Telling True Stores Can Inspire Cultural Change

Storytelling is a familiar form of communication.

Stories fill our everyday lives, from the anecdotes we share with colleagues or friends to the books we read.¹ Factual stories educate us and inspire us to take action. They help people understand, remember, and accept new ideas.² One thing is certain: Lessons without stories rarely lead to learning and change.³ It is the details and the exposed humanity in stories that serve as the catalyst for change. No matter how powerful research data are, there is often nothing more powerful than a story to motivate people to learn and change.

Here is why:

• Stories grab our attention and engage our curiosity, emotions, and imagination.¹
• Stories are mentally rich, making analysis not just an intellectual experience but a much deeper personal experience.⁴
• Stories provide new perspectives and often challenge our preexisting assumptions.⁵
• Stories trigger empathy and healing.^1,4
• Stories are more likely to be remembered and retold.⁶
• Stories inspire and incite change.

In this legal climate, it is unrealistic to expect organizations to simply share unbridled stories of error and risk outside or even within the organization. So, how do we begin to bring our stories together in an actionable way to help keep patients safe?

Here are 3 ways:

Set the stage. Establish an environment in which the organization’s stories can be reported and shared without fear of external exposure, undue internal embarrassment, or unjust discipline of involved staff. Adopt and cultivate a just culture that encourages the reporting of errors along with frank discussions, including storytelling, about their causes.

Craft the story. Stories should be crafted with just enough detail to describe the key events or risks leading up to the event, describe the underlying causes of the error, link the causes and adverse outcomes (actual or potential) to the desired behavioral changes or system, describe the lessons learned, and make the story memorable. If measurement data exist to support the story’s conclusions, provide links or references to the data for those who want more information.

When crafting a story, to the extent possible, de-identify the patient, the individual who reported the error or risk, and the staff members involved, so, it cannot be traced back to specific individuals or patients. Although stories should be truthful, unnecessary details should be omitted, and minor changes to the story such as the patient’s age, gender, and weight, can be made to facilitate contextual de-identification if the key causes of the error and the lessons learned are not misrepresented.

Include stories from external and internal sources. Using external sources for stories prompts the evaluation of similar risks within the organization that may otherwise not be uncovered until an event occurs. Using internal sources for stories helps staff see risks lurking in their everyday activities and sends a message that the entire organization is committed to safety.

Share the story. Establish a formal, simple process for sharing stories. Describe how storytelling will be used within quality improvement processes, the level of confidentiality required among storytellers and listeners or readers, and how to clearly communicate these expectations through confidentiality policies and/or signed confidentiality agreements. Describe the venues at which stories can and cannot be shared. Determine whether organizational stories can be shared verbally, in writing, or both. If stories are shared in writing during meetings, collect the written materials at the end of the meeting for proper disposal.

While reflecting on the ways to collect and share external and internal organizational stories, keep in mind that it is through the telling of these stories that we will break the code of silence surrounding medical errors and make substantial headway on our journey to safer health care.

Michael J. Gaunt, PharmD, is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/Ambulatory Care Edition.

References

1. The Health Foundation. The power of storytelling. health.org.uk/newsletter/power-storytelling. Published December 12, 2016. Accessed June 22, 2018.

2. Pitzer A. Statistics vs. storytelling: the grudge match? Nieman Storyboard.niemanstoryboard.org/stories/statistics-and-storytelling-the-grudge-match. Published November 19, 2010. Accessed June 22, 2018.

3. Stone R. Storytelling: a powerful, unexpected ally in the fight to improve patient safety. Storytelling, Self, Society.2006;2(2):68-86.

4. Gray JB. The power of storytelling: using narrative in the healthcare context. J Commun Healthcare. 2009;2(3):258-273.

5. Tyler JA. Storytelling and organizations: introduction to the special issue. Storytelling, Self, Society.2006;2(2):1-4. doi: 10.1179/cih.2009.2.3.258.

6. Storytelling in healthcare enhances experience for patients and providers. HealthLeaders Media.healthleadersmedia.com/leadership/storytelling-healthcare-enhances-experience-patients-and-providers. Published June 15, 2009. Accessed June 22, 2018.