Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change

Verbatim theatre as a creative approach to health professions education research translation

CONTEXT

Traditionally, the impact and outcomes from health professions education research (HPER) have focused on academic outputs, whereas in the humanities, research translation is conceptualised more broadly and creatively, including research-based performances like verbatim theatre. Translating HPER findings through the emotive and embodied nature of a verbatim theatre performance provides a unique opportunity to translate research data and create alternative learning spaces for rich and valuable insights that aligns with transformative pedagogy.

APPROACH

In this paper, we describe the background of verbatim theatre, a form of performance, which draws on a research participants' testimony and lived experience and how we used this creative approach to translate HPER findings. We discuss the experiential process of bringing an interdisciplinary team together, health professions academics and an academic playwright to craft a verbatim theatre script that provided space to honour the breadth, depth and diversity of participant voices from a large (n = 100) qualitative research study exploring professionalism and sociocultural factors in health professions education (HPE). Furthermore, we discuss the powerful potential of drawing on research-based performance to create alternative, safe and non-threatening learning spaces to resonate with and experience HPER in new and transformative ways. Finally, we offer reflexive insights on the key opportunities and challenges we encountered in translating HPER into a verbatim theatre performance.

CONCLUSIONS

Verbatim theatre presents an innovative and creative way to communicate and translate HPER. This paper offers research and pedagogical insights in translating research into verbatim theatre to support transformative pedagogy and practice in HPE. In conclusion, we encourage other health professions researchers to consider this dynamic and creative approach to transforming HPE.

Grace Under Pressure: a mixed methods impact assessment of a verbatim theatre intervention to improve healthcare workplace culture

BACKGROUND

Healthcare workplace mistreatment has been documented globally. Poor workplace behaviour, ranging from incivility to bullying and harassment, is common in healthcare, and contributes significantly to adverse events in healthcare, poor mental health among healthcare workers, and to attrition in the healthcare workforce, particularly in junior years. Poor workplace behaviour is often normalised, and is difficult to address. Verbatim theatre, a form of research informed theatre in which plays are created from informants' exact words only, is particularly suited to facilitating workplace culture change by raising awareness about issues that are difficult to discuss. The objective of this study was to assess the impact of the verbatim theatre play 'Grace Under Pressure' on workplace culture in NSW hospitals.

METHODS

The intervention was conducted in 13 hospitals from 8 Local Health Districts (LHDs) in NSW, Australia, in October and November 2019, with aggregated impact across all sites measured by a bespoke survey ('Pam McLean Centre (PMC) survey') at the conclusion of the intervention. This study was conducted in 3 Local Health Districts (one urban, one regional, one remote), with data collection conducted in November-December 2019 and December 2020. The study design was a mixed methods assessment of the play's impact using (1) validated baseline measures of psychosocial risk, analysed descriptively, (2) overall findings from the PMC survey above, analysed descriptively, (3) interviews conducted within a month of the intervention, analysed thematically and (4) interviews conducted one year later, analysed thematically.

RESULTS

Half (51.5%) of the respondents (n = 149) to the baseline survey had scores indicating high risk of job strain and depressive symptoms. Of 478 respondents to the PMC survey (response rate 57%), 93% found the play important, 92% recommended others see the play, 89% considered that it stimulated thinking about workplace behaviour, and 85% that it made discussing these issues easier. Thematic analysis of interviews within one month (n = 21) showed that the play raised awareness about poor workplace behaviour and motivated behaviour change. Interviews conducted one year later (n = 6) attributed improved workplace culture to the intervention due to improved awareness, discussion and capacity to respond to challenging issues.

CONCLUSIONS

Verbatim theatre is effective in raising awareness about difficult workplace behaviour in ways that motivate behaviour change, and hence can be effective in catalysing real improvements in healthcare workplace culture. Creative approaches are recommended for addressing similarly complex challenges in healthcare workforce retention.

Playing well with others: lessons from theatre for the health professions about collaboration, creativity and community

Despite collaboration among different professions being recognized as fundamentally important to contemporary and future healthcare practice, the concept is woefully undertheorized. This has implications for how health professions educators might best introduce students to interprofessional collaboration and support their transition into interprofessional, collaborative workplaces. To address this, we engage in a conceptual analysis of published collaborative, interprofessional practices and conceptual understandings in theatre, as a highly collaborative art form and industry, to advance thinking in the health professions, specifically to inform interprofessional education. Our analysis advances a conceptualization of collaboration that takes place within a work culture of creativity and community, that includes four modes of collaboration, or the ways theatre practitioners collaborate, by: (1) paying attention to and traversing roles and hierarchies; (2) engaging in reciprocal listening and challenging of others; (3) developing trust and communication, and; (4) navigating uncertainty, risk and failure. We conclude by inviting those working in the health professions to consider what might be gleaned from our conceptualization, where the embodied and human-centred aspects of working together are attended to alongside structural and organizational aspects.

Narrative Matters: Hidden LIVE - Adam's story - a mental health theatre production as an example of participatory principles and practices

This article presents the co-production principles underpinning the co-creation of a multimedia theatre production on young people's mental health.

"Take a walk in someone else's shoes": the role of participatory arts for health research development and training

Participatory arts are increasingly recognised as a valuable and accessible mechanism for giving a voice to the experiences of individuals' health and healthcare. In recent years, there has been a move towards embedding participatory arts-based models into public engagement processes. Here, we contribute to the existing literature on the use of participatory arts-based approaches and their role in health research and healthcare practise, focusing on two interlinked approaches, the creation of personas and storytelling. We draw on two recent projects which have utilised these approaches to inform subsequent healthcare research and as a professional training tool to improve patient experience in a healthcare setting. We add to emerging literature to outline the benefits of these approaches in supporting research and training in healthcare settings, with a focus towards the co-produced foundations of these approaches. We demonstrate how such approaches can be utilised to capture different forms of voices, experiences and perspectives to help inform healthcare research and training, rooted in the lived experience of individuals who are directly involved in the creative process of developing personas via storytelling. These approaches challenge the listener to "walk in someone else's shoes", using their own homes and lives as a theatrical set in which to envisage someone else's story, involving the listener in the creative process through (re)imagining the stories and experiences of the characters. Greater use of immersive, co-produced participatory art-based approaches should be used in PPIE to inform research and training in healthcare settings as a means of centring those with lived experience through co-production. Involving those with lived experience, particularly from groups who are traditionally excluded from research, via a process which is based on co-creation and co-production, reorientates the researcher-participant dynamic to fully centre those involved in the research at the heart of the tools used to guide health and healthcare research. In this way, it may also aid in trust and relationship building between institutions and communities in a way which is focused around positive, creative methods to aid health research and healthcare processes. Such approaches may help to break down barriers between academic institutions, healthcare sites and communities.

Applying Organizational Change Theory to Address the Long-Standing Problem of Harassment in Medical Education

Issue: Harassment is a common experience for medical and healthcare trainees. Experiencing harassment can have significant consequences for trainees in multiple domains, including mental, physical, social, and occupational well-being. Harassment remains entrenched in medical education despite efforts to address it. Evidence: Many articles have documented the prevalence of harassment in medical education. Likewise, articles have provided recommendations for how individuals or hospitals can attempt to reduce harassment. However, despite calls for reform, harassment persists, largely due to the hierarchical, paternalistic, high-pressure, and evaluative nature of medical culture. Most literature has emphasized the need for policies and reporting structures, yet such top-down initiatives have not had a sufficient impact on the attitudes and beliefs that drive culture change. Instead, change requires intervention at every level of an organization. Little, if any, literature has proposed applying a change management model to change the culture of medical training and therefore decrease harassment. Implications: This paper applies principles of organizational change theory, and in particular, the ADKAR model, in conjunction with a summary of the existing harassment literature, to propose a framework for addressing harassment by facilitating organizational culture change. Intervention is needed at all levels of the medical education system (the healthcare system, the supervisor or training program, and the individual), and the ADKAR framework can guide what interventions are offered and when to capitalize on the current level of change readiness. Recommendations go beyond the typical focus on formalized policies and procedures, which are necessary, but not sufficient, components of culture change. Implementation of these practices, as well as ongoing evaluation and refinement through research, should foster cultural change in medical education to address harassment.

Response-Liminality and the Mirage of Settlement

Little and colleagues' (1998) paper describing a key aspect of cancer patients' experience, that of "liminality," is remarkable for giving articulation to a very common and yet mostly overlooked aspect of patient experience. Little et. al. offered a formulation of liminality that deliberately set aside the concept's more common use in analysing social rituals, in order to grasp at the interior experience that arises when failing bodily function and awareness of mortality are forced into someone's consciousness, as occurs with a diagnosis of cancer. We set out the reasons as to why this analysis was so significant in 1998-but we also consider how the "liminality" described by Little and colleagues was (as they suggested) a feature of modernity, founded on what we term "the mirage of settlement." We argue that this mirage is impossible to sustain in 2022 amid the many forms of un-settling that have characterized late modernity, including climate change and COVID-19. We argue that many people in developed nations now experience liminality as a result of the being forced into the consciousness of living in a continued state of coloniality. We thus rejoin the social aspects of liminality to the interior, Existential form described by Little et. al.

Evaluation of a workshop using verbatim theatre stimuli to address challenging workplace situations: a pilot study

BACKGROUND

Challenging workplace situations such as bullying, harassment, depression, suicide and fatigue exist in health care. The performing arts can generate dialogue and engagement with these difficult issues. This study evaluates a workshop for health care students that used filmed vignettes from a verbatim theatre play that used real stories of such situations. The workshop aimed to improve health professional students' confidence in seeking help for depression, addressing mistreatment, understanding mandatory reporting laws and the impact of driver fatigue.

METHODS

Two workshops were held: one with a mixture of professions, including nursing, medical and allied health students, and the other with medical students only. Participants completed questionnaires before and after each workshop, responding to four Likert questions on understanding and confidence about the issues discussed and free-text responses about the perceived value of the workshop.

RESULTS

Sixty-five people took part in the workshops, with a 100% response rate to the pre-workshop survey and a 98% response rate (n = 64) to the post workshop survey. Students most frequently reported an improvement in understanding mandatory reporting laws (57%), followed by an increase in confidence in dealing with bullying and harassment (44%). Students in the workshop with a mix of professions noted the benefit of learning about these challenging issues alongside students from other health professions.

DISCUSSION

Students valued the facilitated discussion of sensitive issues. Although many respondents increased their understanding or confidence in the four topics, a smaller proportion reported a reduction after the workshop. Perhaps this resulted from greater appreciation of the complexities of these issues. Health care students valued hearing from other professional groups in the mixed professions workshop.