Keywords

A Story: Building a Health Village

It all started with wanting to help people who felt alone.

“How do we reach them before it’s too late?” The head Psychiatrist, Henry, asked his silent colleagues, John and Maria, who were captivated by the question as they also had the same concern.

“If we could create a place to receive our patients that was easy to access. Not a confusing maze of administration and scattered information from many sources. A place where they felt safe, where we could address their individual needs without them having to come to the hospital.” Henry pauses and looks out the window of the staff coffee room. “We have lost so many people because they don’t know how to connect with us.”

John replied pensively, “Yeah, a place where they felt welcomed and wanted like a village, where everyone knows each other. In the small village I grew up in, everyone helped each other. Once, we had a huge snowstorm that blew out the electricity for days, and even though the temperatures were fatal, no one died, as neighbours checked on neighbours. The local community centre provided beds and hot meals, especially to the elderly living alone. This happened years ago, and people still talk about it.”

The psychiatrists work at the largest public hospital in a small Nordic country. The hospital has over 30 specialised medicine departments. All the health care practitioners would agree that the hospital is a great place to work. The practitioners are encouraged to work autonomously, together with the support of their managers. Rooted in Nordic social egalitarian values, the practitioners would expect nothing less for themselves and their fellow citizens. Everyone has a right to good quality care and fair work with integrity.

With John and Maria’s encouragement, Henry pursued approval from his boss and applied for funding at the hospital to create a digital platform that has information on mental health services and a simple booking system for online therapy. The funding was approved on the condition that if the pilot worked, other specialised medicines could also contribute with their own practice.

Two years later, the digital health village was opened with over 32 specialised medicine houses. Like pioneers, the practitioners built the village through common values and beliefs of a hoped-for future, and their collective tacit knowledge of the past. To ensure the village houses would cater to the needs of the community, the practitioners invite and encourage individuals who use the service to consult on the design and practices of the houses. The feedback is continuous through conversations between the practitioners involved in the build and the community it serves.

One beautiful morning, John, Maria, and Henry were in the staff coffee room again, deep in conversation. There were other staff members, a few nurses, and secretaries, who joined as they reminisced about how far the health village had come.

“It feels so much easier to connect with the community. I feel great about my work and can really see first-hand how it is impacting people’s well-being,” John says with a smile.

Jenny, a secretary, nods: “I have worked here for over 30 years and have never been asked by a doctor or a practitioner what my thoughts are on the needs of our community and how to serve them better. Since the health village, I have helped with digital content, and I have a deep sense of ownership of the village that I proudly introduce to anyone who asks or listens!” She laughs.

Henry looks at Jenny in astonished guilt and thinks, “I never thought to ask Jenny her opinion, I just thought we did such different work. Don’t we? She did have a great idea the other day about short videos explaining the symptoms of burnout . I wonder if she ever experienced that here? I know I have.”

Petra, a nurse manager, brings up what she is working on, “We just finished a page on loneliness amongst the elderly living in our city. Talking about it with the other nurses and the social workers has been such an eye-opener. When we are so focused on getting the work done here at the hospital, we forget that the people we don’t see still need our care. Many don’t have families and asking them about their stories has made me think of my own sense of community. Like yesterday, I talked to Margaret, my 80-year-old neighbour, for a bit longer in the yard. I say hi to her, but usually, I rush by because of work or errands. I felt calm and my spirits lifted after our conversation. I look forward to talking to her again.”

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In order to get into a work as craft mindset, we propose a set of questions in different parts of the story. To start, consider the following:

  • Who are the actors?

  • Is there a dominant narrative? If so, by whom?

  • What is the call for action?

  • How many stories or social worlds do you identify?

  • Are there predominant metaphors? Do they mean anything specific to you?

  • What is the overall feeling from the interactions?

Close to the hospital, Susan sits in her small apartment that she shares with two other nurses. She’s scheduled for work in a few hours and asked some of her friends for a quick visit.

Susan has been feeling sad lately. When she came to this country five years ago, she was excited and hopeful. She had worked hard for her nursing degree in the Philippines and was grateful for all the work experience she achieved as a psychiatric ICU nurse.

When she was recruited, her plans were to continue developing her skills with a larger salary, meet new people, and maybe travel. She loves being a nurse, and she knows she is good at her job.

She lets out a sigh and gets up to boil water for their tea. She tells herself that the tea and a quick chat with friends will make her feel more herself, maybe even rested. She hasn’t been sleeping well lately as the shifts at the hospital have been long and difficult, and she continues most of her working days studying to certify her previous degree and practice the local language. She also thinks about her feelings of disappointment which keep her awake wondering and worrying.

“What an irony that you care for others who have insomnia and anxiety. They had much bigger issues than you, and now you feel sorry for yourself! You should feel lucky to have a job in such a safe place!” Susan chides herself aloud.

There is a loud knock on the door. “Coming!” Susan yells and laughs at how loud Julie always knocks as if Susan didn’t know she was coming. Susan and Julie text message each other easily 10 times a day.

Julie and Rick tumble in. Julie is the same age as Susan, mid-30s, and Rick is in his late 40s. Both are great nurses; both are fantastic parents. Rick’s children are teenagers, whereas Julie’s are still in day care. Julie and Rick moved from the Philippines about a decade ago and studied their previous degree again to work as nurses. They struggled with the language at first, but now they are citizens after proving their command.

“You look terrible!” Julie teases but is concerned. Susan has said she is not feeling herself lately and that she has been missing “her family back home.”

“Yeah, I know. I think I am burnt out. All these long shifts and having to study nursing again while working. It is just too much! I don’t have anyone to speak to about this at work as I am either alone on my shift or we are too busy,” she pauses. “I know I should get some help or talk to someone about getting more down time, but I always feel overwhelmed with asking. Who do I ask? And to be honest, I am afraid they are going to blame me for feeling this way. Like, I should be grateful to have what I have and just suck it up until it feels normal.”

“That is ridiculous, Susan, and you know it!” Rick interjects. “I have been here for a long time, and I can tell you that it doesn’t get better. I always feel like my language is not good enough or I need to prove myself more at work so they can finally give me work that I deserve. But it never comes! You got to take care of yourself.”

Julie puts her arm around Susan. Julie also felt frustrated with her skills not being used. She has also felt lonely at work. Like the other day, she was sitting in the staff coffee room, and everyone was talking loudly about this health village. She had heard about creating online services and wanted to get involved, but her manager never asked her. Was she supposed to ask? Would they give her working time? She is a whiz on social media with many following her blog about being a nurse abroad.

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Before continuing with the story, think about the following questions:

  • Who are the actors?

  • Is there a common theme?

  • Is there a problem that should be addressed?

  • Consider the metaphorical social world of Snakes and Ladders in Chap. 2. How does this part of the story compare to the previous one?

  • What is the overall feeling from the interactions?

Later that day, Susan is sitting in a meeting at work, her manager, Petra, is explaining how successful the health village has become. Most of the nurses present are animated and sharing their own experiences about how the village is inclusive. Petra says, “I feel it may have saved many lives.”

This is great! Susan thinks as she looks at the platform which is projected on the screen. But looking at all the images and reading the descriptions of the services, she hesitates. These services are great, but why am I still confused? Where do I get the information I need? And why am I only hearing about this now? Why haven’t I been asked to participate? There is so much I have to say!

That evening, Susan could not sleep. She knew she had to get up early for work, but no matter how hard she tried, she couldn’t shake the feeling of loneliness. “Maybe this was a mistake, and I shouldn’t have left home. I am a good nurse, but I don’t know what they want from me here. Do they need me or am I just another nurse?” She adjusted her body by throwing her leg over a pillow. Her back and shoulders hurt, and she was frightened about not caring for herself. A little past 2 a.m., her body finally succumbed to sleep.

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Take a moment to breathe and think about the story :

  • Do you identify a connection between different social worlds?

  • What do you think the overall theme of the story will be?

  • Is there an actor who stands out for you? Why?

In the morning, Susan arrived a few minutes before her shift. She liked starting with coffee in the staff room and socialising before her rounds. As she prepared the coffee, her manager, Petra, walked in.

“Good morning, Susan. How are you?” Petra asks while grabbing a clean mug from the dishwasher and heading towards Susan who’s brewing coffee.

“I am fine, but tired. I haven’t been sleeping lately.” Susan responds with a warm smile.

Petra smirks “Yeah, I hear ya! I didn’t sleep well either, guess it comes with being a nurse working shifts.”

Susan hesitates but decides to speak, “Actually, I like being a nurse and shifts don’t bother me. Sure, the heavy lifting is hard on my body, but I love connecting with people, and I’m passionate about mental health.” She pauses. “Lately, I have been wondering if I am doing enough here at the hospital. I feel like I have so much to share, but I am not sure who I should ask about taking on more responsibility.”

Petra listens intently but adds only a few words of comfort with no direct suggestions, “I am sorry to hear that, we know you are great at your job.”

A few moments of silence is broken when Susan asks to pour coffee for Petra. They fill their mugs and move together to sit at the table.

“You know, when I was a kid, I never had problems with sleeping because my family had this nightly ritual of sharing stories about the day,” Susan explains. “My parents would tuck me and my brother into bed, and we would take turns sharing what happened that day. Of course, there were good and bad days, but even on the bad days, just by sharing, I could relax to peacefully fall asleep.”

Petra nods, “That sounds a bit like sauna with my kids. On Saturday nights, we all go to sauna to relax and connect after a busy week of work and school. My kids tell some amazing stories, and it is such a pleasure to really see and hear them being animated about friends and experiences.”

As they sip their coffee and continue talking, Henry arrives, grateful to see a full pot of coffee. He grabs a cup, which he fills to the brim with his favourite morning drink and joins the women at the table.

“Good morning, Susan. Good morning, Petra.”

“Good morning,” both women warmly respond.

“Petra, by the way, when is the health village meeting today? Are all the nurses coming?” Henry asks.

“It’s at 10 in room 303. I think everyone confirmed over our group email, so yeah, all will be there.”

Susan blushes and thinks, “Group email? Why wasn’t I included?”

Henry speaks with enthusiasm, “I am so pleased with how well we are building this health village. Can you believe that the idea came from this very room a few years ago?! We have made such progress, and it really is improving how the patients get good, quality care.”

Susan turns and asks Henry, “Where did the idea of the health village come from?”

Henry shares, “Well, we wanted to help people to not feel alone by connecting with us with more ease. Having our services online creates the feeling of a small community like a village where people know where to find us and get the help they deserve.”

Susan recalled her recent experience of looking at the website in the group meeting. She most definitely did not feel that she belonged in that village.

Susan asks a few more questions, “Why only one language? Are there plans to make the information available in English? Not everyone who needs help can understand or make sense of what support is possible in the health village.”

Petra looks at Henry and then back at Susan, “You are right, I never thought of that. I was mostly thinking about my regular patients, my elderly neighbour, and to be honest, myself,” Petra responds and asks, “Susan, are you coming to today’s meeting?”

“I wasn’t part of the group email, but yes, I would like to join. Thanks for asking,” Susan responded.

“Well, time to get started,” Henry says while standing up. Petra joins him to wash her mug, and they walk out of the coffee room together.

Susan stays behind to finish her coffee. She thinks, “I wonder if Petra can add me to the group email? Should I ask if we will get support and time to work on the village? What about the other nurses? How does it affect their work?”

She stands to wash her mug, and before leaving the room, she quickly sends a WhatsApp message to Rick and Julie, “Guess who got invited to the health village!”

Susan switches her mobile to silent and places it gently into her pocket. A surge of energy runs through her body as she walks quickly out the door. “I am definitely gonna get Julie to join,” she thinks determinedly.

Building on the Previous Narratives:

  • What is this story about? Are there main themes or metaphors?

    Is there a protagonist?

  • What is the main activity?

  • What is the object of work?

  • Are there communication tools?

  • Are there rules?

  • Who are the decision makers?

  • Who belongs to the community of practice?

  • Is there collaboration?

  • Are the responsibilities well defined?

  • Which voices are included or excluded from building on the narratives?

  • What is the overall level of occupational well-being?

  • Can other wellness dimensions be identified in the story?

  • How do they differ among the actors?

Consider Yourself a Decision Maker:

  • Which changes should take place? How?

Consider Yourself a Story Mediator:

  • Which stories should be mediated? Which themes intersect? Which combination of actors should meet to exchange stories and why?

We read the story “Building a Health Village” to various audiences, including our 10-year-old daughter, who was up in arms about how poorly Susan was treated by the other health care practitioners. Others felt that Susan was too optimistic in the end and should have been more critical and assertive about the exclusive practices of a health village that promoted inclusion. One person remarked, “if I was left out of group emails, that would be enough for me to leave!” And yet, this is the crux of the story based on data collected over 15 years: your position of power and how you make sense of and act on your experiences are social, embodied, contextual, and purpose-driven. Susan did not choose to be excluded from engaging with her work. Rather how the health village, as a digital tool, was socially constructed and subsequently practised was influenced by the dominant social narratives which afforded meaning and significance to the health village metaphor. Susan’s exclusion was not driven by her lack of motivation, curiosity, and willingness, but rather a lack of an opportunity to discuss her unique experiences in the community of practice. In other words, she is excluded from an opportunity to collaborate and create a metaphorical story based on collective sensemaking of the health village.

In social and material worlds, power is always present, but difficult to identify and communicate. Most often, like in the case of Susan, making sense of the psychological and physical effects of power happens through communication but also painful symptoms within the body. Sense-making is a retrospective and prospective process which never stops and starts cleanly (Weick 1995). People have an inherent need to continuously make sense of what is happening (Wright and Manning 2004, p. 638) through feedback loops (Argyris and Schön 1974) in relation to social interactions, bodily experiences, and the material environment (Sandberg and Tsoukas 2020). Small mundane acts like Susan boiling water for tea while waiting for trusted friends or sharing coffee in the staff room with colleagues may seem insignificant, and yet, these very situations provide her continuous feedback as to how she is positioned within the cultural-historical context in relation to others and to her purpose being there.

Because social and embodied lived experiences are individually unique, most often it is the individual who feels responsible for material and social consequences of the exclusion. Stories like Susan’s are more common as practitioners navigate social worlds based on global and local narratives and from positions of ranked hierarchy that are beyond one’s control. To build sustainable narratives in organisational change, members need to sense their own power and be open to understand how their power is perceived by others. As American novelist Alice Walker, said, “the most common way people give up their power is by thinking they don’t have any” (quoted in Diamond 2016, p. 169).

To bring about effective, responsible, and inclusive change at the workplace requires leaders (or the dominant sense givers) to “impact and influence situations across diverse and unpredictable contexts, legitimately (with implied or explicit cooperation and agreement of others), for the greater good” (Diamond 2016, p. 196). In a nutshell, it is about listening and making sense of stories; and when there is a recurring metaphor like the health village, questioning what the metaphor means to those affected in practice. Deep reflections of how and why narratives and metaphors are used and of the subsequent effects in sensemaking can reveal deeper meaning of taken-for-granted practices such as who is included and excluded in a group email related to, for instance, a new tool for doing the work.

Introducing new tools to the workplace like a digital platform such as the health village can give practitioners an opportunity to reinvent their ways of working (Nicolini 2011) and harness lively discussions about the tools’ purpose. Stories about the tools, which construct the tools’ instrumentality and potential use, are “free floating” in space and time from a formal meeting or group email to having coffee in the staff room. With a work as craft mindset, new tools can ignite curiosity to tinker with the possibilities of what could be by drawing from a community of practice based on shared skills, purpose, and traditions.

The story of the health village started with a perceived “good intention”: to help those who felt lonely by providing accessible and good quality care. Nonetheless, by developing and practicing the tool within the boundaries of the dominant social world’s identities and narratives, the tool became a material extension of the dominant group’s sense-giving.

Taking stock of the sensemaking processes, the central and critical question that arises is what is the metaphorical story of the health village about? By asking this question in relation to the work and its shared purpose within a community of practice, the question then expands to other questions like:

  • What is loneliness?

  • What is a village?

  • What is health?

  • What is the purpose of a health village?

  • Who are the members of a health village?

  • Who is a part of the health village community?

  • Who comes to the health village for help? Are they a part or separate from the community in the village?

  • What happens in a health village?

  • What are the rules in the health village?

  • What is the future of the health village?

Essential to making sense of the recurring metaphors at work is not questioning others, but rather being interested (Terkel and Parker 1998, p.126) and being open to sharing stories from one’s social and occupational position. Collaborative Storytelling with a work as craft mindset provides the possibility of actively listening with curiosity and motivation, to hold the space for another storyteller, while exchanging one’s own story by engaging with the metaphor. In the case of the health village, the health care workers and other stakeholders constructing a village to provide accessible, good quality health care services for those who are lonely is the metaphorical story. With a Story Mediator, the externalisation and validation of each member’s story in relation to the work and the metaphor accords the members an opportunity to craft their stories in relation to the shared purpose of building an accessible and inclusive health village. Recurring themes of the storytellers are loneliness, a sense of community and belonging, and helping others feel included and provided with accessible, good quality care.

From the crafted scripts of their own stories, each member in the Collaborative Story Craft workshop can participate and give consent to what the metaphor means and how it impacts their sensemaking of the work and the organisational change. The Story Mediators can open the discussions to the storytellers’ social and embodied lived experiences in relation to the metaphor without the dominating members imposing assumptions for the community of practice as a whole.

Conclusions

The story portrayed in this chapter was not a direct report of a real series of events; however, it is based on interviews and workshops from previous research. As such, it carries many elements of reality with similar material consequences and outcomes on those involved. Often, organisational change is messy, confusing, non-inclusive, and does not comply with a clear end. Crafting a story that illustrates the challenges of communities of practice can support the externalisation of stories and the exchange of ideas to craft a common future story together.

Approaching work stories with a craft mindset instigates the members of communities of practice to have a problem-solving perspective on collaborative practices. Decision makers, who value inclusiveness as an important component for sustainable change, will question which stories build on the interests of the collective. By imagining questions to the challenges faced in an organisational story will enable the work as craft mindset to be activated. The questions should consider empathy and a well-defined system of values that speaks to the organisational members. If a system of values is not clear or codes of conduct are not well defined, they also should be put into question.

In our practice, the work as craft mindset is influenced by a combination of models,Footnote 1 theories,Footnote 2 methodologies,Footnote 3 and valuesFootnote 4 that interplay with creativity, intuition, embodied senses, embodied lived experiences, and sensemaking ability. We question dominant narratives, recurring themes, and metaphors, trusting that the affordance given to a story, a system of stories, or process of change depends on inclusion and the interaction of different actors that belong to the Collaborative Storytelling Activity System of a community of practice.