Role of storytelling

Narrator: The ABIM Foundation paired frontline physicians and leading experts to discuss building trust in healthcare. Anton Zuiker, a communications director and Dana Safran, a data scientist, focused on efforts to build trust through storytelling.

Dana Safran: Hi, Anton. I’m Dana Safran. It’s great to get the chance to talk to you this afternoon. Just by way of background, I’m Head of Measurement at Haven, which is a fairly newly formed joint venture of Amazon, Berkshire Hathaway and JPMorgan Chase. And my background is in measurement science. I’ve been doing that work for many years, first in academia, then at Blue Cross Massachusetts and now most recently at Haven. And how about you?

Anton Zuiker: Dana, thanks. It’s great to see you. Anton Zuiker. I am the communications director for the Duke University Department of Medicine. I’m a journalist, medical journalist by training. And I’m very interested in stories. I’m actually coming to the end of my decade of narrative in which I’m trying to become a better storyteller and listener. And so it’s been great to meet you and tell you about some of our work.

Dana Safran: So we’re here today to talk about trust and I know you have been doing some very interesting work at Duke on trust and wonder if you could just tell me a little bit about what you’re doing, having clinicians and patients talk about trust and then sharing that out. Tell me a little bit about that work.

Anton Zuiker: Sure. I mentioned I’m a journalist, a communicator. That means I have the luxury in some ways of time, which is an interesting commodity in a hospital. I sit at a desk, at a computer. I also have the opportunity to wander the hallways and talk to people and listen to stories. I have long wanted to find a way to give patients and their families a way to record their life histories, their oral histories to pass on their knowledge. I see patients sitting in the hospital often for hours at a time, sometimes for days and weeks at a time. So we started with this idea of how could we allow our patients and their family members and our visitors an opportunity to tell their loved ones about each other, by extension to tell us the clinicians, the providers that educators at Duke University. This is informed by many other examples. StoryCorps is the most popular. People love the StoryCorps, stories that they hear on a national public radio on Fridays. Of course, oral history and talking story, we called it in Hawaii or story on in Vanuatu where I was a peace corps volunteer is a common thing of sitting what we’re doing right now, talking to each other and seeing each other and feeling that the emotion or seeing what brings joy to someone.

So that’s the basis of this. Realizing that I have the time of how could I and my colleagues design a program to give people a chance to talk. Now, I’ve done some reading including some of your own research about time for healthcare providers is a very different thing. There’s not enough of it, as they’re working in electronic medical records or they’re rushing from one patient to another. And so we also tried to take this concept of a listening booth, physical space, kind of like in this room that we’re in, to set it up with some nice microphones and to invite people to take some time to have a conversation and to listen. So interestingly, we didn’t approach it with trust in mind. Trust is a byproduct of listening and I’m wondering what your research, what your work tells us about that. Your paper talks about there is optimism.

Dana Safran: Yeah. So that’s an interesting point. And you’re so right that trust can very much be a byproduct of listening or a mistrust, the absence of it. So I find what you’re doing so interesting because the opportunity for human beings to really hear each other and for a person to feel known, I think, is part of what helps to generate trust. In the research that I was involved with, not just before my current role at Haven, but before my role that proceeded that at Blue Cross Massachusetts, when I was prior to that in academia, and really studying trust and trying to measure patient trust and understand how it’s formed and what outcomes it helps to generate, both as we called it business outcomes, like loyalty to a practice or malpractice risk, reduction of malpractices or health outcomes, adherence to clinical advice and improved health and wellbeing.

And what we learned was that there was a tremendous interconnection with patients feeling known, what we called in my work, whole person care, and tried to measure that sense of whole person care, communication and trust. So all those are relational aspects of care or just of human interactions in general can really contribute to trust. And we definitely saw that trust and a sense of being known a whole person orientation to care contributed to all the outcomes that each of us wants out of the system. Clinicians want it, patients want it, payers want it. Employers who are buying insurance on behalf of their employees want it. And that is, you know, better health, better adherence to clinical advice, a good care experience, all of those things.

Anton Zuiker: Can you tell me more about that about being known? Our approach is to set up a conversation among two people and to record it. And if they consent too, then share that recording is a podcast that anyone can listen to and learn and be inspired by. And what we’ve seen is that people at Duke who have listened to that then have some, larger or more informed idea of who that those people were. Is that what you mean by being known?

Dana Safran: It is. And let me come back to that and try to answer it for you but let me understand a little better. Cause what you’re doing I think sounds so important. And I want to understand it and have our listeners understand it. So tell me a little bit more about who’s listening and who’s speaking. So first, is it patients and families alone or also clinicians and others who work in at Duke who sit in the listening booth and share their stories. And then tell me a little bit more about how those stories get heard.

Anton Zuiker: Our listening booth project was a pilot project and we decided to focus on our workforce. Wellbeing, burnout, resiliency, very important issues at Duke University Medical Center, and others, I think. We focused on our workforce. We invited them to come in in pairs or threes or fours. People who knew each other, had some connection in some way, to come into our booth, our space, and to have a conversation of their choice, of their questions. And so that was the primary reason, to give someone a space and time to have that conversation by recording it and then creating a podcast episode that’s available online or on a phone to anyone in the world. Ours is publicly available. It allows other people to hear that conversation. Those conversations show vulnerability, show gratitude, show how people find support from their colleagues at work and how they find pain in losing loved ones.

So our pilot project was satisfying to us all, to the people who had those conversations because it feels good to talk and to be listened to. It was satisfying for people who listen to the podcast who knew Dr Tony Galanos but didn’t maybe know that he had lost his adult son recently. And maybe that helped them understand why he was grieving at work. What we found from Twitter and social media is that people who had no connection to Duke or to these doctors or patients who told their stories also felt grateful for them having told their story and shared it through a podcast.

Dana Safran: That’s a really remarkable thing that you’ve done because, you know, I think part of what we wrote about in terms of patients trust in organizations and also organizations trust in patients and how that needs to be rebuilt. In the end, it comes down to just the very essence of what you’re trying to do, which is have individuals really understand that there’s a shared human experience. And so the idea that clinicians have gone first and told their stories is so interesting to me because I think, you know, as much as, you know, consumerism is trying to take hold in healthcare, there is still a great respect and admiration and kind of emotional distance often between patients and the clinicians taking care of them, and the opportunity for patients to perhaps hear the story of clinicians and understand them as human beings, I think, could go a long way to building trust or rebuilding trust to the extent that there’s been some loss of trust between patients in the organizations and people that take care of them. I’m curious if you think so.

Anton Zuiker: I do. I work as a communications director in the Department of Medicine and it has 750 faculty members. And so I get to learn about them and to know them and to ask them questions about not just their research careers or their clinical work, but also their personal lives. And I think in little by little trying to say in many ways, it’s okay to share your story of who you are because when I’m a patient and I walk in, I want to find a connection. You talked about finding the interconnections in research and in relationships. Interestingly, when I looked at your professional bio, I saw that you had worked for Blue Cross Blue Shield and I saw a connection cause my first job out of college was for Blue Cross Blue Shield of Hawaii. And I then eventually worked for Measure Evaluation, which is a global health monitoring and evaluation program. And so even though I’m a journalist, I go by stories and words. I’m fascinated by the empirical, the numbers, the research that you bring to this. And I guess that’s my selfish question for this interview is how can I use that to make my project better? How can we measure, try to measure trust better, measure listening better, in order to build trust, not just a [indiscernible] [12:01]?

Dana Safran: Well, I think that the way that you measure trust is by asking people questions. And you know, when I was in the business of trying to measure patient trust in the physicians taking care of them, I conceived it as having three main ingredients. That a patient had to believe in the clinician’s knowledge and expertise. They had to believe in the clinician’s ability to use that on their behalf. And they had to believe in the clinician’s desire to use it on their behalf as opposed to use it on behalf of their organization or on behalf of themselves. So a kind of fiduciary trust. And so we designed questions to try to tap into whether individuals had each of those points of view about the people taking care of them. So I don’t know how well you feel that that framework might map onto the work that you’re doing, but perhaps it does. And if it does, then maybe you could be asking individuals those questions about their relationships with each other.

Anton Zuiker: Yes, thank you. I can, I can apply that.

Dana Safran: Yeah. Oh, great. Great. Well, one of the other things that, you know, your comments spark in me is that you talked about my work in measurement and you know, there’s a really important aspect of trust and measurement too. Because I think that, you know, when I began the work that I was doing in measurement, it was largely for academic uses. You know, quality measurement was not something that was applied in anything really other than academic studies. And now of course, they’re very high stakes uses of quality measures, and a tremendous amount of mistrust sometimes of the data, sometimes of the measures, sometimes of those who are using the measures in ways that clinicians or organizations are afraid of or suspicious of or just plain feel is wrong.

And so in the work that I’ve done, you know, going on 30 years now, I really recognized that we not only want to measure trust in the relationships, but we want to have the measures themselves and the ways that we use those measures be trusted to. And that’s a critical part of what I think has to continue to happen as we make healthcare better, as we strive to, you know, produce better outcomes for patients, better experience, lower costs. We have to use measures. But we have to do that in ways that the stakeholders feel are fair and accurate and using data and information in ways that advance the shared goals and not in ways that are punitive or unfair.

Anton Zuiker: This has been fascinating. I’m wondering if there’s a way to have a voices of Duke health conversation about measurement of trust that would be compelling and informative and inspiring. You’ve given me some things to think about and to take back to our project for our next phase.

Dana Safran: Oh, that’s great. That’s exciting. I have a question too. Do you expect that in the next phase—it sounded when we began that part of your vision is that patients will tell their stories and maybe caregivers will tell their stories. Is it part of your vision that the actual clinicians taking care of those patients hear those stories so as to know the patients better without the patients telling them directly? Or is it more, you know, just broadly that you want human beings in the patient role and in the clinician role to hear stories of others and know them?

Anton Zuiker: That’s a really good question. I’m informed in part by a project that’s happened across a number of VA medical centers in which they actually do record an hour long oral history of a patient and put that into the medical record with the idea that the clinician does listen in whole or in part to that oral history before then walking into the exam room to have that that professional encounter. So yes, I think that’s part of it. Part of it would be to have a bank, a voice bank, in some way, that providers would listen and know more about their patients. And conversely, that patients would be able to know a little bit more about the nurse or the doctor or the PA that they’re about to see when they go for their appointment.

Dana Safran: That’s a wonderful idea because it comes back full cycle to where we started this conversation. And the fact of feeling known is so important to human beings. And knowing another, I think can’t help but draw forth empathy because you start to understand that shared human experience. So I’m really excited about what you’re doing and the opportunity that it could go a long way to creating a foundation of trust, both clinicians and patients and patients in the people taking care of them.

Anton Zuiker: Thank you. Well, this has been a really good conversation. I’ve enjoyed it. I’ve inspired to it, to take some of the research and make our project better and to tell the story of measuring of trust of the work you’re doing.

Dana Safran: Thank you so much. Thanks for sharing your work.

Anton Zuiker: Sure.

Narrator: Visit buildingtrust.org to learn more.