Why stories matter

I was very struck by a good piece of service research from Addenbrook’s presented at today’s HSRN symposium (www.hsrlive.org).  Although the session was focused on productivity, the research from Dr Mai Wong really highlighted the power of patient narratives (and clinical storytelling) in understanding demand.  Her work focused on frequent attenders to emergency departments – often the focus of policy initiatives, with claims of excess service use, but poorly understood.  Dr Wong showed the heterogeneity of this patient population.  The clever thing was the way she translated the descriptive HES data and clinical casenote reviews into archetypes - living, breathing pen portraits.

We were told about Kelly, a young woman with COPD and anxiety who visited A&E ten times a year.  And about Bob, well known to emergency staff, homeless and prone to self-harm and substance misuse,  attending A&E every other week.  These personal profiles helped her to understand the different demands of the moderately frequent attender (where brief psycho-educational interventions might help) as opposed to the extreme frequent attender (Bob), requiring intensive case management.

Why does this matter?  John Seddon (www.thesystemsthingreview.co.uk) punctures myths about lean management (or bastardised versions of it).  One is that standardising service operations is exactly the wrong thing to do if we don’t understand the nature of demand.   Our healthcare systems often multiply demand and activity, as needs of the individual patient are not met upfront.  The work of Christiansen also highlights the need to frontload each care pathway with high quality assessment by teams of skilled clinicians – get it right first time.

So why do we need patient stories?   If we don’t understand how people use services and their underlying needs we won’t improve productivity.

HSRN symposium Manchester, 19 June 2012