Stories: the original data for improvement

Update from Quality Improvement

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Shaun Maher

This guest blog post is by Shaun Maher, principal educator, Quality Improvement Team, NHS Education for Scotland. Shaun will be speaking at our quality improvement event in January 2018.

We ignore or relegate the importance of stories in improvement work at our peril. The qualitative data in stories provides many, many improvement opportunities, as well as pitfalls to be avoided and successes to celebrate. When we get serious about stories we can supercharge our improvement work!

Stories are the original data source that human beings have used to relay their experiences and learning about the world around them. Edwards Deming, perhaps the most eminent forebear of the quality improvement movement, was careful to state that we need to be aware of non-numeric intelligence in our efforts to understand and improve the systems we work in. A few of his oft quoted aphorisms affirm this view that qualitative system data is absolutely critical to quality improvement efforts.

“It is wrong to suppose that if you can’t measure it, you can’t manage it – a costly myth.”
W.E. Deming, The New Economics.


When we combine the careful and systematic use of stories with quantitative data, we have the potential to both accelerate and guide our improvement work to optimum effect.

First and foremost, stories connect us to other human beings. They remind us that we are all people and we have a collective responsibility to one another. Important as quantitative data is, data points on a run chart cannot do this with the same power.

The simple invitation offered by Care Opinion to “tell your story” and talk about what really matters to you, is a powerful catalyst. This invitation opens up a great vista of improvement opportunities and learning for those of us working in the health and social care system. While the traditional survey approaches are not without their use, when it comes to understanding people’s experiences there is no comparison with the breadth and depth offered up by stories. Stories shine a light into the deepest recesses of the system and provide a rich source of improvement opportunities.

Stories have the power to connect our heart to our head and then to our hands in the work of improvement

Finally, stories on Care Opinion, and from other sources, can remind us of the deeper meaning and purpose of our work. When we listen in this way we mostly hear about the amazing stuff that is going well - the things people do that make you say “wow!”. This is the stuff that makes our heart sing and our work deeply satisfying. When we see the meaningful impact on people’s lives in some of the most powerful stories, perhaps we might even feel joyful?

Sometimes when we get things wrong the stories are negative and the impact is distressing and that can be hard to bear, but we need to hear it just the same. In both the good and the bad there are improvement opportunities.

Stories remind us of our shared humanity and have the power to connect our heart to our head and then to our hands in the work of improvement. This is where the real power of stories lies: in supporting our efforts to develop a culture that is continually listening and continually improving. As a certain individual once said: “The plural of story isn’t data, the plural of story is culture”.

As we reflect on these things, it becomes clear that a fundamental characteristic of the culture that comes from listening to stories is, among many other things, a culture that is continually learning and improving. And perhaps most importantly, it’s a culture that keeps us grounded and connected to one another.

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