Last week saw the 2012 International Forum on Quality and Safety in Healthcare in Paris, and day two started with an inspiring keynote from the President of the International Health Institute (IHI), Maureen Bisognano. During her address, Maureen used a secret weapon that she believes helps to change the way healthcare is provided to patients – the power of story telling. She recalled examples of patients and colleagues who are creating better care experiences by placing themselves and their families at the centre of everything.
In one example, she talked about a visit to Wisconsin, where she spoke to a nurse who keeps a photo on her desk of a 94-year-old lady, called Ethyl, who lost her husband of many years. As a result of her sad loss, and with no other family members that she could turn to, Ethyl suffered a deep form of depression and before too long was confined to a wheelchair. Maureen described how one day the nurse pleaded with her patient: ‘Ethyl, what matters to you?’ – a question which has a different meaning to the more traditional ‘What is the matter with you?’ Ethyl’s reply was simple: ‘I want a dog’.
Taken aback by the response from Ethyl, the nurse replied: ‘But I’m a nurse who cares for and treats patients – I’m not an expert with animals.’ As weeks went by, so did similar exchanges and Ethyl’s condition unfortunately further worsened. She became more and more tired and frail until, one day, the nurse drove past a dog pound and made a spur of the moment decision – she picked up a dog and gave it to Ethyl during her routine welfare visit.
And that’s not the end of the story: during the following weeks, Ethyl’s condition significantly improved and it wasn’t long before the previously frail, elderly lady who was completely dependent on home support, went on to play the violin for other patients in the hospital’s lobby.
Maureen also recounted the story of Christian Farman – a young man from Sweden with kidney disease. Christian was a mechanic who found that the side effects of his treatment (nausea and constant tiredness) were ruining his quality of life. After carrying out much research on self dialysis, he firmly believed he could reduce the side effects and have more consistent care if he alone were to provide his dialysis, rather than different clinical staff.
He pleaded with his nurse at Ryhov County Hospital in Jönköping to help him treat himself and regain control of his life. After persuasion, the nurse agreed. It wasn’t long before Christian was using the equipment and confidently administering his own treatment. Soon, he noticed the side effects had reduced and, as a result, his quality of life improved.
And there it was – the acorn of change was planted. It wasn’t long before other patients on the unit were taught self dialysis and thereafter the practice became accepted on the unit. 60% of unit’s patients have since followed in Christian’s footsteps to manage their own treatment with support from the clinic. This has not only led to a better quality of life for patients, but has led to cost savings for the department – largely attributable to fewer complications. Now, the unit plans to push their goal of self care to 75% of patients.
Maureen firmly believes that to bring about real change to the way that healthcare services are delivered to patients around the world, leaders need to be effective at story telling. Through telling these stories, she highlighted the importance of flexibility – taking bold decisions and finding out from patients what truly matters to them, as opposed to asking them ‘what’s the matter?’ For me, these cases really demonstrated how empowering patients and their families to be active partners in choosing and managing their treatment led to better outcomes and experiences for all.
At the Health Foundation we're exploring the role of stories and other ways of representing patient and staff experience to help make healthcare better. Stories are powerful because they show people as human beings and their emotions, so they need to be handled very sensitively. We will be sharing more thoughts on this soon.
As for Christian, he never returned to his previous role as a mechanic – instead he now works with other healthcare professionals as a nurse on the Ear, Nose and Throat (ENT) ward at the very hospital where he inspired a new way of delivering a vital service to so many patients.
Simon is a Media and Communications Manager at the Health Foundation.