Experiential Learning: Learning after to enhance the culture of care in a regional hospital
The following is an example of using storytelling and narrative capture as a way of learning after an event. Following a sentinel event in a regional hospital at Interior Health Authority (IHA), a project was initiated to better understand the culture of care and compassion being practiced at the hospital and to find ways to improve patient care.
Across B.C.’s health system, many people receive high-quality care. However, there are times when a patient may experience an adverse effect. Learning from these events is part of developing a culture of trust and continuous improvement. In 2006, a sentinel event occurred at IHA, which brought the health authority under intense scrutiny. Several investigations were undertaken, all in the spirit of improving decision-making and building a culture of care and compassion.
Understanding and finding ways to truly understand and improve workplace culture is not an easy task and requires novel approaches. In this particular case, the environment and the decision-making processes were complex. Ultimately, the staff, managers and professionals involved needed to see the whole picture before they could find ways to improve their approaches, attitudes and behaviours. Different groups (e.g., nurses and physicians) had different perspectives on the countless number of interactions that occur on a day-to-day basis. It became clear that the environment and decision-making was not formulaic, but dependent on circumstances. In other words, applying simple rules and policies was not going to solve the problems or support a change in culture.
Working with an external consultant, an organization development consultant within IHA collected approximately 400 stories from staff, managers and various health care professionals involved. They also collected stories from patients and families. Each story-teller was asked to analyze his or her own stories by answering a number of questions about the stories. A software tool was used to help people see patterns that emerged from the stories. A proxy group of approximately 60 people from a variety of backgrounds was then brought together in a large workshop where the participants collectively made sense of the data, including the narratives and the patterns that the individuals had played a role in formulating. The process provided physicians with key insights into the perspective of nurses when it came to care planning.
From this work emerged 30 action items that were “owned” by management, staff or both jointly. Some of these items were aimed at improving decision-making processes, while others were quick fixes related to equipment or facilities. Many of the action items were more relational in nature – for example, how to behave and speak with each other.
The long-term outcome of this project was a shift both in the styles of senior leaders and in the staff themselves, who became more engaged in developing and organizing ways to improve clinical care. As Terry Miller, the organizational development consultant, stated:
“Which do you think would be more effective? An external consultant or an administrator saying ‘you need a code of conduct’ – or a group of employees who say ‘we need to develop a code of conduct for ourselves?'"