Everyone knows that medical-surgical nurses are the backbone of patient care. We are usually the first to bring attention to a patient who is not progressing as planned. As such, we hold a unique position as the “scout” to influence patient safety and health outcomes.

Here’s a unique idea to mitigate risk when failure is deadly: improv to improve patient care!

I can hear you laughing in the nurses’ lounge at such a wild and crazy idea:

“What?”

“Improv is for comedians!”

But what if I told you that’s not true? That you can employ applied improvisational principles from the arts to enhance communication, adaptability, and teamwork, and with these principles, you can foster a culture of psychological safety, which leads to more employee engagement, better teamwork, safer patient care, patient satisfaction, and higher HCAHPS scores?!

So, What Is Applied Improvisation?

Applied improvisation is the adaptation of improv techniques from all the arts. The principles include active listening, collaboration, adaptability, and the ability to build on others’ ideas. In essence, it differs from performance improv because we aren’t “looking for the funny” (although we laugh a lot); we are looking to relax and relate better.

We study the neuroscience behind the method, the tenets of emotional intelligence, and utilize meetings, workshops, and/or retreats to kinesthetically solidify the learning. For instance, instead of declaring, “Everyone should listen more,” with applied improv learning, we use specific exercises to practice listening in non-threatening ways.

In healthcare, these skills help teams respond swiftly and effectively to unpredictable situations. Unlike scripted responses, applied improv helps us think on our feet. This method fosters even more creativity and flexibility as we continue our work of patient-centered care.

Improvisation and Safety

We know that for more than 20 years, research has shown that miscommunication is one of the main reasons for medical errors and adverse patient events.

By learning improvisational principles and practicing the exercises, nurses can sharpen their ability to:

1. Communicate Effectively: Improvisation encourages active listening and concise communication. These skills reduce misunderstandings during handoffs, emergency situations, and interprofessional meetings.
2. Adapt to Change: In complex adaptive systems, as on medical-surgical units, unexpected situations are a part of life. Improv trains staff to embrace uncertainty and find creative solutions under pressure.
3. Create a Culture of Psychological Safety: Teams that practice improvisational principles learn to trust one another and create an environment where everyone feels safe to speak up and voice concerns, share ideas, or admit near-misses and/or mistakes without fear.

Practical Applications in Medical-Surgical Units

Here are three ways applied improvisation can be integrated into nursing practice to improve workplace safety:

• Simulation: Applied improv exercises can be incorporated into simulation sessions to resolve the natural anxiety student learners feel when being observed. This author taught simulation at the university level for many years and successfully incorporated relationship-building improv exercises into the process, beginning with pre-conference sessions, so students worked more in tandem with others.
• Try this: Group students in pairs. Set a timer for three minutes. Partners must find “as many things in common — outside of nursing.”
• Debrief: Learners share how many items they found and what surprised them.

This practice decreases learner anxiety and fosters teamwork.

• Team building: Encourage team members to build on each other's observations and suggestions in a low-risk environment with "Yes, and..." exercises.
• Here’s how: A facilitator begins by directing learners to find a partner they don’t know well. Then, ask for a suggestion of a hypothetical relationship between the two and an event they are to plan. Person A makes a statement related to the relationship and the event. Person B answers, “Yes, and...” and adds to the idea. They go back and forth, each beginning with “Yes, and...” and adding ideas.
• Debrief: Partners share the unusual (often hilarious) conversations/events that were created. This practice reinforces collaboration, quick thinking, and comradery.
• Improving SBAR: Miscommunication during patient hand-offs is a known safety risk. Improv exercises, like “Word at a Time Story,” are fun ways to practice focused listening and clear communications despite surrounding noise and distractions.
• To begin: Switch partners and construct a narrative, one word at a time. This allows learners to concentrate on the critical elements of the story (as during hand-offs) while ensuring clarity and brevity.
• Debrief: Partners share experiences of interesting twists and turns of their stories. They tell when they attempted to steer the story a certain pre-conceived direction, instead of being completely focused and “in the moment” about what the partner had just said. Each pair adds a “lesson learned” from this exercise.

Facilitators guide teams to debrief, in general, about lessons learned during these sessions. Learners identify what went well and what could be improved. This fosters continuous learning and strengthens psychological safety within the culture.

Overcoming Barriers

Introducing applied improvisation into a medical-surgical unit may encounter resistance from leaders or staff who are skeptical about non-traditional training. Here are three strategies to overcome these barriers:

1. Provide Evidence: Share a bit about the neuroscience research that underpins the method and success stories that show the impact of applied improv in other healthcare organizations.
2. Start Small: Begin with an introduction to the method and reassure everyone that they do not need to try to be funny. A few short, easy, fun exercises during staff meetings, etc., can help break the ice, tear down walls, and build bridges. (Remember to emphasize the connection between these activities and patient safety outcomes.)
3. Facilitate Inclusively: Emphasize that in improv, “mistakes are gifts” for learning. There are no "wrong" responses in improv. Everyone will be supported and included.

Conclusion

Applied improvisation is a powerful tool to enhance workplace safety in healthcare. By fostering trusting relationships and increasing emotional intelligence and adaptability, improv principles can empower teams to navigate challenges more effectively. In turn, having more efficient teams that work together and can spontaneously adapt to challenges and problem-solve results in reduced medication and other errors and improved morale.

Incorporating improv principles into daily practice not only strengthens safety outcomes but also creates a more resilient and collaborative workplace culture. Like Florence Nightingale, as nurses continue to innovate in patient care, applied improvisation can become a vital component of our professional toolkit.