How do we make connections through storytelling?
14 March 2024
Sarah and Laura explore how Schwartz Rounds provide a safe space for health and care staff to share their experiences through storytelling. They discuss their research which identified key types of responses in Rounds which help achieve connections and affiliation amongst staff.
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Sharing stories makes us human. At their best, stories cultivate shared understanding, relatability and compassion. They are a currency of connection. But storytelling also carries risks – like judgement and criticism – especially when focussed on difficult or taboo topics. This is no less true in healthcare, a setting that brings staff into contact with raw, confronting and painful human experiences every day.
While the emotional toll of health and care work is widely acknowledged, staff rarely have time to reflect on their experiences. Schwartz Rounds give health and care staff the time and space to tell their stories, sharing their complex experiences of working in these fields with other people.
The deep importance of this storytelling was highlighted at the recent Point of Care Foundation symposium with Picker, where the value of making connections with others’ stories was discussed as well as the potential this has for shifting organisational cultures.
Connecting through storytelling
But how does this connection through storytelling work in practice? Understanding the ways in which we communicate a connection with others when we tell stories is helpful when thinking about how Schwartz Rounds achieve their aims – and our recent study published in the journal Social Science and Medicine has looked at just that.
Anyone who has been to a Schwartz Round will know that they begin by giving the floor to three or four panellists, who have each prepared a story to tell. Following this, the floor then shifts to the audience, who are invited to give responses to what they have heard. This can be anything from a short comment about their emotional response or a longer story about their own experiences.
Conversation analysis
In our study, we looked in close detail at the spoken interactions that take place during these audience responses, using a sociological method called ‘conversation analysis’ to analyse the turn-by-turn talk. We found some key types of responses that helped achieve connections and ‘affiliation’ (the humanising aspects of storytelling) amongst staff, some of which were quite special to Rounds.
Endorsements
The first thing we (Sarah Atkins, Alison Pilnick, Jill Maben and Laura Thompson) identified was a huge number of what we called ‘endorsements’ in Rounds, where an audience member commended the panellist on their story.
Endorsements came in two types – there could be an endorsement of the emotions or ideas that the panellists might have expressed in their story (such as, “It shows you to be very compassionate and caring”) but there was another very important type of endorsement that happened in Rounds at what is called a ‘metapragmatic’ level. This is when an audience member is talking about the talk itself. In these kinds of endorsements, the audience member was commending the panellist for talking about something difficult or ‘risky’ (such as, “Thank you for expressing your reaction to that patient was negative because that’s a difficult thing to say”).
Second story
Another type of audience response we identified that was really important was the ‘second story’. In conversation analysis, this is where someone tells a story that is explicitly linked to the themes of the earlier story they’ve just heard.
It’s not a surprise that you get a lot of second stories in Schwartz Rounds – that’s partly what they’re designed to elicit, and the facilitator often works to find those common experiences amongst staff. What was interesting about the second stories in Rounds we analysed was that they could also be ‘metapragmatic’ in how they worked. For example, an audience member told a story where they mentioned a member of staff who once apologised to them for ‘ranting’ about a difficulty at work, but they told the colleague, “No that’s fine, it’s part of doing the job that we do” and that “it’s ok to be human.”
The counter-cultural nature of Rounds
Schwartz Rounds harness something that’s powerful in casual everyday conversation – in terms of how we achieve affiliation and connection through our responses to storytelling – and translates this successfully into a more institutional healthcare setting.
What’s interesting is that in Rounds, these ‘metapragmatic’ audience responses come to the fore, much more so than in casual conversation. We argued this was a very important feature of Schwartz Rounds, where difficult topics often come up. These kinds of ‘meta’ endorsements – thanking the teller for a difficult story – mean that contributions that might not be so easily given in people’s everyday work contexts (such as emotional responses to patients) are explicitly encouraged in this setting, without the risk of the teller being criticised.
These responses are perhaps part of what creates the ‘counter-cultural’ space of Rounds, where difficult experiences can be safely aired and discussed. It also means that even the most extraordinary or ‘taboo’ experience can be affiliated with. The audience might not share exactly the same experience, but they can still express their admiration for and connection with the storyteller.
We hope that this first piece of research, looking inside Schwartz Rounds themselves, offers helpful insights into how they achieve their aims and support staff wellbeing through creating these ‘counter-cultural’ conversational spaces.
Those who facilitate Schwartz Rounds (and other group interventions that involve sharing personal stories) can benefit from being aware of the different types of responses that participants may have. Not only for understanding what to expect from an audience discussion but also for considering how to facilitate, encourage and normalise these forms of connection.
Stories are only stories because they are told in relation to others. And the talk about storytelling (and tellers) is clearly just as important as the stories themselves when considering the more risky – and humanising – side of stories.
Our full article is available to read here:
We would like to express our enormous gratitude to the hospital trusts and staff members who consented for their Schwartz Rounds to be recorded so that this research could be carried out.