We hope that the previous chapters have given you insight into how the use of clinical narratives can assist clinicians in the development of a reflective practice, make their practice more visible, identify barriers to excellent practice, and showcase best practice. The narrative has been embedded into the culture of clinical practice at our organization, Massachusetts General Hospital (MGH), for many years. How that happened is a narrative itself, because it is the story of how an idea became reality, and it is a story we hope will be replicated in other institutions.
In this chapter, you read how to create an environment that is open to narratives and then review the strategies we used—and continue to use—at MGH to embed narratives into the culture of clinical practice. This chapter also provides direction on coaching, which is necessary not only for embedding narratives into the culture, but also for ensuring that narratives serve their intended purpose.
EMBEDDING NARRATIVES INTO A CULTURE OF CLINICAL PRACTICE
To achieve a narrative culture, clinicians had to understand what narratives were and how they would be used; leaders had to become comfortable “unbundling” the narrative and in creating a narrative culture on their units; and narratives had to become visible within the organization. The strategies used at MGH to embed narratives into the culture are presented here.
In order for narratives to become embedded in the culture, it was important for clinicians and leadership to understand what narratives were—and, just as importantly, what they were not—and how they could be used to understand the knowledge embedded in clinical practice. Educational sessions were held centrally, at the unit level as well as on all shifts, including weekends. The sessions allowed for clinicians to ask questions, tell verbal narratives, and receive feedback. From these sessions, clinicians were able to begin to think of narratives as a way to describe their everyday practice rather than the earlier view of some that the narratives were highly edited dramatic stories. Clinicians were also given the opportunity for one-on-one consultation with experts who would work with them to help write their narratives.
Critical to the success of any initiative is the support of unit-based leadership, and this was true of creating a narrative culture. Although Nursing was familiar with clinical narratives because of its application by Dr. Patricia Benner (1984), members of the other disciplines—Occupational Therapy, Physical Therapy, Respiratory Therapy, Social Work, and Speech and Language Pathology—were not. Sessions were held with leadership to review narratives and practice unbundling them. It was important that leaders developed a level of comfort so that they could engage with clinicians to help them reflect on their practice and therefore develop their practice.