Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.

In these podcasts, you get to listen in on my conversations with some really remarkable people. You will hear what health literacy is, why it matters and ways all of us can help improve health understanding.

Today, I’m talking with Chad Brough, who is the Executive Director of the Office of Patient Experience at Cone Health in Greensboro, North Carolina.

When I asked for a brief bio, he suggested I use his Twitter profile, stating that “Chad stands for healthcare that is more compassionate, less complicated, more affordable and more predictable.” That sounds great to me.

Chad and I first met at a meeting of Patient Experience leaders and have since reconnected. We discovered a shared interest in the power of storytelling. While my work is mostly audio podcasts, Chad uses video to share patient experience stories.

Welcome, Chad.

Chad Brough: Thank you, Helen. I’m excited to be a part of this.

Helen Osborne: I’m excited about our shared interest in storytelling. I’m actually very energized by that. I know why I’m interested in storytelling. Why does it matter so much to you?

Chad Brough: I would just begin by saying that as an undergrad I was intent on being a writer or journalist. I was attracted to feature writing and people because I just naturally am curious and enjoy learning about people’s experiences.

I think it’s with that kind of background in my work that, as I lead this health system’s commitment to improving the patient experience, I am most interested in what people’s back story is all about when they come to us in the most vulnerable moments in their lives.

Helen Osborne: That’s what you talk about when you’re thinking about story. You’re thinking about that backstory, not that sequential “first I did this and I lived here and then my disease started.” Are you thinking of story in somewhat of a different way than that?

Chad Brough: I will tell you that, in our business, historically some people might think of this customer or this patient in front of them being defined by what’s written in their medical record.

Helen Osborne: What’s wrong with him or her.

Chad Brough: That’s right. There are definitions about what the patient experience even is in healthcare. I like the one that the authors who wrote Patients Come Second use, which is the patient experience is a story that the patient tells at the dinner table the evening after visiting your organization.

Helen Osborne: Oh my goodness. That’s their story. It’s not the story in the medical record. It’s the story the patient tells.

Chad Brough: That’s right. There was something, some backstory or trigger that led them to us that we may or may not be aware of unless we’re curious and get to know them better.

There are times when people have amazing adversities and things that have brought them to us that we have the honor to help them with.

I would say the same thing about our courageous caregivers as well. It’s amazing and I so much admire what our providers and our caregivers do every day when they are taking care of our patients.

I would say there’s a reason why so many television shows are based in hospitals. There is a lot of drama there.

Helen Osborne: There is a lot of drama. I agree with you. I can just relate to my core about what you talk about when you’re not in that situation.

Your work is on patient experience and you’ve got a big, lofty role at your health system. Why does that story matter in the work that you’re doing?

Chad Brough: That’s a great question, Helen. I would say I learned early on when we would do new leader orientation and when we’d bring new people into our organization in leadership roles. We started those sessions with a patient telling their story.

The feedback that we consistently received from the audience or the leaders was that the patient was the most meaningful part of the whole day.

Helen Osborne: You’re using the patient’s story just to remind all the caregivers, and yours is a huge system, why they’re doing this work.

Chad Brough: Yes. It connects them to purpose. It helps them to see the difference that they make. It helps them understand and empathize about a patient’s backstory.

When I work at a health system that has over 11,000 employees in 100 locations, I can’t ask a patient to come and talk to every one of those people.

With technology and video, you have the ability to put together these stories and put it out there on YouTube or share it across a complex health system and reach so many more people.

Helen Osborne: That’s like “Why video?” It’s because your reach has to be so vast.

You raised something about putting patients’ stories on YouTube. I know HIPAA is a big thing in what we do in patient protection, privacy and confidentiality and all that. Does this cross any borders that we need to be aware of?

Chad Brough: Yes. Of course, you want to be considerate of privacy, and like anything else we have to have approaches to ensure that the patient has signed off and agrees to allow us to share their story.

We have a small and very resourceful production team within our organization. We actually call it Caregiver Productions. It’s not their full-time job, but it’s a part of their job that the team is extremely passionate about.

They have a process, and whenever we approach a patient that has a compelling story that they have shared with someone. We, of course, will get their permission before we do anything else.

Helen Osborne: It’s written permission?

Chad Brough: Absolutely. It’s written permission that they release this type of information in a way that they understand. What we find so many times, Helen, is how grateful patients can be that they can share their stories.

Helen Osborne: It’s not like they say, “Oh my goodness, if you really have to do it.” They say, “Thank you for honoring me.” Is it in that way?

Chad Brough: Absolutely. We never spend a lot of time persuading people to do this. Most times, they have already expressed this story to someone.

We collect these from leaders and from staff. We get letters in the Office of Patient Experience all the time that are extremely inspiring.

Through a curious conversation with them, we begin to build a relationship or rapport and really let them understand how meaningful it is and how inspirational it is to all the caregivers to see this. Then they feel like it’s their way of giving back or paying it forward to the people who cared for them.

Helen Osborne: That’s wonderful. I’m delighted hearing about that.

I know you had told me that your primary audience is really the caregivers rather than the public. I wonder if you can tell us a story about your telling a story. Give us an instance, because I’ve had the joy of watching some.

In fact, I was looking at one again just in preparing to talk with you for this podcast. It was the one about two moms, I think, and their son who had a skateboard accident. I almost got goosebumps watching that again.

Make it clear for our podcast listeners. Tell us a little bit about that, please.

Chad Brough: We learned one day that a patient and his mothers had come into our emergency department on the anniversary of his accident, which was a skateboarding accident, to thank our staff for saving his life in our trauma ED.

When we heard about them doing this and expressing this gratitude, we asked to meet them and to talk to them more.

As we learned their story, we found out that the two mothers actually worked for us at one of our other hospitals and they so much wanted to say thank you to the staff that saved their son’s life.

What was really remarkable about it was what motivated them to go to the emergency department to express that thank you was they had watched one of our other videos.

When they saw that video and they saw a patient saying thank you to all the caregivers, they said, “We’ve got to go to the emergency department and thank them.”

Little did we know, that led to our second Caregiver Productions video, which is “Team Ericksen.”

Helen Osborne: Which is this one.

Chad Brough: Yes.

Helen Osborne: That’s wonderful.

Chad Brough: It talked about Ericksen’s recovery from his skateboarding accident and just the amazing partnership that his family forged with our neuro ICU team.

Helen Osborne: A lot of things are bubbling in my brain as you’re talking about that. One is that I certainly want to have o a link to some of Cone Health’s videos on your web page, and we will certainly do that.

The other one is that I’m hearing how you’re using storytelling not just to remind caregivers of why they are caregivers and how they can help, but maybe a little more pragmatically. Isn’t it a little bit of a marketing tool too, like here’s what happened and here are services we can offer?

Chad Brough: I would tell you that our audience is predominantly our staff. I guess I would say to you that in our country with patient experience work, often the driving measurement tools of patient surveys can seem to be the focus of everything, such as the score on a survey.

Really, it’s supposed to be about listening to our patients and really learning how to improve the care. People didn’t go into healthcare to improve survey scores.

Helen Osborne: No, they didn’t.

Chad Brough: They went into healthcare to take care of other people and to serve. What we have found is that using the videos and using storytelling helps people connect back to the why.

What is this patient experience really all about? It’s not about a survey. It’s not about improving your HCAHPS scores, the mandatory Medicare inpatient survey tool. It’s about improving the care of these people that we have the honor of taking care of every day.

Helen Osborne: Being pragmatic about this, did it also improve the scores when you have these videos?

Chad Brough: I would tell you what it does is it shifts the mindset. It shifts the mindset that, when we’re talking about having a culture where patients are first, people feel that it’s authentic.

This is authentically what goes on in our organization every day. It’s not about a monthly report card with a number on it that we’re trying to get to the top 10% in the country.

Helen Osborne: Listening to you and seeing some of this work, that authenticity comes through.

Our listeners can be anywhere across the US and around the world. They may not be in a position like yours to have a production team or department or have people who can help out that way, but they might grasp, especially from listening to you, why storytelling matters and why it helps to share those stories.

What recommendations would you give for someone who may not have the resources to do this in a magnificently put-together and edited video?

Chad Brough: That’s a great question. I would say, Helen, that there is maybe good, better and best.

Helen Osborne: Of storytelling?

Chad Brough: Yes, there’s a good, better or best of storytelling, and I would begin by saying what a patient’s story is not. A patient’s story is not presenting information that’s in the medial record, unless it derives some kind of context to what is going on. Instead, it’s more about what their backstory is.

If you can’t afford a production team to create videos, just approach it saying, “Here’s a good way, a better way and the best way to tell a story.”

Helen Osborne: What would be a good way?

Chad Brough: A good way maybe is just to read a letter that a patient wrote from the heart.

Helen Osborne: We can do that.

Chad Brough: A better way may be to include photos of the patient and say, “This is who the patient is.”

If you see this patient in front of you, it’s different than reading about them or reading a letter. If you see the patient in their own environment among their family in these photos, it’s different than seeing them in a gown and hooked up to equipment.

Some of our best work is when we can engage the family and really show them who this person was.

Helen Osborne: You’re just bringing out the people part of people care. That’s beautiful. I love those examples.

I’d love for you to share some more of the basics. Let’s say somebody does want to do a video, retell someone’s story or capture someone’s story. What do they need to consider?

You already talked about permission and getting that in writing. I do that too for podcasts. I asked you to sign something so that there is that permission process there.

You and I, for this podcast, and as I do for every other one, there’s always that planning process, so what people hear in the end of the podcast or maybe in your videos isn’t all that there was.

That’s a behind-the-scenes peek. What else do you do at your behind-the-scenes to make this seem so easy?

Chad Brough: I would say that we have to be mindful of the length of time to tell a story. We’ve gotten much better about that. In our day and age, most people want to be able to see a story beginning to end in three to four minutes.

Helen Osborne: Three to four, whoa.

Chad Brough: You have to be really concise. That means a lot of planning. That means you interviewing the patient and really understanding the basic story elements that need to be shared. You can’t share every detail of their life.

What was the adversity they overcame? What was it that was really most important about the connection they made with their patients? Who are other key characters in the story?

Helen Osborne: You know you have a sense really of what that story is behind the patient’s story. It’s not just a series of anecdotes or reflections.

I know from storytelling that it has characters, place, obstacles and how to overcome obstacles. Are those elements that you put together? I’ve heard the term story arc.

Chad Brough: Exactly. We look at the story arc.

I guess the other important thing I’d want to say to your audience is to really be focused on how you can bring the characters out in the story, who are the caregivers.

If your audience is focused on the caregivers, I think it’s important to really acknowledge and honor your caregivers for the amazing work that they do.

I’ll tell you a very quick story about one of our films. We had a story about this young woman who found out that she had cervical cancer immediately after she came home from her honeymoon, and it changed her life.

As she began to tell her story and tell us about the people who meant the most to her, we went and started interviewing them. Little did we know how some of those people’s backgrounds and backstory were so powerful.

One of our phlebotomists, this person who was drawing the patient’s blood every day at our cancer center, told us when interviewing her that the reason she came to the cancer center was that her 41-year-old husband died of cancer.

As I was interviewing her, I looked at the person that was shooting the video and just shook my head and said, “You can’t make this up.”

As a healthcare leader, I have found so much reward and respect for the people I work with every day when I get the honor of interviewing them, telling that story and sharing it with others. It’s really so inspirational.

Helen Osborne: Chad, I hear that from you, I heard that from you when we met in person and I’m hearing that in the podcast now. It seems to go back to your very roots when you were first beginning this work that you’re naturally curious and you enjoy hearing about other people’s experiences.

From Health Literacy Out Loud, I want to thank you so much for sharing with our listeners your experiences and lessons learned about storytelling and video and putting them together to remember the care in caregiving.

Thank you so much for being a guest on Health Literacy Out Loud.

Chad Brough: Thank you, Helen.

Helen Osborne: As we just heard from Chad Brough, it’s important to remember the caring part of healthcare and then sharing those stories with people who can make a difference. All of that is a part of health literacy, too.

Health literacy isn’t always so easy. For help clearly communicating your health message, please visit my health literacy consulting website at www.HealthLiteracy.com. While you are there, sign up for the free monthly e-newsletter, What’s New in Health Literacy Consulting.

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Until next time, I’m Helen Osborne.

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