At the National Patient Safety Foundation annual meeting in May, the sharing of patient stories was once again at the forefront of the meeting. Helen Haskell, Tanya Lord, Regina Holliday and more, provided real-life examples of why a focus on patient safety is still a much needed and continuous journey. There is also a growing awareness of the need to honor provider stories, perhaps one of the missing links in the quest for zero preventable harm across the country. The Doctors Company Foundation (TDCF) is well aware of the power of medical student and resident physician stories, and instituted the Young Physicians Patient Safety Award, which is given to the author of the best patient safety driven essays written by 3rd and 4th year medical students, and first year resident physicians. TDCF shared those essays and the award winners at this year’s NPSF, with the winners to be honored at the 6th Annual Association of American Medical Colleges’ Integrating Quality meeting June 12th & 13th.
Excerpts from the winning essays follow, but being less than two weeks away from our first 2014 Telluride Patient Safety Summer Camp–and in our 10th Anniversary year–it was with great enthusiasm that I read the 2014 Award-Winning Essays. Since 2010, our student and resident physician driven Telluride blog has seen an increase in submissions, and I can only hope it is more than the younger generation’s acculturation into blogging communities or social media. I would like to believe it has more to do with the younger generation of providers embracing the transparency that will be needed as they navigate the challenging landscape the present day career in healthcare holds. The following excerpts, like our blog posts, hold knowledge and wisdom far beyond the years of the author’s tenure, and are equally reflective of what is needed to provide the full complement of safe, patient-centered care we all want. We talk of educating the young, but far more often, they are educating and inspiring us. So in the spirit of educating the young (and old!)–Please keep writing!
…I read everything I could get my hands on about root cause analysis, the Swiss cheese model, and methods to “engineer out” potential for human error. It was not until my third-year surgery rotation, however, that I encountered the major challenge to patient safety that no number of PDSA cycles can resolve–the problem of a medical culture that is not safety conscious…
…In the case of this patient, who cannot read, more time has to be spent educating him about his medications and adverse drug reactions…emphasizing the most important points to be certain they’re understood…Some patients may not readily admit to their health care provider that they cannot read, and we should be sensitive to clues that suggest the patient may be illiterate…
TIME: 6:00AM, Surgery Morning Rounds Began: Ms. A, your MRI shows you have colorectal cancer…said my surgery attending, who rushed out of Ms. A’s room right after he dropped this shocking news…TIME 12:30pm Rounds Just Adjourned: A nurse ran into the surgery dictation room: “Who is Ms. A’s doctor? Did you know she has depression, and today is the first time she’s heard she had cancer? She just attempted suicide”…I was shocked by this…how could the whole surgery team not know Ms. A hadn’t yet been informed of her cancer status?…
Shekhar Kapur, the Hollywood/Bollywood director who directed Elizabeth and Mr. India, gives an excellent TED talk below that examines how valuable stories are to the expression of the self. He claims that we are the stories we tell–that without the ability to tell stories we would “go mad”. When he evaluates a script, he looks at the story from the psychological level, the plot line, the political level, and the mythological level to find the truth the story is trying to convey. This truth is what he believes will ultimately move an audience and it is up to him to convey this truth visually. Storytelling ultimately is the search for harmony, he says, which is greater than just a fleeting moment of resolution.
How does this apply to medicine and medical education? Because engaging patients will require a type of harmony, or at the very least a deeper connection, that good stories–the ones that stir the heart or hit like a punch to the gut–inspire to create the real change needed in healthcare.
So how do non-English majors or filmmakers like Kapur learn to tell good stories in healthcare environments in order to move colleagues and patients? Ryan Biggs offers some simple techniques to exercise your storytelling muscles in the blog post, A Quirky Experiment Proves the Value of Story Driven Content. Substitute “marketing” with “healthcare” and see how good storytelling might be implemented in your own health system:
- Brainstorm a new marketing campaign by starting with the phrase “Once upon a time…” and conclude with “and so customers lived happily ever after.” You’ll be pleasantly surprised at the story you end up creating.
- Write a letter to a friend about your product, service, or brand. The letter format encourages a more natural narrative and eliminates buzzwords.
- Distill your marketing story down to 140 characters. All strong stories can be condensed to a single sentence. Stuck? Start by creating a message map.
- Create an Aesop’s Fable that uses your brand or product as the protagonist. Don’t forget to include a moral.
A previous ETY post, The Power of Storytelling in Medicine, which references Jonathan Gottschall’s, The Storytelling Animal: How Stories Make Us Human is also a good foundational read on storytelling.
Follow ETY for more tips on incorporating storytelling into your healthcare improvement projects! And please tell us how you have used story in your own piece of the world to get your message across.
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.