Walking into the Pennsylvania Hospital (PAH) emergency room with a self-described “weird” cough in early spring 2020, Mathew Beshara, MD, an associate professor of Clinical Obstetrics and Gynecology in the Perelman School of Medicine at the University of Pennsylvania, wound up being one of the first cases of COVID-19 treated at Penn Medicine. His condition deteriorated very quickly — he was intubated and remained in the intensive care unit for about 56 days and on a ventilator for over 30 days.
As someone who was always on the other side of the healing equation, Beshara was not only at the mercy of the coronavirus, but he also experienced vulnerability as a patient dependent upon a care team to save his life. The experience impacted him deeply and permanently, and he ended up sharing his story in a piece titled “56 Days.” For the first time, the Penn Medicine surgeon explained in the audio and written piece, he truly understood how the power differential registers from the patient’s point of view.
This all came about through the Penn Medicine Listening Lab.
Narrative-based medicine, which has been gaining traction for quite some time, focuses on placing a patient’s story at the center of care. A diverse group of Penn patients, caregivers, academics, clinicians, and administrative staff came up with an approach to listen in a way that was unique and innovative in a health care setting and the Listening Lab was born. The first of its kind in the country, the Listening Lab is an online storytelling initiative that advocates listening as a form of care. Its mission is to “affirm and celebrate listening to everyone in the care setting as essential to the work of healing.”
Programs that capture stories such as The Patient Revolution from the Mayo Clinic, the Healthy Story Collaborative at Harvard, and the My Life, My Story Veterans Affairs program, focus on the patient experience and storytelling. The Listening Lab evolves those models by creatively expanding storytelling efforts to include not just patients, but the whole care team and caregiver community.
It was a matter of happenstance that the Listening Lab would prove to be an important lifeline for so many during the early days of the pandemic.
Launched in 2019, the Listening Lab was introduced to the health system just before the pandemic and the racial justice awakening would challenge us to care for one another in ways we never have before.
“The stories return agency to the individual and enable individuals to creatively work through their experiences and their grief, but also be more receptive to the grief of others,” said Aaron Levy, PhD, MPhil, senior lecturer in English and History of Art at Penn, special advisor for Health Humanities Initiatives at Penn Medicine, and founding director of the Listening Lab. “When we listen intentionally to each other, and share our experiences with one another, we are better caring for one another.”
The Launch Heard Around the Health System
The Listening Lab launched under the sponsorship of the Patient Experience Leadership Team (PMXLT) — a group of more than 50 operational, clinical, and administrative leaders from across the system who focus on the patient experience at Penn Medicine — with an exhibition at the Hospital of the University of Pennsylvania (HUP) during Penn Medicine Experience Week. The exhibit then traveled across the health system from 2019 through 2020 and transitioned to an online format during the pandemic.
Over 50 stories and 30,000 listening sessions later, a variety of voices have been featured, including physicians, nurses, food service workers, environmental services staff, caregivers, and patients, as well as chaplains, call center staff, ambassadors, social workers, and home care workers. There are also first-person narratives of lived experiences of illness, disability, sexual assault, COVID-19, trauma, racism, and other issues.
Teya Sepinuck, a Penn Medicine patient advisor, patient, and co-creator of the project, describes the impact of finding oneself in these stories, “the healing we can do as human beings with each other is greater than just the healing of stitching up the body.”
The Elements of Listening
Levy asserts that the Listening Lab serves as a complement and innovative approach to measuring the patient experience and clinician well-being. The essential ingredient is right in the name — listening. While sharing experiences can be cathartic for the storyteller, through listening students can learn more about caring for patients, caregivers can gain a better understanding of their work, and more. Levy says listening is a form of art that requires work, self-discipline, and skill. Two specific types of listening are integral — active and reflective.
Active listening forms the basis of all good relationships and involves listening not just to the content, but the intent and feeling of the speaker — and showing an interest as the listener.
Reflective listening entails acknowledging that the person you are listening to is heard and understood. It is an active ingredient in cultural humility, a value that Penn Medicine leaders plan to emphasize in an educational campaign with health system staff beginning this summer, with storytelling support from the Listening Lab.
“Cultural humility underpins our health system’s core behavioral standards and you can see it reflected in the Listening Lab,” said Stephanie Kindt, senior organizational development consultant and a Listening Lab co-founder. “It’s iterative nature encourages continuous learning and self-reflection, which will only strengthen our service excellence.”
What’s Next for the Listening Lab
The Listening Lab has attracted interest outside Penn Medicine, with features in local and national media, as well as through health care and patient experience groups. For example, the Beryl Institute (a premier organization focused on the patient experience) selected the project as part of its spring 2021 Webinar Series and Vizient selected the Listening Lab as a power presentation during its fall 2021 national conference. The project was also highlighted in the American Journal of Medical Quality, and it has been featured as a topic of multiple grand rounds at Penn Medicine and other hospitals.
Along with continuing to gather stories, the Listening Lab recently launched Listening Guides through its website that offer instructions to use the stories as a catalyst for discussion with a group, team, or for individual reflection. The guides are created around themes that have emerged from the lab’s collection of stories. The project demonstrates awareness of the impact listening can have on an individual and offers the guides as well as other supporting resources to support its audience.
In addition, the team recently launched a newsletter, “On Listening,” which will be shared as new stories are added, events scheduled, or new publications come out. People are welcome to subscribe to the newsletter by joining the mailing list.
Adding to the suite of mediums for distributing Listening Lab audio content, the team is currently developing a podcast series titled, “Listening as Medicine” that will explore the impact and ripple effects for those who have shared their stories publicly and how the act of sharing and being heard has been transformative.
What’s more, earlier this year, transcripts of each story were edited and turned into a publication, “The Language of Care: Stories from the Penn Medicine Listening Lab.” It is available for download as an e-book or PDF or you can purchase a copy. Penn Medicine employees can request a free copy. Copies are also available at the Family Caregiver Center at the Pavilion at HUP.
From the beginning, the project had support from many senior leaders across Penn Medicine including Chief Executive Officer for the University of Pennsylvania Health System Kevin B. Mahoney, who authored a foreword in the new book. “Stories have incredible power to drive organizational transformation,” he wrote. “They help us take a second look at our own belief systems through someone else’s lived experience.”