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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
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
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“Medical Improv”
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An innovaFve bridge…
From many challenges we face…
Errors, adverse, and/or sentinel events Patient complaints Workplace violence Resistance to change Substance abuse
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and…
Wasted resources Staff turnover, burnout, stress Toxic cultures Readmissions Spiraling costs
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To soluFons we seek:
1 Safe, quality care
2 Healthy staff & organizations
3 Patient satisfaction
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How does Medical Improv do all this?
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By building the so0 skills we need…
1 Communicate 2 Collaborate 3 Lead
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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
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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! )
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Lauren Dowden, MSW Candidate
Stephanie Draus, ND
Edward J. Dunn, MD
Dan Sipp, SP
Nancy Smithner, PhD Richard Snyder, MD Tobias Squier-‐Roper, BFA
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What are so0 skills?
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• Communication • Emotional intelligence • Interpersonal/relationships
How are problems with so0 skills contribu7ng to problems with safety and
quality?
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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
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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
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Soft Skills
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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?
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Leadership Human Factors Communication
http://www.jointcommission.org/assets/1/18/Root_Causes_Event_Type_04_4Q2012.pdf
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Each cause or category has subcategories that are filled with implicaFons involving so0 skills
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
Priority se*ng requires…
• Self awareness • Awareness of others • Being assertive • Being a respectful listener
How are problems with so0 skills contribu7ng to concerns with our workforce and work cultures?
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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
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Physical Harm
Health care workforce injuries are 30 times higher than other industries.
“I need help giving this patient a boost in bed”
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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
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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.
Is bullying a problem in healthcare?
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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.
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Defining PaFent Experience:
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What does a Medical Improv class look like?
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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
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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
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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.
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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.
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Unpredictable and fluid, the human interactive aspects of healthcare interventions can emerge in the moment with a positive dynamic that has already been established.
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How can you begin to pilot Medical Improv programs?
Beth Boynton Stephanie Frederick
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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
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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)
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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
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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
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THANK YOU!
Beth Boynton confidentvoices.com Beth@bethboynton.com
Stephanie Frederick stephaniefrederick.com Stephaniefrederick@outlook.com
Judy White theinfusiongroupllc.com Judy@theinfusiongroup.com
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