The answer is “Yes”!

In today’s post we’ll go over why setting-limits, including saying “No, is an important communication skill. Then we’ll explore the “YES AND” philosophy of Medical Improv as a teaching modality for developing and practicing it.

A Critical & Complex Skill

Setting limits requires self-awareness about what our limits are, self-respect for them, and confidence in expressing them to others. Psychological safety and a culture of trust are organizational factors that contribute. Speaking up in this way is crucial for best outcomes in patient safety, patient experience, workforce health, and cost-effectiveness.

Here are some examples of limit-setting by nurses, doctors and other healthcare professionals that contribute to these outcomes.

I haven’t had training in using that IV pump and need help.
Stop! Don’t make that incision! It is the wrong leg.
I can not keep seeing patients at this pace and feel like I am doing a good job.
I need more time with Mrs. Smith before she is discharged. She is expressing fears about her colostomy.
I need proper PPE before going into that room.
I can’t help you right now. I need to get Mr. Jones’ pain med. Maybe Sally can. I just saw her come in.
Please step back and out of my personal space.

Can you see how important these limits could be to the outcomes mentioned?

Danielle Ofri, MD, describes the interrelatedness of communication, workload, burnout, and safety in her New York Times Op-Ed piece (2019), The Business of Health Care Depends on Exploiting Doctors and Nurses – One resource seems infinite and free: the professionalism of caregivers.

“One additional task after another is piled onto the clinical staff members who can’t—and won’t—say no.”
Danielle Ofri, MD

Why can’t or won’t we say “No”? For many of us, such statements can feel risky. We may be afraid of being wrong, worried we’ll be judged, and/or fear job repercussions. All may be real possibilities.

Yet with our patients’ lives, our lives, and the very health of the system all on the line isn’t it important to build limit-setting skills?

Here is a teaching modality that can help.

“YES AND” Medical Improv!

You’ve probably heard of the principle of Yes And. Often associated with improv comedy and more recently in the mainstream as a team-building tool. It is the golden rule of all improvisational activities whether for comedy, business or in healthcare.

Basically it means you accept what another person says, (the YES) and you add something to the scene or story (the AND).

Consider two conversations:

Person 1: There is a big hole in our boat.

Person 2: YES, there is a big hole in our boat.

In this conversation, Person 2 is validating Person 1 and following a ‘say YES’ philosophy. Developing and practicing listening skills is one big way Medical Improv can help healthcare professionals. What makes this next conversation different?

Person 1: There is a big hole in our boat.

Person 2: YES AND let’s get to that island STAT!

Notice how the second conversation creates more opportunity to create a story together and is akin to working in a team where there is trust and all voices are spoken and heard with respect. Who knows what might happen next?

Person 1: Yes. We can camp there tonight. Hurry! (All sorts of possibilities!)

Deeper learning

In an experiential teaching zone, the second conversation reveals how valuable the learning potential of ‘AND’ is as it nudges people to take the risk and share an idea.

Deep down this risk occurs in the same place we may be afraid of being wrong, worried we’ll be judged, and/or fear job repercussions. As we do this in a safer, more fun environment, (i.e. outside our high-stress, high-stakes work), we gain awareness and confidence. A practice that helps prepare us for sharing concerns, ideas, and limits that impact critical outcomes back in the workplace.

Try it!

One way to appreciate this deeper learning is to ask yourself what you might say and how you might feel on the spot!

Person 1: There is a big hole in our boat.

You: _______________________________

What did you come up with? Did you have ideas for fixing up the hole? Did you jump out and find the water was only a few inches deep? Did you call 911?

Was it easy? Did you notice any hesitation?

I can feel a little anxious when called upon to add something to an improv story. For me, a little bit of a fight, flight, or freeze response is going on. Yet, I trust my ability to move through the stress response, access creativity, and share an idea. Something that I’ve learned in taking improv classes!

Improv experiences help people develop confidence, show ownership, and speak up. Even when there is a power gradient. Even when there is a need to say “No”.

Learn more!

Other ways to explore the learning possibilities of medical improv:

Find a willing partner and try out this “YES AND” tutorial.
Google Medical Improv.
Find some research.
Join me for Game Changing Team Development for Healthcare Leaders – One Activity at a Time. (one hour sessions which you are welcome to try for free!)

In Person (York, ME) Session 1 – Sunday, Oct 2nd , 1-2pm EST: https://www.eventbrite.com/e/game-changing-team-development-for-healthcare-leaders-york-me-session-1-tickets-407592519197

Online Session 1 – Tues, Oct 4th, 6;30-7;30pm, EST https://www.eventbrite.com/e/game-changing-team-development-for-healthcare-leaders-online-session-1-tickets-405878693097