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LEAD - Legislative Education & Advocacy Development Guide

This guide was developed for the LEAD Program

Story-telling

LEGISLATIVE POLICY-MAKING AND STORY-TELLING.

Legislative policy-making engages the art of story-telling. Persuading our fellow citizens to commit time and treasure to change requires us to engage them in the social construction of a set of stories about the nature of the problem, the suspected causes, the presumed effects of many potential remedies, and the rationale for choosing one solution over another. All of these scenarios require imagination, choices among values and characterizing features, an ability to appreciate complexity, and a willingness to include multiple perspectives and voices.     

Motivational story-telling in policy-making is accomplished by communicating knowledge in such a way that listeners are able to realize its fullest meaning. Powerful stories help us create dynamic mental representations of situations to expand our understanding and ability to envision a better future. 

It has been observed that people will inevitably develop divergent narratives about the same situation based on their level of awareness, prior experiences, mental frameworks and assumptions, acquired values, innate preferences, coping abilities, customs, factional alliances, beliefs about causality, and more. Our story-telling is influenced by our histories. However, in the realm of collective decision-making, narrative divergence can impede the creation of the consensus required for legislative action. In the arena of collaborative policy development, it is vital to establish mutually acceptable procedures for mediation and the reconciliation of divergent narratives (e.g., truth and reconciliation commissions represent the utmost instance of narrative reconciliation to restore civil society after extreme conflict).  

The importance of a shared narrative in legislation is underscored by the way courts seek evidence about the mindsets of constitutional or legislative framers' before deciding on the application of law (e.g.., originalism). In other words, the judiciary wants to know what was the story-by-consensus at the time the law was written since the story provides context for interpretation.        

Story-telling always involves the preferential selection of some phenomena at the expense of other phenomena. We highlight some values at the expense of others. Divergence sometimes occurs because people do not agree about what contexts deserve mention. Litigators and debaters know that a case is often made based on the inclusion or exclusion of contextual elements -  even the inclusion of distracting elements to divert attention or mislead may be feature of political communication.

More than anyone, healthcare professionals participating in the legislative arena must be aware of the ways in which many divergent social values, types of bias related to context, and other forms of error can creep into the construction and application of scientific knowledge because the healthcare professional is called upon to be a fair witness, acting for society's benefit.

 

SCIENTIFIC STORY-TELLING AND NARRATIVE MEDICINE 

Healthcare practitioners often have training and experiences that enable them to make significant contributions to  knowledge construction and narrative development for policy-makers. Their training in scientific discourse familiarizes them with the formal methodologies whereby scientists construct evidence based on controlled observation, construct validity,  reduction of confounding factors, and the application of principles of reasoning. Healthcare professionals have experience appraising evidence and assimilating many data points from a variety of sources in their clinical practice. Additionally, Charon et al. describe the trend from the 1990s to introduce Medical Narrative programs that support clinically useful reflective practices: "The capacity to perceive events or persons fully and to inspect one’s perceptions for accuracy are prerequisites for delivering attentive and empathic clinical care" [1].

In addition to their training in evidence appraisal, professionalism, humanistic care, and reflective practice, healthcare professionals have  experience that helps them understand the differences among people and the need for nuanced approaches to problem-solving. Practitioners have direct experience of how small interventions make significant changes over time, how the lack of intervention sometimes snowballs into disaster, how first doing no harm can be better than a flurry of interventions with problematic risk/reward ratios, and how persistent educational follow-up works as an engine for change over time. Complex circumstances require the ability to approach knowledge building and story-telling with a high tolerance for uncertainty and ambiguity. Legislative policies are always conceived in an environment of complexity.  

 

USING SCRIPTS TO STRUCTURE COLLABORATIVE STORY-TELLING

The LEAD program invites participants to think about the process of collaborative story construction in complex health policy-making. It invokes a variety of scripts (scripted methods) to enable multi-perspectival modeling, values clarification, and decision-making that appreciates the pros and cons of policies that may have mixed results.

Scripts for the LEAD project provide a mutually held, organizing framework for students with diverse backgrounds to form an intentional learning community with shared aims, premises of practice, curriculum-based thinking behaviors, and measures of achievement. Since the goal of developing citizen advocacy within the healing professions, in order to promote broader healing in the body politic, requires the capacity of individuals to enter into community, cooperatively, and with robust collegiality, these scripts are adopted to stabilize the group's common focus as a community of practice.  

LEAD invokes Bloom's taxonomy as a framework for story construction. It is used to support cognitive and affective processing of knowledge in order to maximize dramatic impact, motivation, and integrative understanding. Consider the old adages: "a picture is worth a thousand words" or "seeing is believing" or "the medium is the message [McLuhan]": these maxims speak to the importance of attending to the way an informational message is delivered. Learners that intentionally reflect on their messaging using Bloom's taxonomy to label their communications have been observed to utilize higher level cognitive processing. [2]       

Bloom's taxonomy is essentially a way of classifying thinking activities with increasing complexity. In the box below, each cell represents a knowledge-process predicate that can be used to impart information more effectively in the process of story construction.

 

[1] Charon, Rita, Nellie Hermann, and Michael J. Devlin. "Close reading and creative writing in clinical education: Teaching attention, representation, and affiliation." Academic Medicine 91.3 (2016): 345-350.
[2] Valcke, Martin, et al. "Supporting active cognitive processing in collaborative groups: The potential of Bloom's taxonomy as a labeling tool." The Internet and Higher Education 12.3 (2009): 165-172.

Use Knowledge-Process Predicates to Build Stories

Note the chart of knowledge-process predicates below. Each predicate (e.g, list, classify, differentiate) represents a mental operation on a type of knowledge - these mental operations are tools for increasing awareness within a story or illuminating an impact or value.

Consider how listing the full spectrum of potential consequences associated with keeping sugary sodas in school vending (e.g., the life course of obese children) might be accomplished to maximize the impact of these consequences. 

Consider how legally classifying cocaine in the form of crack versus powder affected federal sentencing and how you might describe and predict the consequences for the families of offenders for generations (e.g., utilizing adverse childhood event evidence of the influence of parental incarceration on the life course and health of children).  

Consider whether ranking students' cognitive functioning and performance following repeated traumas might aid your audience in calculating the cost-benefit payoff of early intervention into predictable cycles of violence.

Consider how to assess the impact of various asthma drug delivery devices and summarize the consequences of denying payment for them in order to conclude that the economic costs of failing to prevent status asthmaticus in children and adults outweighs the costs of making these devices universally available.            

http://oregonstate.edu/instruct/coursedev/models/id/taxonomy/

Why Study The Uses of Narrative In Medicine...in Healthcare Policymaking?

Source: Greenhalgh, Trisha, and Brian Hurwitz. "Why study narrative?." BMJ: British Medical Journal 318.7175 (1999): 48.

Consider substituting the word "patient" for "constituent" or "citizen".

An Example of Utilizing Bloom's Taxonomy To Understand the Story of Goldilocks

The following illustration of Bloom's Taxonomy was presented in Mary Forehand's online essay* about the taxonomy and was drawn from the Omaha Public School Teacher's Corner lesson based on the story of Goldilocks and the Three Bears. (The OPS.org link is inactive).  

* Forehand, M. (2005). Bloom's taxonomy: Original and revised. In M. Orey (Ed.), Emerging perspectives on learning, teaching, and technology. Retrieved <12/07/16>, from http://projects.coe.uga.edu/epltt/

 

Utilize Bloom's Taxomy to Developing a Briefing for a Bill to Improve Academic Outcomes for Students with Disabilities

1. List the "priorities" described on the ADA.gov "Checklist for For Existing Facilities" (version 2.1) - https://www.ada.gov/racheck.pdf

2. Summarize the stated goals of the ADA with respect to facilities and the purpose of the checklist.

3.  Construct a theory as to a ripple effect of non-compliance with the checklist on at least 5 effects on persons who relate to disabled students, but are not themselves, disabled based on articles you retrieve by searching the literature.

4. Explain how the quality of life of students  and learning outcomes may be affected by non-compliant educational facilities based on your search of the literature. .

5. Assess the barriers to educational organizations improving their compliance with the checklist based on your search of the literature.

6. Devise a plan for communicating with 3 significant stakeholder groups who have direct experience of the problems with non-compliance and formats in which you might record the knowledge you attain from them for further dissemination. Provide at least one reference from the literature to justify your choice of formats.

About Rhetoric and Literary Devices Reference & Glossary

Stanford Encyclopedia of Philosophy Website: Aristotle’s Rhetoric - This entry is still meaningful for today's communicators and describes the importance of attending to the quality of rhetorical expression.   

Literary Devices Website - This website defines and offers examples of many literary terms and concepts that may be useful to you in developing stories for your briefs and presentations. How something is said can be make a crucial difference in the impact it has on listeners and the potency of the idea conveyed.

Disclosures

This guide and theory pages were conceived and written by Maureen Clark with James Ronayne as a scholarly work for the purposes of supporting  education and research in legislative advocacy. 

Suggested citation:

MD Clark & JP Ronayne. Legislative Education & Advocacy Development (LEAD) Guide. Library of the Health Sciences, University of Illinois at Chicago, 2016-18.