Applying Storytelling to Health Care Innovation: An Interview with Steve Denning

This interview by the United States (US) Agency for Healthcare Research and Quality (AHRQ)'s Health Care Innovations Exchange Team explores the work of author Steve Denning, who served as the programme director of knowledge management at the World Bank from 1996 to 2000 before becoming a consultant in knowledge management and organisational storytelling.

In the interview, Denning begins by explaining why storytelling is such a powerful communications tool. He indicates that storytelling comes naturally to human beings, who have drawn and/or told stories throughout the millennia to explain events and make sense of their world. Denning has focused on sharing knowledge systematically in order to spark organisational change. While at the World Bank in 1996, he told a true story to employees about a health worker in a remote, economically poor village in Zambia who was able to find information he needed about treating malaria on the Centers for Disease Control and Prevention (CDC) website. By telling that story, Denning claims, World Bank employees were prompted to think about how they could share their knowledge - through a website - to more systematically to help reduce poverty. This example illustrates Denning's concept of a "springboard story", which "has an impact not by transferring large amounts of information but by rapidly bringing an audience to a new level of understanding of how change that occurred elsewhere could work in their own context."

As Denning elaborates, a springboard story should be plausible (based on actual events), with a protagonist the audience can identify with and an ending that shows the successful implementation of the idea in context that is different but experiencing a similar predicament to the organisation to whom the story is being told. "Extraneous details should be eliminated so the audience can quickly grasp the story's essence and draw analogies to their work and expertise."

Denning is next asked to reflect on how health care organisations and professionals can use springboard stories. For example, these organisations have used stories to create open and supportive environments for creative ideas to emerge and be implemented. "Once management...empowers employees to identify problems and develop solutions, they will have radically different conversations." Similarly, health care professionals can use storytelling to identify and communicate improvements; establish a set of values in the organisation conducive to making improvements; and understand their own roles as leaders to be credible communicators of health care improvements. According to Denning, this approach differs from conventional wisdom, which is based on the premise that you change people's minds by giving them reasons for change. Although this can work well with audiences that are likely to agree, this strategy tends to drive cynical or hostile audiences deeper into opposition by activating their biases. In contrast, Denning's communication paradigm focuses on first grabbing the audience's attention, eliciting desire, and only then reinforcing with reason. Pointing to the US health care reform debate, Denning asserts that President Barack Obama's move, in the last 2 months of the debate, to begin telling stories that dramatically highlighted what the problem was and how the health bill would improve the situation helped change the dynamic of the debate. He suggests that this strategy ultimately led to the bill's passage and enactment on March 23 2010.

"Narrative intelligence" is what Denning here describes as the ability to use narrative in real-life situations and understand how it works and why. Unfortunately, he says, organisations tend to reward left-brain abstract thinking; yet most people tell stories socially and can learn how to apply similar right-brain skills and talents to the workplace. Denning also suggests that innovators can inspire audiences to adopt their innovations by passionately believing in their innovations, using narrative intelligence to craft stories that the audience can identify with, and stimulating their desire for change before presenting new ideas. If innovators don't get the desired response from the audience, it may be that the specifics of the story don't resonate with the audience. Furthermore, the innovator must communicate his or her story so that listeners envision themselves implementing the innovation in their health care organisations/settings. "Once listeners become excited about the innovation, they will talk about it with their colleagues and become its champion. When an idea goes viral, it will take permanent root within the organizational culture."