8. By building the soft skills we need…
1 Communicate
2 Collaborate
3 Lead
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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
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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! )
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12. What are soft skills?
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•Communication
•Emotional intelligence
•Interpersonal/relationships
13. How are problems with soft skills
contributing to problems with safety and
quality?
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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
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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
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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?
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18. Leadership
Human Factors
Communication
http://www.jointcommission.org/assets/1/18/Root_Causes
_Event_Type_04_4Q2012.pdf
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19. Each cause or category has subcategories that are
filled with implications involving soft 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 setting requires…
• Self awareness
• Awareness of others
• Being assertive
• Being a respectful listener
22. How are problems with soft skills contributing to
concerns with our workforce and work cultures?
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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
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24. 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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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
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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.
27. Alan Rosenstein, MD, MBA
Medical Director of Clinical Efficiency & Care Management at ValleyCare Hospital
www.physiciandisruptivebehavior.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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28. How are problems with soft skills contributing
to problems with Patient Experience?
(Presented by: Stephanie Frederick, M.Ed., RN)
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29. We all have an equal opportunity to be
recipients of hospital care…
What would YOU want your
Patient Experience to be like?
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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
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31.
32.
33. 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
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34. Medical ImprovBuilds “Soft Skills”
for
Communication
Collaboration
Leadership
To support “the sum of all interactions”
(the Patient Experience)
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35. Patient Experience
Will you tell about
how well you were treated,
or
what was “done” to you
while a patient in the hospital?
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36. What does a Medical Improv class look like?
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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
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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
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39. Games & Activities (100s more)
Yes and…, Yes but…, No…
Teaching/learning:
Assertiveness, listening, collaboration, validation/inval
idation & 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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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.
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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.
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42. How can you begin to pilot
Medical Improv programs?
Beth Boynton Stephanie Frederick
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43. "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: stephaniefrederick@outlook.com
Website: stephaniefrederick.com
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44. 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)
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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
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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)