storytelling: the why and the how - ihi home...
TRANSCRIPT
12/1/2013
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Storytelling: The Why and the HowBy Martha Hayward, IHI
Helen Haskell, Mothers Against Medical Error
and Alide Chase, Kaiser Permanente
D18E18
Dec 11, 2013
• 9:30-10:45
• 11:15-12:30
These presenters havenothing 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
P2
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StorytellingMartha Donovan Hayward, IHI
None of these presenters
have anything to disclose
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 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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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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The Plural of Anecdote is Data
Helen HaskellMothers Against Medical Error
D18, E18
This presenter has nothing to disclose
Dec 11, 2013
9:30-10:45
11:15-12:30
Helen HaskellMothers Against Medical [email protected]
The Lessons of Patient Stories
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If you want to serve, you need to begin with the stories.
—President Bill Clinton
� What is your story?
� What are your needs?
� What are your desires?
� What are your interests?
Listening
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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
Wired for Story
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
The Illness Script – The Basis of Medicine
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“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
Diagnosis -The Detective Story
� Marcus Welby, MD
�Ben Casey
� Dr. Kildare
�General Hospital
� ER
� Grey’s Anatomy
� Doogie Houser
� Scrubs
The Appeal of Medical Stories
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� 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
The Physician as Patient
Patient Stories –
The Other Side of the Equation
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� 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
Barriers to Patient Stories
Those who cannot remember the past are doomed to repeat it.
-George Santayana
The consequence?
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Lewis Blackman
1985-2000
� 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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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-to-diagnose 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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� 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.
The Global Experience of Healthcare
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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
The plural of anecdote is data
Reframing the Issues
� Listening
� Caring
� Providing effective, coordinated care
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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.
International Network of Narrative Medicine
©RHC 36
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Helen Haskell
Mothers Against Medical Error
(803) 312-4390
How to use stories to catalyze change and focus quality improvement
Alide ChaseSenior vice president, Medicare Clinical Operations and Population Care and Executive Director, Kaiser Permanente Care Management Institute
D18, E18
This presenter has nothing to disclose
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.
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The science of storytelling
A factwrapped in a story is 22 times more memorable- Jerome Bruner, Cognitive Psychologist
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Benefits of storytelling: Accelerating Performance41
Why Stories Matter 42
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Recipe – Sharing Stories
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 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
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Video Example47
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
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Thank you!
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• 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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Appendix
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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)
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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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