What Improv Comedy Can Teach Us About Communication In Clinical Trials

Over the holiday season, I took the time to reflect on the whirlwind and craziness of the past year. I don’t know about you, but I was ready for some comic relief, so I indulged in one of my favorite pastimes -- attending an improv comedy show. It’s been 10 years since the original Whose Line Is It Anyway ended its successful run as a TV show (much to my chagrin), but Saturday Night Live is alive and well after 40 years. However, nothing beats a live improv show. While you are all likely familiar with improv as a form of entertainment, you may not be aware of its growing role in the fields of medicine and business.^1-4 Why, you might ask?

In improvisational theater or comedy (improv for short), most or all of what is performed is unplanned or unscripted. It’s a no-brainer then, that the techniques should apply in our daily worlds at work (who has ever had a day that went as planned?) and in medicine, where few, if any, patients ever follow a scripted path or planned approach, sequence, and timeline to getting ill or having an injury. Thus, for many, it’s only natural that improv is working its way out of the performing arts arena and into our professional lives. On top of that, we are all faced with constant change that appears to be happening at an even more rapid pace, and improv is perfectly suited to these situations. In fact, the folks at Second City Works (the B2B side of the famous The Second City in Chicago) note that the ability to thrive amid change requires four things:¹

• The ability to recognize where you are in any given moment
• The flexibility to choose a new path
• A willingness to collaborate on a solution
• The freedom to take a risk…and to learn from failure

Businesses are increasingly using improv training to help teams develop and improve communication skills, creative problem solving, and supportive teamwork abilities. Improvisational skills can be used in a workplace setting to enhance listening skills, conflict resolution, and team building, not to mention the ability to think on your feet and be creative in times of distress.³ Specifically, it’s being used at places like Northwestern University, the Mayo Clinic, and Cleveland Clinic to teach physicians how to improve patient engagement.⁵ The core principles of improvisation — equality, collaboration, flexibility, responsiveness, differing perspectives — can be applied to anything from comedic theater to a hospital room.⁶

So, how exactly do you teach improv and help people apply it in their day-to-day work? The simple answer lies in learning how to “Yes, and…”. “Yes, and...”, also referred to as “Yes, and...” thinking, is a rule of thumb in improvisational comedy that suggests that a participant should accept what another participant has stated (“yes”) and then expand on that line of thinking (“and”).⁷ A simple way to try this is to have two or three people engage in a conversation with each person following a different rule. Person A starts every sentence with “yes, but,” Person B starts every sentence with “no,” and Person C starts every sentence with “yes, and.” Such an exercise “gets people thinking about what it feels like if every time they say something, they’re met with a ‘no’ or ‘yes, but’ response, which can feel adversarial and dismissive. The alternative ‘yes, and’ feels collaborative.”⁶ In fact, try to go one step further and listen to yourself every time your boss, colleague, client, CRO partner, or anyone else asks you to try something new or different. I’m sure I’m not the only one who is guilty of saying:

• Yes, but that’s the way we’ve always done things, or
• No, we can’t, because our SOPs require us to do things that way

If our current approach to managing whatever situation was working, then it’s unlikely whoever is posing the question would even be asking us to consider an alternative approach. What if the next time, you try to “yes, and…” them back?

• Yes, we are three months behind in terms of (meeting our enrollment goals…getting the database locked…or whatever problem is at hand), and we know we have to take a different approach to getting things back on track
• Yes, we realize that our clinical research associate (CRA) turnover rates are higher than expected, and we appreciate that this is causing significant disruption to the site relationships
• Yes, asking for additional funds to support the interim investigator’s meeting will require a change order, and we are interested in discussing ways to make this as cost-effective as possible

You get the idea. By reiterating the yes part of the sentence, it:

• Requires you to really be paying attention to what the person is saying or asking for
• Validates to the requester that you have actually heard them and you aren’t jumping ahead with your own justification, defense, or already planned or scripted response

The “and” part keeps the door open to furthering the discussion (or the story line in the case of the comedy scene). Any other response — “yes, but,” “no, and” (here’s why or justification for the no), or just plain “no,” causes the conversation to take a more contentious direction, leaves the requester feeling frustrated and unheard, and doesn’t result in a productive resolution. The point is not to try to get to any specific answer or force the other party into a preconceived solution but rather to keep the dialogue going and see where it goes and what creative ideas emerge.

On stage, when the actors are given crazy suggestions for a scene and stay totally open to the information coming at them, that’s where the creative genius takes place and the conversations can turn incredibly funny. For the rest of us, it can be equally rewarding to experience the power of “yes, and…” in our personal and professional lives — even if it doesn’t result in any laughs.

References:

1. http://secondcityworks.com/goals/whatdoesimprovhavetodowithbusiness/
2. http://annals.org/aim/article-abstract/2536866/medical-improv-novel-approach-teaching-communication-professionalism-skills
3. https://intheloop.mayoclinic.org/2014/10/09/improvising-their-way-to-becoming-better-colleagues-and-caregivers/
4. https://www.amazon.com/Medical-Improv-Improve-Communication-activities-ebook/dp/B071DTVWS8/ref=mt_kindle?_encoding=UTF8&me=
5. https://medcitynews.com/2016/04/improv-training-helps-cleveland-clinic-improve-md-communications/
6. http://www.modernhealthcare.com/article/20160502/NEWS/160509999
7. https://en.wikipedia.org/wiki/Yes,_and...

About The Author:

Beth Harper is the president of Clinical Performance Partners, Inc., a clinical research consulting firm specializing in enrollment and site performance management. She is also serving as the Workforce Innovation Officer for the Association of Clinical Research Professionals (ACRP). She has passionately pursued solutions for optimizing clinical trials and educating clinical research professionals for over three decades. Harper is an adjunct assistant professor at the George Washington University who has published and presented extensively in the areas of protocol optimization, study feasibility, site selection, patient recruitment, and sponsor-site relationship management. She is currently serving on the CISCRP Advisory Board as well as the Clinical Leader Editorial Advisory Board, among other industry volunteer activities. And … when she isn’t doing all this, she is happily facilitating improv workshops with her colleagues at http://sealthedealwithimprov.com/.

Harper received her B.S. in occupational therapy from the University of Wisconsin and an MBA from the University of Texas. She can be reached at 817-946-4728 or bharper@clinicalperformancepartners.com or bharper@acrpnet.org.