Narrative Capture as a KM tool

Thursday, November 8th, 2007
Terry Miller is presenting on organizational change in healthcare and how narrative capture is being used as a KM tool. (Terry's an Organizational Development Consultant, British Columbia Interior Health Agency.)

Terry shared about a hospital during crisis, low morale, and intense public pressure, and how, as an OD consultant, he had to create a sensemaking project in the aftermath.

Presented "A model for sensemaking" (Snowden) from
Complex Complicated
Chaotic Simple

Narrative and workplace stories define an organization's culture. The challenge is that we need to be able to see multiple perspectives.  Terry used narrative capture as a tool for to make sense of how all of the people involved (healthcare providers, management, patients, and families) experience their system and how solutions were identified to encourage change.

Proposed to collect stories from people. Within 6 hours, the network produced 20 people, trusted by the "system" who were ready to share stories.

Formed a front line design team to capture narrative
- Staff designed, staff implemented

Used mass narrative capture to diagnose the system

Created conditions for capturing stories
       Created prompting questions (listen to voice recorder for examples)

Took a look at a sample story sheet (Eric talking here)

1. Collect narrative
2. Asked some questions:
The title I would give this story is ...  ___________

From whose perspective was this story told?
  • A patient
  • a patient's relative or friend
  • a care provider
  • a physician
  • hospital support staff
  • hospital management
  • volunteer

How experienced are the key care providers in this story?

       not at all        somewhat        very

How common is the situation or event described?

       not at all        somewhat        very

What would you say is the emotional tone of the story?

       strongly negative        negative        neutral        positive        strongly positive

Transcribed all narratives, depersonalized them (removed all identifying references) and entered them into a system for analysis.

Next, asked the story teller to classify the story they just told...

Think about the story you just told. For each of the following 6 "scales", color in the ONE bubble that you think best signifies what was going on in your story..

If you think a scale does not apply to your story, leave it blank

Compassion & respect shown towards people in this story is...

       nonexistent _ _ _ _ _ _ _ _ Excessive, smothering

Decision making & teamwork reflected in this story is ...

       Rudderless, confused, group paralysis _ _ _ _ _ _ _ _ Total Dictatorship, working in silos, do it my way.

People's personal accountability in this story is...
       Total abdication, that's not my job _ _ _ _ _ _ _ _ Taking on too much. Spreading one's self too thin

The concern for patient safety & quality health care reflected in this story is...
Absent altogether _ _ _ _ _ _ _ _ Over the top, paranoia, gross over treatment.

Next, they created archetypes, had an illustrator create each, to be shared.

Finally, they presented the archetypes and narratives to teams to review and determine actions.


Shifts in type of senior leadership
- using contextual decision making framework
- getting the right people at the table
Staff are becoming engaged
- Delivering leadership and communication workshops
- Facilitating tricky decisions

- Don't fight multiple approaches
- Dedicated resources required for change
- Plan beyond the scope of the project
- Brace for setbacks
- Don't forget the "middles"

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