Understanding narratives in health care
Understanding narratives in health care

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Understanding narratives in health care

4 Examining narratives

You have now practised the interpretation of others’ accounts and searching for narratives that might be expressed there. Did you find that difficult? Did colleagues interpret things differently? Whilst at first the examination of accounts and the identification of narratives will perhaps seem problematic, it is likely that you will become better at this. Talking about yours and others’ narratives helps you to articulate ideas in a more inquisitive way. To examine where narratives are more or less clear and constant and where they collide as beliefs and expectations differ.

The process of narrative identification and analysis is progressive and demanding, so it is important to discuss your discoveries and compare your worries. The amassing of accounts, the ways in which you and others describe things will become interesting in itself. It can seem a revelation that so many agendas or needs were in play. That which previously seemed frustrating in practice may now seem more tolerable. Your comprehension of the complexity of healthcare, and of change will have grown.

Perhaps the narratives help clarify what is critical within your chosen skill and what remains underdeveloped. Perhaps these narratives indicate what appears to advance or inhibit the service improvement project. Perhaps they help you to clarify the work underway within your system improvement? Figuratively it might look rather like this:

Described image
Figure 2: Gathering accounts, identifying and then examining narratives

There is no formula for the correct number of accounts (what people said) to collect nor the right number of narratives (what people meant) to identify. Instead, the numbers are a function of how hard you concentrate on your field work, how adept you become at reflection and what seems justifiable in terms of narratives that you can discuss clearly. Too many and you may struggle to make sense of what you are discovering.

In practice, some of these accounts may be variants of the same thing. The accounts may come from different people and yet still contribute to your stock of narratives. Whilst everyone is individual, it is nonetheless true that people have things in common. For example, if you are attending to patient concerns, there may be a collective need amongst patients to secure enough information to feel in control of recovery/rehabilitation when they go home. This is a collective narrative (regaining control).

A similar approach should be adopted towards narratives which underpin verbal accounts. If you have too many recorded, then it may be difficult to discuss them later. Some narratives may be too vague for you to confidently analyse. Others might coalesce into one after further analysis. Some draft narratives simply don’t ‘make the cut’. They are not clear and coherent enough to feature in the later stages of your work. Of course, if there seems a deficit of narratives, then you should discuss your accounts further. Are there narratives here that you agree could be carefully speculated about, which could be discussed?

You might decide that you have arrived at three or four narratives that seem clear, significant and worthy of examination. In what ways are they significant for the project you have in hand?

Table 1 indicates some ways in which narratives affect the project you are conducting:

Table 1 Some possible relationships between narratives and improvement


The narrative clarifies your chosen improvement, it indicates what is required, what is working or problematic, what represents a way forward.


Attending to narratives, your own and others’, will often help to clarify your project: what is involved in enhancing a skill or implementing a service or system improvement. Listening harder, and more, to different people can deepen your understanding of the project work in hand.
The narrative confuses the improvement – it indicates why progress is difficult, what has not yet been understood or agreed. This may dismay you but it does help to show how a project has started without all the right insights. It might suggest that work will need to continue for longer.
The narrative counters your improvement, it contests what was considered important to do. Understanding what opposes the improvement, what limits or prevents it is important. You have to decide how to proceed. Should you adjust your goals to accommodate the new insight or try to counter what you or others are most concerned about?
The narrative adds dimensions to the improvement, it indicates more that needs to be understood or, possibly, done. This can be exciting, as you think about the potential discoveries yet to be made. A note of caution however: your project needs to be written up in assessments along the way so you do have to reach periodic and interim conclusions!
The narrative refocuses the improvement, it indicates a different, higher, priority or better value direction for work. Daunting as this seems, the insights gained here might save your improvement – rescuing what might otherwise not develop very far.
The narrative resources the improvement, it indicates why something is valuable or valid and further fuels your endeavour and commitment. This is an exhilarating discovery, but be careful to be clear and certain about what you have found. It is vital that you verify your discoveries, discussing your reflections with others before making your final proposals for change.
The narrative shifts your mode of thinking Perhaps you have thought about this project in the wrong way. This is rarely the case. If it happens, however, it is critical to discuss your ideas with others. The focus of project work will shift significantly and you need to determine what it is possible to discover and report in the remaining time.

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