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Catalyst for Change: Some insights into the power of story

2 Sep, 16 | by BMJ Quality

Nancy at Tower Bridge LondonBiography
With scientific and healthcare underpinnings, Dr Nancy El-Farargy is a researcher and educationalist.  Her work covers a range of quality, improvement and safety research & development to support the delivery of safe, effective and person centred
care.  She is based at NHS Education for Scotland (NES), which is the national health board for education, training and workforce development for the NHS in Scotland.

Twitter: @NancyElFarargy

Every Person, Every Time

The Healthcare Quality Strategy (Scottish Government, 2010) aims to deliver the highest quality healthcare to the people of Scotland and in turn, it aims to make Scotland one of the international leaders in healthcare quality.  The following ‘Quality Ambitions’ (p. 7) outline the principles of safe, effective, and person centred care at every healthcare encounter, for every person, every time.

  • Safe: “There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean, and safe environment will be provided for the delivery healthcare services at all times.
  • Effective: “The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.
  • Person centred: “Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making”.

Person Centred Care

There is a revival in healthcare that is focusing on active engagement, patient experiences, and the power of story in driving improvements and transforming services.  As highlighted in the above person centred ‘Quality Ambition’ this also broadly involves (Ahmad, Ellins, Krelle, & Lawrie, 2014, p. 28):

  1. Care that is respectful, compassionate, dignified, and sensitive to the whole person and their needs.
  2. Care where individuals can participate in their own treatment.
  3. Collective involvement in service design, delivery, and improvement.

Hence, in working together, people can highlight what matters the most, make decisions about care and treatment, and identify and achieve goals (Health Foundation, 2014, p. 8).

Our Voice

The following presents some examples of how experiences are being used to highlight improvements, catalyse change, and transform services.

  • Recent research has highlighted how stories – based on staff and patient experiences – have the potential to support ongoing quality improvement, learning, and reflection.  For instance, they are used during team meetings, safety briefs, and formal presentations, and they appear to be powerful in catalysing positive action and sharing of good practices.  Alongside quantitative data, stories (including other qualitative data) offer a “human side” to ongoing service improvement, and could perhaps provide the impetus for swifter action.
  • The ‘Patient Opinion’ website offers patients the opportunity to narrate their healthcare encounters and experiences.  In turn service providers can tune in to What's your story - Catalyst for Change Blog Photowhat really matters to users, and employ the narratives to inform patient focused service improvements.  Whilst it’s a relatively simple concept that’s grounded on user experiences, it’s the actions that result which appear to make it a useful tool for driving improvements.
  • The board game ‘Whose shoes?®’ uses narrative scenarios to support participants in reflecting on their own practice and interpretations of person centred care.  The exercise also highlights the importance of practitioners/professionals of actively listening to service users and working together to reach shared goals.
  • Starting out as ‘Stronger Voice’, the ‘Our Voice’ initiative aims to support people to engage with health and social care providers to continuously improve and transform services.

Summary

Stories – in their wider context – have been used throughout history for sparking knowledge, disseminating lessons, and supporting ongoing reflection.  Whilst they often reflect on the past, their power lies in their ‘memorability’ and their universal links with current contexts and situations.  Within healthcare, stories generally appeal to what people really care about and there is a growing recognition of their use to support safe, effective, and person centred care.

References

Ahmad, N., Ellins, J., Krelle, H., & Lawrie, M. (2014).  Person-centred care: from ideas to action.  London: The Health Foundation.  Retrieved from http://www.health.org.uk/publication/person-centred-care-ideas-action

Health Foundation. (2014).  Person-centred care made simple.  London: The Health Foundation.  Retrieved from http://www.health.org.uk/publication/person-centred-care-made-simple

Scottish Government. (2010).  The Healthcare Quality Strategy for NHSScotland – putting people at the heart of our NHS.  Edinburgh: Scottish Government.  Retrieved from http://www.gov.scot/Publications/2010/05/10102307/0

Dr Nancy El-Farargy, NHS Education for Scotland, Nancy.El-Farargy@nes.scot.nhs.uk.

This article was originally published (independently) on 16 August 2015.

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