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Making an investigative piece about ‘preventable harm’ accessible to readers Date: 08/27/15

Sarah Kliff

By Sarah Kliff

My story,“Do No Harm,” began with a simple question.

I am one of AHCJ's 2015 Reporting Fellows on Health Care Performance and, while writing a series on fatal medical errors, I wanted to understand why preventable harm happens. Why do errors that we know how to stop persist?

My attempt to answer that question became one of the largest projects I've undertaken as a journalist. “Do No Harm,” published on Vox, took me about four months to research, report, and write. I learned a lot about how to manage big projects — and find good sources for long narratives. Here are a few lessons I took away from the experience.

Use readers to find sources

To help track down patient sources, I collaborated with ProPublica. The investigative news nonprofit allowed me to create a copy of its Google Survey to collect patients’ stories of harm. I posted the spreadsheet with an explanatory piece about the frequency of harm in the health care system. Responses began to come in almost immediately.

A woman named Claire McCormack wrote about her daughter, Nora Bostrom, who had died in November 2013 after suffering four central line infections in her last year of life. She was 3 years old.

Nora's story jumped out at me immediately. I knew that central line infections were one of those harms that researchers largely had figured out to prevent. I contacted Claire in late February for an initial interview, which lasted about two hours.

I began to research central line infections more heavily, as I now knew that would be the focus of my story. I contacted Johns Hopkins University’s Peter Pronovost, who pioneered much of the research on prevention of these types of infections, as well as other experts on Nora's particular disease, pulmonary hypertension. I also took a two-day trip to Palo Alto, Calif., to visit Claire and her husband, Tomas Bostrom.

Tame the data deluge

One of the biggest challenges I faced in this story was working with a large volume of medical records. Claire sent me thousands of pages of Nora's records, which I needed to document the harms she had said occurred. I had never worked on a story with so many medical records and, at first, had a bit of trouble figuring out where to even start.

I found DocumentCloud to be a hugely helpful tool. It gave me the ability to search the (previously unsearchable) PDFs that Claire had provided and insert notes at important points. This was a huge help in keeping me organized as I wrote the narrative about Nora's experience.

Even though I now had the medical records organized on DocumentCloud, I needed help understanding them. When I would get to a point in Nora's record where I didn't understand a particular note, or wanted more information about the prognosis for a patient like her, I sought out researchers who had done work in these particular issues. I searched academic journals via Google Scholar to find relevant researchers, or asked the communication department at the appropriate professional society to connect me with an expert.

Tell the story with analogies

On the plane ride back to Washington, D.C. from my visit with Nora's parents, I brainstormed the best way to tell her story. I was still thinking a lot about the central question I had started with: why does harm we know how to prevent still persist in the American health care system?

I had come away from my reporting thinking hospitals' attitudes to harm mattered — whether they saw it as something they could preventable, or that it was an inevitable occurrence. I wanted a way to make that difference understandable to readers. I thought about using an analogy about how we react to car crashes compared with plane crashes. I texted Johnny Harris, a multimedia producer at Vox who was working on the story with me, about it.

This analogy began as a paragraph in my first draft, but by the end of the editing process it was an entire section in the story. It’s an aspect of the story that I’ve gotten some of the best feedback about. Readers have told me that the analogy to something outside of health care helped make my story make sense to them. In a 5000-word narrative, an analogy to help organize your main point can go a long way.

Use teamwork to produce a multimedia experience

In the Vox newsroom, we have a very collaborative culture. Writers work closely with designers and product developers to think about how we can best serve our readers, especially for our bigger projects.

For this project I worked with a team of about a dozen staff members, including a project manager, videographer, designer, news app developer, illustrator, copy editor and a lawyer. After I returned from California, we began to hold weekly meetings to check on what each person had done, and what tasks remained. The meetings were helpful to make sure that each part of the project — whether it was an interactive map on hospital infection rates or a video documentary — would make deadline. These meetings also would give a heads-up whether one team member was holding up another team member – our designer, for example, couldn't create a GIF of a PICC line until I got the right instructions from a hospital.

Working together so closely, and in constant communication, helped us manage and track a large project with many moving parts.

Sarah Kliff is a senior editor at the online news site Vox. During her 2015 AHCJ Reporting Fellowship on Health Care Performance, she has been focusing on fatal medical errors and what differentiates hospitals with high and low rates.