Medical improv-Draft: Google Event 8/13/13


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Improv or “Medical Improv”* builds skills that promote the emergent behaviors we need for collaborative practice and cultures. In this 75 min presentation, you’ll learn how the principles of improv can be applied to critical skills, thinking, and relationship-building among healthcare professionals. You’ll meet pioneers in the “Medical Improv” field, explore opportunities for utilizing current strategies, learn about upcoming applications, and participate in Q and A. Join Organizational Development, Consultant Beth Boynton, RN, MS with Co-presenter Stephanie Frederick, RN, M.Ed and and Sponsor, Judy White, SPHR, GPHR in an invitation to learn more about cutting-edge applications of Improv in healthcare settings.

“Medical Improv”, is a term coined by Professor Katie Watson, JD of Northwestern University Feinberg School of Medicine in her curriculum for medical students.

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  • Beth introduces Stephanie and Panel. (Unless Stephanie or Judy want to).
  • Beth
  • Beth
  • People skillsEmotional intelligenceTrustAssertiveness and ownershipFlexibilityRespect for self & othersCooperativeCuriosityRespectful listeningAbility to see other perspectivesEmpathyImpulse control
  • We’ll be talking a lot about soft skills today.
  • Two PointsPersistent problems in patient safety.And they involve “soft skills”.
  • Leading healthcare policy journal
  • The order changes a bit for leadership and HF (2011 and 2012 HF was first and Leadership 2nd).
  • “Many [healthcare workers] are subjected to being bullied, harassed, demeaned, ignored, and in the most extreme cases, physically assaulted. They are also physically injured by working in conditions of known and preventable environmental risk”Full report, exec summary and slide presentation all available online.Over 100 citations.
  • Common injuries include musculoskeletal and blood-borne pathogen exposure.
  • Leading to:Burnout, lost work hours, turnover, inability to attract newcomers to caring professionsLess vigilance with regard to safety practices –both for patients and for workforceIncreased opportunities for medical errorsImpact on patient experience
  • Pioneer in disruptive behavior, Led landmark study w/ VHA West Coast on impact of disruptive behavior. Involved over 4500 docs, nurses, execs and others.
  • Thank you, Beth.As Judy mentioned in my introduction, some of my consulting work has been as an RN Health Advocate….What I’ve realized is that most patients never imagined themselves to be in the situation they were in. But, as we all know, life is full of surprises! I see it as an equal opportunity for any one of us to be a recipient of hospital care…So, I invite you to imagine yourself as a hospital patient as I go through the next few slides...What would YOU want your patient experience to be like?
  • This is the definition for Patient Experience provided by the Beryl Institute, who’s a global leader in this area. Patient Experience is…. the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care….I’ve seen how vulnerable, frightened, and confused people are when they’re hospitalized. They’re not in control of their environment and their perspective is often distorted by their condition and the interactions of the hospital “culture” that they’re exposed to.The next couple of slides reference a 2013 Benchmarking Study, also from the Beryl Institute, highlighting The State of Patient Experience in American Hospitals.
  • We’ll focus on the top 2 priorities, and Beth has already covered Quality and Safety, which is second on the list. Patient experience and satisfaction is the #1 priority of the 1,100 healthcare leaders that responded to this 2013 study.And coming from a patient or family member’s perspective, they don’t know where the boundaries are between where service, quality and safety.They’re seeing their overall experience, and that’s how they’ll judge the healthcare facility.
  • This slide indicates what a hospital sees as the key components in their organization’s Patient Experience effort.All of these key tactics, whether it’s sharing patient satisfaction scores, or discussing client cases…..the top 4 areas all reflect a need for improving hospital communication among administration, leadership and staff members.
  • Once again, to emphasize that communication is essential….consider yourself as the patient or family member…..Observing hospital administration/staff:……It’s important for patients and family members to feel listened to, to understand information and their options, to be encouraged, engaged and empowered in their care…..
  • So, if you’re the hospitalized patient I’ve been talking about…..Will you be telling stories about how well you were treated (that the healthcare team was kind, respectful, understanding, supportive), or what was “done” to you? (no explanations, interruptions, not listening, disregarded, inflexible schedules, etc.….)As healthcare delivery shifts and is redesigned, it’s important for each one of us to stay empowered and to be heard about how we define the Patient Experience for ourselves, as individualsSo, thank you all, once again, for being here today. And now Beth will continue with the Medical Improv presentation….
  • In pairs (two panel members) discuss foodEvery sentence except the first starts with:Yes and…In pairs (two panel members) discuss animalsYes but…In pairs (two panel members) discuss musicDebrief:Which is easier?What learning opportunities does this offer?How are they relevant to you? To healthcare? Debrief to panel: Quick thoughts: Relevance to you in your HC role?
  • It is the missing piece in addressing communication & collaboration.
  • Stephanie:"Creative Solutions for Integrating Healthcare" Communication and collaboration across all disciplines of healthcare (conventional, traditional, complementary). (Start the conversation and think of it as cross pollination of information and support) Medical Improv training coordination to facilitate communication, quality and safety of care. (Beth, myself and others bringing an awareness and implementation of Medical Improv programs around the country).Consultant for engaging and empowering the Patient Experience. (Continued work with individuals and administration to target positive patient experience) Program and Curriculum Development for healthcare organizations and higher education. (Han University of Traditional Medicine…..current project for new program design that will focus of the cross pollination of education across all disciplines, in addition to ways of enhancing the patient experience)
  • Medical improv-Draft: Google Event 8/13/13

    1. 1. Exploring Learning Experiences that Promote Safe Care, Patient Satisfaction, & Rewarding Careers With Beth Boynton, RN, MS Organizational Development Consultant & Author © 2013 B. Boynton, S. Frederick, & J. White #medimprov08
    2. 2. Sponsored by The Infusion Group™ with Judy White, SPHR, GPHR, HCS Presented by Beth Boynton, RN, MS • Lauren Dowden, MSW Candidate • Stephanie Draus, ND • Ed Dunn, MD Co-presented by Stephanie Frederick, M.Ed, RN • Dan Sipp, SP • Nancy Smithner, PhD • Richard Snyder, MD • Tobias Squire-Roper, BFA With #medimprov08
    3. 3. “Medical Improv” #medimprov08 An innovative bridge…
    4. 4. From many challenges we face…  Errors, adverse, and/or sentinel events  Patient complaints  Workplace violence  Resistance to change  Substance abuse #medimprov08
    5. 5. and…  Wasted resources  Staff turnover, burnout, stress  Toxic cultures  Readmissions  Spiraling costs #medimprov08
    6. 6. To solutions we seek: 1 Safe, quality care 1 Healthy staff & organizations 1 Patient satisfaction #medimprov08
    7. 7. How does Medical Improv do all this? #medimprov08
    8. 8. By building the soft skills we need… 1 Communicate 2 Collaborate 3 Lead #medimprov08
    9. 9. Overview  Introductions: Meet our Expert Panel  Compelling evidence for building soft skills.  Medical Improv Classroom: teaching strategies, principles, and games.  How can you begin to pilot Medical Improv in your healthcare setting?  Q & A #medimprov08
    10. 10. Our Expert Panel Who are you? What inspired you to join us today? How are you or will you be using Medical Improv in healthcare? (About 2 minutes each!  ) #medimprov08
    11. 11. Lauren Dowden, MSW Candidate Stephanie Draus, ND Edward J. Dunn, MD Dan Sipp, SP Nancy Smithner, PhD Richard Snyder, MD Tobias Squier-Roper, BFA #mediprov08
    12. 12. What are soft skills? #medimprov08 •Communication •Emotional intelligence •Interpersonal/relationships
    13. 13. How are problems with soft skills contributing to problems with safety and quality? #medimprov08
    14. 14. Progress with patient safety has been slow! In 1999. Institute of Medicine (IOM) Report -To Err is Human: Building a Safer Health System Estimated 44,000-98,000 deaths every year due to medical errors #medimprov08
    15. 15. Health Affairs April 2011 • 187,000 deaths in hospitals per year • Preventable medical errors are ten times more frequent than hospitals and regulators are reporting. • Estimated cost of 17.1 Billion in 2008 #medimprov08
    16. 16. Soft Skills #medimprov08
    17. 17. The Joint Commission tracks root causes of sentinel events. What do you think the top 3 causes of these preventable and catastrophic errors were in 2010, 2011, 2012? #medimprov08
    18. 18.  Leadership  Human Factors  Communication _Event_Type_04_4Q2012.pdf #medimprov08
    19. 19. Each cause or category has subcategories that are filled with implications involving soft skills
    20. 20. Category: Leadership Subcategories: Organizational planning, organizational culture, community relations, service availability, priority setting, resource allocation, complaint resolution, leadership collaboration, standardization (e.g., clinical practice guidelines), directing department/services, integration of services, inadequate policies and procedures, noncompliance with policies and procedures, performance improvement, medical staff organization, nursing leadership
    21. 21. Priority setting requires… • Self awareness • Awareness of others • Being assertive • Being a respectful listener
    22. 22. How are problems with soft skills contributing to concerns with our workforce and work cultures? #medimprov08
    23. 23. Workforce & Culture Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Healthcare- Lucian Leape Institute-NPSF Roundtable Report (2013)- #medimprov08
    24. 24. Physical Harm  Health care workforce injuries are 30 times higher than other industries. “I need help giving this patient a boost in bed” #medimprov08
    25. 25. Psychological Harm Lack of respect  A root cause, if not THE root cause, of dysfunctional Cultures  95% of nurses report it; 100% of medical students; huge issue for patients #medimprov08 A nurse waits a little too long to report a patient’s increasing blood pressure to a physician. The last time she tried to talk with him about a concern, he was abusive.
    26. 26. Is bullying a problem in healthcare? #medimprov08
    27. 27. Alan Rosenstein, MD, MBA Medical Director of Clinical Efficiency & Care Management at ValleyCare Hospital No one starts out the day planning to be disruptive. We must recognize the emotional impact and downstream effect of inappropriate behaviors and explore experiential learning methods, like “medical improv” that build the necessary skill sets for positive change. #medimprov08
    28. 28. How are problems with soft skills contributing to problems with Patient Experience? (Presented by: Stephanie Frederick, M.Ed., RN) #medimprov08
    29. 29. We all have an equal opportunity to be recipients of hospital care… What would YOU want your Patient Experience to be like? #medimprov08
    30. 30. Defining Patient Experience: The sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. -The Beryl Institute #medimprov08
    31. 31. COMMUNICATION is the key… Patients observing hospital administration/staff:  Interactions (content, tone, manner of what’s said)  Culture (is it supportive?, safe?, respectful?) Patients and family members want to:  Feel listened to,understandinformation and options, be encouraged, engaged, and empowered in their care #medimprov08
    32. 32. Medical ImprovBuilds “Soft Skills” for Communication Collaboration Leadership To support “the sum of all interactions” (the Patient Experience) #medimprov08
    33. 33. Patient Experience Will you tell about how well you were treated, or what was “done” to you while a patient in the hospital? #medimprov08
    34. 34. What does a Medical Improv class look like? #medimprov08
    35. 35. Teaching Strategies  Frame with objectives & brainstorming  Principles of Medical Improv  Games & activities  Debrief, reflection, action plan Notes:  Variables: time, audience, skill focus, complexity…  Expertise in healthcare AND improv #medimprov08
    36. 36. Principles of Medical Improv  “Yes and…” Affirm and add (don’t negate)  Surrender your plan & co-create  See ‘failure’ as opportunity (to learn, be human, forgive, help)  Listen-be present  Avoid questions  You have everything you need!  Support each other #medimprov08
    37. 37. Games & Activities (100s more) Yes and…, Yes but…, No…  Teaching/learning: Assertiveness, listening, collaboration, validation/invalidation & reinforces medical improv principle: “Yes and...” Status Slide, One-Up-Man-Ship  Teaching/learning: Status-related verbal & nonverbal communication, body language, comfort level, self and other awareness, leadership skills, and therapeutic relationships. #medimprov08
    38. 38. Like practicing a team sport, Medical Improv elevates each player’s ability to communicate, collaborate, and lead. So when the game starts, individuals and teams are performing at their best. #medimprov08
    39. 39. Unpredictable and fluid, the human interactive aspects of healthcare interventions can emerge in the moment with a positive dynamic that has already been established. #medimprov08
    40. 40. How can you begin to pilot Medical Improv programs? Beth Boynton Stephanie Frederick #medimprov08
    41. 41. "Creative Solutions for Integrating Healthcare" (Stephanie Frederick, M.Ed., RN)  Collaborationacross all disciplines of healthcare (conventional, traditional, complementary)  Medical Improv training coordination to facilitate communication, quality and safety of care in the U.S.  Consultant/Advocatefor engaging and empowering the Patient Experience  Program and Curriculum Development for healthcare organizations and higher education in the U.S. Contact: Website: #medimprov08
    42. 42. Beth Boynton, RN, MS Consulting  Medical Improv workshops  Integrating with ‘Whole Systems’ consulting work  Hospital-based Programs (pilot projects)  Undergraduate curriculum development for of ALL healthcare & related studies  Promote/develop train-the-trainer programs (Professor Katie Watson, Dr. Belinda Fu are planning next one-fall 2014) #medimprov08
    43. 43. Q & A Working Definition: Medical Improv is the study and practice of improv theater philosophy and techniques as applied to the unique challenges and environment of healthcare for the benefit of improved health and well being of providers and patients. --Professor Katie Watson, JD Northwestern University & Belinda Fu, MD, University of Washington #medimprov08
    44. 44. Lauren Dowden laurendowden@ Stephanie Draus Edward J. Dunn Dan Sipp Nancy Smithner Richard Snyder Tobias Squier-Roper #medimprov08
    45. 45. THANK YOU! Beth Boynton Stephanie Frederick Judy White #medimprov08