Thor Ringler, national program manager, My Life My Story
Humans are hardwired for narrative. We think in story, talk in story and connect with others through the power of story. Storytelling is at the heart of a novel program that’s expanding across VA medical facilities across the country.
The “My Life, My Story” program uses patient narratives to build a stronger connection and improve care between healthcare providers and their veteran patients. Veterans who choose to participate are interviewed ahead of their appointment by an interviewer who writes a 1,000 word story about the patient and submits it into the person's medical record.
I recently spoke to Thor Ringler, the Department of Veterans Affairs national program manager for My Life, My Story. Ringler's background is uniquely suited for this project. Ringler earned a masters degree in fine arts and poetry before he became a marriage and family therapist. Ringler piloted the narrative-based program at the VA hospital where he works in Madison, Wisconsin.
“If primary care providers know their patients better—what matters to the patient and what their values are—they are better able to approach conversations about care and health decisions,” Ringler says.
More than 4,000 narratives have been written by VA hospital staff and volunteers since the program began in 2013. Ringler shared some samples with me. One story was about Joe, a veteran who joined the marines and fought in Vietnam in 1967.
We fought in Con Thien, Phu Bai, and even in the DMZ. We lost a lot of people. At one point our company was down from 500 guys to 100. I did get a hearing concussion from an explosion and was bleeding out of both ears. It was rough at times but I just kept going.
Joe’s thirteen month tour in Vietnam haunts him to this day.
I still get flashbacks at night, maybe once a month…It’s definitely better now than in the past. I’m able to wake up and calm myself down…I don’t care to be unhappy, I just keep going. I’d rather be laughing than frowning.
Joe visited a VA hospital because his sodium levels were low, which may have contributed to his recent stroke. I asked Ringler to explain how writing and sharing these stories improves patient care. According to Ringler, Joe’s story invites primary care providers to ask better questions or change a treatment plan. For example, reading Joe’s story might prompt a provider to say:
"It seems like you’ve come up with some ways of calming down when you have flashbacks. I was wondering if you’d be interested in learning some other ways you might be able to handle flashbacks or perhaps even reduce them. We have a lot of treatments available through out mental health service that weren’t around when you came home from Vietnam."
According to Ringler, “Stories let us walk in the shoes of our patients and that changes how we think and feel about them.”
The story-based program is catching attention, and catching on. In a 2014 survey of healthcare providers at the VA in Madison, 32% strongly agreed that reading patient stories was a “good use of my clinical time.” Three years later, the number of healthcare providers who “strongly agree” with the program’s benefits had jumped to 67%. In addition, a majority of the healthcare providers surveyed say that reading the stories helps them provide better treatment and care.
The results of the program are so promising, the VA has approved an expansion of the program from several dozen medical centers who use it today to 1,500 VA medical facilities who choose to participate.
Effective healthcare leaders act as chief storytellers
Improving communication at all levels of healthcare is a significant area of focus at the VA as well as private hospitals around the country. For example, hospitals in America are rated on patient satisfaction (HCAHPS score). The scores are publicly reported. Government reimbursements to hospitals are also tied to the results. While conducting the research for one of my books, I learned that 70% of negative scores are directly related to a breakdown in communication.
This is a serious problem. Poor communication leads to decreased revenue for healthcare systems and more health problems for patients. Good communication and strong storytelling is directly correlated to better health outcomes and happier, healthy patients.
Dr. David Feinberg, former CEO of UCLA medical center and the current vice president of Google Health, once told me that storytelling is his most important tool as a healthcare leader. “I think of myself as the chief storytelling officer,” he said.
When Feinberg was running hospitals, he changed the culture beginning with town halls, staff meetings , and monthly executive meetings. Instead of starting his meeting with PowerPoint slides, tables, charts and revenue graphs, Feinberg invited patients to share stories that reflected on the positive or negative experiences of their care.
At the VA, Ringler says the My Life, My Story program has also prompted leaders to begin their staff meetings by sharing stories of patients and their experiences.
"For veterans, the experience of being interviewed and the knowledge that their story will be shared with providers is an important recognition that they matter and have a voice in their health care," says Ringler.
"In a world of high-technology health care, where time is the only thing in short supply, My Life, My Story leverages the old-world technology of storytelling to bring providers and patients closer together."
