Short Narrative Films Inspire Change

Throughout the past three decades, the use of health-related or medical narratives has gained increasing support as a successful device for changing health behavior and outcomes. Patient and provider stories have also played a pivotal role in challenging healthcare leaders to make patient safety and quality a priority. 

These narratives, in the form of short films and educational documentaries, have been used in various healthcare environments such as the Telluride Patient Safety Summer Camps for medical and nursing students and resident physicians as the foundational curriculum for teaching patient safety and the value of open, honest communication after patient harm; the Centers for Medicare & Medicaid Services’ annual Quality Conference as a keynote centerpiece setting the tone for greater patient engagement in the coming year; and within the MedStar Health system to reinforce transformation to a high-reliability culture, raise awareness of sepsis, and to increase joy and meaning in the workplace.

The Center for Healthcare Narratives was formed within the MedStar Institute for Quality and Safety, established by MedStar Health, the largest healthcare provider in Maryland and the Washington, D.C., region, with more than 300 locations including 10 hospitals and several ambulatory and urgent care centers. MedStar Health has used short narrative films for nearly 10 years to capture the heartfelt stories and experience of patients and providers. These stories are cathartic for the teller and the listener, and can slip past preconceived ideas to compel a change of heart and mind. In healthcare, stories make data come to life, providing the why to policies and procedures. They can raise the urgency of improving the delivery and patient experience of care, and, most recently, help find hope and meaning during the COVID-19 pandemic.  

Healthcare Stories in Action
In mid-2012, MedStar Health began using stories and narratives to bolster high-reliability transformation and a culture of safety with increasing anecdotal success under the leadership of David Mayer, MD. The 60 Seconds for Safety series gives life to the tenets of high reliability. Please See Me, a short film, encourages providers and patients to see each other as people first to promote patient engagement. Annie’s Story: How a System’s Approach Can Change Safety Culture tells the dramatic story of one nurse whose experience after a medical error provided a teachable moment for building a learning culture in medicine.

In 2015, in collaboration with the organization’s sepsis awareness team, the story of Cheryl Douglass, a former MedStar Health patient who had been transferred to MedStar National Rehabilitation Hospital after her sepsis diagnosis was missed in a community hospital, was developed and released in September 2016 as a six-minute short film titled Sepsis Awareness: Through the Eyes of a Survivor on MedStar’s YouTube page. Cheryl was left a quadruple amputee as a result of her missed diagnosis. Her story was built into a dramatic narrative with the goal of complementing organizational safety programs to raise sepsis awareness in EDs and to share the information with external healthcare consumers and stakeholders to encourage early diagnosis of and prevent mortality due to sepsis.

Evidence of Behavior Change Inspired by Short Healthcare Films
Shortly after Through the Eyes of a Survivor was released, Douglass and her husband, Paul, reached out to Jeanne DeCosmo, director, clinical quality, MedStar Health, expressing an interest to do more to prevent sepsis. Together, with the help of MedStar Health’s vice president of government affairs, Pegeen Townsend, they began shaping legislation that might further sepsis prevention through public awareness.

In 2018, Townsend wrote two bills that were introduced in the Maryland state legislature. The Douglass film was included in an informational package presented to the Maryland General Assembly at a hearing, and when the film ended, “you could hear a pin drop” in the room, according to Townsend, who attended the hearing. The General Assembly passed the legislation, establishing a Sepsis Public Awareness Campaign Workgroup to develop a statewide campaign in 2018.

A follow-up short narrative film, Changing Healthcare, One Story at a Time: Taking Sepsis Awareness to the Maryland General Assembly, was created in May 2019. The film outlines the process and value of using narratives for sepsis awareness.

Bolstered by this continued success, the MedStar Institute for Quality and Safety team turned to stories and narratives during the COVID-19 pandemic. The team came together via videoconferencing technology to engage a panel of nine global patient safety and quality experts, patient advocates, and healthcare leaders to share lived experiences during the pandemic. The goal was to raise awareness of COVID-19’s impact, and to document this unprecedented challenge to our global healthcare systems. Videoconferencing software proved a low-budget filmmaking tool. The six-part series, Finding Hope and Meaning During the COVID-19 Pandemic, is available on the Consumers Advancing Patient Safety YouTube page. 

Finding Health-Related Narratives for Use in Practice
The MedStar Institute for Quality and Safety portfolio of short narrative films using storytelling techniques to connect the hearts and heads of healthcare stakeholders has shown considerable anecdotal proof of concept. The entire portfolio is available to the public, and MIQS stakeholders receive repeated requests from healthcare leaders to use the films for their own safety, quality and patient engagement initiatives. Healthcare administrators, clinicians, consumers, patients, families and students alike have given positive feedback on the value of using this content in the healthcare workplace and educational environments.

Making connections through patient and provider stories engenders empathy and heartfelt knowledge of healthcare, which can inspire improvements in the delivery of safer, higher-quality and more patient-centered care steeped in a more meaningful experience for those delivering care. According to research (see sidebar on this page), when human beings feel empathy and are transported by a story, they will recall what they have seen and act on it. Healthcare leaders and stakeholders can benefit from learning how to intentionally create, cultivate and curate narratives from within their own health systems. 

Tracy Granzyk is executive director, the Center for Healthcare Narratives at the MedStar Institute for Quality and Safety, Columbia, Md. (tgranz24@gmail.com).