A Line of Defence: Using Stories in Healthcare Education

El-Farargy, Nancy; Walker, Gill

doi:10.1007/s40670-017-0482-5

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…Stories have a degree of emotional power that can spark attention, resonance and change (54)(55)(56)(57). Like our ndings, other studies have found that sharing patient success stories enables HCPs to feel energized after watching them, as these stories are "impactful, heartwarming, and understandable" (53).…”

Section: Impact Of Sharing Patient and Family Storiessupporting

confidence: 57%

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Flynn

Mrklas

Campbell

et al. 2020

Preprint

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Background: In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these efforts. Methods: We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN initiatives. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results: We conducted thirty realist interviews in two cases and found four important mechanisms facilitating sustainability: the use of a collaborative approach audit & feedback, the informal leadership role, and patient stories. Informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the initiative. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of initiative sustainability. Patient stories demonstrated the initiatives’ impact on patient outcomes, motivating staff to want to continue doing the initiative, and increasing the likelihood of its sustainability. Conclusions: There are important contextual factors and mechanisms within sustainment processes that may apply to systems change implementers. Our research revealed the causal relationship between implementation and sustainability and how outcomes from implementation shape sustainability contexts. Future work is needed to evaluate the effectiveness of informal leadership, learning collaboratives, audit-feedback, and patient stories as sustainability interventions, to generate better guidance on planning sustainable improvements with long term impact.

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Section: Impact Of Sharing Patient and Family Storiessupporting

confidence: 57%

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Flynn

Mrklas

Campbell

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Stories have a degree of emotional power that can spark attention, resonance and change (55)(56)(57)(58). Like our ndings, other studies have found that sharing patient success stories enables HCPs to feel energized after watching them, as these stories are "impactful, heartwarming, and understandable" (54).…”

Section: Impact Of Sharing Patient and Family Storiessupporting

confidence: 57%

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Flynn

Mrklas

Campbell

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts.Methods: We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior’s Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research.Results: We conducted thirty realist interviews in two cases and found four important mechanisms facilitating sustainability: the use of a collaborative approach, audit & feedback, the informal leadership role, and patient stories. Informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit & feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two scaled, multi-component interventions. Patient stories demonstrated the interventions’ impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability.Conclusions: There are important contextual factors and mechanisms within sustainability processes that may apply to systems change implementers and decision makers. Our research revealed the causal relationship between implementation and sustainability and how outcomes from implementation shape sustainability contexts. Future work is needed to evaluate the effectiveness of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact.

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“…However, composite diaries could be kept in other patient populations where care providers or family members make entries during the periods of care where the patient is not able to make diary entries themselves (as is often done with patients in the intensive care unit) 22. The completion of diaries by patients appears to be a simple and intuitive method of capturing the patient experience which patients appear to engage with, and so this approach could easily be extended to other healthcare domains 12 30. The use of questionnaires to assess patient satisfaction with healthcare clearly has its place, and questionnaire data are generally considered to be simpler and faster to summarise than the qualitative data yielded by unstructured diaries.…”

Section: Discussionmentioning

confidence: 99%

“…These recommendations have added momentum to the development of the patient-centred, and more recently, the person-centred healthcare paradigms 4 6–11. While scope for improvement certainly still exists in healthcare, for the vast majority of patients, care proceeds very well and research on patient safety has seen a real neglect of the opportunities for learning provided by these positive outcomes and experiences 12 13. Learning from what went right, in addition to what went wrong, is consistent with the modern concept of ‘Safety-II’, which focuses on making good performance better, in addition to attempting to eliminate the relatively small number of remaining adverse events that continue to occur 14…”

Section: Introductionmentioning

confidence: 88%

Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study

Webster

Jowsey

et al. 2019

BMJ Open

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ObjectiveTo capture and better understand patients’ experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement.DesignProspective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy.Participants and settingPatients undergoing vascular surgery in a metropolitan hospital.Primary outcome measuresComplete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated.ResultsWe recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients’ experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21–99) years and diaries contained a median (range) of 197 (26–1672) words each. Study participants with a tertiary education wrote more in their diaries than those without—a median (range) of 353.5 (48–1672) vs 163 (26–1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts—primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients.ConclusionsUnstructured diaries completed in a patient’s own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient’s own perspective, and to identify opportunities for improvement.

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A Line of Defence: Using Stories in Healthcare Education

Cited by 9 publications

References 25 publications

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Contextual Factors and Mechanisms that Influence Sustainability: A Realist Evaluation of Two Provincially Scaled Evidence-Based Initiatives

Capturing the experience of the hospital-stay journey from admission to discharge using diaries completed by patients in their own words: a qualitative study

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