Telling Stories that Promote Health Transformation

The following excerpt comes from the article by Pedja Stojicic published October 4, 2017 on ReThink Health.


Stories are an important part of the human experience. As we go about our days, we tell stories all the time. Yet when it comes to our professional lives, those of us leading change tend to forget the power of a good narrative. We assume that, if our strategy is good and we present compelling evidence, people will get on board. But I’ve learned that no matter how good you are at developing the strategy—even if you back it up with data—you will not be able to implement your plan if people are afraid or are not motivated to join you. To successfully motivate people, I’ve found that I need a different skill: the ability to tell a good story.

It is not accidental that traditions and cultures often are preserved through narrative and storytelling. Stories remind us who we are and what we believe, so we can navigate the complexities and uncertainties of life. Contrary to popular belief, there is no such thing as a purely rational decision; emotions often play a larger role than we think in informing our choices. Our emotions can help us see what we value in the world. We process every call for action or change through that emotional lens, and then we choose to act or not to act.

Public Narrative as a Skill

Communities leading transformation efforts can benefit from this insight, using stories to draw out emotions and motivate stakeholders. At ReThink Health, we have adapted a framework for change that centers on effective storytelling. Public Narrative has been used in many different arenas, from political campaigns to community activation, and in many different places in the world, from Japan and the Middle East to Latin America and the Balkans.

Developed by legendary community organizer and Harvard professor Marshall Ganz, Public Narrative provides a way of thinking through the stories needed to mobilize people for collective action. The framework supports the development of three stories—a Story of Self, Story of Us, and Story of Now—that are meant to shift sentiment from “we have to do this” or “we don’t want to do this” to “we want to do this and we believe we can.” Taken together, the three types of stories can help to build a compelling narrative that motivates change.

Health system transformation, in particular, can benefit from this approach because decades of false assumptions and misguided priorities have resulted in longstanding mistrust and real disagreement among stakeholders. For decades a common misperception has been that the best way to create healthier communities is to spend more money on health care. If only we had better hospitals or could afford more expensive care, this thinking goes, people would be healthier.

The evidence suggests, however, that to really improve health and well-being, we need to look not just at the health care system but at the entire health ecosystem, convincing organizations and communities to invest differently. To make this case, health leaders will need to think more broadly, embrace new tactics, and tap into emotions.

Read the full article.

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A Key to Successful Health Transformation: Build Relationships

The following excerpt comes from the article by Lindsey Alexander, Pedja Stojicic, and Rebecca Niles published on September 22, 2017, on ReThink Health.


Several years back, Atul Gawande, a surgeon, public health researcher, and staff writer for the New Yorker, wrote an article on how good ideas spread. In his piece, Gawande detailed the BetterBirth Project, which strives to spread safer childbirth practices in parts of rural India. Gawande wrote:

To create new norms, you have to understand people’s existing norms and barriers to change. You have to understand what’s getting in their way. So what about just working with health-care workers, one by one, to do just that? With the BetterBirth Project, we wondered, in particular, what would happen if we hired a cadre of childbirth-improvement workers to visit birth attendants and hospital leaders, show them why and how to follow a checklist of essential practices, understand their difficulties and objections, and help them practice doing things differently. In essence, we’d give them mentors.

Gawande’s article suggests that the heart of any real transformation is, quite simply, relationships. While in recent years we’ve become enamored with spreading ideas at the speed of light (think TED talks and the quest for the next viral video), the bottom line is this: effective relationships, which take time, are incredibly powerful. For those of us engaged in the art of regional health transformation, it’s imperative that we step back and reevaluate our relationships, considering both their quality and their quantity; pondering the extent to which they are productive and whether anyone important is missing from the table.

Given the imperative of building relationships, we decided to take a look at just how multisector partnerships experience relationships in each of ReThink Health’s three practice areas of stewardship, strategy, and sustainable financing. What do effective relationships look like and what do these relationships enable partnerships to do?

Stewardship: Building Relationships is More Than Networking

Stewardship occurs when regional stakeholders–leaders, community members, organizations, and others across multiple sectors–align and act around shared priorities, strategies, and vision for fostering healthy people and thriving communities. Effective stewardship is often the key to addressing the core challenges facing multisector partnerships as they strive to transform regional health. In this process of alignment, relationships are critical.

Let’s be clear about what we mean by “relationships.” We’ve found that some people confuse building relationships with networking. While networking is done to connect and get informed, building meaningful relationships requires commitment and some degree of openness and vulnerability. Unlike networking, relationships are open-ended, creating the opportunity for growth. It’s similar to the difference between checking how your friends are doing on Facebook and getting together in person for a coffee or dinner. The former will get you informed, but the latter helps you truly connect (and may even take you on an adventure!).

Through ReThink Health’s work with regional transformation efforts, we’ve observed that multisector partnerships and integrator organizations with effective stewardship practices form relationships with at least three critical characteristics:

  1. Shared values – Shared values is about finding common ground; the areas where you agree. It does not necessarily mean everyone has to think or behave the same way. Instead, you can agree on a few foundational elements: that you want to improve health outcomes or increase economic vitality; or that achieving true systems change requires working together. The best way to create shared values is to explore and share stories that motivate us to act, such as deep personal stories that inspired us to do this work or collective stories that bind us as a community. Our Story of Self and Story of Now tools can help you do that effectively.
  2. Clear commitment  – Clear commitment is the glue in any relationship. Taking action and following through demonstrate that you care and that you are committed to collaboration. These are indicators that a relationship exists. We often see stakeholders coming together around the partnership table and participating in meetings or networking without actually taking any action between meetings. Without commitment to each other to meet common goals, there is no relationship.
  3. A spirit of co-creation – Co-creation of new things is a sure sign of a meaningful relationship. Groups that have good relationships tend to be very productive. They might create a Value Proposition for Health System Transformation, implement successful campaigns to improve population health, or develop new guides or manuals for their partners. If you are not producing anything together, soon you will discover that you are not in an effective relationship. You are just playing it safe–because creating something new requires courage, collaborative energy, and creativity.

Read the full article.

Hospitals and the Social Determinants of Health

Recently, the American Hospital Association (AHA) released a one-page strategic document for its members to use in understanding and addressing the social determinants of health (SDOH). The document – Emerging Strategies to Ensure Health Care Services: Addressing Social Determinants of Health — provides three general strategies hospitals can use, briefly defines the SDOH, and discusses policy options that could assist hospitals in making a difference in community health.

The new guide was developed as one of several resources outlining various SDOH and how hospitals can respond. Currently, the series includes Housing and Food Insecurity with others planned for development.

Learn more about Community Health Initiatives from the AHA.

Mental Health & Latino Kids

In September 2017, Salud America! Published an issue brief that reviewed the evidence related to the mental health of Latino youth. Findings from the research included:

Latino children suffer alarming mental health issues.

  • 22% of Latino youth have depressive symptoms, a rate higher than any minority group besides Native American youth.
  • More than 1 in 4 Latina high-schoolers have thought about committing suicide.
  • Latina high-schoolers are more likely to attempt suicide than their white peers (15.1% to 9.8%).
  • 32.6% of Latino students say they feel hopeless and sad, and participate less in things they enjoy as a result (vs. 27.2% of whites, 24.7% of blacks).

Latino children do not access mental health services as much as their peers.

  • Only 8% of Latinos say their child has ever used mental health care services (vs. 14% of whites).
  • Latino children had half of the outpatient mental health visits that their white peers had.
  • One study found 38.3% of school-aged Latino children and 37.2% of Latino preschoolers had a clinical need for mental health services; yet only 17.3% of school-aged Latino children and 10.8% of Latino preschoolers had received mental health services in the past year.
  • Despite the higher rates of suicide attempts among Latino youth, these children are less likely to be identified as suicidal, and less likely to receive crisis intervention services than others.

The migration experience causes stress, anxiety, and depression in Latino children.

  • Before migrating to the U.S., 38% of Latino children are separated from their parents for up to a year and 32% of Latino children are separated for longer than a year.
  • Latino families face economic hardships, difficult travel conditions, and stressful family separations during migration to the U.S.
  • After migrating to the U.S., Latinos are stressed by social status changes, language issues, discrimination, and immigration status questions.
  • For instance, compared to peers in their native land, Puerto Rican youth living in New York were lonelier and more depressed, anxious, exposed to more violence, and more likely to be discriminated against.

 

See the full report.

Useful Resource: Pay It Forward: Guidance for Mentoring Junior Scholars

In September 2017, the Forum for Youth Development and the William T. Grant Foundation released an updated edition of Pay It Forward: Guidance for Mentoring Junior Scholars. Written for both mentors and mentees, the guidance covers four main themes:

  • Building and maintaining mentoring relationships
    • Develop explicit agreements
    • Create a comprehensive mentoring plan
    • Protecting mentoring time
    • Consider mentoring in group settings
  • Mentoring across difference
    • Acknowledge context
    • Encourage and broker additional mentoring relationships
    • Consider how race and identity influence career decisions
    • Develop your own cultural competency
  • Supporting career development
    • Broker access
    • Create a career development plan
    • Develop and review a skills inventory
    • Prepare your mentee to assume the role of colleague
    • Collaborate with your mentee
    • Discuss work-life balance
    • Develop effective task prioritization and time management
  • Managing conflict within mentoring relationships
    • Anticipate potential conflicts
    • Revisit underlying structures and agreements
    • Identify solutions
    • Seek outside help and support

Download Pay It Forward to learn more.

Upcoming Events from Community Health Advocates

The Community Health Advocate (CHA) program provides motivated community members with training and resources to become active contributors and participants in activities addressing health needs in their communities. As a part of the program, CHA’s are encouraged to identify health concerns and develop their own strategies/programs for addressing these with support from the Center for Healthy Communities. The following CHA events were planned in connection with Breast Cancer Awareness Month in October. Click each link to download a flyer for the event.

Useful Resource: Health Moments Radio Broadcast

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers weekly radio episodes providing tips on how to prevent and control diseases “that are important to the community and NIDDK’s mission. A minute in length, the Healthy Moments Radio Broadcast is hosted by Dr. Giffin P. Rodgers, the Director of NIDDK. Recent episodes include:

See the full list of episodes.

Useful Resources: CCTS Grant Library

The UAB Center for Clinical and Translational Science provides a web portal of best practice in grant writing samples. The goal is “to share the wisdom of [investigators] award-winning experiences in communicating about research in support of both scientific excellence and discovery.”  Samples include:

Visit the CCTS Grant Library to view other useful tools.

USA Family Medicine Center Becomes Reach Out and Read Program Site

The following article is cross-posted from the Med School Watercooler: The Blog of the University of South Alabama College of Medicine.


The University of South Alabama Family Medicine Center recently became a Reach Out and Read program site, providing age-appropriate books to children at their well-child appointments.

Reach Out and Read (ROR) is a national non-profit organization that advocates for child literacy by working with primary care clinics.

Dr. Ashlen Aggen, a family medicine resident with USA Health, said she is excited for USA Family Medicine to participate in the program. “All of our providers went through training to learn about the importance of helping children build their home libraries and to learn how to select age-appropriate books for children based on their level of development,” she said. “Our first year of the program will be funded by ROR, and USA Family Medicine will take on the expense of continuing the program.”

According to Dr. Aggen, it is important to emphasize the importance of reading to children at a young age. “Reading teaches children to imagine, explore and look at the world in a different way,” she said. “Reading unlocks the door to higher education and becoming whatever you want to be in this world. As a primary care team, the greatest thing we can do is be advocates for our patients. A program that will help set them on a path to achieving their dreams allows us to be the advocates our pediatric patients deserve.”

The Family Medicine Center recently held a “Champions of Reading” themed kick-off event. “At the event, we encouraged children to decorate their own capes and masks to become their own reading superheroes before ‘defending the city’ and taking pictures at our photo booth,” Dr. Aggen said. “Our clinic staff dressed up as various superheroes and fictional characters.”

To learn more about Reach Out and Read, click here.

See the original article or what’s new from the Med School Watercooler.

USA Health Staff Dancing For Patients’ Health

The following article is cross-posted from the Med School Watercooler: The Blog of the University of South Alabama College of Medicine.


 

Dr. Lynn Batten, associate professor of pediatrics at the University of South Alabama College of Medicine and a pediatric cardiologist with USA Physicians Group, has a plan to help her pediatric patients get excited about fitness.

During the past several months, she and her staff, along with other medical professionals throughout USA Health, have appeared on the YouTube channel Dr. Fun’s Dance Party USA. The channel is a series of videos featuring USA staff dancing along to hit pop songs. The goal is for the videos to inspire young patients to get up and move with the videos.

“For the past few years, I’ve been interested in creating dance parties for my patients as a way to inspire them to have fun while they exercise,” Dr. Batten said.

After a young patient was hospitalized while waiting for a heart transplant in Birmingham, Ala., the mother of the child emailed Dr. Batten and said their days were very long, and that her daughter could use something to make her smile.

Dr. Batten found inspiration in YouTube. “My son Lucas has been making YouTube videos for quite some time, and so I came to him with the idea of creating a channel where my patients can smile and dance with me no matter where they are,” she said.

With her son’s filming and editing expertise, Dr. Batten was able to get her staff up and moving for their first video, a dance to the pop artist Bruno Mars’ song “24K Magic,” which was the patient’s favorite song.

“The patient passed away soon after the video went up,” Dr. Batten said. “However, her mother did let me know that she in fact saw it and it made her heart shine.”

Four videos later, Dr. Batten remains committed to getting her patients excited about getting up to move. Most recently, staff from the entire first floor of the Strada Patient Care Center came together to film a  choreographed video featuring the song “Shut Up and Dance” by the pop group Walk the Moon.

“We’re thrilled to have so many colleagues, including physicians, residents, nurses and medical students who are stepping up to make patients smile and exercise with us,” Dr. Batten said. “Plus,” she laughed, “You should see some of their incredible dance moves. Have you seen Dr. Maertens’ freestyling moves? They are great.”

Dr. Batten feels that by connecting with her patients through popular music and dance, maybe she can make them more excited about incorporating exercise in their lives. “There was a young patient who would not talk to me at all about walking or any form of exercise, but when I asked him what his favorite song was, he lit up and wanted to tell me all about his dance moves,” she said.

Dr. Batten plans to continue making the videos and hopes that other physicians will branch out to make their own videos for patients. “Other physicians’ patients do not know me and would not be interested in seeing me dance in their videos, but they would be very excited to see their doctor being silly and having a great time,” she said.

Dr. Batten takes song requests during every appointment with her young patients. She also includes the link for the YouTube channel in the patients’ paperwork when they check out. “Most of the time they find the link before they even get home,” she said. She said she remains committed to making her patients feel good about themselves, their fitness and their visit to the clinic.

To view Dr. Fun’s Dance Party USA videos, click here.

Visit the Med School Watercooler for more news from the USA College of Medicine.