Releasing the Inner Improviser

Best health includes improvisation in the relationship between health professionals and those in their care. One picture of improvisation is discretion to customize response and interaction and go off script and track with each individual’s or families journey. Yet the capacity of health professionals to remain up-to-date in their knowledge, compliant with practice and regulation, and productive while still able to be kind and improvise approaches possessing a superpower. As Kate commented yesterday, other knowledge workers – teachers – have the same challenges.

What conditions release the inner improviser?  Let’s consider a few: clarity of purpose; trust and team dynamics; predictability and responsiveness of  systems; and ability to learn from the improv: fix what seems broken.

Clarity of purpose can be mission, focus on the task at hand, or even clear boundaries. Every organization I’ve worked for had a mission statement. St. Peter’s Health Care Services (SPHCS) in Albany, NY, was committed to being a transforming healing presence in the communities we serve. Like the golden rule, easy to say, tough to do. Difficult decisions at SPHCS often included explicit consideration of the mission.  Focusing on the task at hand is mindfulness. As in right now the task at hand is pain relief, teaching, mobility, whatever. Not my co-worker, not the next person who needs me, not Dancing with the Stars. Concentration. Zen. Finally, improvisation occurs within boundaries – knowing the tune. For health workers the tune is policies and procedures, regulations, standards of practice.

Trust and team dynamics. Sustaining kindness and improvisation without feeling trust in yourself and your team truly IS superpower. Good team dynamics are healthy relationships – role clarity, communication that greases the constant shifting and movement of the day’s flow, re-prioritization, and mutual helpfulness.

Predictability and responsiveness of  systems used by your team –  workflow, supply chain, information systems. Knowledge workers create work arounds when systems don’t work quite right. They ingeniously seek a state where they can accomplish their daily tasks productively. Disruption of these systems draws valuable energy away from kindness and improvisation.

If all the stars are in alignment and staff feels able and empowered to improvise, we are idiots if we don’t learn and fix. Some proportion of improv is kindness and some is in response to something that is broken. Often both. Lord, I feel another post coming on.

I contend that the most important job of leaders – the people who supervise those who touch the public – is to nurture the environment of kindness and improvisation. Nurture the environment and model the behavior.

Improv and Health Leadership

Why improv and health leadership? Health experience is unique, of the moment, a journey. A different possible riff every moment.

The patient, client, consumer (let me use the term consumer for now) expects safe, quality, kind, empathetic care and service from professionals and their organizations-it’s a given. Even when safe, quality, and kind are present the health journey can be a very rough road. The challenge for the professional and support staff is to maximize the ability to know and relate to consumers as individuals and respond to the roadblocks, detours, potholes of that journey. 

The compliments my peers hear about health care are not usually about saving a life, successful surgery, hand washing. Rather it’s about the housekeeper who brought coloring books to the child; it’s about the nurse who knew the child’s passion for Ninja Turtles and brought a Ninja Turtle balloon to the bedside or exam room; it’s about the doctor who called the family on her day off; it’s about the registrar who found a private space for a mother to breast feed a non-patient child. These leverage the whole experience positively.

The relationship between professional caregivers and consumers includes constant improv-discretion to customize response and interaction and go off script. Yet the capacity of caregivers to stay up-to-date in their knowledge, compliant with practice and regulation, and productive while still able to improvise approaches superpower.

How can professionals and support staff tap their inner superpower without the intentional complicity of their leaders? Health leaders model and create the conditions that cultivate and learn from this improv. More about those conditions in the next blog.

Improv and Best Health

Why improv and health? Health is unique, of the moment, a journey. A different possible riff every moment. Successful maneuvering the roller coaster of dis-ease depends on religious taking care of what is well with your instrument; on you and your team dynamics; on the predictability and responsiveness of the tune: systems and infrastructure through which you journey; listening for the germ of truth in yourself, your caregivers, and professionals. Best health seeks simplicity: values, mission, common sense and of course chutzpah when you can afford it. The rest is commentary.

How is your health improv?

Improvisation

As an amateur jazz musician I spend 3-6 hours per week working on improvisation.  In NY I studied with Al Golladoro, a virtuoso extraordinaire. Now in MA I learn from Jeff Harrington, a saxophone professor from Berklee College of Music, and for the past year I’ve played weekly in a student combo practicing improv under the direction of Dan Fox.  I’m blessed with the chutzpah to venture outside my comfort zone. I’ve landed on several fundamental principles while studying improv:

  1. Listen first, play next
  2. Know the underlying tune
  3. Keep my place
  4. If nothing else, feel the rhythm
  5. Less is more
  6. A good sound beats dexterity
  7. Forget it all and have fun
The lessons of improv serve me well as patient, caregiver, nurse, and leader. Subsequent blogs will dive into improv and the other hats, but I can distill it down as follows:
  1. Listen first, act next 
  2. Excel as a team member on a good team
  3. Know the goal and the related systems
  4. Keep it simple
  5. Enjoy life

Superpowers

What are my superpowers? What are your superpowers? Love having this conversation with my grandson. Today, he has atomic breath like Godzilla (especially in the morning). I first had this conversation with my son when we first knew he was dying of cancer. His superpower was poetry.

i am not things.
i am sums of things,
guessing that i’m part of God,
wondering if there is some place
where my soul will go
from where i might look down
with advantages my eyes did not have
and see the tops of trees
which i used to walk beneath for
shelter from rain and sun,
and see the way things go together
like continental tracts of land
punctuated by water and lights
and roads and other concrete artifices

Preface to “the way I become about dying” by Michael P Funk, 2002

When diagnosed with MS, my superpower became the ability to accept what is. Superpowers are a magic lever for best health.

What are your superpowers?

Rest – another magic lever

I’m on vacation with my family on Cape Cod, playing, eating, napping, and swimming. For best health we need rejuvenation. All components of individual health: spiritual, mental, and physical, depend on rest and relaxation. These days most healthcare organizations exist in a constant state of change. Change is seldom restful. I suspect organizations need rest and rejuvenation for their best health. The front line bears the brunt with interrupted work flow and changes in staffing and technology. Those touching our patients, clients, consumers feel less worn when they can depend on a steady routine of care and service. One of the hardest jobs of leadership is to care for the front line so they don’t burn out. We can set realistic timelines, support flexibility in hours to promote work/life balance, and make sure that changes at least make some of the work easier. We can promote positive storytelling that links staff back to the mission – why they do the work they do. What a dilemma: ever shifting environmental challenges necessitates the constant change that exhausts staff.

How does your organization rest and rejuvenate?

Exercise – the instant magic lever

Seems like a no brainer. Exercise, the instant magic lever for best health. Profoundly affects spiritual, mental, and physical health. One of the ways I discovered that I had multiple sclerosis was my inability to stay on a bicycle. I kept falling off when I stopped. Receiving the diagnosis was sobering at best! Sometimes very sad and depressing. Six months after my diagnosis I bought a Recumbent tricycle. I cried with relief that I could still get my favorite exercise. Can’t fall off a trike. Good for my soul, good for my heart, good for my quads. The direct connection between activity and recovery is so well documented.

How have we redesigned healthcare to include more activity? In that last 20 years patients walk right away after surgery and recover much more quickly. When I was an ICU manager we incorporated more activity into our standard operating procedure. We needed to use the families and caregivers to increase activity. We struggled with reluctant patients. But more activity for patients led to fewer complications, shorter stays, and better outcomes. Good for staff as well.  Have we taken this far enough? Do we build our organizational systems to maximize activity for staff?  I wonder if the magic levers of best health are obvious but fundamentally challenging-like the golden rule. Obvious and tough. 


What have you done to include physical activity in the routine of care giving?

Best Health: Different lens, Different point of view
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This first blog begins to set the stage. “Best health”. How will we recognize best health? For individuals, could it be love, peace of mind, a cure, ability to complete activities of daily living, or freedom from dis-ease? For organizations, could it be making a profit, growing volume, high overall satisfaction or NetPromoter score? 

Just like anything with the human condition, best health isn’t static. Best health has constant variation. At one point in my life working for a landscaping company, I had the task of completing the final hand raking of top soil for a brand new 2 acre rolling lawn. Took 20 hours. With the lens of that solitary monotonous gig I learned that there is no up without a down. Every depression had a corresponding rise. Zen for the 20 year old! Best implies less than best, always together.

While in nursing school, as a rehab aide, I was going down the hall with a 18 year old quadriplegic from a gunshot wound to the neck learning to maneuver his wheelchair with his mouth. Coming the other way was a 50 year old man suffering from a debilitating stroke, learning to locomote his wheelchair with his left hand and foot. Behind the drooling, slouching, struggling man was his beautiful 20 something wife dressed to the hilt looking completely disgusted. Out of the corner of his mouth my young patient muttered, “glad I’m not him.” It’s all relative. 

Different lens, different point of view. Attaining best health means figuring out the unique goal of the person or organization and working toward that goal collaboratively.

I invite you tell your story.