Three stories

Reminding myself about the power of story telling! I was recently asked to talk at a conference for between 5 and 7 minutes as part of a panel of three. If any of you have ever been asked to talk at any event you will know that preparing a talk (and delivering said talk) for 5 minutes is so much harder than if someone asked you to speak for an hour. Every word seems to matter. So I did my preparation and cobbled together what I thought were really important things to say.

I pitched up at the conference and was able to listen to the panel before ours. I was happily listening to some wise words when one of the panel members said, ‘instead of a speech I thought I would share with you three stories’. They did so fluently (you always do when it is your story) and struck a cord with the audience. The stories bought to life the points she wanted to make.

I have always known that story telling is the best way to share information but you kind of get into a situation where you want to share as much facts and evidence as you can and you forget the stories. I sat there with my carefully crafted words on five sheets of paper and wondered if I should do the same. So I quickly jotted down three stories that bought out the points I had wanted to make. Armed with this I went into my session. The following is the brief outline of my stories.

1. My personal perspective of life as nurse in the 1980s when something went wrong – in essence, very little learning, lots of blame and fear.

2. Life as a risk manager in the days when risk managers were rare and we had no internet or google to help us figure out what a risk manager did. How the role quickly became overwhelmed with data and the challenge of analysing a mountain of data. If we were ever to try to identify patterns, let alone early warning signals, we were definitely not taking the right approach.

3. Life now and my role in helping individuals and organisations to rethink their approach to patient safety and risk and how there are so many things we can and should do differently.

Each of these stories has a common thread of a desire for learning. I linked them together by talking about the Harvard study – you know the one – carried out in 1984 (my nursing years) and published in 1991 (my risk manager years). The study that triggered similar studies all across the globe to try to quantify the level of harm within healthcare.

I bought it full circle by sharing the fact the Harvard study had been repeated, by the same researchers who carried it out, again and published in January 2023 (my current role).

The authors found that healthcare had become significantly more complex – however sadly we still were not as safe as we should be, and the things that were going wrong in the 1980s were the same things that are going wrong in 2023. Even the percentage of avoidable harm had increased. In their words, ‘the patient safety movement has stalled’.

Did I give the audience any hope? I am not sure about hope but I suggested 3 things.

1. To think about what they were collecting and why they were collecting it. The whole purpose of data collection has been lost. It’s the collect all mentality that has got us into this mess. Incident data is simply one small component of a recipe for patient safety that at its foundation is all about relationships.

2. To think about what could they stop doing in order to free up time to do other things well. To redesign incident reporting systems to collect less!

3. To truly understand what was going on for people in their jobs every day. Go and talk to people and help people talk to each other. If flour and eggs are essential for making a cake (the vegans might argue differently) then ensuring we are able to talk to each other, talk together are the essentials for the safety for patients and staff.

In my story of time as a nurse, if we had all talked to each other we might have figured out all the factors that led to things going wrong.

As a risk manager, instead of just asking for more data, maybe if I simply went out to the people doing the actual work and asked them about their lives I might have learnt more.

In my job now I know that getting to know each other and having the ability to talk to each other safely is almost the most important thing we can help people do.

As for the Harvard study – will we ever know the true number or the percentage of harm? I doubt it. Perhaps it is time to start to collect stories instead which might help us learn differently and restart the patient safety movement.