Connecting The Creative and the Clinical Through Medical Improv

Beth Boynton, RM, MS

                                                by Jude Treder-Wolff, LCSW, RMT, CGP
                                                                             Lifestage, Inc
It’s an ordinary day on the dementia unit of a health care facility and one of the residents – we’ll call her Sarah – is trying to leave. The unit is secure and residents wear alarm-triggering ankle bracelets that alert staff if they pass through the door. Matilda, a nurse assistant, reaches out to Sarah, validates and engages her in an attempt to gently dissuade her desire to make that exit. But empathy and redirecting are just not working. Sarah wants out! Beth Boynton, RN, MS, and Medical Improv expert, observes the situation, makes a rapid calculation, then goes to the entryway, hands on her hips, and musters up a stern scowl. “Matilda and Sarah, this room is closed and you are not allow to enter,” she says sternly, like a military guard on patrol. The nurse assistant picks up the story immediately and puts her arm around Sarah, saying “We’re so sorry, we’re leaving, we’re very sorry.” Sarah accepts Matilda's response to the situation and they move on to other things.
     In this real-life example, Boynton defused a potentially dramatic and difficult conflict using an improvisation technique called “quick-change." With a simple role shift the entire scene changes, moving the nurses assistant to the role of Sarah’s ally rather than her antagonist. “The magic was that we found a way to meet Sarah where she was,” says Boynton. “Matilda became her friend in that moment and sort of rescued her from the mean old nurse. Plus, I think Sarah could understand “No” but was not able to understand why she couldn’t leave.” Talk about thinking on your feet.

     Beth Boynton, RN, MS is an organizational development consultant, nurse, writer, improviser and trainer who works with other medical professionals to develop emotional intelligence,communication and creative thinking skills as well as other dimensions essential to 21st century health care. On August 13, 2013 she led the presentation, “Medical Improv: Exploring Learning Experiences For Promoting Safe Care, Patient Experience & Rewarding Careers” which aired on Google + and is now available on YouTube. The 75 min program is co-presented by Stephanie Frederick, RN, M.Ed, sponsored by Judy White, SPHR, GPHR, HCS of The Infusion Group and includes a distinguished panel of  influential thinkers in the field.
      Experienced in the power of improv to foster creative thinking and emotionally intelligent relationships through direct experience Boynton emphasizes the importance of bringing its philosophy and tools to the increasingly collaborative – and pressure-intensive - world of modern medicine. “The medical model focuses on controlling things which is great for measuring medication, analyzing EKGs, and sterilizing equipment, but not effective for long term positive behavior change,” she explains. “With the staggering incidence of catastrophic medical errors associated with poor communication skills, relationship issues, and workplace culture we need new and innovative solutions. Over the last 10 + years the success of our efforts to provide safer care have been limited. I believe it is because we are not getting at the underlying problems. These require growth and behavior change and 'Medical Improv' is perfect for this kind of experiential teaching/learning/practice.”

  Open communication and emotional intelligence on a medical team can have life-or-death implications. These are skills that can be learned and improvisation a model that can work with - and potentially transform - the barriers presently imposed by workplace culture. And while it may on the surface seem like improvisation, with its emphasis on not knowing what will happen next and accepting offers rather than controlling the action is far afield of the scientific method that guides the medical model, there are some striking parallels between the problems encountered in improvisation and in science. Both involve a willingness to suspend assumptions, enter into a process of discovery and accept what is given. Out of the tensions produced in an experiment, whether in an improvised scene or in a lab, some new direction can be found. Breakthroughs occur, if we let them. The highly interactive nature of improv heightens awareness of others' thoughts and feelings, strengthens partnerships and enhances social sensitivity, building the skills that reduce stress and allow a team to be more creative and innovative even while under great pressure.  
      At the TEDGlobal 2013 event Uri Alon, Professor and Systems Biologist at the Weizmann Institute of Science spoke about the unique insights and new ways of thinking his experiences in improv provided to his work as a researcher and teacher. “Unlike science, in improvisation theater they tell you what will happen when you get on stage: you will fail miserably,” he states. “You’ll get stuck.” He and his improv friends practiced what to do when they were stuck. They used the real-time experience of improvisation to prepare for those real-life episodes of being in the dark. Uncertain. In that period when nothing is going as planned, the experiment goes in unexpected directions and everything is up in the air that Alon refers to as “the cloud.”
     He explains. “In science, you do something quite heroic; you face the boundary between the known and the unknown. You face 'the cloud.'” When his students tell him they’re in the cloud, he congratulates them. “I say ‘great! You must be feeling miserable! But it’s happy, because they must be close to that boundary between the known and the unknown.”     
     The medical model rightly values accuracy, precision, and predictability in its methods, yet health care professionals must constantly accommodate the ever-changing, dynamic demands of actual care, which includes a complex interplay of relationships and a hierarchical system of authority. Improvisation games and exercises are an ideal training ground for developing interpersonal skills that bring out the strengths of every member of a medical team and maximize its effectiveness. Beth Boynton views Medical Improv as a kind of “magic” that allows for everyone involved to develop the skill set they need. “As an example a physician who made need to practice listening and a nurse who may need to become more assertive can participate in the same activity and grow in ways that they need to grow while building a relationship. How enriching is that?”
     Perhaps the most overlooked – but hopefully compelling – reason to experience improvisation, especially with professional peers, is its potential to for emotional renewal. “Stress, burnout, compassion fatigue are huge problems for us in healthcare. With increasing and constant pressure to do more with less, caring for folks who often have tragedy or loss going on, high incidence of substance abuse, workplace injuries, and workplace violence, trust me, we NEED to have some fun together! In addition to learning vital skills and building relationships, it is a wonderful way to reduce stress. There is so much at stake and such cultures of blame. Medical Improv has enormous
potential to help bring the joy back in being a healthcare."

Jude Treder-Wolff, LCSW, RMT, CGP is a trainer/consultant and writer/performer. Her storytelling show Crazytown: my first psychopath will be performed at The Triad in New York City on May 18, 2014 at 3 pm. To buy tickets click here