"Medical Improvisation for Harried Healthcare Professionals" with Dr. Kenneth Cohn, MD, MBA and Beth Boynton, RN, MS Ppx from 11/12/13 webinar focuses on definition, rational, and examples of this innovative process that helps to promote safe care, optimal patient experience, and positive work cultures.

1. Medical Improvisational Skills for
Harried Healthcare Professionals
Beth B. Boynton, RN, MS
Beth@bethboynton.com
www.confidentvoices.com
Kenneth H. Cohn, MD, MBA, FACS
ken.cohn@healthcarecollaboration.com
http://healthcarecollaboration.com

2. Overview
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Medical Improvisation
Definition
Rationale
Medical Improvisation Examples
Questions and Discussion
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

3. Definition
Medical Improvisation is the study and practice of
in-the-moment theater philosophy and
techniques applied to healthcare, to improve the
health and well-being of providers and patients.
Watson K. Perspective: Serious Play: Teaching Medical Skills with
Improvisational Theater Techniques. Academic Medicine.
86(10):1260-1265.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

4. Rationale
• We live in a time of disruptive innovation, in
which conflict is inevitable
• Learning and practicing Medical Improvisational
skills can help healthcare professionals deal with
unexpected developments and feel more
engaged in the present
• These feelings of learning and mastery can
improve patient outcomes, staff morale, and
workplace retention
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

5. Rationale, II
• We learn more in our training about technical skills than
relationship skills, self-awareness, self-management, and
social awareness (emotional intelligence)
• Every healthcare interaction is to some degree
improvisational
• The practice of Medical Improvisation can help us become
more aware of the leadership styles that build cohesion, such
as coaching, visionary, affiliative, and democratic rather than
relying on command-and-control and pacesetting leadership
styles
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

6. Rationale III
• We need emotional intelligence in order to communicate and
collaborate respectfully.
• Healthcare is a Complex Adaptive System and Medical Improv
builds the skill set necessary for the best human dynamics
• People can learn different skills in the same activity, such as to
be more assertive or listen better.
• Opportunity to develop relationships when the stakes aren’t
so high
• Stress relief
• Less intellectual learning and more behavioral, like practicing
life
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

7. Dr. Cohn’s Brief Bio
• To the best of his knowledge, Dr. Cohn is the only practicing
general surgeon/MBA in the US who speaks, consults, writes,
and teaches about physician-hospital relations.
• Using real-life stories from his work in 43 states, he
demonstrates ways that collaboration improves retention and
clinical and financial outcomes.
• His four books, Better Communication for Better Care,
Collaborate for Success, The Business of Healthcare, and
Getting It Done, have sold over 5,000 copies.
• Dr. Cohn has been mentoring physicians in leadership
development over a decade, finding that they enjoy learning
from a fellow practicing physician.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

8. Ms. Boynton’s Brief Bio
• Beth Boynton is the author of the award-winning book, “Confident
Voices: The Nurses’ Guide to Improving Communication and
Creating Positive Workplaces”.
• She is a national speaker and organizational development
consultant specializing in communication, collaboration, &
emotional intelligence.
• She is a Per Diem RN in a LTCF caring for folks with dementia.
• She is trained in the Professor Watson Curriculum for Medical
Improv through Northwestern University Feinberg School of
Medicine and a student of improv.
• Her videos, “Interruption Awareness: A Nursing Minute for Patient
Safety” and Blog, “Confident Voices in Healthcare” have drawn
audiences from all over the world.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

9. Some Examples of Medical Improvisation
• 20 year-old man with abdominal pain
• KC family example
• Beth’s examples with exit-seeking resident
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

10. An Example of Med Improv in Dealing with
A Troubling Healthcare Dilemma
• “Doctor, this patient doesn’t look right, even though his vital
signs are normal right now.”
• “Yes, but I am in my office now and can’t see him”
• “I am concerned and wanted to make you aware”
• Cardiac arrest several hours later
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

11. A Healthier Alternative
• “Doctor, this patient doesn’t look right even though his vital
signs are ok”
• Yes, and because I am in my office right now, please ask the
Rapid Response Team to evaluate him for possible ICU
transfer for continuous vital sign monitoring and for a chest Xray, EKG, and arterial blood gas.”
• “Thank you, Doctor. I appreciate your taking my concerns
seriously.”
• “Thank you for calling me.”
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

12. Pitfalls to Avoid
• Angry Bird(s)
• Systemic Avoidance
• Event thinking
• Sophisticated resignation
• Current Mastery
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

13. Avoiding Amygdala Hijack
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Breathe
Drink
Clarification ?
Timing ?
Visualize a balcony
“ your happy place
• Excuse yourself to BR
• Call an AM buddy
http://northofneutral.files.wordpress.com/2009/11/
amygdala-hijack.jpg
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

14. Becoming a Trusted Leader
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Team player
Responsive and respectful
Understanding, listening, and learning without judgment
Safe, approachable, someone who protects confidentiality
• Talented, knowledgeable, competent
• Executes: someone who gets results and honors commitments
• Dedicated: someone who models the work ethic and timeliness
Wong B. 2013. Heroes Need Not Apply. Bozeman:Second River Healthcare Press.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

15. Conflict Resolution Framework
• Set mutually agreeable time to discuss issues
• Prepare by writing behavior, feelings, consequences, and
proposed solution:
When … happened
I felt …
Because …
In the future, I would appreciate ….
What are your thoughts?
Moral: Strive to maintain data-driven, objective, I-messaging
format for optimal resolution
Lachman V. Breaking the quality barrier: critical thinking and conflict resolution. Nurs Case Manag 1999;4(5):224227.
Rosenberg MB. Nonviolent communication: a language of compassion. Puddle Dancer Press 2002.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

16. General Guidelines for Giving Feedback
• Kind and helpful.
• Check to see if feedback is wanted. (Unless in leadership role).
• Look for opportunities to include ownership.
• Be specific & don't judge or exaggerate.
• Focus on your concern for the person and behaviors that can be
changed.
• Perception check.
• Ask questions.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

17. General Guidelines for Receiving Feedback
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Breathe
Consider your choices
Listen carefully and try to drop defensiveness
Acknowledge the feedback
Take time to sort out what you have heard
Be honest with yourself
Give yourself credit
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

18. Lessons Learned
• Medical Improvisation represents a life-long
learning journey
• It brings out the best in people and has a
positive impact on every problem we have
• Given that most healthcare interactions are
unscripted and therefore improvisational,
additional training in Medical Improvisation can
give us a sense of growth and mastery
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

19. Conclusion
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Participants must listen and speak up in order to practice activities
Medical Improvisation optimizes in-the-moment behaviors
Authentic engagement is a prerequisite for progress
Facilitation, coaching, & reflection support organizational needs,
such as professionalism and improving the patient experience
• Medical Improvisation represents a way to be fully engaged in the
present
• It does not matter so much where we begin, provided that we:
– start now
– build a culture that supports reflection, inquiry, and dialogue
– act, learn, and adapt
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

20. To Learn More
• Please contact us with your specific needs
• Stage an event to give group members a taste of the
experience and the benefits that they can derive
• Provide ongoing guidance
• Train-the-trainer opportunities
• For further information, please contact:
Beth B. Boynton, RN, MS
Beth@bethboynton.com
www.confidentvoices.com
603-319-8293 (Eastern time)
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS

21. References
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Watson K. Perspective: Serious Play: Teaching Medical Skills with
Improvisational Theater Techniques. Academic Medicine. 86(10):1260-1265.
Improvisational Exercises to Improve Pharmacy Students’ Professionals
Communication Skills, Kevin P. Boesen, PharmD, Richard N. Herrier,
PharmD, David A. Apgar, PharmD and Rebekah M. Jackowski, PharmD,
American Journal of Pharmaceutical Education, April 2009.
Sentinel Event Data: Root Causes by Event Type. 2004-2012 Title for
http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_04
_4Q2012.pdf
Becker ER, Wendel A. Coaching Teams to Improved Performance, in Cohn
KH and Fellows SA. Getting It Done. 2011. Chicago: Health Administration
Press, 189-208.
Rosenberg MB. Nonviolent communication: a language of compassion.
Puddle Dancer Press 2002.
Staff Conflict and Patient Complaints: Which of these Scenarios is Too
Familiar and How Can Medical Improv Help? Boynton, B. Confident Voices
in Healthcare, Sept. 2013.
Medical Improvisation
Beth B Boynton, RN, MS
Kenneth H. Cohn, MD, MBA, FACS