Improv to improve patient outcomes

When you woke up this morning, did you grab the script that tells you the dialogue for exactly how your day would go?

Of course not. Nobody knows exactly how those conversations will go, right?

That’s because, as we say onstage, life is improv.

Yes, we all improvise—every day, every hour, every minute.

Even the thoughts that give words to our actions are improvised in the moment, based on what’s happening around us, our perceptions, and how we react, consciously or subconsciously.

But if you’re like many people, that word improv calls to mind comedy.

And if you’ve seen some of the popular TV shows based on this method, you might be thinking, “Whoa, wait a minute, I’ve seen it. Improv’s a kind of theatrical magic. Only really talented folks can pull that off.”

Ready for some good news?

There is a lot of research (including my doctoral work) that shows improvisation from the arts can be a valuable communication and relationship-building skill. This is especially true in healthcare, where we need to address problems with miscommunication, employee disengagement, burnout, high resignation rates, and all the various issues that add up to the present healthcare workplace crisis—not to mention how our workplace culture impacts patient safety!

Reality vs. comedy

When actors first began learning about improv principles, the goal was usually for entertainment. As a co-founder of a stand-up and improv troupe, our goal was to be funny and delight our audiences. Occasionally, a semi-serious scene would sneak in, but not often. We were pretty good at finding the funny.

Facilitating non-performance-based, so-called applied improv, requires a slightly different set of instructional skills since the goal isn’t comedy. The goal is to cement relationships with colleagues, so they can function better as a team with less personal drama.

Then, in 1995, when I first began facilitating applied improvisational training to nascent Silicon Valley businesses, I realized participant success was tied more to allowing people to share their ‘aha’ moments and building relationships by facilitating more frequent debriefings. As a result of this subtle change in approach, interprofessional communication improved and teams began to learn how to solve problems creatively and effectively (often spontaneously) in the workplace.

The WHY

So, how can that be?

The answer is because applied improvisational exercises tap into the power of play. Cognitive behavioral neuroscience research shows the experience of play is the best way human beings learn.

Play also promotes inclusion and belonging by fostering a collaborative environment where all voices are valued and heard.

In this atmosphere, new ideas percolate because the facilitated applied improv environment has been intentionally created to be a safe space to learn and grow.

The exercises help participants’ ability to read nonverbal cues and respond to the emotions of others— not by being lectured about listening, but by practicing interactive listening. As a result, learners adapt to different perspectives and co-create solutions in a judgment-free zone. This practice promotes a sense of fairness and equal participation.

We find that participants laugh a lot during these workshops because they are so surprised and delighted with what happens when they practice active listening without having to tell jokes.

Three improv tips to change your focus

By now you might be wondering, “What would I need to do to learn this method?”

Apart from taking an actual improv class, here are three tips (based on the 12 principles that I outline in my books) to begin to acquire an “improv mindset.”

1. Leave perfection at the door.

   Let’s face it. In healthcare, we must strive to do the very best in our work, lest someone be injured or die! Just as athletes or dancers train diligently before performances, nurses can view improv games as a form of mental exercise, honing their skills in a safe and supportive environment. By cultivating a willingness to learn and adapt, nurses can enhance their ability to respond effectively to dynamic and challenging situations in patient care, utilizing techniques learned through improv training to navigate uncertainties and promote patient safety. (That is why improv works so well in simulation training!)
   

2. Silence your inner editor.

   Remember the anxiety you felt when you first attempted to learn a new skill? Like the first time you placed a catheter on a mannikin? You may enter the ‘improv environment’ with the same nervous feelings. Recognize that little negative voice inside (“You’ll lose face! You’ll look stupid!”) that will try to derail you from stepping out into the unknown. That voice will try to convince you that it’s dangerous to try something new. If that happens, tell that little voice to go take a hike. Give yourself permission to play.
   

3. Practice saying “Yes, and ...”
   As nurses, if we’re talking about a medication or other discrete value, our training to stop an accidental dosage, etc. is important, and we must answer with “Yes, but ...” However, with improv exercises, we practice ways to choose a positive attitude in conversation by saying, “Yes.”  Then, we add to the idea with “and ...,” which allows for creative imagining and sparks innovative solutions to the problem at hand. For instance, if someone hands you a medication to cross-check and you calculate a different dose (or some other discrepancy), if you say, “Yes, and ... the dose I calculated is slightly different. Let’s look at it together.” The tone you set is collaborative and respectful, not accusatory.
   

Tips for beginners

If you haven’t had the opportunity to enroll in an improv class yet, you can still work on improving your communication and collaboration flexibility by finding willing, playful friends and trying these exercises together:

• Stand a few feet apart and decide who begins tossing an imaginary ball to the other.
• Person 1 ‘throws’ the ball, and they must include the sound it makes (i.e., “SSHHoosh!”).
• Person 2 ‘receives’ it by mimicking the sound, then tosses it back to person 1 with a new sound (i.e., “ZZZAP!”).
• Continue to speed it up and play for a few minutes.

• Stand in a circle and choose a person to begin, as above.
• Person 1 throws the imaginary ball to anyone in the circle by first making eye contact.
• The person who catches it mimics the sound, and then makes eye contact with another person and tosses the imaginary ball using a new sound.
• Continue to speed it up and play for a few minutes.

Debrief - There is no sound too silly. Did you find yourself “editing” your sounds? The trick is to go with whatever sound comes out first.

• One person begins with a word.
  
• The other person adds to the story with another word that makes sense and continues the thought.
• Keep going until the story is complete!
  Note: The sentences should make grammatical sense!

Debrief: Did you find yourself struggling to come up with a word that made sense to the suggested task/story? Did you try to steer the story to your idea of how it should be told, instead of letting it unfold in a new, surprising way? What surprised you? What frustrated you?

Happy patient outcomes

As nurses, learning and applying improvisational principles is a particularly helpful skill in team building, especially when you are challenged to think quickly or need to collaborate with anyone who may have a different perspective or communication style.

In my practice, I’ve found when teams learn the principles and practice applied improvisational exercises from the arts, they enhance their emotional intelligence and communication skills and develop more creativity and problem-solving abilities.