This film weaves together and amplifies the stories from individuals and groups intentionally leading change, wherever they are situated in their respective ‘system’. It reveals some of the many ways that these changemakers have managed to significantly impact their health care environments and improve health outcomes, often through relatively small, local interventions. Their experiences span subjects such as improving patient safety and reducing patient harm; preventing the death of newborns through a model that places parents at the centre of specialized care; transforming mental health programming; addressing the root causes of teenage suicide; saving the lives of babies born with anomalies; or promoting community health and introducing compassion in health leadership.
Why transformative approaches in health care?
The COVID-19 pandemic has revealed the challenging, stressful and highly complex environments that staff working in health and social care must navigate. Health systems are a microcosm of the societies in which they are embedded and therefore have social and cultural attributes that influence clinical and technical practice.
If countries are to strengthen primary health care and universal health coverage as contributors to the Sustainable Development Goals, what is needed are: shifts in mindset, the re-design of health services, an overhaul of training for all health professionals, and a redistribution of resources and accountability to an unprecedented extent. Pockets of innovation are taking place in many different contexts, innovations that reflect these shifts.
The developmental process
In 2021, WHO and the Presencing Institute convened a series of online gatherings as part of a global Health & Well-being Hub. These gatherings brought together people engaged in health system transformation from different parts of the world. Health care professionals, community health workers, patient representatives, health educators and activists, across low-, middle- and high-income countries described how they worked through their challenges and inspired and enlisted others to act. The Hub hosts and professional storytellers they had invited into these gatherings harvested these stories.
Following these initial meetings, the storytellers held interviews with individuals representing a wide range of health issues and variety of settings. From these detailed descriptions, emerging themes were analysed and synthesized. The themes were explored and validated through a further series of online meetings. Then came the task of turning these stories into a script and film that kept the integrity and humanity of the stories intact, while capturing the complexity as well as the simplicity of a wide range of interventions and practices that were being successfully implemented and making a difference within health systems.
The skill of the storytellers/scriptwriters was to embody what they were capturing throughout the process of creating the film: how they listened; what kinds of questions they asked; and how they prepared themselves and the actors, who were engaged to bring the stories to life. The task of the actors was to portray and maintain fidelity to peoples’ lived experience; to give the stories “the justice that they deserve” (as Karlina-Grace-Paseda, one of the three actors, observed).
The storytellers/scriptwriters observed that in hierarchical organizations individuals often do not feel they have the power to bring about change. The intention of the film is to amplify the small changes that people have initiated, and thereby hopefully give confidence to others to do the same. The power of stories is that they show the complexity and diversity of lived experience in these different contexts, without trying to make ‘one golden rule’ for initiating change. The result is a mosaic of an entire system engagingly captured through the voices of multiple perspectives.
Reimagining health care systems of the future
The call to action is that change can be triggered by anyone, at any level of a health system. The message for policy-makers, funders and researchers is to connect our head and heart and invest in solutions developed by people and for people. By turning inwards and creating opportunities for the “system” to see itself and feel itself, the stimulus and impetus for change is ignited from the inside out. Leadership is relational and a practice that is to be stepped into, while learning becomes a way of being and doing that spreads in ways that are organic, emergent and unexpected – and therefore far-reaching and sustained.