Medical Improv: A Surprising Intervention for Critical Outcomes
You don’t often connect improv with the improvisations that happen across healthcare daily. Learn the potential of improv training to advance healthcare outcomes. Read how using improv to design fun and engaging ways can improve communication, collaboration, and organizational culture.
Beth Boynton, RN, MS, CP
What do Critical Outcomes in Healthcare and Medical Improv Have in Common?
Patient safety, patient experience, workforce health, and cost-effectiveness are critical outcomes that have an important common root. They’re all impacted by our ability to communicate effectively and respectfully[1][2]! Challenging, in part, because communication involves underlying emotional intelligence, which is hard to develop and practice, especially in high-stakes, high-stress work[3] or in toxic cultures[4].
The good news is that Medical Improv is an engaging, effective, and fun way to learn these skills!
What is Medical Improv?
It is an emerging field that adapts the “Yes and . . .” philosophy and activities from theater improvisation for improving communication-related skills & critical outcomes in healthcare.
For example, Radical Acceptance is an activity actors use to warm up before a performance. Deceptively simple, it can be adapted for individual and team development to promote confidence, collaboration, assertiveness, and more[5]. Here are short clips of three activities useful for a variety of communication-related skills:
- Same-Time-Story - (listening, creativity, nonverbal communication)
- Ebb Tide - (situational awareness, presence in a team)
- Physical Phone - (communication errors in handoffs[6])
Recent work with Ball State University faculty and students proved invaluable in building core competencies of Interprofessional Education Collaboration (IPEC)[7].
How did I become a specialist in Medical Improv?
Around the turn of the century, after 15 years of practice mostly in Occupational and Home Health, I thought I was leaving healthcare for good. Divorce, and sharing custody of my 5-year-old son provided big incentives for diving into psychotherapy where I learned I was a great advocate for patients, but not for myself.
As I started to identify, value, and express my own needs and wants at work, I discovered that being assertive for patients was welcome, but being assertive for myself was not!
For example:
Beth: I’m sorry, I can’t work this weekend. My son is with me.
Manager: If you can’t be a team player, you know where the door is.
Peers:
- I had to work weekends when my kids were little.
- Come on, it’s just one weekend.
I loved my work, yet was becoming aware of the many expressions of disrespect that nurses face, including bullying, blaming, and chronic understaffing. In becoming healthier, I was no longer willing to accept the status quo.
I switched to per diem, enrolled in graduate school, and studied leadership, coaching, emotional intelligence, organizational behavior, and systems thinking. I took an improv class with my son and could see how it helped us develop emotional intelligence and skillful communication. Planning on leaving healthcare, I designed a model using theater games to promote emotional intelligence in children as my Masters’ Practicum.
Did I leave nursing?
Almost. After earning my MS in organization and management, I began using my theater games’ model with school systems. I still worked as a per diem nurse, but considered nursing as a job to pay bills rather than a profession I felt proud of. Then I accepted an invitation to teach a course in contemporary issues in healthcare at Antioch University. The Institute of Medicine’s report, Crossing the Quality Chasm[8] was the textbook. The class consisted of a small group of healthcare professionals committed to improving healthcare. Open and honest discussions about problems and solutions were invigorating. I realized my combined expertise from school, nursing, improv and therapy was needed in healthcare and started to provide communication training. I integrated improv activities into workshops on assertiveness, listening, constructive feedback and emotional intelligence.
What did I learn?
Over and over again in sessions, two things became clear:
- Me lecturing about skills like listening, confidence, or speaking up was not effective.
- Facilitating experiences where people could practice and debrief skills was!
The experiential improv activities, when facilitated properly, made the light bulbs go off!
- I never realized how my communication might impact others.
- That’s the first time I ever felt heard.
- I shared an idea in a staff meeting. We’re going to try it.
- A difficult conversation went much better.
This discovery helped crystallize my career path and go on to write many articles and several books, direct and edit videos, and present workshops. All with an increasing emphasis on Medical Improv. I’ve been inspired by visionary colleagues along the way; Stephanie Frederick, M.Ed[9], RN and Candace Campbell, DNP, RN, CNL, FNAP[10].
Currently I design introductory, customized, and train the trainer workshops. As a solo practitioner and in collaboration with Corporate Trainer Ellen Schnur and former Major League Baseball Pitcher, Jim Mecir of ImprovTalk, and Mindfulness Teacher, Liz Korabek-Emerson, MFA.
To learn more
The best way to understand how profound the learning can be is to experience it. Try taking an improv class or find a willing colleague to explore this “Yes And” Tutorial with.
Summary
I’ve learned that respect is essential, the creative process is not a straight line, perseverance is a valuable trait, improv is a fantastic teaching tool, and nurses have a huge potential for improving healthcare!
Beth Boynton, RN, MS, CP is a Nurse, Author, Speaker and Medical Improv Practitioner. She can be reached at beth@bethboynton.com.
[1] Boynton, B. (2022). Successful Nurse Communication Revised Reprint: Safe Care, Healthy Workplaces & Rewarding Careers. F.A. Davis Publishing Inc. Philadelphia, PA.
[2] Boynton, B. (2017). Medical Improv: A New Way to Improve Communication. CreateSpace.
[3] Boynton, B. (2022). Improving communication requires tough soft skill development. Retrieved from: https://www.kevinmd.com/2022/08/improving-communication-requires-tough-soft-skill-development.html
[4] Behavior that undermines a culture of safety. Committee Opinion No. 683. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017:129:e1–4.
[5] Boynton, B. (2022). “Radical Acceptance”: Simple activity - profound individual and team development. Retrieved from: https://bethboynton.com/radical-acceptance-simple-activity-promotes-sel-positive-group-dynamics/
[6] Boynton, B. (2019). The patient handoff game: For smoother report and fewer communication glitches, borrow team exercises from improv theater. Working Nurse. Retrieved from: https://www.workingnurse.com/articles/The-Patient-Handoff-Game/
[7] Boynton, B. (2022). Core competencies of interprofessional education collaborative (IPEC) & medical improv. Retrieved from: https://bethboynton.com/core-competencies-of-interprofessional-education-collaborative-ipec-medical-improv/
[8] Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. PMID: 25057539.
[9] Boynton, B, and Frederick, S. (2013). Exploring medical improv: Learning experiences that promote safe care, patient satisfaction, & rewarding careers. Retrieved from: https://www.youtube.com/watch?v=uG0jRAQWOVQ
[10] Campbell, C. (2014). Improv to improve interprofessional communication, teambuilding, patient safety and patient satisfaction. Doctoral of Nursing Practice Thesis, University of San Francisco. Retrieved from: https://repository.usfca.edu/dnp/27/
