Improv or “Medical Improv”* builds skills that promote the emergent behaviors we need for collaborative practice and cultures. In this 75 min presentation, you’ll learn how the principles of improv can be applied to critical skills, thinking, and relationship-building among healthcare professionals. You’ll meet pioneers in the “Medical Improv” field, explore opportunities for utilizing current strategies, learn about upcoming applications, and participate in Q and A. Join Organizational Development, Consultant Beth Boynton, RN, MS with Co-presenter Stephanie Frederick, RN, M.Ed and and Sponsor, Judy White, SPHR, GPHR in an invitation to learn more about cutting-edge applications of Improv in healthcare settings.
“Medical Improv”, is a term coined by Professor Katie Watson, JD of Northwestern University Feinberg School of Medicine in her curriculum for medical students.
www.confideentvoices.com
8. By building the soft skills we need…
1 Communicate
2 Collaborate
3 Lead
#medimprov08
9. Overview
Introductions: Meet our Expert Panel
Compelling evidence for building soft skills.
Medical Improv Classroom: teaching strategies,
principles, and games.
How can you begin to pilot Medical Improv in your
healthcare setting?
Q & A
#medimprov08
10. Our Expert Panel
Who are you? What inspired you to join us today?
How are you or will you be using Medical Improv in
healthcare?
(About 2 minutes each! )
#medimprov08
11. Lauren Dowden,
MSW Candidate
Stephanie Draus, ND
Edward J. Dunn, MD
Dan Sipp, SP
Nancy Smithner, PhD Richard Snyder, MD Tobias Squier-Roper, BFA
#mediprov08
12. What are soft skills?
#medimprov08
•Communication
•Emotional intelligence
•Interpersonal/relationships
13. How are problems with soft skills
contributing to problems with safety and
quality?
#medimprov08
14. Progress with patient safety has been slow!
In 1999. Institute of Medicine (IOM)
Report -To Err is Human: Building a
Safer Health System
Estimated 44,000-98,000 deaths
every year due to medical errors
#medimprov08
15. Health Affairs April 2011
• 187,000 deaths in hospitals per year
• Preventable medical errors are ten
times more frequent than hospitals
and regulators are reporting.
• Estimated cost of 17.1 Billion in 2008
#medimprov08
17. The Joint Commission tracks root causes of sentinel
events.
What do you think the top 3 causes of these
preventable and catastrophic errors were in 2010,
2011, 2012?
#medimprov08
18. Leadership
Human Factors
Communication
http://www.jointcommission.org/assets/1/18/Root_Causes
_Event_Type_04_4Q2012.pdf
#medimprov08
19. Each cause or category has subcategories that are
filled with implications involving soft skills
20. Category: Leadership
Subcategories:
Organizational planning, organizational culture,
community relations, service availability, priority
setting, resource allocation, complaint resolution,
leadership collaboration, standardization (e.g., clinical
practice guidelines), directing department/services,
integration of services, inadequate policies and
procedures, noncompliance with policies and
procedures, performance improvement, medical staff
organization, nursing leadership
21. Priority setting requires…
• Self awareness
• Awareness of others
• Being assertive
• Being a respectful listener
22. How are problems with soft skills contributing to
concerns with our workforce and work cultures?
#medimprov08
23. Workforce & Culture
Through the Eyes of the Workforce: Creating Joy,
Meaning, and Safer Healthcare-
Lucian Leape Institute-NPSF Roundtable Report (2013)-
http://bit.ly/104KSE4
#medimprov08
24. Physical Harm
Health care workforce injuries are 30 times higher than
other industries.
“I need help giving this patient a boost in bed”
#medimprov08
25. Psychological Harm
Lack of respect
A root cause, if not THE root cause, of dysfunctional
Cultures
95% of nurses report it; 100% of medical students; huge
issue for patients
#medimprov08
A nurse waits a little too long to report a patient’s
increasing blood pressure to a physician. The last
time she tried to talk with him about a concern,
he was abusive.
27. Alan Rosenstein, MD, MBA
Medical Director of Clinical Efficiency & Care Management at ValleyCare Hospital
www.physiciandisruptivebehavior.com
No one starts out the day planning to be
disruptive. We must recognize the
emotional impact and downstream effect of
inappropriate behaviors and explore
experiential learning methods, like
“medical improv” that build the necessary
skill sets for positive change.
#medimprov08
28. How are problems with soft skills contributing
to problems with Patient Experience?
(Presented by: Stephanie Frederick, M.Ed., RN)
#medimprov08
29. We all have an equal opportunity to be
recipients of hospital care…
What would YOU want your
Patient Experience to be like?
#medimprov08
30. Defining Patient Experience:
The sum of all interactions, shaped by an
organization’s culture, that influence patient
perceptions across the continuum of care.
-The Beryl Institute
#medimprov08
31.
32.
33. COMMUNICATION is the key…
Patients
observing hospital administration/staff:
Interactions (content, tone, manner of what’s said)
Culture (is it supportive?, safe?, respectful?)
Patients and family members want to:
Feel listened to, understand information and
options, be encouraged, engaged, and empowered
in their care
#medimprov08
34. Medical Improv Builds “Soft Skills”
for
Communication
Collaboration
Leadership
To support “the sum of all interactions”
(the Patient Experience)
#medimprov08
35. Patient Experience
Will you tell about
how well you were treated,
or
what was “done” to you
while a patient in the hospital?
#medimprov08
36. What does a Medical Improv class look like?
#medimprov08
37. Teaching Strategies
Frame with objectives & brainstorming
Principles of Medical Improv
Games & activities
Debrief, reflection, action plan
Notes:
Variables: time, audience, skill focus, complexity…
Expertise in healthcare AND improv
#medimprov08
38. Principles of Medical Improv
“Yes and…” Affirm and add (don’t negate)
Surrender your plan & co-create
See ‘failure’ as opportunity (to learn, be human, forgive,
help)
Listen-be present
Avoid questions
You have everything you need!
Support each other
#medimprov08
39. Games & Activities (100s more)
Yes and…, Yes but…, No…
Teaching/learning: Assertiveness, listening,
collaboration, validation/invalidation & reinforces
medical improv principle: “Yes and...”
Status Slide, One-Up-Man-Ship
Teaching/learning: Status-related verbal &
nonverbal communication, body language, comfort
level, self and other awareness, leadership skills, and
therapeutic relationships.
#medimprov08
40. Like practicing a team sport,
Medical Improv elevates
each player’s ability to
communicate, collaborate,
and lead.
So when the game starts,
individuals and teams are
performing at their best.
#medimprov08
41. Unpredictable and fluid, the human interactive aspects
of healthcare interventions can emerge in the moment
with a positive dynamic that has already been
established.
#medimprov08
42. How can you begin to pilot
Medical Improv programs?
Beth Boynton Stephanie Frederick
#medimprov08
43. "Creative Solutions for Integrating Healthcare"
(Stephanie Frederick, M.Ed., RN)
Collaboration across all disciplines of healthcare
(conventional, traditional, complementary)
Medical Improv training coordination to facilitate
communication, quality and safety of care in the U.S.
Consultant/Advocate for engaging and empowering the
Patient Experience
Program and Curriculum Development for healthcare
organizations and higher education in the U.S.
Contact: stephaniefrederick@outlook.com
Website: stephaniefrederick.com
#medimprov08
44. Beth Boynton, RN, MS Consulting
Medical Improv workshops
Integrating with ‘Whole Systems’ consulting work
Hospital-based Programs (pilot projects)
Undergraduate curriculum development for of ALL
healthcare & related studies
Promote/develop train-the-trainer programs (Professor
Katie Watson, Dr. Belinda Fu are planning next one-fall
2014)
#medimprov08
45. Q & A
Working Definition:
Medical Improv is the study and practice of improv theater
philosophy and techniques as applied to the unique challenges
and environment of healthcare for the benefit of improved
health and well being of providers and patients.
--Professor Katie Watson, JD Northwestern University & Belinda
Fu, MD, University of Washington
#medimprov08
Beth introduces Stephanie and Panel. (Unless Stephanie or Judy want to).
Beth
Beth
People skills
Emotional intelligence
Trust
Assertiveness and ownership
Flexibility
Respect for self & others
Cooperative
Curiosity
Respectful listening
Ability to see other perspectives
Empathy
Impulse control
We’ll be talking a lot about soft skills today.
Two Points
Persistent problems in patient safety.
And they involve “soft skills”
.
Leading healthcare policy journal
The order changes a bit for leadership and HF (2011 and 2012 HF was first and Leadership 2nd).
“Many [healthcare workers] are subjected to being bullied, harassed, demeaned, ignored, and in the most extreme cases, physically assaulted. They are also physically injured by working in conditions of known and preventable environmental risk”
Full report, exec summary and slide presentation all available online.
Over 100 citations.
Common injuries include musculoskeletal and blood-borne pathogen exposure.
Leading to:
Burnout, lost work hours, turnover, inability to attract newcomers to caring professions
Less vigilance with regard to safety practices –both for patients and for workforce
Increased opportunities for medical errors
Impact on patient experience
Pioneer in disruptive behavior, Led landmark study w/ VHA West Coast on impact of disruptive behavior.
Involved over 4500 docs, nurses, execs and others.
Thank you, Beth.
As Judy mentioned in my introduction, some of my consulting work has been as an RN Health Advocate….
What I’ve realized is that most patients never imagined themselves to be in the situation they were in. But, as we all know, life is full of surprises!
I see it as an equal opportunity for any one of us to be a recipient of hospital care…So, I invite you to imagine yourself as a hospital patient as I go through the next few slides...
What would YOU want your patient experience to be like?
This is the definition for Patient Experience provided by the Beryl Institute, who’s a global leader in this area.
Patient Experience is…. the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care….
I’ve seen how vulnerable, frightened, and confused people are when they’re hospitalized. They’re not in control of their environment and their perspective is often distorted by their condition and the interactions of the hospital “culture” that they’re exposed to.
The next couple of slides reference a 2013 Benchmarking Study, also from the Beryl Institute, highlighting The State of Patient Experience in American Hospitals.
We’ll focus on the top 2 priorities, and Beth has already covered Quality and Safety, which is second on the list.
Patient experience and satisfaction is the #1 priority of the 1,100 healthcare leaders that responded to this 2013 study.
And coming from a patient or family member’s perspective, they don’t know where the boundaries are between where service, quality and safety.
They’re seeing their overall experience, and that’s how they’ll judge the healthcare facility.
This slide indicates what a hospital sees as the key components in their organization’s Patient Experience effort.
All of these key tactics, whether it’s sharing patient satisfaction scores, or discussing client cases…..the top 4 areas all reflect a need for improving hospital communication among administration, leadership and staff members.
Once again, to emphasize that communication is essential….consider yourself as the patient or family member…..
Observing hospital administration/staff:……
It’s important for patients and family members to feel listened to, to understand information and their options, to be encouraged, engaged and empowered in their care…..
So, if you’re the hospitalized patient I’ve been talking about…..
Will you be telling stories about how well you were treated (that the healthcare team was kind, respectful, understanding, supportive), or what was “done” to you? (no explanations, interruptions, not listening, disregarded, inflexible schedules, etc.….)
As healthcare delivery shifts and is redesigned, it’s important for each one of us to stay empowered and to be heard about how we define the Patient Experience for ourselves, as individuals
So, thank you all, once again, for being here today. And now Beth will continue with the Medical Improv presentation….
In pairs (two panel members) discuss food
Every sentence except the first starts with:
Yes and…
In pairs (two panel members) discuss animals
Yes but…
In pairs (two panel members) discuss music
Debrief:
Which is easier?
What learning opportunities does this offer?
How are they relevant to you? To healthcare?
Debrief to panel: Quick thoughts: Relevance to you in your HC role?
It is the missing piece in addressing communication & collaboration.
Stephanie:
"Creative Solutions for Integrating Healthcare"
Communication and collaboration across all disciplines of healthcare (conventional, traditional, complementary). (Start the conversation and think of it as cross pollination of information and support)
Medical Improv training coordination to facilitate communication, quality and safety of care. (Beth, myself and others bringing an awareness and implementation of Medical Improv programs around the country).
Consultant for engaging and empowering the Patient Experience. (Continued work with individuals and administration to target positive patient experience)
Program and Curriculum Development for healthcare organizations and higher education. (Han University of Traditional Medicine…..current project for new program design that will focus of the cross pollination of education across all disciplines, in addition to ways of enhancing the patient experience)