In this piece I will explore the use of stories and, in particular, digital stories, as ‘objects of reflection’. The intentional creation and collection of stories can prompt new ways of thinking and highlight potential and actual solutions. If we are prepared to listen and attend to these stories, there are powerful lessons for change and improvement.
In her novel Lighthousekeeping, Jeanette Winterson likens stories to flashes of light from a lighthouse: ‘Every light was a story and the flashes themselves were the stories going out over the waves, as markers and guides, comfort and warning.’
Over the past 12 years I have had the great privilege of working with nearly 1000 people who have participated in the Patient Voices Programme, sharing their stories of care (and sometimes the lack of it) with the aspiration of improving the quality and safety of care for everyone: patients, service users, carers and the clinicians who provide clinical care for them. Every story has been a flash of light and every one offers us an important opportunity to learn, to reflect and to do things differently.
But let us, for a moment, go back in time.
At the beginning of the 21st century, stories were not considered worthy of inclusion in the various methods designed to improve the quality and safety of care. Evidence Based Medicine had, quite rightly, grown in importance and influence in the world of healthcare; stories were considered to be at the bottom of the hierarchy of evidence. In fact, in those long-ago days, patient experience was only just beginning to be recognised as being of importance in understanding how to improve the quality and safety of everyone.
But times have changed and now stories are everywhere – and everyone is talking about them!
So what has happened to bring about this change? Why are stories so important?
The French philosopher Pascal is alleged to have said: ‘We tell stories to entertain and to teach.’
If you think back to your best teachers, I would guess that they were also good storytellers. For those of us who studied humanities, stories were at the core of our learning: learning about humanity from the stories of literature and history. The best teachers were those who could tell the best stories. The author Jeanette Winterson tells us that ‘Stories are always true – it’s the facts that mislead’, reminding us that, at the core of every good story is something important about the human condition. Those of us who are engaged with the crucial work of transforming health and social care would do well to attend to her wise words.
But there is more to stories than just learning about humanity, although that is a great starting point. Stories offer us the opportunity to suspend belief – or disbelief – to wonder and to wander, exploring possibilities that might never otherwise present themselves. In his excellent book If this is your land, where are your stories, Chamberlin encourages us to ‘find the common ground’ that stories invite us to share. He encourages us to ‘understand our stories because our lives depend upon it.’ When we hear the opening words of a story, we can enter a different state, one that allows us to hold ambivalence, to suspend judgement, to wonder….
‘Wonder and wondering are closely related, and stories teach us that we cannot choose between them. If we try, we end with the kind of amazement that is satisfied with the first explanation, or the kind of curiosity that is incapable of genuine surprise. Stories make the world more real, more rational, by bringing us closer to the irrational mystery at its centre. Why did my friend get sick and die? Why is there so much suffering in the world? Whose land is this we live on? How much is enough?’ These are crucial questions for all of us, but especially those of us who are concerned with driving change in health and social care.
The great guru of reflection, Donald Schön, tells us that ‘Storytelling is the mode of description best suited to transformation in new situations of action.’ This is an important message for us as change agents. Time and time again I have seen the process of storytelling and the product – the stories – bring about transformation.
The first, most radical and, undoubtedly, the most important changes resulting from the story are the internal changes within each storyteller, reinforcing the idea that change begins with me. I am not statistically valid. So I can’t change the world with my statistic, but I have the opportunity to change the world with my story.
In most cases, telling an authentic story has an enormously beneficial and healing effect, often freeing the storyteller to move forward in new ways.
Tim was a roofer. It was his last call of the day – an urgent call to repair storm damage to a wet factory roof. The roof was slippery. Tim fell 50 feet to the concrete floor below. He tells of the long journey back to life and reality, the struggle with pain, depression and PTSD.
Having created a digital story about his experiences, his comment was ‘I can now put this DVD on the shelf. I’m finished with that story and now I can move on.’ A year later, he made a very different story. Tim’s first story can be seen here. His story, and others from that project, are used by Sheffield City Council to promote greater understanding and awareness of the needs of people affected by mental health problems and those who care for them, helping the Council understand the kind of support that will be most useful and appropriate.
Stories can also bring about organisational change.
A Nursing Times article about the use of storytelling to engage teams suggests that space and time to share stories at work can help team members understand one another better, feel valued and share values in a way that honours each individual but also nourishes the team.
Offering teams the opportunity to tell and share stories has been helpful for one clinical team who had been placed on special measures. Three years on, things had improved immeasurably with a new ward manager, but there were still unresolved feelings. An opportunity to tell stories resulted in shared understanding and renewed enthusiasm for their shared work on a busy oncology ward.
After the workshop, the team manager commented that there was better team working and more obvious enthusiasm for the work. The stories can be seen here.
Digital storytelling work has been ongoing with Manchester Mental Health and Social Care Trust since 2011. The work was commissioned in an attempt to address poor ratings in both patient and staff satisfaction surveys.
Two years later, 43 stories had been created. Staff and patient satisfaction rates had improved dramatically, the number of complaints has been reduced by 45%, litigation costs had dropped by 50% and a great deal of management time was being saved.
One story is shown at the beginning of every Board meeting. Important lessons are drawn from the stories, the Board given an opportunity to challenge and the Board then undertakes to assure itself that undesirable things could not happen again and that good practice will continue. The Chief Executive of the Trust blogged about the impact of one of the stories here.
Stories are used in staff training and induction as well as in recruitment interviews to ensure that new employees will have an acceptable level of emotional intelligence and will share the Trust’s values. The use of stories in recruitment has changed the approach of the Trust towards its staff – you can read more about that here.
A good story isn’t just a story, you see. It is an opportunity for reflection and for transformation.
What stories do you need to hear?
What stories do you need to tell?
How will you tell them?