The Power of Stories

Tell me a Story . . .

Judy L. Schueler Chief Learning Officer, UCH Academy The University of Chicago Hospitals June 2003

Underlying the concept of family-centered care is a respect for the differences that influence each person’s attitudes and experiences, including cultural, racial, religious, socio-economic and other factors. At the University of Chicago Hospitals, respect for differences applies to our interactions with patients and families, and colleagues. The movement toward a family-centered care philosophy at UCH began in the neonatal intensive care unit (NICU) led by Lynn Schultz-Benjamin, RN, BSN, MBA at the University of Chicago Children’s Hospital. The NICU’s work in developing a family- centered care environment began over two years ago. Staffs were engaged in a process that fostered a philosophy acknowledging the family’s right to respect and inclusion in the patient care process. A Family Advisory Board was formed providing an added dimension to data and comments from patient satisfaction surveys.

Central to the success of this initiative were the discovery of new avenues for recognizing staff by sharing the stories of team-based efforts that resulted in memorable experiences for patients and their families. We leveraged the power of stories to begin moving the family centered care philosophy throughout the organization.

The University of Chicago Hospitals’ Academy serves as an internal corporate university serving the learning needs of hospitals’ staff. The UCH Academy aligns its learning offerings with key organizational goals. This Fall, the UCH Academy offered an innovative learning experience that leveraged personal stories as a tool to improve patient care and staff recognition practices. A broad spectrum of staff — including representatives from Nursing, Social Work, Chaplains, and other staff participated in a storytelling workshop led by Julie Heifetz, writer-in-residence at Philadelphia-based Moss Rehabilitation Hospital. The workshop included presentations of three life stories, followed by instructive dialogue on storytelling methodology and how to solicit life stories from patients. The process for using storytelling methodology focused on: how to communicate complex ideas in a memorable way; how to launch change in a resistant environment; and how to use the power of narrative stories to sustain organizational culture.

Heifetz is a leader in using life stories to enhance the patient-care experience. She also works with staff to share stories that can build morale and rekindle caregivers’ passion for their work. Storytelling reveals the cultural patterns of an organization and provides a framework for sustaining the positive aspects of culture. By collecting stories about our patients, families, and the staff who care for them addresses the need for people to make connections with each other.

1 Heifetz encouraged our staff to write their stories, not simply tell them orally. Writing the story makes the process different. It also makes the end product different. You create a story that can be used in many ways. The story can be used to sustain a culture of family- centered care by incorporating the story into hiring/selection, orientation, professional development and nursing practice dialogues. Capturing the voice of the patient and their family became a powerful tool for change.

It’s helpful to know more about a person’s life story and major events in their life, and how that impacts their medical condition. One of the participants in our workshop cited an example of a geriatric patient he met recently who was the youngest of 13 siblings. By now, the woman had outlived all of her siblings, and was alone. We talked about what it was like growing up the youngest in such a large family, and her sense of loss at outliving all of her brothers and sisters, and whether her life had turned out the way she had planned. These insights helped us consider the support the patient might need to cope with her sense of loss, and to identify whether she needs assistance with meals, transportation and caregiving because she did not have family to help her.

Theatre as a Forum for Sharing Stories

Our experiences with the storytelling methodology led us to reflect on stories brought to life via theatrical-based productions and apply them to our interactions with patients, families, and staff. Sponsored by the UCH Academy, staff nurses and managers from Cardiology and General Medicine at the University of Chicago Hospitals were provided an opportunity to enjoy a performance of the play “Comfortable Shoes” at Chicago’s Royal George Theater. Going to the play was a learning process —— aimed at building an “inclusive” care environment by increasing awareness of diversity and tolerance among staff.

The autobiographical play “Comfortable Shoes” traces the life of Clint Holmes, the biracial son of a white British woman and an African-American man who married in the 1940s. Now 55 years old, Holmes recalls, “Growing up, I was obsessed with the notion that I did not fit in anywhere.” The play served as a metaphor for what it’s like to be different and not be accepted. The “story” of Clint Holmes served as a vehicle for discussions among staff for how differences can either divide or unite people. Cultural competence requires an appreciation of other people’s differences and a willingness to find common ground. The “Comfortable Shoes” performance and discussions urged staff to consider how they provide care that is respectful and appreciative of the differences among patients, families, and co-workers.

The play spurred uncomfortable — but important — insights. Some participants shared that the story of Clint Holmes served as a reminder of how they felt when others demonstrated bias or applied stereotypical labels to them. Participants noted if we look at the play and see the effects that racism plays on the development of a young person, we may be able to see how and why our patients react to us as they do. Sometimes our interactions with patients and their families are based upon unconscious biases. Through the use of stories we are less defensive—we can reflect on our own behavior.

2 After viewing the play and participating in group discussions, Darrel Davis, RN, staff nurse on the General Medicine unit, commented, “It’s important not to prejudge people because of their differences. In order to get along, we have to respect people and their values and choices, regardless of their race, sex, religion, nationality or other differences. If we can do that, we’ll work together better as a team and provide better care for our patients.”

Barbara Power, RN, MSN, on the General Medicine unit, commented, “ Comfortable Shoes” was an excellent vehicle to initiate dialogue on cultural diversity issues. Addressing diversity will assist the Hospitals in fulfilling its mission, vision, and transition to a family-centered care model. In addition to group discussions about differences, the staff will learn to use stories to express feelings about their similarities and differences.

June Gradman, RN, clinical nursing director for Cardiology and General Medicine, notes, “We’re so busy at work that we often don’t take time to appreciate what we can learn from one another and from our patients. The power of story provided us that opportunity to learn.”

For additional information contact:

Judy Schueler Chief Learning Officer University of Chicago Hospitals 773-702-4380 [email protected]