A technique used in comedy clubs is helping nurses develop vital communication skills—but without the laughs.
In the emerging practice of medical improv, humor isn't the end goal.
When people hear the word "improv," they usually˙ think of the type of comedy made famous by The Second City, Chicago's comedy club, theater and school of improvisation. But improv doesn't always have to lead to a joke.
"We take teaching strategies and activities from improvisational theater and we use them to build soft skills that we need for communication, teamwork, and leadership," says Beth Boynton, RN, MS, organizational development consultant at Beth Boynton Consulting Services, in Portsmouth, NH.
"Instead of worrying about entertaining or being funny, we're going to focus on how medical improv helps us build skills and solve these big problems in healthcare," she says.
Medical Errors are No Laughing Matter
Major issues such as patient safety, patient experience, job satisfaction, and horizontal and vertical violence are all effected by communication, interpersonal interactions, and teamwork, says Boynton.
Likewise, The Joint Commission cites failure of communication, lack of empowerment, and distraction as contributing factors to sentinel events like wrong-site surgery, patient falls, and unintended retained foreign objects.
The beauty of medical improv is that it helps participants move from intellectually knowing a problem exists to experientially understanding the problem, says Boynton.
Take, for instance, nurse distraction and medical errors. The impact that distractions can have on a nurse's cognition becomes very clear in this video of the medical improv activity "Overload," where one person counts to 100 by fours and mirrors another person's hand motions while being asked simple math and personal questions by the rest of the group.
As the activity goes on, the participant becomes increasingly frustrated and has more difficulty completing the task. Replace the group with call lights, questions from patients' family members, and beeping IV pumps, and it becomes clear why medication errors continue to happen.
A Framework for Medical Improv
Boynton uses six principles to create a framework for a successful medical improv experience:
- Yes, and… A group participant says "Yes" to what another person says and then follows that with an "And…" statement.
- Support your partner. The primary responsibility in an improv relationship is to want your partner to be successful.
- Celebrate risk taking. In medical improv, it's okay to do something that's uncomfortable, like being assertive or speaking up.
- Avoid questions. Participants are encouraged to make statements rather than asking questions because that means they are bringing something to the table rather than asking someone else to do so, Boynton says.
- You have everything you need. This principle helps participants relax and understand that, while they may not be trained actors, whatever they do in that moment is enough and the group is there to support them.
- It's okay to make things up. Obviously this wouldn't fly in a clinical situation, but in medical improv, participants sometimes need to make things up to continue the flow of an improv exercise, says Boynton.
These concepts can be applied to hundreds of different improv activities, like Dr. Know-It-All or Yes, and…/Yes, but…
In the Yes, and…/Yes, but… activity, a group breaks into pairs to talk about a simple topic such as pets. Boynton asks them to have a Yes…and conversation. One person may say, "I love golden retrievers and my dog is going to have puppies." His or her partner could say, "Yes, I like dogs and puppies are adorable."
During a Yes, but… conversation, the partner would respond, "Yes, I like dogs, but puppies are a lot of work."
"What happens is those two conversations have completely different tones," Boynton explains. "You have one conversation that's collaborative and cooperative and builds a relationship. And you have this other conversation that's a little bit antagonistic."
During Yes, and…, participants learn how to listen and be assertive, Boynton says.
"The 'Yes' part is you listening to your partner. The 'and' part is you being assertive. You're bringing something of yourself into this picture," she explains. "If you learn how to play some of these basic improv games, you can learn to have respectful conversations. From that, we will have better teamwork."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.