Contributed by Richard Stone

There’s an old moniker that is accepted wisdom when it comes to presenting ideas to groups you’d like to convince to change: Tell Them, Tell Them What You Told Them, And Then Tell Them Again. Western cultures also have a tradition to moralize at the conclusion of fables—“therefore children, don’t ever go into those deep dark woods by yourselves because…” Inherent in both of these approaches is the belief that combining the story or the message with an admonishment will ensure that the listener will learn or change their behavior.

If such approaches were indeed truly effective, this would be a better world, and all healthcare leaders would have to do is tell their teams three times to adopt behaviors that keep patients safe, and like magic, all errors and disgruntled patients would evaporate. Unfortunately, such approaches don’t succeed despite the best of intentions. Why?

Native Americans have had millenia to learn about how to persuade people and how to deal with powerful forces of change that could upend their world in the breath of a moment. They came to understand that learning was the most important and valuable function to ensure the resilience of their people and the perpetuation of their culture. Interestingly, they had no word for teacher in the way we understand teaching. The closest translation for their terminology would be “enabler of learning.” Needless to say, they studied closely how people learned best. Before anyone in this world received an advanced degree in cognitive psychology, the Oneida people came to see that one of the most powerful tools available to a communicator to engage listeners in learning was a simple question, not an answer. As a result, they developed a tradition of learning stories that were meant to engender questions, not answer them. Raise issues, not resolve them. The most powerful question that they designed at the conclusion of a story is simple and elegant by design, yet more potent than any of us can imagine: What might we learn from this story?

When people come together to listen to a story who are challenged by serious issues related to keeping patients safe or satisfied, and then are asked what they might learn from the story without the teller directing their learning, something remarkable is unleashed—the creativity and engagement of every team member. By catalyzing the power of teams to make a difference in the spirit of learning, true transformation becomes possible, and perhaps, inevitable.

In the context of improvement, I like to think of stories as powerful catalysts for action. Tribal peoples long ago developed a keen understanding of this effect, and nurtured their skills at constructing and telling stories to engage their people from an early age to explore alternate approaches to the challenges of surviving in hostile environments. In those settings, rigid thinking most often led to responses that were out of touch with the demands that dynamic circumstances placed daily on a clan or tribe. Inflexibility could be costly, and often deadly, as is the case in healthcare settings.

For teams to function at the highest level with regards to protecting patients from harm while at the same time providing caring touch in every interaction, all of the team members must share a common mental model for what that means. I believe that one of the fastest and most efficient approaches to attaining such a model is through meaningful, constructive conversation focused on a relevant issue. This is where a powerful story comes in. Stories engage the mind in a particular, unique fashion. We now know that the mind has schemata or patterns that it is using to scan every communication with another person. One of the most powerful of these is known as “narrative schemata.” Research has demonstrated that as we listen to another, our mind is scanning what is being shared with reference to this schema, and stays engaged to the degree to which the “information” conforms to 7 progressive steps, which you will agree after reading them, conforms with the very structure of what we commonly refer to as a story:

1. Introduction of a setting and characters;
2. Explanation of state of affairs;
3. An Initial event;
4. Emotional response/statement of goal by the protagonist;
5. Complicating action;
6. An Outcome;
7. Reactions to outcome.

Imagine a story about a key behavior such as cross monitoring and the fact that its performance by the key actors in the story actually is the difference between the life and death of a patient. As the team listens to this story, they will have in a sense all shared vicariously in the experience of saving this patient by practicing these behaviors. Then, imagine the team sharing all of the past experiences and behaviors they have witnessed or participated in related to cross monitoring, or its absence. This is also what stories evoke—connections with other spheres of knowledge and experience that are related, thereby facilitating the growth of our knowledge and understanding. In the span of a few minutes of conversation spurred by the story, the team can coalesce around the importance of this life saving team strategy, and thereafter becomes catalyzed in every situation to be aware of whether or not they are practicing cross monitoring. Such an awareness becomes the foundation for change.

This is what we have been witnessing when teams gather to listen to a story using the processes developed within the StoryCare^TM system. In the space of just a few days, teams begin demonstrating new behaviors that would have typically taken months or even years to engender employing traditional training models. In doing so, they are tapping into an ancient practice for which each of us is wired, and which has served to help people survive the most hostile environments imaginable. And yes, environments even more inhospitable and dangerous than hospitals!

We have been using stories since the beginning of time to make sense of our world. Stories told as ‘cautionary tales’ warn us of dangerous threats to our safety. The very personal stories of Josie King, Jesica Santillan, Elaine Bromiley, the Sheridan family and the Quaid twins are powerful testimonies of real danger, system failures, uncoordinated care and preventable harm. Over the past decade, these stories and many others like them have become catalysts for change within our healthcare system.

I have had the distinct pleasure to serve as a facilitator of these transformative experiences with thousands of healthcare professionals over the past 8 years and can personally attest to the power of these stories to transform attitudes, behaviors, and perceptions. Most of these stories were shared in the context of our patient safety and quality improvement training sessions related to TeamSTEPPS®, patient-centered care, and professional behaviors. These stories provided necessary context, instant connection and profound urgency. A couple of reflective questions following the video stories got the conversation started. How did this story make you feel? What can we learn from this story?

As many listeners wiped tears from their eyes, some remained stoic; still others would shake their heads in disbelief. The first responses were usually shared in a soft voice as though the speaker wanted to make sure it was safe to say what they were feeling among their colleagues. Responses became louder now and more frequent; one reaction building on another like bricks in a wall. Then, without warning, the true power of the story is unleashed. Someone shares their own story. Now we’ve made a real connection and the stage is set for experiencing change.

Please share ways and examples of how you are using stories to transform care in your healthcare organizations.