Everything is held together with stories

Our latest online session was delivered by Shaun Maher (Strategic Advisor for Person-Centred Care and Improvement, Scottish Government) @s4maher and Tim Norwood (Healthcare Improvement Scotland) @norwood_tim.  They gave an introduction to some fascinating work they've been doing in relation to stories shared on Patient Opinion and how these can identify areas for improvement at a local level.

Shaun writes:-

“Everything is held together with stories. That is all that’s holding us together, stories and compassion” Barry Lopez

There is a sense in which stories are the original data. The way human beings have connected with one another and shared learning and knowledge for millennia is through the medium of story. Sadly, all too often in the modern era stories, either inadvertently or perhaps sometimes consciously, are treated as a second-class data source. I can’t help but feel this is especially the case in the world of healthcare. The numbers generated by large randomised controlled trials are viewed as the gold standard, whilst individual stories from people about their experiences, interesting as they may be, are not really of much use in helping to us to understand what really works – after all, you can’t generalise from individual experiences. Or can you?

Before you start climbing the ladder of attribution I should make it clear that I’m a big fan of numbers! But numbers alone, or for that matter stories alone, are only able to provide us with part of the picture. My contention is, that all too often we rely solely or heavily on numbers alone, a stance which can (and has) lead us to false conclusions about the quality of service we are providing.

So, we need to find a way to use both numbers and stories with equal status to get the whole picture. We can use the primary sources, the actual stories and the actual numbers, but we can also generate numbers from the stories and stories from the numbers! If we can develop a systematic approach to this blending of stories and numbers that helps us to understand what’s good and what needs to be improved (in other words the variation), then we will be able to develop a much fuller, more balanced understanding of reality on the ground.

In my view Patient Opinion has great potential to be one of the things that can help us achieve this aim and open our eyes to the full galaxy of rich learning contained within stories about peoples’ experiences of the health and care systems. It also has the power to connect people, to connect heart and mind in a way that is open, energising and empowering.

With this in mind I’ve been working my colleague, Tim Norwood, to develop some quality improvement data to use alongside (heavy emphasis on ‘alongside’) the individual stories people are telling on Patient Opinion. This is helping us to start looking at Scotland’s Patient Opinion stories as a whole, at individual provider organisation level, and where there are enough stories we can also look at service or team level. This systematic approach means that not only can we look at the individual stories in their own right, but we can now also look at the stories as data over time on run charts or statistical process control charts. In addition, because of the way Patient Opinion works, we can also look at the tags that have been used with each story to generate a word cloud that shows at a glance some of the key themes around ‘what’s good’; ‘what could be improved’ and ‘how people are feeling’.

We are currently just starting to test this data with NHS Boards in Scotland to see how they can use this data that blends stories with numbers to support their quality improvement work. Feel free to give me shout if you’d like to find out more.

Listen/view Shaun and Tim's online session here.