Storytelling

Challenge  The pharmacy department has decided to centralize the production of ambulatory chemotherapy  and parenteral nutrition by the end of the year. To achieve this goal, it begun renovating and  expanding these production facilities and planned a staﬃng plan to meet the increased demand. The pharmacy production sector was facing a 100% increase in the number of chemotherapy  preparations (15,000 to 30,000 chemotherapies) and 600% in the number of parenteral nutrition  preparations (1,200 preparations to 7200 per year)

Production constraints were multiple. The preparation of parenteral nutrition and chemotherapy is  at risk for the patient (risk of dose error with important consequences because they are addressed  to a vulnerable population) and for the pharmacist technician or pharmacist with regard to  chemotherapies (toxicity of the products). One of the consequences was diﬃcult working  conditions (work in controlled atmosphere area, clothing constraints, use of poor ergonomic types  of equipment like isolator, manipulation of toxic products, anxiety about the error of preparation  with a risk of serious consequences for the patient).

The team has undergone several important changes with the departure of a part of the production  management staﬀ and of several pharmacy technicians.

The challenge is to reinvent a production process that meets the new needs of the unit.

Selection  The storytelling tool is a method of narrative communication of discourse, similar to tales and  stories. It allows participants to emotionally involve themselves in identifying with the heroes of the  story and thus to adhere to the project.  In our situation, the purpose of storytelling was to present a narrative of change. The storytelling  was to help capture the team's attention, to announce the change, to involve and value the  participation of everyone from the beginning of the project. The story should be simple, it  announced where the production team should go, namely the satisfaction of the customers (care  staff and patients)   as recommended by Jay Johnson, Chief Learning Officer, at

Mars.Jay Johnson, Chief Learning Officer, at Mars.  It has been the signal for the change in work habits both at work organization level and in the way  of working with participation and exchange between the whole team and not just management  staff.

Application  The imagined model was to present the storytelling as a drawing. The frame defined to build the  storytelling was that of the hero. The story was about an outpatient patient, Mr D. This patient had  his diagnosis of cancer a few months ago. After the initiation of treatment in hospital he should to  now receive the continuation of his outpatient treatment. He chose to go back to work. His feelings  were as follows. He was worried about the evolution of his illness and was stressed about arriving  too late for work. He was told that the administration of chemotherapy treatments was often  delayed. The doctor and the nurse have been to see and to reassure him. The nurse was also  worried, she had a lot of patients to take care of and this was the first time that the pharmacy  prepared the treatments of her patients. She did not know exactly how it was going to unfold. She  knew a friend who was a technician pharmacist and she called to be reassured. The latter (one of  the pharmacist technicians of the production unit) invited her to see how were prepared the  treatments of Mr D by the pharmacy service. The prescription was made by the doctor J. The  pharmacist technician produced the chemotherapy while explaining the conditions of safety and  the new organization of work in the production unit. The nurse then understood that the announced  manufacturing time was due to the precautions taken for the patient, the care team and the  pharmacist technician. She also saw that the preparation time was short thanks to a good  organization of work within the pharmacy team. The patient received his treatment on time and  was happy to meet and discuss with those who had prepared and administered his medication.  The health care team was reassured and was now able to make their work more serenely. The  nurse also discovered that she had more time to take care of the patient.

We could imagine the same story with parents who have just had a neonate born prematurely  neonatalogy service and whose child would need parenteral nutrition.

Insight  It was very difficult at first to imagine how I could go about applying storytelling to my challenge. I  did not succeed to find immediately what story I could tell to motivate my colleagues. In fact, as  long as I was limited to theoretical aspects, it was difficult to perceive and understand the  motivation mechanism and the power of storytelling. Then, once I focused on the goal I wanted to  achieve with this tool, the plot of the story came to me naturally little by little. It now seems obvious  to me. It is clear that to progress in the use of this tool, it is necessary to go through the practice  phase.

Approach  Now to apply this tool or another I would lose less time trying to understand the theory. We must  reflect on the goal we want to achieve, then think about how to achieve it with this tool and finally,  the most important, try.  The thing that I would like to change the next time in my approach would be perhaps to take a  cartoonist to create the storytelling and have it told in the first person as an experience lived by one  of my pharmacist technicians or a real patient. It seems to me that in this way I would gain in  emotion and that the speech will be more convincing. I will also try to place more, the employee in  the centre of story.

