Integrating narrative medicine into laboratory quality improvement: a sustainable model for reducing coagulation specimen rejections

BACKGROUND: Pre-analytical errors, particularly specimen rejections due to insufficient volume, represent a persistent challenge in coagulation testing, especially in oncology settings where patients often have compromised vascular access. Conventional quality improvement (QI) approaches frequently focus narrowly on procedural compliance and may inadvertently reinforce a punitive, blame-oriented culture between laboratory and nursing teams, thereby undermining systemic problem-solving. This study evaluated whether integrating narrative medicine principles into QI could reduce rejection rates while fostering a just culture grounded in empathy, shared accountability, and patient-centered learning. METHODS: A longitudinal QI study using iterative Plan-Do-Study-Act (PDSA) cycles was conducted at a large tertiary oncology hospital (Jan 2019-Nov 2025). Root-cause analysis identified a "culture of blame" as core drivers. A narrative medicine curriculum utilizing "parallel charts" to foster empathy and mutual understanding was implemented. Monthly coagulation specimen rejection rates were analyzed across three phases using non-parametric statistics and staff behavioral changes were monitored. RESULTS: Rejection rates decreased by 98.6%, from a median of 1.862% (baseline) to 0.026% (optimization phase; p < 0.001). This reduction remained stable during a major staff rotation, indicating the resilience of this system. Qualitative feedback indicated that narrative reflection rebuilt trust and created a "just culture" focused on patient safety rather than individual blame. CONCLUSIONS: Embedding narrative medicine in laboratory QI is a rigorous, evidence-informed strategy. By shifting the focus from technical compliance to human-centered understanding, healthcare systems may better bridge the gap between the laboratory and the clinic, and potentially achieve breakthroughs in patient safety.