Dissertation (Doctoral) Letting Stories Breathe: Using Patient Stories for Organizational Learning and Improvement


Carol Ann Fancott


There has been a recent upsurge in the use of patient stories to better understand patients’ experiences of illness and of care, and to inspire leaders and staff for quality and safety within healthcare. However, to fully realize the potential of patient stories, a more nuanced understanding is needed of how they are used, who tells them, for what purpose, and in what context. Using a constructivist case study methodology with qualitative methods, this study examined four healthcare organizations that are known leaders in the systematic and deliberate use of patient stories, exploring the storytellers, the types of stories told and their purposes. It also examined the contexts that enable the use of stories and the impact they have had on organizational learning and quality improvement.

An interpretivist approach to analysis highlighted the specific types of stories told by patients and of patients, and how they were co-constructed from stories of chaos into quest stories for learning, “authorized stories” to be shared for particular purposes. The storytellers who emerged were those who had extended their involvement as patient advisors/members, determined by leaders to be the “right fit” and at the “right time” to share their stories. Strong leaders modeled and supported the philosophical orientation toward patient and family-centred care that patient stories helped to develop and sustain. Leaders also created the organizational structures and processes required to gather and share stories, and to link them purposefully with learning and improvement.

The act of storytelling is not a simple one and tensions surfaced relating to what stories are told, how, by whom, and for what purposes. In many ways, the organizations demonstrated how they were thinking with stories and how learning occurred at individual, team, and organizational levels. However, leaders and organizations continued to retain control of which patient stories were shared, in what forum, and for what purposes. Despite their best intentions and explicit demonstrations to hear the patient voice, a more reflective practice is required to better appreciate the power and privilege that exists within organizations, making this an area to explore further in theory development for organizational learning.


G. Ross Baker