Staff narratives perpetuate patient-focused values in face of rapid change
Staff narratives perpetuate patient-focused values in face of rapid change
Storytelling: It's not just for kids anymore
In today's health care environment, where mergers and acquisitions are the rule rather than the exception, employees may inadvertently shift their focus from patients to politics. When Nightime Pediatrics Clinics, a five-facility chain of after-hours pediatric clinics in Salt Lake City, faced growing pains because of accelerated expansion, CEO Teresa Lever-Pollary turned to an old-fashioned, yet effective, solution: storytelling.
"I wanted to collect stories that demonstrated how time and time again, we have gone the extra mile to provide quality care for patients as well as put forth extra effort in caring for each other," she says. "I believe that articulating these experiences holds the key for the perpetuation of our company's culture."
To help design a system for collecting and disseminating value-based stories from physicians, nurses, staff, patients, and parents, she enlisted the help of Richard Stone, president of StoryWork Institute. The Maitland, FL, consultant is the author of The Healing Art of Storytelling (Hyperion, 1996) and uses stories to develop training programs and seminars for team building, leadership development, diversity training, and sales effectiveness.
More than 50 people were interviewed and 90 stories constructed from the recorded transcripts. Sixty of the stories were compiled in a book called Nightime Stories, which was given to each employee during the company's 15th anniversary celebration. With Stone's direction, Nightime is also developing training applications that feature the stories as a cornerstone for new employee orientation and for physician recruitment.
"While management philosophies may come and go, one thing that may be immutable and unchanging is the need to share stories that inspire, teach, and guide new and old members of the organization," says Stone.
Story sharing at the corporate level provides the same benefits as at the personal level, he explains. "In both environments, shared stories help to guide us. Without sharing our stories, it's nearly impossible for us to fully grasp who we are. Without our stories, how can we know where we have come from, or have a sense of confidence about where we are going?" he says.
Lever-Pollary agrees that personal narratives about pivotal experiences can provide a sense of roots as well as trajectory for organizations undergoing profound change.
She explains that when Rod Pollary, MD, started the first Nightime Pediatrics Clinic in 1983, the pediatrician created specific goals and concepts that eventually turned into the present mission statement. Knowing that sick children are already full of fear and anxiety, Pollary designed the first clinic from their perspective. For example, there are no waiting rooms, to decrease likelihood of spreading communicable disease, and exam rooms are designed to look like a family room, including couches and a TV with entertaining videos. There is also a play room for siblings where parents can monitor their children by a remote camera hookup into each exam room. Each subsequent clinic was carefully designed on this model to diminish the fears and anxieties of parents and pint-sized patients.
But, unlike design elements, a corporation's culture isn't automatically transmissible, she points out.
"Every time we added a new clinic, something else was lost. Some of our organization's values were being disregarded and buy-in to our mission was decreasing," she says.
For example, politics began dominating relationships and battle lines characteristic of more traditional health care were drawn, she says. "Some docs even insisted on wearing white coats," says Lever-Pollary, who explains that one of the basic expectations of Nightime's doctors and nurses is that they wear casual clothing to make children feel at home.
Intensifying the growing pains was the fact that most of Nightime's staff, including physicians, are part-time. "Another one of Pollary's basic tenets was to create an environment that is conducive to balancing home and work," Stone says. "But getting part-timers to buy into Nightime's core values was a challenge." Yet Lever-Pollary recognized that perpetuating corporate culture would take more than spelling it out in a newsletter, memo, or orientation. She recalled pivotal events in Nightime's early history when staff went above and beyond the call of duty to help patients: a time staff paid out-of-pocket for premature twins' medicine or when a leukemia patient needed a bone marrow transplant and paid $75 each to be typed and registered for a bone marrow donors list.
"I suspected there was something important about these experiences. I wondered if collecting these experiences would allow us to capture the essence of Nightime and share among ourselves who we are," she says. "I also hoped these stories will ensure that those who come in the future will have the gift of knowing what has been contributed."
Once upon a time . . .
To begin collecting stories that reflect the organization's most cherished values, Lever-Pollary and Stone referred to the values themselves. In a memo to all employees, she outlined her request by listing each value followed by a suggestion for a pivotal event. (See chart on p. 91 for story guidelines.)
Lever-Pollary then asked training and development managers Sue Kiisel and Peggy Gustafson to oversee the project's implementation. "We began calling current and former patients who had sent us thank you notes and asking them if they would like to contribute a story. Every single one said yes," Kiisel says.
But the staff were another matter. "At first there was some resistance to the project," she says. "They wondered why we needed to spend time and money on story collection. They also questioned why we needed to hire someone from the outside to help us. After all, we had English majors on staff."
Some staff members also voiced the concern that they had no stories to share - or else the stories weren't "interesting" enough to be shared with anyone else.
"They had a hard time seeing what they do as special or unique because they do it every day. [Focusing on the patient] is just a part of working here," Kiisel says.
Others discounted their personal contributions, not wanting to be viewed as bragging, while some could not remember distinguishing events as the years of working at one place blurred together, adds Stone.
Kiisel attributes overcoming the resistance to Stone's ability to ask sensitive questions and help tellers make connections in their narratives. "He helped staff to see their lives as story - one that made an important contribution to the company's history," Kiisel says.
This devaluing of the "everyday" story is not surprising, given the media's proliferation of the lives of the rich and infamous, explains Stone, who laments the loss of stories in America's culture, calling it "de-storification."
"You must engage in intentional listening, not merely hearing," he cautions. For example, when a employee would casually mention a small event during an interview, Stone would make a comment or draw a conclusion that helped the teller recognize the true meaning.
Another tip for drawing out employee stories is to assemble three or four employees and ask them to recall pivotal events in their career, Kiisel recommends. "Once one person said, 'Remember when . . .' and told a story, it triggered others' memories and they began to recall their stories easier," she says.
From concept to completion
After Stone interviewed physicians, nurses, patients, parents, and staff, Lynda Jones, secretary, "worked forever" transcribing the interviews, which lasted from half an hour to 45 minutes each. "This was more work than we anticipated. Because we wanted to have the project completed in time for our anniversary celebration, we hired a temporary transcriptionist," Kiisel says.
The process of turning archival transcripts into 90 stories was also a labor-intensive one, she adds. Because each value would stand as a chapter heading, Stone examined transcripts for anecdotes that best illustrated those values. Then he constructed a story out of the raw material, creating what he calls "artistic bridges."
"Every story needs a beginning, middle, and end to be compelling. So I rewrote them in that basic storytelling format," he explains.
He also paid close attention to the underlying meaning of the tale. "You have to keep one eye on the integrity of the story as told by the contributor, but you have to keep the other on the reader or listener to ensure that the story would come across with its full potential impact, and leave its mark as good stories do."
Next, the drafts went back to the original tellers for review. "If there was another person mentioned in the story, we sent it to them also," Kiisel says. "Most people OK'd the draft and signed the release our attorney prepared for us, but a few felt the story didn't accurately convey their feelings."
After another rewrite, Stone returned the stories again to the tellers and the compilation was ready for final assembly. First Stone rated each story with one, two, or three stars and then Lever-Pollary, Gustafson, and Kiisel exercised final editorial approval. "We knew it was important for us to have an outside eye select the stories, but we also wanted to include those that had special meaning to us," she says.
A volume of 60 stories debuted at a packed anniversary celebration; Stone read several of them. "They loved it - and moreover, they finally understood why it was important," Kiisel says.
The end?
Although Stone points out that this project doesn't lend itself to quantitative evaluation, the team members continue to ask themselves these questions:
· What does it mean for an organization to make a conscious effort to collect and share its legends and lore?
· How will this affect productivity?
· In what ways will these stories make employee behavior more congruent with the company's mission and values?
· By knowing these stories, will staff members bring more heart and caring to their work with children and each other?
· As people come to know themselves and the company better through these narratives, will their work become more meaningful and rewarding?
"It's still too early in the project to fully grasp the implications of Nightime Stories," says Stone. "Like all good stories, the answers to these questions are still unfolding."
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