Medical Improvisational Skills for
Harried Healthcare Professionals
Beth B. Boynton, RN, MS
Beth@bethboynton.com
www.confi...
Overview

•
•
•
•

Medical Improvisation

Definition
Rationale
Medical Improvisation Examples
Questions and Discussion

Be...
Definition
Medical Improvisation is the study and practice of
in-the-moment theater philosophy and
techniques applied to h...
Rationale
• We live in a time of disruptive innovation, in
which conflict is inevitable
• Learning and practicing Medical ...
Rationale, II
• We learn more in our training about technical skills than
relationship skills, self-awareness, self-manage...
Rationale III
• We need emotional intelligence in order to communicate and
collaborate respectfully.
• Healthcare is a Com...
Dr. Cohn’s Brief Bio
• To the best of his knowledge, Dr. Cohn is the only practicing
general surgeon/MBA in the US who spe...
Ms. Boynton’s Brief Bio
• Beth Boynton is the author of the award-winning book, “Confident
Voices: The Nurses’ Guide to Im...
Some Examples of Medical Improvisation
• 20 year-old man with abdominal pain
• KC family example

• Beth’s examples with e...
An Example of Med Improv in Dealing with
A Troubling Healthcare Dilemma

• “Doctor, this patient doesn’t look right, even ...
A Healthier Alternative
• “Doctor, this patient doesn’t look right even though his vital
signs are ok”
• Yes, and because ...
Pitfalls to Avoid
• Angry Bird(s)
• Systemic Avoidance
• Event thinking
• Sophisticated resignation
• Current Mastery

Med...
Avoiding Amygdala Hijack
•
•
•
•
•
•

Breathe
Drink
Clarification ?
Timing ?
Visualize a balcony
“ your happy place

• Exc...
Becoming a Trusted Leader
•
•
•
•

Team player
Responsive and respectful
Understanding, listening, and learning without ju...
Conflict Resolution Framework
• Set mutually agreeable time to discuss issues
• Prepare by writing behavior, feelings, con...
General Guidelines for Giving Feedback
• Kind and helpful.

• Check to see if feedback is wanted. (Unless in leadership ro...
General Guidelines for Receiving Feedback
•
•
•
•
•
•
•

Breathe
Consider your choices
Listen carefully and try to drop de...
Lessons Learned
• Medical Improvisation represents a life-long
learning journey
• It brings out the best in people and has...
Conclusion
•
•
•
•

Participants must listen and speak up in order to practice activities
Medical Improvisation optimizes ...
To Learn More
• Please contact us with your specific needs
• Stage an event to give group members a taste of the
experienc...
References
•

•
•
•
•

Watson K. Perspective: Serious Play: Teaching Medical Skills with
Improvisational Theater Technique...
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Boynton cohn med improv webinar

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"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.

Published in: Health & Medicine, Business
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Boynton cohn med improv webinar

  1. 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. 2. Overview • • • • Medical Improvisation Definition Rationale Medical Improvisation Examples Questions and Discussion Beth B Boynton, RN, MS Kenneth H. Cohn, MD, MBA, FACS
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 13. Avoiding Amygdala Hijack • • • • • • 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. 14. Becoming a Trusted Leader • • • • 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. 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. 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. 17. General Guidelines for Receiving Feedback • • • • • • • 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. 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. 19. Conclusion • • • • 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. 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. 21. References • • • • • 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

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