Using improv techniques in a health care setting, Episode 4: Interprofessional medical communications
In this concluding episode to this series, we discuss how to improve communications with other physicians, colleagues, and staff members using improv techniques.
Also available on Apple and Spotify. A transcript of this podcast is found below.
Additional episodes in this series:
Episode 1: Fundamentals of medical improv
Episode 2: Dealing with difficult patients
Episode 3: Improving patient interactions
Bonus episode: “Signposting”
Transcript:
Shana Merlin (preview):
“I want to say that what health care providers do is so important and so hard. And part of why I love doing improv for medical communications is I like to bring joy and skills to people who do such hard work every day. What they do is harder than what I do, which is teach improv. So, I love to fill those people's cup with that joy and hopefully give them tools to have a more sustainable career.”
Tony Passalacqua:
Hello and welcome to TMLT's podcast, TrendsMD, Answers for health care's digital trends. I'm your host, Tony Passalacqua. This is our fourth and final episode in our series on using improv techniques to improve communications. In this episode, we will discuss how techniques, as well as those we will learn in today’s discussion and those we learned in previous episodes to improve interprofessional communications between physicians and their staff as well as colleagues.
We have been joined this season by Shana Merlin, an improv instructor who has worked with such organizations as the Dell Medical School at UT Austin, the Methodist Medical Center, and TMLT. She has founded her own improv school, the Merlin Works Institute for Improvisation in Austin. You can learn more about Shana and Merlin Works at www.merlin-works.com.
We are also joined by Stephanie Downing, an education coordinator in TMLT’s Risk Management Department. To learn more about TMLT’s CME offerings or to schedule any future CME activities, you may contact Stephanie at 1-800-580-8658.
Shana, we've talked a lot in our other episodes about how to communicate with patients, but I would like to shift our conversation to how to communicate with your colleagues and other physicians.
Shana Merlin:
Yeah, there is so many of these tools, and even the tools we've talked about with patient communication can help interprofessionally.
As we all know, you have difficult conversations with people you work with as well as patients. So, um, we can apply a lot of those tools. But I want to get to some specific, um, improv tools that I think can really help when you're communicating with colleagues, with staff. Um, And the first one, you could not, I would be remiss if we finished an improv podcast and did not talk about the number one improv rule that probably most people, if they know anything about improv, know this, it is…
Stephanie Downing:
“Yes, and…”
Shana Merlin:
“Yes, and!” That's right! Wherever you study improv, you are going to learn in the first few weeks of class about this concept of “yes, and.” It's a fundamental building block of how we're able to create scenes and stories and songs and dances on the spot Inspired by audience suggestion.
I don't know the exact number, but I think there's at least six improvisers here in Austin with “Yes and” tattoos. So, it’s an important part of our culture. So, um, to help us kind of understand the value of “yes and,” I'm going to have Stephanie help me with an activity, and this is going to be a brainstorming planning activity.
So, I want you to suggest something fun that we could help, uh, we could brainstorm with you.
Stephanie Downing:
Okay. I am in the process of planning a surprise birthday party for my 80-year-old mother-in-law.
Shana Merlin:
Wonderful. And what's her name?
Stephanie Downing:
Her name is Mary.
Shana Merlin:
Mary, okay.
Stephanie Downing:
And she lives at an assisted living facility, so she's in a different place. So, there are some obstacles that I'm…
Shana Merlin:
Yeah, how do you still make a fun party? Inclusive party for someone who's 80? Okay, great. And Tony, would you be willing to do this activity with us as well?
Tony Passalacqua:
Sure. Yeah, I'll jump in
Shana Merlin:
Yes, get three people for a brainstorm. So, what’s going to happen is we're going to have four rounds of brainstorming on this, uh, creating a surprise party for Mary. The first round, we're going to have every line after the first line is going to say, is going to start with “yes or.”
Okay. So, um, Stephanie, you're going to say that, uh, first line, “Let's, let's plan a surprise party for my mother-in-law.” And then I'm going to say, “Yes, or blah, blah, blah, blah, blah.” And then you'll say, “Yes, or blah, blah, blah, blah, blah.” And we'll go around like that every line after the first line, starting with “Yes, or.”
Okay? And as you're listening to this just notice what the dynamic is like in the conversation. Notice what the resulting party is like, because we're gonna do a few rounds of this and kind of compare and contrast. So, go ahead and begin Stephanie.
Stephanie Downing:
Okay, let's plan a surprise birthday party for my mother-in-law.
Shana Merlin:
Yes, or we could get her in on it and have it not be a surprise party and just plan a regular party.
Tony Passalacqua:
Hmm. Yes, or maybe what we could do is pick her up and then bring her back to another location, maybe?
Stephanie Downing:
Yes, or we can organize the party with the facility and keep her there.
Shana Merlin:
Yes, or we can have a party and make a video of the party and then show it to her later. Okay, that's mean. All right. So, we'll stop there,
Stephanie Downing:
Okay, so I say not to be mean.
Shana Merlin:
So, we'll take that example, and we'll put it in our pocket 'cause we're gonna talk about it in a little bit later. But now we're gonna do another round. You're gonna say, “Let's plan, uh, this party,” and then I'm gonna say, “Yes, but blah, blah, blah.” And you'll say, “Yes, but blah, blah, blah.” And we'll go around like that. Okay? So, this will be round two. Begin.
Stephanie Downing:
Let's plan a surprise birthday party for my mother-in-law.
Shana Merlin:
Yes, but I don't know your mother-in-law and what she likes.
Tony Passalacqua:
Yes, but how long do you think this is going to take?
Stephanie Downing:
Yes, but, uh, hopefully not long because she'll probably need to take a nap.
Shana Merlin:
Yes, but won't the other people at the facility feel jealous if she's the one that gets the party, and they don't?
Tony Passalacqua:
Yes, but what about, is there going to be any rules about maybe what can happen at the that facility?
Stephanie Downing:
Yes. But I don't think it'll be that big of a deal because it'll be something exciting for her to attend.
Shana Merlin:
Okay. We'll pause there. Okay. We'll take that second example. We're gonna put it in our other pocket. It was very negative. I'm so sorry. Yeah, we're gonna talk about that in a minute. Sorry. Okay, now we're do our third round. So, this one is our “Yes and” round. Okay. So, you're gonna start with that same prompt where I'm gonna say “Yes and blah, blah blah, “yes, and blah, blah, blah.” And we'll go round like that. Okay?
Stephanie Downing:
Let's plan a surprise birthday party for my mother-in-law.
Shana Merlin:
Yes, and let's bring, uh, balloons and decorate the event room.
Tony Passalacqua:
Yes, and, I mean, what would, can we show up and, like, surprise her?
Stephanie Downing:
Yes, and I was thinking of inviting some of her friends from out of town.
Shana Merlin:
Yes, and we could, um, bring some of her favorite foods and have a cake with 80 candles!
Tony Passalacqua:
Wow. Yes, and we could also maybe get her a couple of gifts.
Stephanie Downing:
Yes, and I was thinking of making a slideshow for her.
Shana Merlin:
Yes, and a memory book that she could look at every day.
Tony Passalacqua:
Yes, and maybe bring her, like, maybe her favorite pet? Or not.
Stephanie Downing:
Yes!
Shana Merlin:
Stephanie's shaking her head. Okay, we'll stop there. Um. so, um, we've got one more round. Um, and this one, uh, still, this will just be me and Stephanie. So go ahead, Stephanie. Uh, you go first. This one's going to be more open. You could say “yes or,” “yes but,” “yes and,” whatever you like.
Stephanie Downing:
Okay.
Shana Merlin:
Okay, but go ahead and give us that first prompt.
Stephanie Downing:
Let's plan a surprise birthday party for my mother-in-law.
Shana Merlin:
Yes!
Stephanie Downing:
Yes, I'm excited to put together a surprise party.
Shana Merlin:
Yes!
Stephanie Downing:
Yes, but you're not really giving me any ideas.
Shana Merlin:
Yes. Okay. Let's stop there. All right. Well done everybody. So, we had four party planning conversations.
“Yes, or,” “yes, but,” “yes, and,” and just “yes.” So, we could talk a little compare and contrast of what those conversations were like and what the resulting party was like. So “yes, or,” we kind of went round and round. We didn't even really agree on whether to plan the party or not. We were kind of coming up with different options of other things we could do. And that's kind of similar to that conversation you have with the person you live with about what's for dinner, where you're like, “we can have these leftovers.” “Yeah.” “Or it could cook something.” “Yeah.” “Or we could go out.” “Yeah.” “Or we could order,” and you're like, ah, no decisions, no momentum, just a lot of different options.
So “yes or” was good for putting a lot of different ideas out there, but it's hard for getting anything done. That “yes, but” conversation, like you were saying, it got pretty negative. What did you notice?
Stephanie Downing:
Yeah, it didn't help me at all. And it made me not even want to plan a party.
Shana Merlin:
Yeah, that's kind of, “Here’s my idea.” “Yes, but here's what's wrong with that idea.” We were kind of pointing out all the problems and all the flaws and it made it feel impossible for this party to even happen — the regulations in the facility and all this stuff! So, it's tricky. Because in a lot of professional settings, um, “yes, but” can get rewarded because you're pointing out, uh, possible pitfalls. But it can be really hard for momentum, and we know that we often are not excited to bring our best ideas to a “yes, but” person, otherwise known as a “blockasaurus,” that just swats our ideas out of the sky.
But “yes, but” can be really important for learning boundaries, values, rules, something like that, um, to keep everything on track. What about our “yes, and” party planning? What happened there?
Stephanie Downing:
It was the most helpful. We had great ideas and actually started planning.
Shana Merlin:
Yeah, we got a decent party plan done in about 30 seconds. Balloons, cakes, friends.
“Yes, and” is so successful because it's cumulative, it's collaborative, each idea building on the next. It goes pretty far pretty fast though, so we have to be careful and sometimes rein it in after we're done. And what about that “Just, yes” conversation? I was being so supportive and nice, didn't you think Stephanie?
Stephanie Downing:
Really? I was like, well you sound like you're being positive, but you're not helping at all.
Shana Merlin:
Right! So, it's like that conversation. “Hey, we should hang out.” “Yeah, totally.” “Okay. I'll see you later.” Right. We're not hanging out. So, one of the takeaways from this activity is that there's a thousand sneaky ways to say “No.”
“Yes, or” is no. “Yes, but” is no. And, surprisingly, “just yes” is no.
And there's only a few ways we know to really say yes to other people's ideas and one of those is with “yes and.” So, you not only have to say yes to something but add on to it, uh, in agreement to really be able to say yes to each other's ideas. And this is a great gift we give each other in improv all the time, and it's something we can do interprofessionally to help us be more collaborative and productive.
So. One thing you can start to do is just notice how much you say “yes or” and “yes but” and just “yes.” Just notice that starting today. Maybe tomorrow see what happens when you substitute, “yes and” in. It's going to help things get unstuck. It's going to help things be more positive. So let me talk a little bit about the mechanics of how “yes and” works.
There's kind of two ways we can think about it. So the mechanics of “yes and” — “yes and” is a response. It has to be a response to something, so you respond to an offer. In improv, an offer is anything anybody says or does on stage is an offer. It's just information you can respond to. Uh, there's a great improv book called “Everything's an Offer.” Right?
So, of course, we have to get present, and open, and aware to see all the offers that are happening. And that's why that's always the foundational skill of improv, being present and in the moment. So, once we're present and aware, that's our first step, awareness. The second step is someone's going to make an offer.
They're going to say or do something. That's an offer, that's information. And the third step is we want to accept that offer. In the improv world, we want to accept things with instant enthusiastic agreement, as if it's a genius, amazing, brilliant idea, and that's how we can kind of create things together.
In the real world, it might be like, it is what it is. That is not what I wanted or expected, but that is what's happening. I'm going to start with reality and not something I imagined, right? So sometimes we have to put those “yes goggles” on to find an area of agreement. A lot of times that area of agreement might be value, belief, motivation, something we care about.
You can find something we can say yes to. And then lastly, we add on with addition. We want to add on something connected to the original offer. So, when you say, “let's plan a birthday party for my mother-in-law,” and I say, “yes, and, uh, let's decorate with balloons,” right? I'm connecting, um, saying yes to it and connecting and building on with a connected idea.
In a more of an interprofessional situation, somebody might say something like, “I think we should cancel this project, because I don't think it's working,” right? And you might not agree with that, but you can find something you can agree with and build onto it. “Yes, I think the way we spend our time is really important, and let's take a look at where we're at on the timeline of this project to see what we need to do to get it back on track,” right?
So, “yes, and” works in creativity and brainstorming, it can also work in conflict and negotiation and finding a way forward. So that's our mechanics of “yes and,” and it's something you can literally say to help move the conversation in a positive direction. You say “yes,” you repeat what they said, you say “and,” and you add on to it.
And then we have from the book, “Everything's an Offer,” I say “spiritual yes and,” which is the idea of notice more. Use everything. Let go. These are kind of this triangle of this “yes and” kind of spirit and attitude, where we are open, we are playful, and we have moved things forward. So, any of those things can kind of help you realize what's going on in interprofessional situations.
So, a lot of times after I teach this, the next day people will be like, “Hey, you just, ‘yes, butted’ me,” or “hey, you just ‘yes, or-ed’ me!” Or like, “Hey, let's do a ‘yes, and.’” And sometimes what you can do is just set the timer in a meeting. If things are feeling stuck or bogged down in the conversation, do three minutes of “yes, and-ing.” It's not a lifetime commitment, but things can start to roll, and then you can kind of get back on track. And often the good ideas will float to the top.
Tony Passalacqua:
Shana, do you have any other techniques that you would like to talk about with increasing interprofessional medical communication or just, you know, communication amongst your peers?
Shana Merlin:
Yeah, I do a lot of team-building trainings, and I do a lot of medical team building. I actually taught for many years in the interprofessional education course at Dell Medical School at UT. And one of the principles that really help medical teams succeed is the idea of making each other look good. So, this is, I think, really ties in nicely with “yes and,” right? “Yes, and” is kind of an expression of making each other look good.
And it's interesting because medical teams can, especially in hospitals, it can be a different team every day or every, every moment, you know, depending on who's on the care team for a particular patient. So, teams are forming very rapidly and disbanding rapidly. And so, when everyone goes in with an attitude that they're trying to make each other look good, that helps the whole team succeed.
And part of that is assuming positive intent. So, when someone says or does something that you find, uh, uncomfortable or offensive or something like that, trying to think about what are they, what are they trying to do? What is their intention? Could I imagine a positive intention behind that? And can I assume that and kind of roll and respond not to what they said or did, but that intention that I can imagine behind it.
Another thing is to kind of resist the temptation to blame, correct, um, you know, that kind of thing. Of course, we want to get things right, but in terms of saying who's responsible for it and why… just having that like, “I got you; I think you meant this,” or like, “yes, that's a good idea, and let's, let's make sure we get this correct,” right?
And so, you're, you're not having to pause things, blame, and, and make people look bad. You're trying to make them, you know, look good. And when they have your back like that and you have their back, it really makes amazing things possible.
I talk about this in improv performances, wherever you go in the world, the improvisers backstage are nervous. Even, even I get nervous, and I've been doing improv for 25 years. Um, you're backstage because you're about to go in front of people you don't know and you're about to do, you don't know what, and you don't know how it's going to be, right?
So, there's this ritual that happens where the improvisers are backstage and they make eye contact with each other and they touch each other on the shoulder and they say, “I've got your back. I've got your back. I've got your back.” And they all whisper that to each other and we make eye contact and let each other know we've got each other's back.
And what that means to me is that if I get out on stage and I do something foolish, you're not going to leave me hanging. You're going to either come out there and you're going to do something foolish with me to help me look good, or you're at least going to clear me off the stage and do something different so something better can happen.
And because I know I've got that support, I can really make big moves and play boldly because I know that my team has my back. And one of the things I like to do in team building sessions is have people share stories of a time that someone's had their back. And I know we didn't prepare for this, but maybe I could put, put you on the spot, Stephanie. Maybe you can, maybe you can think of a story, it doesn't have to be long, but a time that somebody at TMLT has had your back. Maybe you dropped the ball, and they picked it up. Maybe you, you were out sick or on leave and somebody, you know, finished something. Maybe somebody covered for you. Does a story come to mind?
Stephanie Downing:
I am thinking of like a colleague that I work with. We're the CME team and we're so “got your back.” And she's newer in the department, and so she has lots of one-on-ones with our manager. And my manager comes back and says that she gives me great accolades on how well she's being trained and everything.
And so, I feel like it's a testament to me in my job, where this new person's coming in and already saying, that she's great at what she does. You know what I mean? It's just like giving me some encouragement that I'm doing it right. And then and then I do the same with her. Like she has these great ideas, and I go to my bosses and be like “she had this great idea. We should do it.” You know? So, it's really give and take with us, too.
Shana Merlin:
Great. So, like supporting each other, not just in the room, but with other colleagues as well. Being like, “yeah, I think this is a great idea” or getting that positive feedback that, you know, it's a big risk to hire somebody and train them and getting positive feedback that you're doing it well.
Stephanie Downing:
It's great.
Shana Merlin:
Um, So, yeah, sharing stories. This can be a great activity you can do in your team meetings. Maybe you just say, “give me one story of somebody who's had somebody's back this week” and, and, and solidifying the culture of having each other's back. Um, making sure when someone has your back that you thank them and acknowledge that.
Do you have a story?
Tony Passalacqua:
Yeah. Yeah. So, actually, um, mine goes back to when I was an EMT. And so, one of the things that we used to run into was that we were out doing all these different types of responses for life-saving situations. We would transport people and, you know, you always had that feeling like, yeah, you know, I've saved some lives today. This was a great day, right?
And it was interesting as I was sitting down with one of my coworkers the one day, and he was super just bummed out. Because we had at this point been going nonstop for several days, the energy levels kind of decreasing a little bit, and the, you know, we refer to it as a “honeymoon phase” kind of went away, and you start to feel like the weight of your job.
And, uh, one of the things that he said to me was, “You know, it's interesting that we're doing all of these crazy things, right? Like, we're actually out saving lives.” And he goes, “you know, no one says ‘thank you.’” Or “hey, I appreciate what you did.” And so, the funny thing is, and even some of our coworkers at TMLT probably noticed this, but I will take time out of my day to say, “Hey, I just appreciate everything that you're doing.”
Because it's so important for us to sit down just for a moment and just say, “Hey, you know, I appreciate everything you're doing behind scenes. I know it's just part of your job. But it's still something that without your dedication and hard work, um, it may not turn out as great as what we're looking for.” And so yeah, “We just started saying I appreciate that, you know I appreciate you to each other. And the funny thing is that started off originally as a joke, but towards the tail end it started to turn into something that we would just say to each other if we saw each other having a bad day and it just helped out.
Shana Merlin:
Yeah, there's a ton of evidence that a practice of gratitude helps you and your team members. During your day, you're looking for moments of gratitude. And at the end of the day, you look back and try and think about what are the good things? What did I accomplish? What am I grateful for? Um, and it helps on the good days, and it really helps on the, on the hard days. I do want to say, I feel like, um, I want to make something clear because we're talking about clear communication.
So, I feel like what we're talking about is a pat on the back, which is important and expression of gratitude and, and accolades. But what I'm trying to talk about is having the other person's back, which means that when that person makes a mistake, does something wrong, needs help, someone else organically picks up the baton and starts carrying it. So that's the kind of, do you, do you see the difference? It's more, it's not just something you say, it's often something you do. So, for example, uh, yesterday I had a training and I, in my mind I thought it was kind of in San Marcos, but then when I looked at the calendar, I was like, “Oh, it's in San Antonio.”
And I was not going to be home in time to make my kids dinner. And I usually try and give my partner a heads up, like, way ahead of time if I'm not going to be around to do that. The night before I was like, I messed up. I didn't understand. I didn't read my calendar right, and I'm not going to be home for dinner tomorrow. And he's like, “I got you, right?”
Not even, he’s like “I saw the calendar and I knew.” And he had my back. You know, we've all had that experience being over committed, right?
I could go do my work and he helped make dinner and then um, you know, I came home and we had a great evening. So that's an example of having someone's back. Can you think of a story like that?
Tony Passalacqua:
Yeah, um, you're just kind of in the same situation. I work in a smaller department and so we are constantly just helping each other out when, when things are, when things are needed.
So, if someone needs to reach out to like a specific client or policyholder, then it's, it's really nice to be able to say, “Hey, I'm running behind on this. Can you help me out in this situation?” And more often than well, all the time, we're very quick to say, “Yes, I've gotcha.” And it's just nice to have that type of support.
Shana Merlin:
That's a great example. The person's not like, “look, I got my people to contact. You got your people. You're on your own.” Right? It's like you’re a team; we're all have the same goals and we can, we can all have each other's back in pursuit of those goals and pick up the slack when needed. Yeah.
Stephanie Downing:
Yeah. I think this might be what we're talking about. Where I was running a webinar and, you know, technology can always mess up. When it came time for me to do the closing remarks, my mic wasn't working. And so, my partner does, um, also working as a host behind the scenes, she picked up right there and had it. So, she totally had my back, and I was like, “Oh my God, what would I have done without you?” And so, it was like seamless to the audience.
Shana Merlin:
They didn't even know.
Stephanie Downing:
I was like freaking out because A/V tech stuff, it's so frustrating and scary. But.
Shana Merlin:
That's a wonderful, that's a wonderful example, right? Cause that person could have been like, “Stephanie? Stephanie, where are you?” Right. And throwing you under the bus. It's going to make you look really bad, but they made sure you look good and go, “Great. So that's going to wrap up our session tonight.” You know, and the audience doesn't even know.
Stephanie Downing:
Um, yeah, she handled that really well. So that was great.
Shana Merlin:
Yeah, and with our great kind of “failure bow” and accountability thing, they can also help you like, let's figure out what went wrong and fix it for next time. So, it's not that we just gloss over mistakes, we want to address them and fix them and have each other's back at the same time and make each other look good.
Tony Passalacqua:
And do you have any sort of closing remarks for what would be helpful for, you know, what's the main takeaway that our audience should leave with when communicating with others?
Shana Merlin:
I want to say that what health care providers do is so important and so hard. And part of why I love doing improv for medical communications is I like to bring joy and skills to people who do such hard work every day. What they do is harder than what I do, which is teach improv. So, I love to fill those people's cup um, with that joy and hopefully give them tools to have a more sustainable career. Because people are reporting burnout in medical school. And we need these providers to, to work for a lifetime, uh, to take care of me and my kids and my kids’ kids. Um, so I, I want health care to be sustainable for patients and providers.
And I think improving, all these little interactions to make them more compassionate, more rewarding, more enjoyable, uh, is my small contribution to, to that effort. I also work with a lot of, of health care professionals and medical students and they're wonderful people. Um, they, they are there for the right reasons. They're smart; they're capable; they're dedicated. So, it gives me great comfort to know that when my loved ones are, um, sick and need help, that people like that are helping take care of them. And I want to reinforce that compassionate care, um, selfishly and for others.
So, um, I hope people, yeah, take one thing, you know, there's a lot of things we've covered and there's so much, um, in improv and in medical communications to do. Um, but find one thing that feels easy, doable that's going to make your day more fun and more efficient and um, give it a shot.
Tony Passalacqua:
Thank you, Stephanie and Shana.
Stephanie Downing:
Thank you.
Shana Merlin:
Thank you. It's so great to be here.
Tony Passalacqua:
Thank you for listening to our podcast. If you're a TMLT policyholder, please feel free to contact us with any questions by calling 1-800-580-8658 or check out our resources at TMLT.org.