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An Oscar for the Pacient

Oscar for the Pacient
Inspiring Active Learning through Action Methods

by Irina Stefanescu


“I do what I like and I like what I do… every day” (Mary Poppins)

Context

A business manager in a pharmaceutical company invited me on a November day into her office and said:

– I am organizing a symposium on epilepsy for our product reinforcement, I have arranged speakers and a festive dinner, and I thought I had done everything, but you know what several neurologists asked me yesterday? “Could you bring the facilitator we worked with last year in October as we remember that workshop as a very special one. We discussed a lot, we shared from our experience, we all had time to speak, there were some serious issues we focused on, and we had fun together!”

When I asked “How many participants?” her answer shocked me: “between 100 and 120”. This would be the first time I had worked with so many specialists, many of them considerably older than me. The workshop in October one year before had been with 40 participants. I took a deep breath and I started to interview her.

After a long discussion about her specific goals for the workshop, we ended up focusing on 3 key outcomes. We wanted to create:

–          clear pictures of the patient profile in the prescribers’ minds

–          clear statements of the product’s benefits compared to other products

–          a memorable event for the doctors to reinforce the company and the product image

We also considered some valuable background information:

–          the neurologists are generally not fond of diagnosing and treating epilepsy

–          although the product is highly effective, it isn’t the first choice prescription because of its high cost and powerful impact

–          patients with epilepsy perceive the disease as a stigma and many of them experience discrimination in their families or working environments

I agreed to design and run the workshop, as long as there was no scientific presentation, or commercial claims included so that participants felt free to express their opinions, fears, likes, dislikes and experiences.

How I did it

Set-up and resources

The huge square conference room was ideal for this workshop. There was plenty of room for 110 chairs around the room in a big double circle; the carpet was vividly coloured and I could use the forms and colours to arrange working spaces; the sound was good and the greatest thing for me was the lighting system – a large circle of light projectors on the ceiling that could highlight a round scene on the floor.

I had a small wooden stage, two cordless microphones, a beamer, a laptop to project 5 slides, 3 mantles made of sackcloth and 4 differently coloured sets of 3 ribbons.

3 colleagues, a video camera, a lighting operator.

The scientific resource I needed most – 3 real clinical cases, minus private details, appropriate for treatment with the product involved – had been prepared two weeks beforehand with a University lecturer and researcher who had considerable experience with the product.

Time: half a day

Warm-up

For the warm-up I needed a good, impactful story to be able to reach their minds and hearts and also to redefine their role as therapists. Why should they move, as they don’t like epilepsy too much? I needed to empower them to believe in their therapeutic holistic role – they are treating not only a disease, but also a human being with mind, soul, spirit and body. I remember Jörg Burmeister’s story about Flamenco and about the significance of this dance. The simplest Flamenco step used by women and men means “I have the right to be, here I am!”

So the title of the workshop was “Restore self-confidence with just one step”. On the wall I beamed a huge picture of Flamenco dancers dressed in red with Flamenco music in the background. I introduced myself briefly, stated the goals of the workshop and named the doctors as architects who restored the inner beauty of their patients with epilepsy by helping them to regain their self-confidence. I told a story about Flamenco and its birth in Andalusia, made the step 2-3 times quite loudly on the stage and then invited everybody to do it.

Once they were standing and dancing, they are involved! In just 7 minutes they were up on their feet, stepping and smiling!

Participants needed to feel secure and to begin to explore the space we were working in, so I asked everybody to show where they came from. I asked the groups to demonstrate the specific sound of their place. They talked for one minute, then started smiling and became curious about the other places’ sound.

I quickly needed to know who were the most experienced participants in working with this product, so I invited them to form a spectrogram. After interviewing 5 of them, I learnt who were the specialists I could count on for technical issues.

The last thing before warming up for roles was to have heterogeneous groups. I needed 12 groups. There are 12 months in a year, so I got the participants to arrange themselves in groups according to the month they were born in.

The 12 groups were:

– 3 groups of patients (P1, P2 and P3),

– 3 groups of therapists (T1, T2, and T3 – T1 is therapist for P1, T2 for P2 and T3 for P3),

– 4 groups of molecules (M1, M2, M3, M4), (M1 – the company’s product and M2, M3, M4 – three competitors)

– 1 group to be the Ministry of Health (MH)

– 1 group to be the National Health Insurance House (NHIH)

I showed 3 slides with the 3 clinical cases and I gave the clinical report of patient 1 to P1 and T1, that of the second patient to P2 and T2 and the third one to P3 and T3. All three clinical cases were handed to M1, M2, M3, M4, MH and NHIH. There were no diagnoses, no names, no jobs, and no information about family; just age, gender, symptoms and some previous episodes described very briefly.

Each group had 18-20 minutes

a)      for group members to present themselves to each other saying their name, the town they came from and 3 personal traits

b)      to find 2 things they had in common apart from being doctors, neurologists or something too evident

c)      to select a main actor for the group

d)     and to prepare

  • P1, P2, P3 – the stories of the three patients
  • T1, T2, T3 – the questions to probe the patients
  • M1, M2, M3, M4 – the possible benefits for each patient
  • MH and NHIH – what is most important when dealing with these patients from their point of view and what are their main goals

Enactment

As the patient groups sent their representative one after the other onto the stage to tell his/her story, we dressed that person with the disease mantle and invited the person to sit on a chair. We handed a set of 3 ribbons to each molecule group.

  1. P1 told the story to T1. T1 asked questions, received answers. Stop. The same with pairs P2-T2 and P3-T3.
  2. T1, T2 and T3 were invited to return to their groups and discuss the possible diagnosis.
  3. Meanwhile M1, M2, M3 and M4 were invited – one at a time – to go to each patient and tell why that molecule fits or doesn’t in the treatment scheme, outlining indications, main benefits, side effects, treatment terms, drug interactions and the mechanism of action. If a molecule considered herself appropriate for a patient, then she put a ribbon around the neck of the patient.
  4. T1, T2 and T3 groups were then invited to confer for 3 min. about the treatment they would have recommended.
  5. T1, T2, and T3 then told the patient (T1 to P1, etc.) the diagnosis, then recommended treatment and advised the patient about the appropriate life-style for the treatment to be effective. If they didn’t validate a molecule, then they took the ribbon off the patient while justifying the decision.
  6. MH and NHIH assessed the treatment according to their goals and policies.

Sharing

The P’s took off their mantles while still on the lit stage and shared loudly from their role how they felt they had been treated and what had happened to them during the enactment. This was a very important part of the workshop, because it was a strong educational moment about managing the relationship with the patient. Nobody normally tells the specialists how to manage a relationship with the patient.

Then, back in groups, people had 12 minutes to briefly share– the actor from the role and all from their former experience linked to what happened on the stage. They then prepared a 30” conclusion as to the learning points they were taking back home with them and presented these through another group member to the entire audience.

End

Finally back on the small wooden stage, with the Flamenco music in the background, I concluded about what I had observed and congratulated them on their role of self-confidence restorers. I got everyone to make the Flamenco step again, thanked them and said good bye.

Conclusion

What happened to those 3 goals we had? 14 months have passed since then and the doctors in their feedback to the medical representatives still remember the workshop. They retained vivid images of the patients on the stage and they remember which molecules were chosen and why. The medical representatives can still rely on those images to build new patient profiles and to remind them of the product’s benefits.

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Ce urmeaza:
2-3 iunie 2012

"Dezvoltă și transformă - oameni, grupuri, organizații"

Living Newspaper, Forum Theatre, Playback Theatre


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