prevention professionals around the country, know this disease has been threatening the West African countries of Liberia, Sierra Leone and Guinea with increasing magnitude since March of this year, taking the lives of far too many West Africans over the last 7+ months. As a result, Ebola abroad, and now for the first time in the US, is also a very dynamic situation, like much in healthcare. As such, responsible healthcare journalists, weekend warrior bloggers or persons with a Twitter account might want to take into account that as more is learned, protocols and best practices will, as expected, evolve.
An excellent Infectious Disease (ID) blog sharing good information about Ebola is Controversies in Hospital Infection Prevention, hosted by three ID physicians from the University of Iowa: Mike Edmond MD, MPH, MPA, Chief Quality Officer, Eli Perencevich MD, and Dan Diekema MD, Director, Infectious Disease. In July, Edmond (@Mike_Edmond) posted, Ebola Hemorrhagic Fever: A Primer, which contains foundational information about the virus, much of which is based on CDC Ebola interim guidances, that are also evolving. And to put Ebola in a more realistic perspective and take away some of its horror film power, it is a very slow-moving infectious disease per Eli Perencevich MD (@eliowa), who writes in an October 9th post, Traveling with Ebola is not traveling with influenza:
The…most important difference between the current Ebola outbreak and the 2009 H1N1 pandemic is that Ebola is very slow-moving….the first case of Ebola is thought to have occurred 307 days ago on December 6th in a two-year old boy. Since that time there have been an estimated 8,032 cases …If you compare a similar 307-day period for 2009 H1N1, April 12, 2009 to February 12, 2010 CDC estimated between 42 million and 86 million cases occurred in the US with a mid-level estimate of 59 million people infected…7300 times more cases of H1N1 using the mid-level estimate
Fast Company staff writer, Rebecca Greenfield (@rzgreenfield), in Ebola Deeply is the Only Place You Should Be Getting Ebola News, directs those in search of Ebola related content without the hype, turn to the single source news website, Ebola Deeply, started by Lara Setrakian (@Lara) a former ABC News and Bloomberg reporter. After clicking onto the site, readers are immediately drawn to the NYTimes video story by video journalist, Ben C Solomon, also embedded below. The story shows what life is like on the streets of Monrovia for Gordon, a Liberian Ebola ambulance driver, separated from his family as a safety precaution for over five months. What he describes sounds like going to war against an invisible opponent, with limited armor and safe harbors. Certainly in a resource rich country like ours, we should be able to handle what courageous true front line Ebola warriors are fighting with much less.
While healthy critique of those charged to create solutions in the US provides a good check and balance, it’s disappointing to watch the finger pointing that rears up in such a well-resourced, educated country, especially as those in West Africa have far less time to discuss and instead are using that energy to improvise and stay alive while caring for their thousands of ill patients vs our limited number of cases to date. In fact, more people died in the last week due to all medical harm in the US than to an outlier of an infectious disease like Ebola. To add even greater perspective, a recent New York Times article by Elisabeth Rosenthal MD, For Ebola Health Workers Risks and Duty Collide, closes with the following:
…Meanwhile, Dr. Cooke said she has tremendous admiration for the doctors in West Africa: “It’s been inspiring to hear African health care workers saying ‘I’m a doctor, these are my people. There’s no choice.’ It’s a fundamental reminder of what it means to be an M.D.”
And with the arrival and death of an infected patient to a Dallas hospital, and the subsequent infection of two nurses who treated him, many of the existing cracks in our healthcare system are being exposed by the media on the larger stage that is now practicing medicine. In an interview on the Today Show last Thursday, a nurse working at the hospital spoke with Matt Lauer, sharing the need to come forward knowing full well she might lose her job. Not knowing the full story, the fact that this could happen comes as no surprise to those working in healthcare. However, it is important to note we still have one of, if not the, very best systems in the world–cracks and all. A safe healthcare system has a just culture, and when a nurse “voices concern” about his/her own safety, as well as that of patients and colleagues, he/she is heard, even thanked, by those who can fix and address those concerns. Many healthcare organizations across the US are creating environments that welcome this voice, yet others are still far from adopting this culture. While not at all familiar with the culture at this particular hospital, nor the institution’s side of the story, it appears from the Today Show interview this nurse voiced concerns that initially went unaddressed. To this end, we see how failure to embrace elements of a just culture could affect patient and provider safety in real-time. This could be an unfortunate example of a long existing need for greater urgency around culture change in healthcare.
And despite the “he said, she said” or “they should of…” thinking, there are many looking for solutions to stop the outbreak in Africa. In a recent @FastCoExist article, Can Better Design Stop Ebola? How Creative Minds Can Help, Jessica Leber writes:
…On just one day’s notice, almost 200 people crowded an auditorium at Columbia University’s engineering school on a Thursday evening in early October. Engineers, designers, and public health researchers were there to learn and brainstorm, and do so quickly…Columbia isn’t the only institution interested in applying design thinking to the health and humanitarian disaster. On October 9, USAID, partnered with the innovation platform OpenIDEO, the CDC, the Department of Defense and the White House, announced its sixth in a series of “grand challenges for development” focused on crowdsourcing ideas for better tools to fight the virus. Anyone can contribute to the brainstorm, and the government hopes to begin funding the strongest ideas in a more formal challenge competition “in a matter of weeks.”…
Getting to the other side of this real-time test of our infection prevention and containment abilities at home, the hope is that we will rise to the challenge and become that much stronger as a national healthcare system for having gone through the experience. As Edmond writes in a Controversies in Hospital Infection Prevention post on October 14th, Ebola: The Questions Keep Coming:
…the Ebola crisis is challenging us in many ways and will likely continue to do so for quite some time. But perhaps we’ll emerge from this with a more thoughtful approach to patient care that improves safety without sacrificing quality.
In a recent Fast Company, Co.Create piece, Bloody Hell: Steven Soderbergh Dissects His Modern, 1900s Medical Drama, The Knick, editor Teresa Iezzi (@tiezzi) provides a deeper look into the strategic planning side of the brain belonging to one of Hollywood’s most successful directors. Soderbergh, who was pulled from retirement by a script “too good to pass up,” talks about how fun and fear-free working in television has become, especially when served up series-style. The Knick, per reviews, is an all too real view of surgery done 1900s-style–a time when chloroform was the anesthetic of choice, scalpels were far less the fine carving tools of today, and exploratory surgery took on a whole new meaning. To keep content as realistic as possible, Soderbergh and team consulted with Dr. Stanley Burns at the Burns Archive, which houses an “…unparalleled collection of early medical photography, but…is also renowned for its iconic images depicting the darker side of life: Death, Disease, Disaster, Mayhem, Crime, Racism, Revolution and War…”
While the subject matter of Soderbergh’s current choice is always of interest in both true and fictional worlds, what caught my attention was the emphasis on continued production of an entire season of TV episodes at one time and then releasing the series in its entirety, encouraging the binge-watching our current online entertainment environment allows. Emmy-award winners and nominees, shows like Dexter, Breaking Bad, Mad Men, True Detective and Orange is the New Black are consumed in mass quantities over single sittings, leaving fans thirsty for the next season’s installment or new series creation just shortly after release. Once a Netflix or HBO phenomenon, full series like The Knick are now being uploaded to a wider range of channels such as Cinemax, AMC and PBS. As technology and resulting viewing habits evolve, so must the way stories are shared–at least in mass media formats. Soderbergh has embraced the change with his usual creativity, and has already been given the green light for a second season of The Knick, and is working on a new pilot for Amazon. What does this mean for new storytellers? There are far more venues for content release–keep writing, keep creating.
Hugh Hart (@hughhart) recently wrote an article for Fast Company (@FastCoCreate), Movie Meltdown, $100 Tickets, And Dream Control: Lucas and Spielberg Forecast The Future Of Entertainment. In the piece, Hart shares eleven predictions made by the two storytelling geniuses, illuminating what the future of the big screen might, and might not, look like.
Becoming part of the movie, tapping into dream-tainment, games melding with movies and sensors taking the place of joysticks, controllers and devices insert audience members directly into the movie-going experience in the not too distant future. Big movies will garner higher ticket prices. Niche audiences will support indie filmmaking careers. I like the sound of this —
But what will remain unchanged is the need for good stories. As Spielberg says,
…show business, past, present, and future, depends on stories worth telling. “The thing I emphasize to everybody who comes to work at my company is, don’t play with the toys until you have something to say.”
As I prepare for a talk to be given at the National Quality Colloquium’s Innovation Track this September (Using Storytelling to Change Behavior), I have been pouring through reading on the topic of story, and how it can help change behavior. Having been part of the team that created the Tears to Transparency series, I am continuously reminded first-hand just how powerful patient stories are — to providers, as well as patients. Every time we share Lewis’ or Michael’s story–stories of harm at the hands of those entrusted to care for them–it is visibly apparent that medical students, residents, care providers and patient advocate audiences alike all feel the weight of the families’ loss. From the tears shed to the gratitude expressed for sharing these stories, a collective desire to do better for all patients permeates the room.
Most recently, I’ve been reading Lisa Cron’s (@LisaCron), Wired for Story, which has not only provided a number of pearls for my talk, but also a reminder of just how powerful the brain is in creating its own, very real, physiologic reality when engaged in reading or watching a story unfold. According to Cron’s research, stories–when told by writers who understand how to create characters we can relate to, and then place them in a world that provides just the right combination of conflict, resolution and reward–supply a pure dopamine rush to the reader, an almost addictive reward in itself.
We have written about the “how tos” and “whys” re:the use of story in healthcare a number of times (see Storytelling Tips from the Pros, Developing Storytelling Skills via TEDxEaling, Storytelling and the Reality of Medicine, Using Storytelling…to Develop Empathy, The Power of Storytelling in Medicine). As a fan and student of good stories, I am not surprised at the mounting research and resources teaching craft. Research studies, mainstream authors and marketing gurus all point to the innate need we all have to make sense of life via stories. Stay tuned for more advice from the pros.
In the Co.Create section of Fast Company magazine recently, Jonathan Gottschall, author of The Storytelling Animal, writes about the science supporting story as the most powerful means of communicating in his article, Why Storytelling Is the Ultimate Weapon. He writes:
…Until recently we’ve only been able to speculate about story’s persuasive effects. But over the last several decades psychology has begun a serious study of how story affects the human mind. Results repeatedly show that our attitudes, fears, hopes, and values are strongly influenced by story. In fact, fiction seems to be more effective at changing beliefs than writing that is specifically designed to persuade through argument and evidence…
The more absorbed the reader is in the story being told, the more likely he or she is to be changed by it, according to his research. We know that stories shape entire societal belief systems–and Gottschall uses the example of how we once believed the world was flat. Until Columbus discovered America, people lived in fear of falling off the end of the earth. How powerful is story?
It’s true the business sector has known for some time that stories sell–entire marketing departments are built upon this belief. But now, science and medicine are slowly catching on to the power of story to create the change that has stymied healthcare leadership, organizational and behavioral psychologists. We know the proposed steps of behavior change, and have for a while, yet the instance of obesity in the US continues to hit record highs. Maybe getting patients to make that critical move from pre-contemplative to contemplative stage is where story can be most effective.
After all, how do you help someone recognize they need to change? Tell them a story they can relate to–at least researchers and the media increasingly seem to think so. Patients are sharing their own stories on the NYTimes Well Blog, connecting with others around the US struggling with similar health challenges. Researchers like Amy McQueen and colleagues from Washington University in St. Louis looked to better understand the effects of breast cancer survivors’ stories on African American women in their 2011 Health Psychology study, Understanding Narrative Effects: The Impact of Breast Cancer Survivor Stories on Message Processing, Attitudes, and Beliefs Among African American Women. And McQueen is far from the only researcher beginning to measure the effects of story in medical populations, as the body of research in this area continues to grow.
Anecdotally, we have had similar results with our Tears to Transparency film series.
By sharing Lewis Blackman’s and Michael Skolnik’s stories of patient harm with other care providers, medical students and residents in order to prevent similar harm from occurring, we have watched in awe the transformation that occurs in the room when the credits roll and the lights go back on. These stories stimulate conversation around medical error that creates change in the moment. We need to study this, and evaluate how lasting an effect these stories have, and whether or not a booster shot of story is needed, and how often.
Story indeed appears to hold promise for medicine, and healthcare in general. Why don’t people exercise as they should? Or eat things that are good for them? It’s not about the data–we’ve known exercise is good and Twinkies are bad for us, yet behavior change remains a tricky business. It keeps heart surgeons and Hostess in business. But hit someone between the eyes with a story that touches their heart–about a grandfather who adores his grandchildren but now sits on the sidelines in a wheelchair watching them laugh and play, unable to walk for more than a few blocks because of complications from a heart surgery that might have been avoided altogether had he just lost those thirty extra pounds–well that tells a little more compelling story than obesity statistics.