title: Understanding Values in a Large Health Care Organization through Work-Life Narratives of High-Performing Employees.
abstract: OBJECTIVE—: To understand high-performing frontline employees' values as reflected in their narratives of day-to-day interactions in a large health care organization. METHODS—: A total of 150 employees representing various roles within the organization were interviewed and asked to share work-life narratives (WLNs) about value-affirming situations (i.e. situations in which they believed their actions to be fully aligned with their values) and value-challenging situations (i.e. when their actions or the actions of others were not consistent with their values), using methods based on appreciative inquiry. RESULTS—: The analysis revealed 10 broad values. Most of the value-affirming WLNs were about the story-teller and team providing care for the patient/family. Half of the value-challenging WLNs were about the story-teller or a patient and barriers created by the organization, supervisor, or physician. Almost half of these focused on "treating others with disrespect/respect". Only 15% of the value-challenging WLNs contained a resolution reached by the participants, often leaving them describing unresolved and frequently negative feelings. CONCLUSIONS—: Appreciative inquiry and thematic analysis methods were found to be an effective tool for understanding the important and sometimes competing role personal and institutional values play in day-to-day work. There is remarkable potential in using WLNs as a way to surface and reinforce shared values and, perhaps more importantly, respectfully to identify and discuss conflicting personal and professional values.
authors.affiliation: Department of Community Mental Health, University of Haifa, Israel, and Indiana University School of Medicine, Indianapolis, Indiana, USA;
authors.forename: Orit
authors.initials: O
authors.lastname: Karnieli-Miller
authors.forename: Amanda C
authors.initials: AC
authors.lastname: Taylor
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
authors.forename: Steven S
authors.initials: SS
authors.lastname: Ivy
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
keywords: Values; appreciative inquiry; narratives; work-life narratives
references.citation: Nurs Inq. 1995 Dec;2(4):211-4
references.pmid: 8705605
references.citation: J Gen Intern Med. 2010 Dec;25(12):1309-14
references.pmid: 20714822
references.citation: J Holist Nurs. 2004 Dec;22(4):379-98
references.pmid: 15486156
references.citation: Ann Intern Med. 2011 Mar 15;154(6):384-90
references.pmid: 21403074
references.citation: Patient Educ Couns. 2006 Sep;62(3):323-9
references.pmid: 16887319
references.citation: ANS Adv Nurs Sci. 1990 Sep;13(1):31-40
references.pmid: 2122799
references.citation: J Adv Nurs. 1998 Oct;28(4):728-36
references.pmid: 9829660
references.citation: Nurs Health Sci. 2006 Mar;8(1):20-6
references.pmid: 16451425
references.citation: Circulation. 2009 Mar 17;119(10):1442-52
references.pmid: 19289649
references.citation: Qual Saf Health Care. 2005 Dec;14(6):443-9
references.pmid: 16326792
references.citation: J Nurs Care Qual. 2007 Oct-Dec;22(4):365-70
references.pmid: 17873735
references.citation: Qual Saf Health Care. 2002 Jun;11(2):148-52
references.pmid: 12448807
references.citation: Nurs Adm Q. 2004 Oct-Dec;28(4):241-8
references.pmid: 15612397
references.citation: J Nurs Educ. 2006 Dec;45(12):504-11
references.pmid: 17190363
references.citation: JAMA. 2001 Oct 17;286(15):1897-902
references.pmid: 11597295
references.citation: Ann Intern Med. 1996 Nov 1;125(9):770-1
references.pmid: 8929012