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. 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. “Medical
Improv”
#medimprov08
An
innovaFve
bridge…

4. From
many
challenges
we
face…
 Errors,
adverse,
and/or
sentinel
events
 Patient
complaints
 Workplace
violence
 Resistance
to
change
 Substance
abuse
#medimprov08

5. and…
 Wasted
resources
 Staff
turnover,
burnout,
stress
 Toxic
cultures
 Readmissions
 Spiraling
costs
#medimprov08

6. To
soluFons
we
seek:
1 Safe,
quality
care
2 Healthy
staff
&
organizations
3 Patient
satisfaction
#medimprov08

7. How
does
Medical
Improv
do
all
this?
#medimprov08

8. By
building
the
so0
skills
we
need…
1 Communicate
2 Collaborate
3 Lead
#medimprov08

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. 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. 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. What
are
so0
skills?
#medimprov08
• Communication
• Emotional
intelligence
• Interpersonal/relationships

13. How
are
problems
with
so0
skills
contribu7ng
to
problems
with
safety
and
quality?
#medimprov08

14. Progress
with
paFent
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. 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. Soft
Skills
#medimprov08

17. The
Joint
Commission
tracks
root
causes
of
senFnel
events.
What
do
you
think
the
top
3
causes
of
these
preventable
and
catastrophic
errors
were
in
2010,
2011,
2012?
#medimprov08

18.  Leadership
 Human
Factors
 Communication
http://www.jointcommission.org/assets/1/18/
Root_Causes_Event_Type_04_4Q2012.pdf
#medimprov08

19. Each
cause
or
category
has
subcategories
that
are
filled
with
implicaFons
involving
so0
skills

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. Priority
se*ng
requires…
• Self
awareness
• Awareness
of
others
• Being
assertive
• Being
a
respectful
listener

22. How
are
problems
with
so0
skills
contribu7ng
to
concerns
with
our
workforce
and
work
cultures?
#medimprov08

23. Workforce
&
Culture
Through
the
Eyes
of
the
Workforce:
Creating
Joy,
Meaning,
and
Safer
Healthcare-­‐
Lucian
Leape
Institute-­‐NPSF
Roundtable
Report
(2013)-­‐
http://bit.ly/104KSE4
#medimprov08

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. 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. Is
bullying
a
problem
in
healthcare?
#medimprov08

27. Alan
Rosenstein,
MD,
MBA
Medical
Director
of
Clinical
Efficiency
&
Care
Management
at
ValleyCare
Hospital
www.physiciandisrupFvebehavior.com
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. #medimprov08

29. #medimprov08

30. Defining
PaFent
Experience:
#medimprov08

33. #medimprov08

34. #medimprov08

35. #medimprov08

36. What
does
a
Medical
Improv
class
look
like?
#medimprov08

37. 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

38. 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

39. Games
&
AcFviFes
(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

40. 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

41. 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

42. How
can
you
begin
to
pilot
Medical
Improv
programs?
Beth
Boynton
Stephanie
Frederick
#medimprov08

43.  Collaboration
across
all
disciplines
of
healthcare
(conventional,
traditional,
complementary)
 Medical
Improv
training
coordination
to
facilitate
communication,
quality
and
safety
of
care
in
the
U.S.
 Consultant/Advocate
for
engaging
and
empowering
the
Patient
Experience
 Program
and
Curriculum
Development
for
healthcare
organizations
and
higher
education
in
the
U.S.
Contact:
stephaniefrederick@outlook.com
Website:
stephaniefrederick.com
#medimprov08

44. Beth
Boynton,
RN,
MS
ConsulFng
 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

45. 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

46. Lauren
Dowden
laurendowden@
gmail.com
Stephanie
Draus
sdraus@nuhs.edu
Edward
J.
Dunn
edwdun@gmail.com
Dan
Sipp
dsipp@nc.rr.com
Nancy
Smithner
ns23@nyu.edu
Richard
Snyder
richardsnyder@me.com
Tobias
Squier-­‐Roper
tobysr@gmail.com
#medimprov08

47. THANK
YOU!
Beth
Boynton
confidentvoices.com
Beth@bethboynton.com
Stephanie
Frederick
stephaniefrederick.com
Stephaniefrederick@outlook.com
Judy
White
theinfusiongroupllc.com
Judy@theinfusiongroup.com
#medimprov08