This video is an excerpt from the AMA Advancing Equity Through Quality & Safety Peer Network session on Storytelling for Scale and Sustainability. In this section, Grace Rubenstein from Health Begins, defines the key elements of good storytelling and provides steps for developing a compelling story to help advance equity efforts at your institution. While data alone is important, the use of storytelling and narrative are important tools that can better convey what the data is telling us to attract additional allies and garner more support. An example from the Children's Hospital of Philadelphia is provided in the video.
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Grace Rubenstein: [00:33] Today's workshop is called Storytelling for Scale and Sustainability. Because we have found, even as we're doing the hard and good work of advancing health equity, we need to be able to share that work with others, to bring in more allies, to bring in more support, and perhaps to help other people do that work as well. So, that's what we're going to be focusing on today.
[00:56] Our goals today are to... enable you to be ready to provide examples of story sparks, to identify the key elements of a story that you want to tell, and then to go through the key steps in the process of actually developing that into a compelling story.
[01:14] Just for a moment, I want to give some appreciation to the source of a lot of the material we're using today. I am editorial director with HelpBegins, but in another hat of mine, I also am cofounder of SeedPod Media, a podcasting company with my cofounder, Julia Scott. SeedPod and Julia were gracious enough to let us use some of the SeedPod storytelling curriculum for the good and worthy work that we're doing here today. Thank you to them.
[01:50] Where we're going to begin is: finding the story. I think as you know, format wise, we're going to just charge through a lot of material in this hour because it's a limited time. We are very fortunate to have the team from CHOP, ready, willing to be our guinea pigs, to show us what these instructions look like when you actually apply them to a real story.
[02:14] Storytelling is just about as old as humanity, as you can see from these beautiful ancient pictorial stories. To kick us off, while we get to look at this beautiful visual, I'm going to ask Dan from CHOP to... actually, I'm ahead of myself. Let me talk about story sparks for a second, and then we'll then we'll ask Dan to give us a snapshot of the story spark that CHOP settled on.
[02:42] Before we tell the story, we've got to figure out what the story is. Really often, in this work, we tend to get stuck on like processes, or outcomes-as-stories. The definition of a story spark that I give here is really meant to help you think in terms of... not just a process or an outcome, but the story within it, because that's where you're going to find the compelling material to really engage those hearts and minds.
[03:13] The way I define it: when someone did something that mattered, where the outcome was not guaranteed, and their actions and experiences could inform or inspire someone else. You can probably tell that that's a bit of a frameshift on the way you might have thought of a story before. This could be a transformation, an insight, a challenge, an initiative, an improvement, any of these kinds of things that you see on your screen.
[03:43] Data, yes, data can be a story spark, as long as you're looking through the data to the real human experiences that it reflects. I'm going to now hand the reins over to Dan, who's graciously agreed to give us an overview of the story spark that CHOP settled on.
[04:05] Keep your ears tuned here for the elements that you think might be part of the ultimate story that CHOP tells, and once Dan's done giving us that overview, then we're going to dive into the individual steps in the process of turning that spark into a full-fledged story. Dan?
Dan Hyman: [04:22] Thanks, Grace. I was sitting here at my desk on a Monday afternoon in August, three days before our patient safety committee meeting on the fourth Thursday of the month, and reviewing the PowerPoint deck that my team had put together for the meeting, as is our typical process before it goes out a couple of days ahead of time.
[04:49] I was going through the deck, and the agenda, and our scorecard, and the various elements that we had in the agenda that day, and came to a slide that said "Race, Ethnicity, and Language Stratification of CLABSI Data" and then a set of objectives and the data... This needs a little bit more context:
[05:17] As you know, I work at Children's Hospital of Philadelphia, the oldest children's hospital in the country, it has a very proud legacy of being an exceptional research, clinical care, and academic institution. But it's also cautious and conservative, and when you are innovating and doing new things, I've learned that it's important to make sure that the key stakeholders and decision makers are ready for what ever innovation we are bringing down the pike.
[05:50] The Patient Safety Committee. itself, s a committee of about—it's grown a lot during the pandemic—we now have 75 to 100 people attend it. It includes C-suite level people— vice presidents directors—we have some family members and community members on it, and it's a pretty high-level meeting. I'm looking at the deck that's about to go out and thinking we're going to have to figure out how to frame this conversation in a way that people will react to the data in a positive way.
[06:27] I was fortunate that on Tuesday, we had a planned meeting of the quality and safety leaders from this network and I was able to take the opportunity to talk with this group about the conversation I was about to have and they helped me frame what I did on Thursday morning at the meeting. Briefly, and we can talk more about it, I took a risk and how I introduce the information started by sharing my identifiers.
[06:58] Now I've been in the organization for two years, there wasn't any particular need for me to say, "Hi, I'm Dan Hyman, I identify as a white male of Jewish origin," and then went on to explain why identity matters, why openness to understanding our own experience in the world matters and the experiences of others who are in the room, particularly when we're doing something like looking at stratified data about harm in our healthcare system.
[07:32] I talked a lot about not—so much the fact that the data we were going to see that day was so strikingly bad—but that we were introducing a subject that was going to ultimately result in us looking at data that did make us uncomfortable, and that different people with different perspectives were going to see different meanings in the data, and how we responded to the data—or how we should respond to the data—might be something that caused difficult conversations.
[08:04] Again, we can talk more about the details, but this was the story spark that I was taking a risk in introducing something new in the organization, in a high-level meeting, where the culture of the organization is quite cautious. The conversation wound up being very interesting, with different sharing of different perspectives, and highlighted some of the differences that we weren't anticipating might occur in sharing this data. Then there was a lot of follow up, appreciation for the way that we introduced the subject and the discussion that went forward. I think, Grace, I'll stop there. Is that okay, do you want me to do anymore?
Rubenstein: [08:17] No, that's great and my sense from our conversation earlier was that... the framing that you presented did succeed at setting the stage for those conversations that will continue to follow as you go through this process.
Hyman: [09:08] It did and I also got a lot of positive feedback from people saying that they appreciated the way I introduced the subject. One of the things was—and I think it was Karthik, actually, who shared this with me a couple days before—was being clear that I was approaching this with humility and vulnerability and an openness to learning... That I was on my own learning journey with respect to how to think about differences in race and ethnicity and how it impacts people's lived experiences and how we would see it in the data and that I was coming to the group not saying that I was expert in this, but that I was on a learning journey and wanted them to go along with me.
Rubenstein: [09:55] That emphasis on learning and growth and all of it continuing. Thank you, Dan, and thank you Kelly and Caitlin and Anan and Teresa for dropping those stories sparks in there. In all of the stories sparks that you posted here, I see those key features of a story spark. I'm seeing somebody doing something that mattered, where the outcome was not guaranteed, where that where that experience can inform and inspire others. That's great.
[10:26] We're going to go now from the little story that you just heard from Dan, which is what I heard from Dan and the whole CHOP team when we talked earlier, and then we're going to break down how we went from there, step-by-step, to a tellable story that could be shared in a presentation or a newsletter or another format like that. From the story you just heard from Dan, we pulled this story spark as our starting point. I'll go ahead and let you read it for just a moment.
[11:11] What you see here is a reflection of the risk that Dan mentioned he took, and the risk that I also saw in all the story sparks that you that you posted, everything that you're describing launching in your settings involves some risk— because you don't know exactly how it's going to go—and it's going to probably involve feelings along the way, but it's really important to do. And therein lies the core of a really powerful story.
[11:40] What steps are we going to go through from story spark to story? I break this down into three main elements, which are characters, stakes, and evolution. We'll go through what each of those means. I mentioned the data can sometimes be a story spark, and it can, but data alone cannot be a story, a story has to involve human beings and these human beings have to be someone to whom the story matters. We humans, inherently care about other humans, and we care about what other humans care about.
[12:19] As you look at, all the people who might be involved in—or touched by—the story spark that you're working with, you want to think about, "Who's a person who's somewhere near the center of this work, who may be taking some of those risks, or to whom it matters how this comes out." That's characters.
[12:41] As always, when you're doing this work, there are so many people involved and we rightly want to give credit to all of them. That's really important. But the trap we can fall into is trying to make everybody a main character in the story, which is going to make the story impossible to tell. We just have to strike a nice balance and let one or two people carry the plot of the story forward as the main characters, and then leave room to mention the important contributions that everybody else also made.
[13:15] What are the stakes? What is riding on the outcome of the story? Something has to hang in the balance, and it has to hang in the balance to those central character or characters. It doesn't actually have to be enormous. It can be: "Is this conversation going to set the stage as we need it to?"
[13:41] Obviously, the stakes of our work in health equity, ultimately, are extremely momentous, but the stories that we tell of our work along the way can actually have kind of smaller-scale, individual human-scale stakes, and still be compelling.
[13:59] Finally: evolution. This is what you might think of as the plot. Something's going to have to change. Back in grade school, they used to tell us this is the "conflict" of the story, and I never really liked that term, because it doesn't necessarily need to be a conflict. It's just that something is going to change, we're going to start in one place, and we're going to end up in another place. That's the nature of a story. That even—as it says here—can be just a change in our understanding, or a change in insight or a lesson learned.
[14:33] I put this note in here about how we don't need a really slam-dunk, tidy ending. It's tempting to try to look for one of those when you're telling a story, but it's really not necessary. As long as those key requirements are met: Something evolves, something is learned, something moves forward and in some way, it's okay to say to keep the story of the moment kind of more contained, and allow the future to be unwritten. There's always room for a beautiful reflection at the end that says, "We've come this far we've learned this much. Now, on to the next step."
[15:14] Taking these three key elements of story that you're going to want to identify at the beginning, let's look at how we did that with CHOP's story spark.
[15:27] For our characters—folks online can probably guess who we ended up with [as] our character—in this story it inherently needed to be Dan. Dan, as I was just recognizing, as many people feel, was not looking for the spotlight nor wanting to assume all of the credit. Dan graciously agreed to be the character because he was, in fact, at the center of the action in this story. But he was concerned about making sure other people got credit, and there will be a way to do that as we tell the story. Did I get that right, Dan? You're always free to jump in.
Hyman: [16:08] Sorry. Yes, you did.
Rubenstein: [16:09] Okay, you're always free to jump in and make sure I'm representing your story right.
Hyman: [16:15] Absolutely.
Rubenstein: [16:18] Here we have, Dan. As we went through this exercise, we identified "What are some key moments for Dan in this story?" and you hear those in the story that Dan told about getting this deck and recognizing that it needed more of a human element to.... set up the right kind of conversation. What's at stake in this... story? There can be more than one thing at stake in any story. When you decide to tell the story, you're going to pick the one that you think is the most compelling to help you focus.
[17:08] "Reputation." Thank you. Yeah, sure that's a high-stakes a conversation to lead, and that was the reputation of the broader hospital as well. What else rises up for folks? Lots of possibilities. "Safety and quality." Yep. "Misunderstanding." "These are really hard conversations to have." "Safety." "The quality of the work that CHOP is doing." Yeah.
[17:35] Where we... ended up settling was that what was at stake was the ability to continue to do this work effectively, if I'm saying that right. It was setting this up in a way that this process could then continue successfully with the right introduction.
Hyman: [18:00] Grace, I would say that's exactly right. I appreciated all of the chat comments but, Keisha, especially yours about misunderstanding. I don't feel nervous, talking... either inside or outside my own organization, but this just felt different. There was a risk of people saying things or responding in ways that were going to create barriers to the future conversations. We needed to set it up in a way that people would have grace when people responded in ways that were maybe not as sensitive as they could be—or ideal—and that was what was at stake first and foremost.
Rubenstein: [18:57] As far as evolution, we got a sense from what Dan said that a rich and complex discussion did unfold, that carried its own lessons about how to have these conversations going forward. In the end, the table was, in fact, set to keep doing this work. If you have thought through these three key elements of your story, then you are ready to pivot into the actual the crafting of the story itself.
[19:43] That brings us to "Steps to Successful Storytelling." This is obviously a thing you're going to need to do—presenting to anybody—is consider your audience... It's worth thinking about that as you craft your story: Who are the folks who are listening? What's their role? What matters to them? What might they be listening for? Because within any story that you tell, you can choose which parts to emphasize or underscore more, and it makes sense to consider your audience and what's going to be meaningful to them when you do that.
[20:23] You might then take these same skills that we're learning today, and port them over to, say, a newsletter that's going out to your broader organization, or a presentation to a community partner, or a funder, for example. Then, you would want to do the same exercise at the beginning as you start shaping what the story is going to look like depending on those audiences in those settings.
[20:49] This is near and dear to my heart as a storyteller, it's the step that is probably most often skipped, and when you skip it, it actually makes it harder to then tell your story. I know because I've tried to do stories without this step and it takes longer and causes more pain and suffering along the way. Identifying your topic and thesis: this is going to be your compass as you go through the remainder of the storytelling process. There can be a bit of a fine distinction between the two, but I'll try to make it clear. Your topic is basically like your headline, it's the what is the main content of your story, it should be very specific.
[21:34] A lot of people are tempted, as you can see here, to say, "Oh, my story is about food insecurity." That's not a topic... yet. A topic needs to be a complete thought about who did what. You can see the examples here: "A medical team tackles food security in its own neighborhood." That's a lot more precise than just the topic of "food insecurity."
[22:02] A thesis, by contrast, is not really the content or the subject matter. It's the idea, it's the thing that you want your audience to still remember, weeks later, when they've forgotten the specifics of whatever you did and they just remember... that residue from the story that they heard from you. It's the idea or the message or the lesson that you want people to walk away resonating with.
[22:27] In the food insecurity example, you can see examples of those potential ideas or theses here: Food security actually should be thought of as a part of medical care. That's a real sort of prospective-changing idea that you might like people to walk away with.
[22:50] Let's... cast these lights onto our story from CHOP, and think about what CHOP's topic and thesis might look like. This is where we landed with CHOP. The topic being "Sensitively introducing the importance and use of real data to the hospital leadership team paved the way for engagement and support," is basically your headline, it summarizes the action and the content of the story.
[23:20] Different from the thesis, which really was about the tone that was set... This was—please correct me if I'm wrong, but I think—what you would really hope people would still remember long after they hear your presentation. As we saw from the story sparks that many of you shared in fact, a lot of folks are embarking on similar kinds of journeys with similar kinds of risks and challenges. The resonant lesson, idea, thesis from the story is that embarking on these journeys with vulnerability, honesty, and room for learning and growth is essential and especially when a leader does that in a high-stakes kind of a space. With these—the topic and the thesis—set, you've got your compass, you've got your guideposts. These are going to be your touchstone and anytime you get lost in the storytelling process, these are going to tell you where to go from here.
[24:23] This I've touched on before, but it feels it may feel a little bit strange to do this in the settings that we're working in. We're really often about processes and data. These are professional settings, where we often don't bring as much of our person as we might in other settings, but if you're telling a story and you want that story to stick and to resonate, the story is going to need humans and feelings in it.
[24:59] Try not to be too shy about that. You have... your instincts—and they're probably good instincts—about where it's okay to go with this, but take a moment to ask yourself these kinds of questions: "Who's really invested in this work? What inspires them? What drives them? What scares them? and "Which steps in the process have them holding their breath and anxiety or anticipation?" The answers to these questions are going to shed light on the really pivotal moments and actions in the story for you.
[25:38] Here comes the plot part, and this is going to reflect the thinking you did early on about the evolution of your story: Where you're going to begin, where you're going to end, and what should evolve in between? It's okay if you have too much on the page at the beginning with this stuff. Don't hold yourself back too much. Put it all down there on the page and then you'll have a chance later to reflect... to use your topic and your thesis that you've already crafted and come back, and reflect and decide what should stay and what should go.
[26:13] But don't let that inner editor get in your way, just yet, at this stage of the process. Story beginnings tend to have a lot of pressure on them. A lot of people get stuck right there at the top of the blank page. But I really like to emphasize that there are many, many ways to do a strong beginning. The only thing you don't want to do is give everything away right at the top. But it could just be, as you see here, an idea, a scene, a reflection, just one detail, the beginning of a story.
[26:53] Dan's throwing out a potential kind of storytelling device that you could use: inviting the audience to imagine themselves in the scene. That can be an effective device as well. Another trick you may use, if you are staring at the top of a blank page is to... give yourself 10 minutes and write four different beginnings. You don't have to use any of them, the pressure is low, but just get four different beginnings on the page and you will see, quite clearly at that point, that there are multiple entry points and there is no one right answer and hopefully that gives you the breathing room, you need to pick a direction and go with it.
[27:41] Endings, again, also tend to have a lot of pressure on them and I like to take that pressure off. I like quiet endings, I like reflective endings, endings that just kind of look towards the future. Occasionally you get lucky and you have a story that just has some kind of a slam dunk at the end. Hurray! But not usually, that's not usually what happens.
[28:00] Usually it's your task at the end to decide what is going to answer the stakes that you set forth at the beginning. That's really the main role of an ending. Because once you answer the stakes, then the audience is kind of cognitively emotionally free to go. You've given them a complete experience.
[28:28] How do we land on all these things with CHOP? I listened to the little story that Dan told and... I saw a moment, that was a really compelling moment to start on, that kind of embodied the tension inherent in the stakes, which was Dan looking at this draft deck and seeing that it was just data. Just data about some very challenging and potentially charged work that lay ahead for the CHOP team and thinking it's Monday and I have this deck that's not going to cut it for this purpose and it has to be presented on Thursday. It's a small moment, that's just one person's experience, but it's really a beautiful one because it sets up the stakes inherent in that story. The top team agreed with starting there and that's what we decided to do.
[29:37] As far as ending points, there are all kinds of different possibilities there. Again, I would encourage you in your own stories to look at different possibilities and weigh them and use your instinct about which one you liked the best. This is subjective work. That's our evolution.
[30:02] I'm skipping ahead to the ending, actually... because I think it's helpful to know where you're going. Here with CHOP, we thought this could be one of those opportunities in the story to bring in people beyond our main character of Dan and allow some of those other voices to shine through with the conclusion simply being: now having had this conversation, we know the spirit in which we're going into this process and the spirit of humility and learning and growth and that spirit is going to carry us forward as this work evolves.
[30:42] An opportunity there to bring in the voices and perspectives of other people who also were important parts of the work would be to have another team from CHOP describe how this really set things up for them. If you have your beginning point and your ending point in mind, then you get to go back to the evolution that you set forth in the beginning and fill in the details. What are the key steps that get us from here to there and that show us how that evolution takes place? That show us the change unfolding? Dan, or anyone from CHOP: Would you like to jump in here and describe how that how that conversation did unfold and what were the key things that you took from it?
Hyman: [31:33] Sure I'll do it. One of my colleagues who was going to be here had an issue that she wound up not being able to. I think when we do this in December I'm going to have her reflect on it. What happened was really interesting:
[31:49] We showed CLABSI data that really didn't show significant differences for this particular data set in between different racial and ethnic groups. But our chief medical officer—who is a public health researcher/epidemiologist, self-described, data geek— was talking about our decision making that we would need to go through with respect to what we worked on, whether things were clinically significant and statistically significant and I was cringing a little because I knew that this was going to land differently with different people.
[32:37] In fact, one of our other executives who's from a Black/African American background, responded... that those comments landed differently for him. What I took away from that, and the subsequent discussion is that, it's not that it's not valid to think about statistical significance in the interpret interpretation of data—of course it is. But when we're looking at this particular type of data, there are going to be many people who, who don't need to see something, two or three points beyond the standard deviation, to say, "This is consistent with my experience of bias and we need to understand the reasons for it." Without it necessarily being beyond that statistical control in it.
[33:36] I had forgotten—actually, Grace I haven't told you this—that I had also gotten an email from our chief operating officer who's an accountant, with a similar question about the specificity of the data and its presentation and it just all pointed out for me that as we do this going forward, incorporating that tension between pure statistical significance, and the interpretation of race, ethnicity, and language-stratified data in different audiences is going to be something we have to be intentional about, including in the conversation.
[34:19] I think less than that, what I would say, and what my team has said, to me is that it was very unusual—and they've been here for longer than I have—it was very unusual in their experience at CHOP for someone in a senior leadership role to be so overtly vulnerable in that setting, that it really impacted people in a positive way.
Rubenstein: [34:46] Absolutely and my understanding from our conversation is that opening with the setting of that tone, then allowed conversations like the one you just described to take place and it showed you, going forward, that you're going to need to anticipate this tension in the process and be ready to have that conversation, and sometimes to say, "Let's not let these rigid statistical methodologies let us lose sight of real life for a lot of folks."
Hyman: [35:19] Yeah and that it's okay... for us to be uncomfortable and to hear and say things that may not come out perfectly, and go on to do that work of learning and improved understanding of one another, that this work is going to require, does require.
Rubenstein: [35:42] Beautifully said, absolutely. I've just a couple minutes to get you through the last few steps of storytelling process and then we'll start looking to how you're going to apply this to the presentations that you're all preparing. We can do these pretty quickly:
[35:57] Step five: Answering the basic questions early on. Once you have set forth your beginning, and before you really dive into the evolution, there's a couple basic things that your audience is going to need to know and you're going to need to tell them so that they're invested, and they're ready to follow along with you. One of those things is always going to be the stakes. They need to know right away why this matters to the people involved. The other is your basic context. Your who, what, where, when, why. The key here is just to be concise. To think to put yourself in the shoes of your audience and think, "What are the three-ish things that I just need to know in order to understand what's going on here?"
[36:44] How we did that with CHOP, real briefly, you probably need to know that the patient safety committee that Dan's talking to is this high-level hospital committee charged with monitoring safety issues. You need to know there's about 75 people in the room, it's pretty big. And that the people there include this really wide variety of stakeholders at a whole bunch of different levels in the org chart—and even outside the org chart—and include people from the community as well.
[37:16] That's really just the basics that you need to know, then you're in the room, and you know what the room is like, and you're ready for the story. When you're crafting your own stories, you can just do that little exercise of putting yourself in the audience's shoes for a second and saying, "What are the few things that I just need to know."
[37:35] Once you have gone through and drafted out your evolution, your beginning, your ending, included your context and your stakes, that's when you get to go back and start pruning. This is where the story really starts to shine forth and go from your brain dump to a beautifully crafted narrative. Here, again, your topic and your thesis are going to be your guides.
[38:00] We always have the instinct to include all of the wonderful details from the work that we've done, but do your audience a favor and don't. Try to be as heartless as you can about really following your topic and your thesis and making sure you're sticking to the one story that you're telling right now. There's probably 10 stories you could tell from your work, but we're just telling one at a time.
[38:32] Lastly: data. The same principle applies to data. Data is obviously going to be crucial in a lot of these stories in the settings where you are and the kind of work that you're doing, but this is another place where less is more. If you choose a couple of data points that really connect to the stakes of your story and the thesis, the idea that you want to leave people with, that gives those few data points a chance to really stick and really resonate and really help land the point of your story. If there's a lot more data points than that, they're going to start to blur together and each one loses the impact that it might have.
[39:12] What kind of data points do we need in the CHOP story? Actually none! Sometimes that's cool, too. Sometimes you have a story that's not rooted in data and that's okay, too. Don't feel like you have to be reined in by any of the steps. You know your story best and you should trust that.
[39:38] This we've touched on—but it's always worth a gut check again—about which voices you're including and where there might be opportunities to bring in different ones. The presentation itself can also be an opportunity for this, as Dan mentioned, even though he's inherently at the center of this story, there's an opportunity in the presentation itself for other team members to get to weigh in. This is just a good gut check to always keep on hand.
[40:13] Rubber meeting the road here, putting the story to work. Everything that we've just learned here is kind of the homework that goes into telling a story. But everything that you will write down on your brainstorming worksheet or, notes that you might take as you prepare to tell the story, all of that does not actually belong in the final story itself.
[40:37] Some of the questions that I've led you through here, you're going to need to answer for yourself as you craft your story, but your answer doesn't have to be in the story that you present to your audience. You'll be able to go from your brainstorming notes to a crafted story using that template.
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