by Neil F. Horton, MS, RN
Consulting Director
12/15/20

“After nourishment, shelter and companionship, stories are the thing we need most in the world.” — Sir Phillip Pullman

You can picture the scene. Sandy, who is a nurse, had been asked to present to the leadership team as a part of an effort to implement a Value Analysis program for the hospital that would be responsible for decision making for millions of dollars of spend annually. She knew the hospital had seen shrinking profit margins, disappointing outcomes and a culture that had trouble saying “no.”

Sandy began her presentation by saying, “The two most important drivers of a successful Value Analysis program are executive support and physician alignment. Today, we have neither.” All the eyes in the room looked up and were fixed on her.

With a slide on the screen that said “Status Quo,” Sandy continued, “We have a half dozen different groups making decisions on clinical products and services and no two share a process or criteria. There is no governance in place to support them. They have no goals and do not meaningfully use data or evidence. And we don’t measure the outcome of their decisions.”

She shared real examples of product decisions that had been made and stories of the downstream impacts on clinicians across the organization.

Then Sandy presented a recommendation for a new structure and process that would establish a clinically approved, streamlined product formulary where decisions were based on value and variation reduction.

Sandy hit a home run. She knew the importance of leveraging storytelling and did just that. Sandy knew that stories help us relate to one another, interpret our environment and make sense of the world.

Wired for stories

Neuroscientists tell us that our brains are wired for stories—that they strengthen connections between brain hemispheres and trigger the release of neurotransmitters involved in learning, emotions and behavior. Biologists have discovered that stories help us remember new information and integrate it into our experience. Anthropologists teach that we have been using stories to pass down wisdom for millennia. The Historian Yuval Harari believes that the secret sauce of the ascent of Homo Sapiens over the past 70,000 years is our ability to cooperate flexibly in large numbers—and this can occur only when groups believe the same stories.

Five elements of a story

On the day of her presentation, Sandy knew she that needed to capture the attention of hospital leadership, engage their interest and persuade them to join her cause—all within about ten minutes. She knew she had to leverage the five elements of a story in her presentation.

Characters—These are the individuals in your story. They may be patients, nurses, hospital leadership, etc. Understand who they are, what matters to them, what currencies they value and their allies and adversaries. Empathy requires understanding.

Sandy’s presentation showed an understanding of the primary characters in her story: the Value Analysis staff who wanted to be fair and efficient and be good stewards of quality and revenue; clinicians and physicians who had their own purchasing preferences, but didn’t understand the process or have the tools to understand the implication of those decisions beyond their practice; and hospital leadership who wanted to safeguard quality and revenue, but were not formally involved in the process.

Setting—This is where the action takes place. Consider the landscape, culture, mood, and even challenges and obstacles. Whether it is a hospital system, a specific department or a changing marketplace, these details matter if your story is to resonate with your audience. For Sandy, understanding the landscape was key to implementing change.

Plot—This is the actual story you are telling. It has a beginning, a middle and an end. It may have started with a revenue shortfall, a quality issue or a global pandemic. Sandy’s story began with the impacts of the existing Value Analysis program and ended with recommendations that would transform it into a strategic hospital asset.

Conflict—You likely will have no problem identifying the conflict in your story. 2020 has created a variety of them as hospitals, health systems and suppliers strive to deliver quality and preserve margins. Sandy used conflict in her presentation. She shared stakeholder dissatisfaction, bloated supply costs, fragmented market share and increased risk related to unmanaged variation.

Resolution—Your story may not have a tidy resolution. Many presentations in health care are not about problems that are easily resolved. They often are about complex challenges that require consistent and disciplined effort over time. The resolution of your story may be the action you are asking your audience to take. Sandy’s resolution was a recommendation for a new structure and process that would establish a clinically approved, streamlined product formulary where decisions were based on value and variation reduction.

Your story

Sandy’s presentation was successful that day. In fact, her project became a standing agenda item for the next five executive committee meetings. And these same executives became the steering committee for the Value Analysis program, where they greenlighted her recommended changes in policy and process that began paying dividends the very next quarter. Her ability to tell a compelling story that day captured the attention of the leadership team, demonstrated to team that there was an urgent need at hand and gained their support for change.

Next time you’re asked to give a presentation, I hope you’ll think about the story I shared about Sandy and leverage storytelling in your own presentation.

About the author: A Registered Nurse with more than 30 years of experience, Neil Horton brings a clinician’s point of view to the business of Value Analysis. In 2009, after a variety of clinical roles from psychiatry to the operating room, Neil discovered Value Analysis at a large academic medical center and began a new journey. Five years later, Neil became a regional director for the University HealthSystem Consortium (UHC), now Vizient, Inc., where he has assessed, designed and optimized programs from coast to coast. Neil earned his Bachelor of Science degree from East Carolina University in Greenville, North Carolina, and his Master of Science degree in Nursing from Virginia Commonwealth University in Richmond, Virginia. He completed Lean Six Sigma Training from DePaul University and Value Analysis Training at UHC in Oak Brook, Illinois.