Understanding narratives in health care
Understanding narratives in health care

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Understanding narratives in health care

5 Comparing narratives

Figure 2 portrays enquiries in rather a linear way (helpful for explanation but not necessarily completely representative of all work in the field). Before you reach conclusions it is wise to compare narratives. A collection of narratives may impact on a project, bringing about unexpected outcomes. You might discover that some narratives seem to accelerate a service improvement helping you to refine a skill, to devise something better with clients or a system that works to best effect in your organisation. Other narratives may have an inhibiting effect, acting as a brake upon your improvement. The net effect is an improvement that seems to be advancing in some regards but stalling in others.

Take stock of the net balance of influences that advance and detract from the improvement that you strive for. Decide which barriers to the improvement need to be addressed, or whether you will build on those parts of the change that are already proceeding well. You might, in extremis, shift the focus of the project and accept that modified goals will be agreed. During that consultation period, you will benefit from what you have discovered whilst interrogating narratives, and from the evidence review you engaged in.

Comparing narratives will help you to choose your next action. It will enrich your understanding of advancement in practice. It will help you to test what you see as most desirable, what seems achievable within a given span of time and what you thought ‘most people agreed about’. If it leaves you more cautious, measured and ruminative about the process of improvement, then you will have discovered something very important. Improvements that are sustainable are often hard won. That which seemed straightforward at the outset, might be more taxing in the doing. This is project experience: a disciplined form of evaluative thought that will stand you in good stead when you lead, or contribute, to future projects.

The next questions are:

  1. In the light of these insights into narratives, do I wish to change something?
  2. In the light of these insights must we change something in order to succeed?
  3. Do these insights suggest that we might usefully modify our goals in some way?
  4. Do the insights gained highlight the importance of communication and attending more closely to what others perceive?
  5. Will we, in some way, try to counter the narratives that slow this progress?
  6. Will we instead accept these and work further on those narratives that seem to sustain or accelerate the improvement?
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