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By Beth Boynton
When I teach Medical Improv, what I’m really teaching are ‘soft’ skills! The improv is basically an effective strategy for teaching them. Sometimes I get asked, “What are they?" It is a great question! Emotional intelligence, interactive, people, relationship, and social skills all come under the umbrella of ‘soft skills’. Some of these factors involve skills, like listening and assertiveness, yet many involve human awareness, feelings and behaviors. And when we start getting into these areas, things get a little more tricky, right? They are inter-related, vary among us, and are influenced by almost infinite variables i.e. the weather, being tired, other people’s behavior, and the cultures we work in. Anything that impacts how we feel and behave, individually and organizationally is likely to influence our ‘soft’ skills. This is why they are challenging to teach. It is also why Medical Improv is such an exciting teaching tool. Different people learn different things at the same time playing the same activity! In the activity Same Time Story, for example, one person is practicing speaking up while the other is practicing listening. And it is no small thing that they are having fun and building their relationship too. What are some examples of ‘Soft’ Skills? Here is a list that I’ve developed over the years and am often updating with input from participants:
What would you add to this list now that you get the general idea? Are there any ‘soft’ skills you are working on? Do you have any thoughts on how these skills are related to patient safety, patient experience, or workforce health? Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!
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By Beth Boynton
Doctors, nurses, patient advocates, and administrators want to prevent medical errors! Yet communication, collaboration, and workplace culture pose ongoing problems. Problems with ‘soft’ skills that make patient safety a stubborn challenge. “Everyone agrees we haven’t made as much progress as we’d like to make [with reducing medical errors], and the improvements have been uneven,” -Linda Aiken, PhD, RN – Healthcare Still Misses the Mark on Patient Safety. Our approaches so far To date, we have focused on safety engineering ideas and new communication strategies. They come from a scientific and intellectual mindset. Science of safety interventions and structured communication techniques arise from this way of thinking. Safety Science For instance, the science of safety recognizes that humans are imperfect. Researchers that look at patient safety from this perspective design solutions that attempt to make it impossible to make a mistake. They force or try to force patient safe behavior. Pre-op checklists and color-coded IV tubing are examples. Structured communication Standardized communication protocols like SBAR and the two challenge rule have been implemented and assertiveness training programs such as Vital Smarts have been administered to thousands of nurses and doctors. They are trying to regulate human behavior. While these efforts are valuable, they missing important elements of communication and behavior. Communication is gray and messy and human beings want to have choices in how they think and what they do. Communication and Behavior are complex If we are going to make healthcare safe, we need to take a deeper dive into understanding communication and behavior. Listening and speaking up require ‘soft’ skills like trust, courage, and confidence. The ability to work in teams, honor other points of view, manage conflict, and lead collaboratively and authoritatively are also part of this skill set. While not easy in general, these ‘soft’ skills are almost impossible to develop and practice when bullying, blaming or a code of silence permeates the culture. What’s more, the way we behave influences the culture and the culture influences the way we behave. Forcing behavior will keep a nurse from using the wrong IV tubing in a rush, but it won’t help her address a conflict with bullying peer or eliminate worries about her student loans. The consequences of using the wrong tubing may be obvious. Whereas, the bullying behavior or late payments may not be so clear. For instance, will the bullied nurse ask for advice from the bullying person? Will she remind this person to wash their hands? Will she pass along a message from a patient’s brother about a concern in a timely manner? And what about worries about paying back loans? Will they be a distraction? Will an important detail be missed? If we are going to move the needle on patient safety, we have to address the roots of communication and behavior that influence relationships. So what do we do? We need a radical shift in thinking! In addition to structuring patient safe communication and behavior, we must also engage, inspire, and empower others to be their best! In other words, we need to help motivate nurses, doctors, and others to communicate effectively and behave respectfully. It is an intrinsic approach to behavior change that is aligned with complexity leadership. This analogy will help explain what I mean: Let’s say our goal is to get our children to eat healthy lunches at school. Our first tendency might be to look for ways to control their eating options. We could:
These ideas will probably have a positive impact too. What we're not doing is engaging, inspiring, & empowering healthcare professionals to be more effective communicators! An intrinsic approach Improv activities offer playful opportunities for nurses, doctors, and other healthcare professionals to feel heard, practice listening, share ideas, and develop trusting relationships. When facilitated properly, the emotional risk in listening and assertiveness is minimized. Think about how powerful it might be for a nurse to experience what it is like to be heard in the course of teaching him or her how to listen. Or how memorable a lesson it might be for a surgeon to accept an idea from a nurse and build on it. And how healing it might be for a nurse who tends to be aggressive and one who tends to be passive to share power in a playful way. The principle of “Yes, and…” Many of you are familiar with the principle of “Yes, and”. Maybe you’ve been to an improv comedy show? Or maybe you’ve been to a workshop where improv techniques were used for team-building? Well, the same concept can be adapted for nurses, doctors, and other healthcare professionals. To do this we take the focus off of performance, use facilitation skills to create a safe environment, and frame the learning in goals that involve patient safety and ‘soft’ skill development. “Yes and…” Improves Communication The “Yes” part of improv activities nudges nurses and doctors to accept what others are saying. Translated into communication learning, it is about listening. And listening will improve patient safety. The “…and” part of improv nudges healthcare professionals to share ideas. In terms of communication, it is about speaking up! And speaking up will prevent medical errors. And there are hundreds of activities that naturally engage participants in practicing communication! It is like a fitness program for ‘soft’ skill development. Moving the needle on patient safety requires a radical shift in thinking! Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Beth Boynton
Do you ever wonder why passive-aggressive, passive, and even aggressive behaviors are so common in healthcare or politics? Assertiveness involves relationships, cultures, and communication skills. Trying to be assertive in a culture where aggression is dominant or with a person who is aggressive is very tricky. Since assertiveness means you respect and take care of your own needs as well as others, when it isn’t mutual it doesn’t work so well. A parable that helps to explore this concept What do you do if you knock on a door and no one answers? (Assume you can hear voices behind the door.) Knocking louder seems like a natural response. But what if still, no one answers? Then what do you do?
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Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Beth Boynton
Are you on the fence about going back to school or not? Maybe you have a list of pros and cons going on in your head or like some nurses, even have one on paper. Maybe you are worried about the time and money involved in going back to school or are afraid that you might not be successful. On the other hand, maybe you wonder if the best time to go for your BSN is right now, even with nagging questions in the back of your mind. And maybe, not deciding - sitting on the fence - is the most comfortable place for you. Here you can keep the option open while not making a commitment either way. How can emotional intelligence help your decision-making? Daniel Goleman is the psychologist well-known for bringing the term emotional intelligence (EI) into mainstream culture with his ground-breaking book, Emotional Intelligence: Why It Can Matter More than IQ. His model, which continues to evolve, involves personal and social competencies, each of which include a variety of traits that can be helpful in decision-making. For instance, we can take a deeper dive into the concept of personal competence in an effort to decide about going back to school. Personal Competence and the School Decision There are three areas of personal competence; self-awareness, self-regulation, and motivation. Self-awareness means that you know how you feel at any given moment and have a sense about both present and past causes of your feelings. Try sitting quietly for a few moments and ask yourself what feelings you have about going back to school and not going back to school. Don’t try to change or judge what you are feeling just notice. Once you have a sense on what you are feeling, you can be curious about where the feelings are coming from. Are there old messages that encourage or discourage you from taking a risk? This may be trickier than it seems because sometimes what we feel about a current decision may have more to do with past experiences than anything else. We may fear failure or even success and the fears are keeping us on the fence. The more you are aware of your feelings, the more you use them to guide your decision. Even if you have strong fears that are keeping you from taking action, now you’ll have a sense about what those fears are and use the awareness to take steps to separate the past from the present and the ‘shoulds’ from the ‘coulds’. Self-regulation refers to our ability to manage our feelings and how we respond to various situations. If we are having trouble making a decision, there is a chance that our fears are paralyzing. There may be very good reason for going or not going to school right now and either decision could be best. Yet, if old voices or fears are dictating inaction, that could be a red flag that your self-regulation is hung up on the past and you might miss an opportunity to grow your career. The truth is, if you made it through an Associate Degree or Diploma program, you are one smart dude. With support and encouragement, a BSN could open up many doors for you in your nursing career. However, honoring fears about time and money may give you a sense of relief in knowing this isn’t the best time to go back to school. A psychotherapist or nurse career coach could be very helpful in discerning your next best steps and then taking action. Motivation is the driving force behind our behavior and absolutely essential for successful return to school. This is the part of EI that speaks to your needs and desires. So often, nurses are grounded in meeting needs of patients and families. Even meeting the needs and desires of your own family may take precedence over your own. While sometimes this makes perfect sense such as with your children or at times with your life partner. But, if you are not getting your needs and desires attended to also, this can lead to burnout or even the kind of apathy that contributes to errors. If the idea of going back to school is an exciting one to you, then there is a good chance you have the motivation for you need to be successful. This will be extremely important in participating in career development of any sort. If you can make the connection between your desire and an action step, you’ll be using your emotional intelligence in a healthy way. Conclusion Going back to school is a big decision and the more you understand your feelings, responses and desires, the more you’ll be able to move forward in the best direction for you at this time. Keep in mind that lifelong learning is a given in nursing regardless of your degree and try to stay open to all ways of learning and growing. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success! By Beth Boynton
Daniel Goleman, the psychologist well-known for bringing the term emotional intelligence into mainstream culture with his ground-breaking book, Emotional Intelligence: Why It Can Matter More than IQ, describes empathy as an important component of social competence. In a more recent article, he describes empathy as a component of effective leadership stating the importance of understanding others’ feelings and points of view. Empathy and relationships Ultimately, empathy is important for building healthy relationships of all kinds, including professional ones with colleagues and therapeutic ones with patients. It is closely tied to attentive listening where the focus is on the other person. Remember only 10-20% of our communication is attributed to the actual words we exchange! An empathic person is taking in all sorts of the other 80-90% of information in any given relationship. A nurse with a high degree of empathy has an invisible radar that interprets facial expressions, body language, and tone of voice. She may be the one on the unit who notes the early signs of a patient’s escalating anger or a colleague’s signs of irritability. This nurse can be a real asset to the team because he may help prevent a workplace violence incident or get help for a peer who is developing burnout. Nurses vary with their ability to start an IV in an elderly dehydrated patient or accurately assess subtle lung sounds before a fluid overload crisis, right? We also vary in our ability to show and feel empathy. That’s Okay because just like practicing clinical skills, empathy can be developed too! Many exercises come from the emerging field of Medical Improv where theater activities are used to build emotional intelligence and communication skills. For instance, one activity involves synchronized storytelling aka same-time-story, where two people try to tell the same story at the same time. How to play synchronized storytelling This activity requires working in pairs, where one person tells a story while the other acts as a mirror and tries to tell it at the same time. So if I say, ‘Once upon a time,’ the idea is that my partner is going to say that at the same time that I am. It’s a little slow at first, and what happens is the person following the storyteller becomes intently focused on that person. Because the activity requires almost 100% attention on another person in a safe and fun way, there is a natural opportunity to develop empathy. If you decide to try it with a colleague, make sure you both have a chance to play both roles and notice:
While this activity and these concepts may seem outside the scope of clinical communication, they open the door to developing awareness and skills associated with empathy. They also create opportunities to discuss the value of the skillset and when and where it can help in your work as a nurse. Looking for your next healthcare speaker? Get in touch with us at the Capitol City Speakers Bureau today to make your healthcare event a success!  By Beth Boynton
As an applied improv teacher, nurse, woman, mother, sister, and friend, I think a lot about communication! I study the impact it has on outcomes in healthcare, such as patient safety, patient experience, morale, and utilization of resources. I reflect on my own behaviors in the relationships in my life. And I often wonder how it pertains to our challenging political landscape. Our ability to be our best selves with others in family, groups, teams, organizations, and countries while making room for others to do the same is fascinating to me. And quite complex! Do you ever think about assertiveness and listening with respect to power dynamics? Assertiveness requires ownership and a willingness to take on more power while listening requires us to let others influence any decision, plan, or idea, i.e. give up some power. Either of these can be emotionally risky and can shake our sense of self, confidence, and control beyond measure. When we add a toxic hierarchy, a blaming or bullying culture, or high-stakes work to the mix, the risk involved in taking on or sharing accountability increases….increases a lot. So much so, that the risk involved in sharing power is a formidable barrier to effective communication! Quite frankly, I believe this is a major reason why our efforts to improve communication in healthcare have not been as successful as they need to be. This is why applied or medical improv activities are a goldmine for us. They provide low-risk and fun opportunities to practice sharing power outside the clinical environment that can be so stressful. If we can do this in healthcare, not only will we have better outcomes, we interface with all of the rich diversity of human life. We can model empowering language and behaviors across genders, races, age, political parties, and so on! Wow, right? Where is your growing edge? With listening or assertiveness? Or maybe both depending on what relationships or cultures you are in? Looking for your next healthcare speaker? Get in touch with us today to make your healthcare event a success! By Beth Boynton
Let’s face it, nurses — we’re all different! Millennials grew up with rapid advances and total comfort with technology, more progressive values about women in society and the workplace, and a heightened sense of boundaries and limit-setting. There is so much that Baby Boomer nurses can learn from their Millennial nurse peers. Boomer nurses, on the other hand, have years of valuable experience despite the challenges of providing care amidst inadequate staffing, bullying, and toxic workplace cultures. I have no doubt that if we can build relationships and respect our differences, the things we can learn from each other will have a positive impact on patient care, career paths, and the nursing profession. Here are seven tips to help Millennial and Boomer nurses create bridges to thriving interprofessional relationships and all sorts of positive outcomes: 1. Recognize the inherent value in diversity. Sometimes our differences are overshadowed by fears or power struggles that are hurtful and keep us separated. Yet diversity is an element of complex adaptive systems that allows for a variety of creative ideas. When the clinically seasoned Boomer nurse joins forces with the tech-savvy Millennial, the possibilities for problem-solving in any given situation are much more than the sum of two parts. 2. Be curious! I’ve heard Boomer nurses make unkind and generalized remarks about Millennials and visa versa. Is this necessary? Curiosity is a fundamental listening skill that requires focusing on what we don’t know about another person and a willingness to suspend judgment. Rather than making assumptions about experiences, behaviors, or intentions, consider being curious. 3. Invite dialogue. If you’re a Baby Boomer, use your curiosity to find out what it’s like to be a new nurse in today’s healthcare system. What are the challenges and rewards that your Millennial colleagues are hoping for? If you’re a Millennial, do you ever wonder what it’s been like to practice nursing with chronic problems like toxic cultures and bullying? Taking the initiative to learn more about each other will automatically build relationships. I bet you’ll have some really interesting conversations, too! 4. When values conflict, show ownership for yours. If you don’t like the way someone else is behaving, reflect about what’s going on for you. A Boomer who thinks a Millennial is lazy might really be feeling resentful because their young colleague seems to have a healthier work-life balance and personal boundaries. If that Boomer can identify and deal with such feelings, they’ll have the potential to improve their own self-care. 5. Validate differences with respect. Millennial nurses may find themselves surrounded by Boomer nurses who have much valuable knowledge and skills coupled with very bad habits in terms of bullying and incivility. If younger nurses can express respect for seasoned nurses’ experience while clearly stating that inappropriate behavior is not OK, a whole world of relationships and learning opens up. 6. Ask for what you need from each other. Do you need help with a decision to call a physician? How about help with the new EMR? In a healthy team of Millennials and Boomers, there’s a dynamic exchange of expertise — and if there isn’t, this is one way to get that ball rolling. 7. Show gratitude for what your colleagues bring to the table! Millennial to Boomer: “Thank you so much for your support when Mr. Jones passed away. He was my first patient death.” Boomer to Millennial: “Thank you so much for helping me figure out how to program that new IV pump. I couldn’t get it to work right.” Conclusion Yes, Millennials and Boomers are different, and sometimes differences create tensions that interfere with learning, communication, patient care, and mutual appreciation. Can you envision trying out any of these tips on younger or older colleagues? If you can, let us know how it turns out! Looking for your next healthcare speaker? Get in touch with us today to make your healthcare event a success! |
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