Stories and numbers: there is room for both in understanding patients’ experience
19 November 2014
Bev Fitzsimons, fellow in health policy at The King’s Fund, explores the false dichotomy between numbers and stories in understanding the quality of healthcare.
There is a widely held view that in understanding the quality of health care, quantitative data – the numbers – represent the facts and are held to be true, while qualitative accounts – stories and descriptions – are thought of as anecdotes with no wider application.
At our annual Transforming patients’ and staff experience conference, this year held jointly with The Point of Care Foundation, we heard persuasive arguments that both quantitative and qualitative data have their place, and that neither is exclusively either fact or anecdote – data is shaped by the perspective of the reporter, the audience and the context and is part of a story.
The danger in accepting numbers as facts is that we forget to question their veracity and the nature of their interpretation. One speaker highlighted this when they showed us a photograph of a room and asked, ‘How many people in the room are wearing red?’ A simple enough question, you might think.
But we explored the question: Which room was meant – the one in the photograph or the one we were sitting in? What do we mean by ‘red’ (anyone who has tried to choose white paint to decorate a room will get this one!)? Does it include only the garments we can see? And what do we mean by ‘wear’?
This shows very simply the care that we must take before we draw conclusions, and indeed comparisons, based on data that we unquestioningly hold to be true. And that’s before we even get to reporting it, interpreting it, or planning actions based on it.
The friends and family test has brought this issue into sharp relief, with an increasing recognition that different approaches to data collection in different places mean that the measure, although useful to track progress within organisations over time, is not helpful when comparing one place with another.
At the conference, we also talked about the value of narrative accounts of care and what we can learn from them. One speaker described looking at the painting ‘The Big Trees’ by Cezanne. In looking at the painting, not only do we come away understanding more about those trees, we also understand more about trees in general – and not because Cezanne has produced a statistically accurate representation.
It all boils down to the reason for collecting data in the first place. For the purposes of comparison and benchmarking, we need numbers to be robustly defined and collected. But numbers alone, or ill-defined and inconsistently measured numbers, will not do. In fact they are likely to do more harm than good, leading to distrust and dismissal.
If we are seeking to truly understand health care, it is not numbers or stories, but numbers and stories that are needed. If we want to make changes, we must appeal to the hearts and minds of all those involved – service users and staff – to show we really understand the reality of health care and have some insight into why it is the way it is. And for this we need the stories behind the numbers.
In health care there are so many false dichotomies. Hospital or home; GP or consultant; doctor or nurse. This is just another one to add to the list. The truth is, we need them all.
What is your experience of using stories and numbers in evaluating services? Did the two sources support or contradict one another? Were the stories valued? We’d love to hear about your experience.