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D18 E18 These presenters have nothing to disclose

Storytelling: The Why and the How By Martha Hayward, IHI Helen Haskell, Mothers Against Medical Error and Alide Chase, Kaiser Permanente

Dec 11, 2013 • 9:30-10:45 • 11:15-12:30

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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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None of these presenters have anything to disclose

Storytelling Martha Donovan Hayward, IHI

IHI National Forum December 2013

Why we tell stories Connect to process Connect the heart Engage patients and staff Return to ‘why’ Demonstrate meaning

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Brené Brown

“Maybe stories are just data with a soul”

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Purpose Why? Where? When?

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Why Engage hearts and minds Connect to process Demonstrate humanity of work Encourage vulnerability

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Where Clinical interaction – one on one – deep listening Saves time Provides vital information Builds trust

Team Interaction Provides focus and meaning to process Engages hearts and minds Enhances improvement

Leadership Inspires 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

Avedis Donabedian “Systems awareness and systems design are important for health professionals but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession. If you have love, you can then work backward to monitor and improve the system”.

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This presenter has nothing to disclose D18, E18

The Plural of Anecdote is Data Helen Haskell Mothers Against Medical Error

Dec 11, 2013 9:30-10:45 11:15-12:30

The Lessons of Patient Stories Helen Haskell Mothers Against Medical Error www.advocatedirectory.org [email protected]

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If you want to serve, you need to begin with the stories. —President Bill Clinton

Listening What is your story?
What are your needs?
What are your desires?
What are your interests?


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Wired for Story Story is the language of the brain – we think in narrative. Story is the living, breathing cornerstone of evolution. Story isn’t “a” way we make sense of the world. It’s THE way. -Lisa Cron, Wired for Story

The Illness Script – The Basis of Medicine Doctors build a story about the patient in order to make a diagnosis. It is a story based on the patient’s story but it is freed of most of the particular details of the individual, and structured to allow the recognizable pattern of the illness to be seen. -- Lisa Sanders, Every Patient Tells a Story

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Diagnosis -The Detective Story “A lot of the appeal of internal medicine is Sherlockian – solving the case from the clues. We are detectives; we revel in the process of figuring it all out. It’s what doctors most love to do.” -- Lisa Sanders, Every Patient Tells a Story

The Appeal of Medical Stories Marcus Welby, MD
Ben Casey
Dr. Kildare
General Hospital
ER
Grey’s Anatomy
Doogie Houser
Scrubs


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The Physician as Patient Martha Lear, Heartsounds, 1980
Edward Rosenbaum, A Taste of My Own Medicine, 1988
Itzhak Brook, My Voice, 2009
Sholom Glouberman, My Operation, 2010
Jonathan Welch, As She Lay Dying: How I Fought to Stop Medical Errors from Killing my Mom, Health Affairs 2012


Patient Stories – The Other Side of the Equation

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Barriers to Patient Stories Reluctance to talk about illness
Swimming against the tide – contradicting the received wisdom
May be hidden from the patient
Patients may fear retaliation
All parties may be sworn to silence


The consequence?

Those who cannot remember the past are doomed to repeat it. -George Santayana

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Lewis Blackman 1985-2000

Lewis Blackman


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

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Patterns in Patient Stories


Lack of respect for the power of medications




Overconfidence in the benefit of medical treatments and minimizing of potential harms




Dismissal of patient deterioration as “anxiety”




Psychiatric labeling of patients with difficult-todiagnose illnesses




Certain drugs and procedures




Certain phrases – “Appropriate” “Alternate reality”

Planetree Focus Groups* Top three concerns cited by patients 

Dismissal/trivialization of the patient voice



Absence of caring attitudes from providers



Lack of continuity in care

* “Building A Collective Vision Across the Continuum of Care,” Planetree International, Patient-Centered Care CEO Summit, October 23, 2008

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The Global Experience of Healthcare


Stories are not about the patient but about the commonalities of the patient experience.




This is the data that has the power to transform healthcare.

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The plural of anecdote is data I said 'The plural of anecdote is data' some time in the 1969-70 academic year while teaching a graduate seminar at Stanford. The occasion was a student's dismissal of a simple factual statement -by another student or me -- as a mere anecdote. The quotation was my rejoinder. Since then I have missed few opportunities to quote myself. -Raymond Wolfinger

Reframing the Issues Listening  Caring  Providing effective, coordinated care 

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International Network of Narrative Medicine The hope of the International Network of Narrative Medicine is to build networks worldwide among all who recognize that illness unfolds in stories, that the care of the sick is an art form, and that multi-disciplinary inquiry is the starting point for new knowledge and fresh practices. Together, we will change the face of health care.

LEWIS BLACKMAN

100 90 80 70 60 50

RI

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Helen

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©RHC

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Helen Haskell Mothers Against Medical Error [email protected] (803) 312-4390

This presenter has nothing to disclose D18, E18

How to use stories to catalyze change and focus quality improvement Alide Chase Senior vice president, Medicare Clinical Operations and Population Care and Executive Director, Kaiser Permanente Care Management Institute

Dec 11, 2013 9:30-10:45 11:15-12:30

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Who we are Kaiser Permanente’s mission is to provide high-quality, affordable health care services and to improve the health of our Members and the communities we serve.

The science of storytelling

A fact wrapped in a story is 22 times more memorable - Jerome Bruner, Cognitive Psychologist

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Benefits of storytelling: Accelerating Performance

Why Stories Matter

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Recipe – Sharing Stories

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Know your audience

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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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How to Find Stories

Gather a new story Use your own experience Borrow someone else’s experience or story Go to external sources • •

Pulse Magazine : http://pulsemagazine.org/ NYT video stories http://www.nytimes.com/interactive/2009/09/1 0/health/Patient_Voices.html

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Catalyzing Change

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Results Video Ethnography + Patient & family, staff, physician engagement + Additional data

Improvement Efforts

Significant reduction in readmission rates across our organization

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Video Example

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

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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.

“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

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Thank you!

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Discussion • 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

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Appendix

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Tool to help you plan your story Key message (Insight, Opportunity, HMW?)

Key Supporting Quote(s) / Observation(s)

Audience

Desired Action

Benefit to Audience to Act

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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/videoethnography-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. 55

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