Narrative Medicine into the Mantova ASST: experiences and results

We present a significant experience of narrative medicine application into an Italian healthcare trust. From the analysis of the complaints and praises sent to the URP (Office of Public Relations), an educational project entitled “The relationship of which taking care of. The relationship that cures” is born. This involvs healthcare operators in a multidisciplinary way into a process of integration of the relational and clinical skills, for the definition of actions finalised to the global improvement of the care services. Elena Miglioli, press agent, communication and URP officeer of the ASST of Mantova, explains that this initiative is one of the crucial points of an itinerary developed in years, that aims to transform the listening system of the citizen into a strategic lever for change.


How narration and narrative medicine come into a healthcare company?

The topics related to the communication between carer  and patient is more represented into the complaints and praises sent to the URP. Patient asks for being listened, for a dialogue with the operator, for answers. He/she needs to narrate himself/herself: to diminish tension, to find out confirmations,  to be treated like a “person” and not like a “disease”. This relationship, often neglected, needs much care, because it’s a “relation that cares”, with a huge potential inside. From those verifications, from data analysed and shared with the Strategic Management of the Trust, we started the educational project  to help Mantova ASST’ professionals to improve the communicative point of view, essential part of care and of their soft skills competence. The title “The relationship of which taking care of. The relationship that cures” emblematically underlines a challenge. The  integration between the evidence-based medicine approach, and the experiences,  emotions of patients and of their relatives, makes clinical and welfare decisions more complete, personalized and appropriate. We decided to combine the theatre’s language, for its expressive strength, with narrative medicine, thanks to skills of the ISTUD professionals. The originality of the educational path is that we put on stage complaints and praises that really arrived at the URP,  with the help of the Campogalliani Theatrical Company of Mantova. At the same time, authentic narrative will be a point of reference to start a formative path capable to proivde professionals with useful instruments to improve care’s relationships into daily clinical practice. This initiative is one of the most complex and important that we built in  the last years with the support of results of the listening system of citizens.


Is it possible to improve healthcare services with complaints?

In my opinion, the strategic target  is that any listening system should aim  for, is to become a tool that allows the citizens to join the building of a good healthcare. Voice of patients is a precious resource, also because it comes from the outside and for this reason often it’s more effective when we have to find out critical situations that maybe aren’t so clear for the eye of whom works into the trust .  It gives prompts for reflection and helps us to focalize better our view upon our activity. For this reason, in the last years. we started qualitative surveys focused and customised for some structures, starting from the complaints or from standard questionnaires of customer satisfaction, required by Lombardia region. Another step was completed last year with the creation of a stable multidisciplinary working group, with the purpose of analysing results highlighted by the listening system and translating it into actions of improvement. The group is composed by URP, representatives of Healthcare Management and of the Social Healthcare, of the Administrative Management of Healthcare Services, of Accreditation and Aptness Quality.


How Testimonies of praises could be valued and be useful for healthcare professionals’ burnout prevention?

Praises are an incentive and an encouragement for professionals, who need a feedback for their actions. For this reason we decided to study more about it, splitting them by thematic cores, and insert them into reports that we share with the management. On the wave of feelings related to a negative experience, the citizen is often oriented to complains, underlining  the painful points. Anyway, last results are telling us that the number of commendations is increased and it’s bigger than the number of complains. This U-turn is certainly important. Since this year Mantova Salute, the periodical of ASST’ information, got a section that host “stories of good healthcare”: We invite who is cared in our structures to share his/her positive experience of care, of disease, of healing. One more opportunity to give voice to what works, against the tendency of newspapers that gives space only to sensationalist news or news of inefficient health service (or presumed so). Moreover, into an awareness campaign that we promoted about the appropriate use of the emergency room, we painted the walls of the structure with some key words reported into praises, with the purpose of create a collaboration relationship between user and professional. What do we offer? Professionalism, hospitality, listening. What do we ask? Patient, respect, collaboration. In this occasion, was activated a specific online initiative, “Narrate your story at the emergency room”, with the purpose of gather testimonies from which picking up  of the words then reported into corridors.


Which confirmations did you have inside the healthcare organization from the activities that utilize narration?

Narration point his target upon some topics that underline criticalities to analyse or, otherwise, excellences to be proud and maybe improve. We will soon start the education  path already mentioned, that for the first time will involve healthcare professionals in a multidisciplinary way; we will evaluate the confirmations of this innovative project but meanwhile it is already a result to be here, able to manage a n education specialized onrelational points of view, with the sharing of Strategical Management. We also used the tool of narrative during a deepened survey in Obstetrics and Gynaecology at the Mantova Hospital, asking the mothers to write down their experiences before and after the birth. At the end of the survey there was many ideas of improvement. For example the strengthening of the pre and post-partum courses, the development of training  paths about therapeutic relationship and effective communication,  and the review of the organisational and bureaucratic aspects. Then intervened the Quality Validation and Apppropriateness structure to activate a path of improvement. Now we are developing a very complex work that involve the Orthopaedics and Traumatology departments. Also in this case, the purpose was the gathering of written testimonies and face to face interviews. The results of the customer satisfaction questionnaires talk of a clear improvement of the communicative aspects into the department, before the end of the project and before of corrective implementation. Thanks to the fact that the citizens’ opinion is considered and to the increased attention to them.


If you had complete authority, what kind of narration you would like to collect from the users of your structure of reference?

I’m thinking about an exchange of role between professionals and patients…I would ask a professional to wear the boots of an ill person, to ideally enter inside his bed, to face all the visits, the exams, the surgical interventions, the talks. And then, in this new role, narrate what he/she expects from the department’s staff where he/she is hospitalized. I will propose the same experiment to the  ill patent. I will invite him/her to live the typical day of a doctor or of a nurse and then describe the attitude that should have with him/her. Let’s try?…


Written by

Degree in Natural Science at University of Turin, Italy. Project Manager and trainer at ISTUD – Health Care Area since 2010. Expert in health care organizational research and in the approach with Narrative Medicine, applied to national and international projects to analyse the organization and quality of pathways of care. Coordinator of training programmes ECM accredited (Continuous Medical Education system) addressed to health care professionals, as trainer and tutor. Coordinator of European projects, Lifelong Learning Programme funded, with a specific focus on storytelling. Collaboration with the Italian Society of Narrative Medicine and with international universities. Participation as speaker at several congresses promoted by scientific societies and Health Authorities.

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