In order to deliver the best care we must ensure that the people and processes we employ are safe, robust, and effective. This proposed project aims to improve two key areas of patient safety through the development and implementation of a practical storytelling programme used in peer support.

Approximately 80% of nurses and junior doctors at Medway NHS Foundation Trust recognise the importance and utility of the WHO surgical checklist in improving patient safety, promoting teamwork, and reducing human error, yet less than 30% believe their colleagues are engaged when checklists are being carried out. This is not just a local problem; research has shown significant variability in the delivery of the WHO checklist across Trusts, and identifies nurses’ reluctance to challenge consultants as one of the key problems. The WHO checklist is designed to ensure a minimum standard of safety in theatres, and must be delivered actively and confidently in order to be effective. This requires a sense of self-efficacy and assurance that, if not fostered, can get quashed in a pressurised environment. Through peer support, made relevant, through storytelling we hope to embolden our lower-banded staff to successfully command the attention and engagement of a theatre team in a way that safeguards against error.

However, mistakes can happen, and when they do, we need to support our staff in a way that promotes learning, adaptability and resilience. We are often reminded that doctors are “only human”, yet the expectation of perfection can undermine this sentiment, making it harder for the individual to disclose an error when one has occurred, and for others to accept, and forgive it.   

Eliminating failure is an unrealistic and unproductive goal, but it is possible to support individuals to ‘fail well’ and prevent “second victim” experiences that can have damaging effects on patient safety. One of the most effective ways to learn from failure is through peer support. We know that peer attitude is a key determinant in staff members’ emotional response to, and recovery from, failure. As such, genuine empathetic support from colleagues can provide scope for an earlier, safe and consensual intervention that not only provides immediate relief for the staff member involved, but also helps contribute to a culture of transparency and ownership that minimises the risk of future failure. Putting this support into action is made more effective and easily received through stories.

Stories are tools to understand human behaviour, and help people deal with the most difficult issues they face; the transformative power of stories lies in their ability to evoke emotion, create empathy and instil enthusiasm. They provide a frame of reference that allows the reader accommodate and assimilate new information based on their own experiences. As such, stories are the most accessible means of transferring and embedding new knowledge, skills and qualities. This project aims to harness this power to embolden and support our staff in a readily accessible form, giving confidence to use stories.

This project speaks to the Q Improvement Lab’s work on using stories as evidence, and seeks to develop and implement a structured teaching package ‘Stories4Improvement’ that will provide the theoretical and practical guidance on how to create and tell stories that are authentic, impactful, and motivating. This teaching package will be designed using techniques from film scriptwriting and novel writing to help staff to identify markers of a ‘good’ story, embed these into own narratives, and apply these to promote good practice, inform positive change, and evidence progress. These skills will equip and enable staff to create and tell stories that encourage effective and quality peer support.

Storytelling as a social and cultural activity is time immemorial, but ‘Narrative Medicine’ is a much newer system of improving practice. Traditionally, Narrative Medicine courses have been taught in universities, and focused on the clinician-patient relationship. The novelty of this project lies in the formalisation of existing knowledge into a coherent programme that can be taught and replicated using the ‘train the trainer’ method. The proposed package can be peer-led and delivered and implemented quickly and easily in an acute hospital setting.

During the project we will refine the teaching package by feedback of attendees, and their experiences from delivering the package to peers. The inevitable result of the package will be generation of many peer stories that will be belong to the authors’ departments, to be used in peer support, service design decisions, Quality Improvement and feedback to external organisations.

The development of the Stories4Improvement teaching package means that the storytelling skills can be taught to anyone and applied to any situation. As such, it is a truly adaptive and responsive method that can be applied early and informally to either prevent the start, or escalation, of problems. Given our proposed method of dissemination the reach of benefit will be immediate and broad in scope, extending beyond the Q Community.