Framing Complex Issues for Staff - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

I was recently asked an interesting question during an interview. The writer and I had been discussing value-based purchasing, bundled payments and a host of other issues around health reform. She observed that all of these topics were complex and then asked, “how can managers frame this issues for staff in a way that they can understand?” My thoughts that I shared were that we can’t make any assumptions about what staff know about health reform because generally it is less than you might think. It is important that the information be presented incrementally and simply. I suggested that I thought a great way to do it was through the use of story – a patient story that would be relevant to the clinical area where the staff work.

I gave the example of explaining bundled payments to OR nurses. If your hospital has entered one of the new agreements with CMS for Bundled Payment for Care Improvement, one of the models it might have selected was to accept xxx dollars in payment for a Total Hip Surgery for an entire episode of care that includes pre-op, intraoperative care, inpatient care, post- acute care if needed and all related services for up to 90 days. The OR manager could then present a case example to tell the story of what would happen if all went well with no complications and the risks to the organization if it did not. The story needs to link to the individual staff member’s role in ensuring quality throughout the length of stay. Story can be an excellent way to frame complex issues for staff.

The Importance of Story in Leadership

Nursing leadership is about influence and persuasion. At the heart of persuasion is storytelling. Nurse leaders use storytelling every day whether we consciously think about it or not. Story can be used to simulate experience as illustrated in the example above. Every staff member can grasp the impact of what could happen if there are breakdowns in care.

Story can trump facts because they humanize the problem. As a nurse leader, you can talk to staff about how many patient falls occur each month on a unit, and try to summon a sense of urgency for initiative such as patient rounding. You may find that it is much more powerful to take one patient situation where there was a bad outcome from a fall. You can tell the story of how the fall impacted that patient’s life. At the conclusion of the story present the information about the number of falls are occurring on the unit each month.

As leaders, it is important to give staff encouragement during difficult times when it seems that healthcare is all about business. Story can be excellent way to do this by reminding us that the patient is front and center and our work remains important as do the relationships we have with staff and patients.

Key Elements of the Effective Use of Stories

Douglas Ready, in his article on leadership storytelling, offers some excellent guidance about the components of effective stories.

Effective stories are context specific and fit the topic that is being discussed.
Effective stories consider the position of the staff member and their career stage.
Effective stories are told by respected role models.
Effective stories have drama and draw the listener’s attention.
Effective stories have high learning value and are a call to change behavior.

During turbulent times in health-care like today with the move to value-based care, leaders can tell stories about historical challenges such as the turmoil that occurred with the introduction of the DRGs in the mid-1990s. It too was a difficult time but the reform occurred and everyone adjusted to the change. Through the effective use of story, nurse leaders can both build strong cultures and connect with staff at personal level.

Read to Lead

Simmons, A. (2001). The Story Factor: Inspiration, Influence and Persuasion through the Art of Story Telling. New York: Perseus Publishing.