Storytelling at board meetings: A case study of co-developing recommendations

In healthcare, stories shared by patients often provide details and insights into experiences of illness and care. Stories are a way to educate healthcare providers and others to improve care and systems to become more patient and family centred and to better meet patients’ needs and priorities. Telling stories may bring benefits to both storytellers and audience members but also presents risks of harm. A reflective storytelling practice aims to honor stories and storytellers by ensuring there is time to prepare, reflect, learn, ask questions, and engage in dialogue with the storyteller to explore what went well and where there are learning and improvement opportunities. Healthcare Excellence Canada (HEC) is a pan-Canadian health organization focused on improving the quality and safety of care in Canada. HEC commits to engage patients, caregivers, and communities and aims to develop practices and structures to enable engagement activities. At the request of the HEC Board, the Patient Engagement and Partnerships team co-developed recommendations on the process for how best to meaningfully share stories at Board meetings, including stories from those leading, providing, and receiving care. This Case Study outlines the process HEC used to co-develop storytelling recommendations, focusing on a trauma-informed approach to create safe spaces for preparing, learning from and reflecting on stories, to clearly articulate their purpose, and to ensure the locus of control for storytelling rests with the storytellers. This Case Study shares these recommendations and invites other organizations to use these recommendations and/or adapt them within their own context. Experience Framework This article is associated with the Infrastructure & Governance lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Revisiting QRS detection methodologies for portable, wearable, battery-operated, and wireless ECG systems

Cardiovascular diseases are the number one cause of death worldwide. Currently, portable battery-operated systems such as mobile phones with wireless ECG sensors have the potential to be used in continuous cardiac function assessment that can be easily integrated into daily life. These portable point-of-care diagnostic systems can therefore help unveil and treat cardiovascular diseases. The basis for ECG analysis is a robust detection of the prominent QRS complex, as well as other ECG signal characteristics. However, it is not clear from the literature which ECG analysis algorithms are suited for an implementation on a mobile device. We investigate current QRS detection algorithms based on three assessment criteria: 1) robustness to noise, 2) parameter choice, and 3) numerical efficiency, in order to target a universal fast-robust detector. Furthermore, existing QRS detection algorithms may provide an acceptable solution only on small segments of ECG signals, within a certain amplitude range, or amid particular types of arrhythmia and/or noise. These issues are discussed in the context of a comparison with the most conventional algorithms, followed by future recommendations for developing reliable QRS detection schemes suitable for implementation on battery-operated mobile devices.Mohamed Elgendi, Björn Eskofier, Socrates Dokos, Derek Abbot

"Letting stories breathe": Using Patient Stories for Organizational Learning and Improvement

There has been a recent upsurge in the use of patient stories to better understand patients’ experiences of illness and of care, and to inspire leaders and staff for quality and safety within healthcare. However, to fully realize the potential of patient stories, a more nuanced understanding is needed of how they are used, who tells them, for what purpose, and in what context. Using a constructivist case study methodology with qualitative methods, this study examined four healthcare organizations that are known leaders in the systematic and deliberate use of patient stories, exploring the storytellers, the types of stories told and their purposes. It also examined the contexts that enable the use of stories and the impact they have had on organizational learning and quality improvement. An interpretivist approach to analysis highlighted the specific types of stories told by patients and of patients, and how they were co-constructed from stories of chaos into quest stories for learning, “authorized stories” to be shared for particular purposes. The storytellers who emerged were those who had extended their involvement as patient advisors/members, determined by leaders to be the “right fit” and at the “right time” to share their stories. Strong leaders modeled and supported the philosophical orientation toward patient and family-centred care that patient stories helped to develop and sustain. Leaders also created the organizational structures and processes required to gather and share stories, and to link them purposefully with learning and improvement. The act of storytelling is not a simple one and tensions surfaced relating to what stories are told, how, by whom, and for what purposes. In many ways, the organizations demonstrated how they were thinking with stories and how learning occurred at individual, team, and organizational levels. However, leaders and organizations continued to retain control of which patient stories were shared, in what forum, and for what purposes. Despite their best intentions and explicit demonstrations to hear the patient voice, a more reflective practice is required to better appreciate the power and privilege that exists within organizations, making this an area to explore further in theory development for organizational learning.Ph.D

Cultural values, beliefs, and attitudes of immigrant Chinese women towards physical activity and exercise, a qualitative inquiry

grantor: University of TorontoThis qualitative study has explored cultural values, beliefs, and attitudes of immigrant Chinese women (aged 50-70 years) towards physical activity and exercise. Symbolic interactionism within a cultural model provided a theoretical framework in which to understand the findings of this study. Meanings of physical activity and exercise were subsumed under the broader rubric of health, which may be viewed through a Chinese cultural lens related to values of family and longevity. These women see health as increasingly important as they age. At this life stage, they are receptive to messages about health, particularly in regards to diet and exercise, which they have identified to be elements that they can control and take responsibility for. Exploring underlying cultural meanings may help to direct appropriate interventions and strategies by health care professionals to promote and enhance health and well-being in diverse, multicultural populations in Canada.M.Sc

Patient and family engagement in infection prevention in the context of the COVID-19 pandemic: defining a consensus framework using the Q methodology – NOSO-COVID study protocol

Introduction Healthcare-associated infections are an important patient safety concern, especially in the context of the COVID-19 pandemic. Infection prevention and control implemented in healthcare settings are largely focused on the practices of healthcare professionals. Patient and family engagement is also recognised as an important patient safety strategy. The extent to which patients and families can be engaged, their specific roles and the strategies that support their engagement in infection prevention remain unclear. The overarching objective of the proposed study is to explore how patients and families can effectively be engaged in infection prevention by developing a consensus framework with key stakeholders.Design and methods The proposed study is based on a cross-sectional exploratory study at one of the largest university hospitals in North America (Montreal, Canada). The targeted population is all healthcare professionals, managers and other non-clinical staff members who work on clinical units, and the in-patients and their families. The study is based on Q methodology that takes advantage of both quantitative and qualitative methods to identify the consensus among the various stakeholders. This exploratory Q research approach will provide a structured way to elicit the stakeholders’ perspectives on patient and family engagement in infection prevention.Ethics and dissemination The research ethics board approved this study. The research team plans to disseminate the findings through different channels of communication targeting healthcare professionals, managers in healthcare settings, and patients and family caregivers. The findings will also be disseminated through peer-reviewed journals in healthcare management and in quality and safety improvement