Performance of a Lifetime led a leadership retreat designed to improve the working relationships between a hospital’s medicine and emergency department nurses, with particular emphasis on helping them to deal with ongoing conflict and communication challenges, and improve how they respond to stress and navigate hand-offs between the two groups.

The first part of the retreat for the 75 nurses included growth-oriented performance exercises through which the leaders of both units were able to get to know one another in new and more personal ways. In one of our signature exercises, the nurses “performed their lives” in 60 seconds, which created an immediate, positive change in some of the tense relationships in the room. The nurses then created improvised scenes of the work challenges they were facing. Putting their real-life conflicts on stage provided the distance the group needed to explore some of their very charged issues in productive ways. The session closed with the nurses working in cross-department “performance work teams” that generated concrete solutions to some of the previously “intractable” conflicts each group had with the other.

In a post-retreat survey, 73% of emergency department participants reported an improvement in cross-department relationships as a result of the Performance of a Lifetime program, while 86% of medicine nurses reported a boost. In another survey, the emergency nurses reported a 30% increase in patient reports taken by medicine nurses on the first call. Survey results also showed improvement in hand-off communications, with 80% of emergency nurses reporting that medicine nurses asked appropriate questions on the report.

More than 15 years ago, Performance of a Lifetime pioneered the use of improvisational performance to enhance medical residents skills in communication and relationship-building with patients. We have worked with over a thousand doctors, at several leading hospitals and medical education retreats, helping them to create conversations — both with patients and with one another — that support attentive, respectful and collaborative relationships.

Using a combination of theater-for-growth exercises — including improvisational listening and communication games, role-plays between doctors and patients, and video feedback from actual patient interviews — physicians learn to focus on the “art” of conversations with patients at the same time as they carry out the science of doctoring. Medical residents practice listening actively to patients or colleagues, and learn to create conversations that make use of all of the “material” offered by the other person. Viewing (and performing) conversations in this way makes available several often-underutilized features of human interaction, and removes the separation between the scientific activity of medicine and the relationship-building activity. Watch the video.

A few testimonials:
I saw first-hand how the Performance of a Lifetime program enhanced residents conversational repertoire with patients. Many told me that the work with Performance of a Lifetime was also humanizing experience, allowing them to bring more of themselves to their work — as well as providing new tools for dealing with the stress of the hospital environment.”
— Resident education program coordinator and director of ambulatory care

Since the programʼs completion Iʼm trying to listen more, and to be aware of the ʻwhole personʼ — their emotions, attitudes, fears etc. The patients seem more satisfied and I think Iʼm getting better information.
— Second-year resident

I was very skeptical at the outset — but I find myself going back to the philosophy of listening and attending to the relationship. The communication exercises come back to me during interviews with patients. This is a powerful approach — Iʼd like to do more of it.
— First-year resident

My colleagues and I have found this improvisational methodology to be a tremendously effective tool for improving and enhancing healthcare relationships. It is, in our opinion, a valuable methodology for physicians in all phases of their careers.
— Medical educator

Performance of a Lifetime designed and led two programs to develop the leadership skills of the residents at a major teaching hospital.

In the first program we worked with all of the residents, helping them to explore the challenges they face in their high-stakes conversations with patients, families, and more senior doctors. To facilitate an open and candid environment among the residents, Performance of a Lifetime improvisers asked them for examples of their toughest conversations, and then performed scenes — funny, dramatic or poignant — that portrayed these challenges in settings outside the hospital environment and provided a jumping-off point for conversation.

A Performance of a Lifetime facilitator led the residents in deconstructing the scenes, reflecting on the leadership choices the characters made, and providing direction to the improvisers to try alternative approaches. One scene looked at the issue of telling a patientʼs family that a treatment mistake had been made. The improvised scene was set on a construction site, with the foreman telling the homeowners that termite-infested wood had been used to build their home. An intense dialogue followed this scene, about the “right” way to deliver this message. The Performance of a Lifetime facilitator worked to help the group see the “art” of an interaction, and the risks associated with immediately moving the dialogue to right versus wrong — their job as leaders was much more complex than that. The director of the residency program has since shared that “termite scene” became a phrase that the residents used to refer to a tough patient or family interaction.

The following year we were invited back to help the incoming second- and third-year residents to explore the new leadership challenges they would face in the coming year. We focused on conversational skill-building, leading the residents through improvisational communication exercises and having them create and perform in scenes that reflected the leadership issues they were most concerned about. In one of the scenes the group performed a series of interactions with the attending physician, who was clearly the “villain” in the scene. In the dialogue that followed, the group continued to “vilify” the character of the attending. The Performance of a Lifetime facilitator directed another version of the scene, this time with the resident playing the attending stepping out of the scene periodically, and sharing the characterʼs “inner voice.” When he did, he expressed what the attending was up against — high insurance costs, pressures from hospital administration, the pressure of the “role of attending” to always be right, etc. The scene helped to start a conversation about the temptation to simply write the attending off, and that they had to grow as leaders in order to communicate and have an impact in these very difficult interactions.

The director of the residency program has shared that “Performance of a Lifetimeʼs boundless professionalism, creativity and ability to make learning engaging, impactful and fun helped our residents have much more candid, courageous and effective conversations.”

One of the top teaching hospitals wanted to better support their oncology nurses in handling the particular emotional, physical, personal and spiritual demands of working with cancer patients. High rates of turnover and vacancy among oncology nurses had raised concerns that the stress of professional bereavement, the challenges of patient, family and staff interactions, and the issues associated with being part of any large hospital organization were negatively affecting the well-being of the nursing staff. Data from focus groups and a subsequent electronic survey of all oncology nurses confirmed that these concerns were mirrored by the nursesʼ experiences.

To provide nurses with more support, the nursing leadership chose to focus on helping the nurses develop greater resiliency in the face of these challenging circumstances, and engaged Performance of a Lifetime to design and lead the program.

Entitled The Performance of Resiliency, this program began in September 2008 and is still underway, with the goal of building greater resiliency among the hospital’s 250 oncology nurses. Performance of a Lifetime designed and led a series of cross-unit workshops and “performance coaching groups” in which we created “stages” upon which the nurses performed the “scenes” of their lives, explored how they interact with one another and their patients, and experimented with ways to shift and develop their performances as a way of becoming more resilient.

Over the course of the year, the nurses performed and improvised many different hospital situations — the loss of patients with whom they had developed close connections, working with distressed family members, their own experiences with cancer in their personal lives, trying to “learn the ropes” as a new nurse, and much more. Performing and dialoguing in this way enabled the nurses to be open and honest, to shed some of their more constrained and “scripted” performances, to be of greater support to one another, and to better handle the stressful and painful circumstances they were dealing with on a daily basis.

Reports from nurses indicate that individuals, and the oncology nursing department as a whole, have developed in ways consistent with greater resiliency. In addition, a leadership body of nurses has emerged, whose aim is to influence the nursing culture — to value not only the science of nursing but also the art of nursing. This has had a small but perceptible impact on the entire departmentʼs relationships with one another and their patients.

Over a five-month period, Performance of a Lifetime led two programs at a large urban hospital center — one with the staff of the child psychiatry department and one with a new adult inpatient unit. Program participants included social workers, psychiatrists, nurses, medical residents, creative art therapists, psychologists and administrators.

For the child psych unit, the purpose was to support the department in working more effectively as a team and with their patients — to better handle stress, conflict, and a crisis-oriented environment. The department turned over their regular staff meetings (which were happening too infrequently) to the Performance of a Lifetime team, and by restaging the meeting as a theatrical rehearsal, we enabled them to have collegial dialogue and sort out much of their disagreement.

For the new adult inpatient unit staff, Performance of a Lifetime helped the team get to know one another, to better understand the hospitalʼs vision for the unit, and to communicate in a more empathetic way together and with their patients.

Post-training interviews, focus groups and surveys indicate that the staff members of both units grew in their ability to communicate more openly and respectfully; gained awareness of the impact they have on their colleagues; and learned how to “lighten up” and see the value of spontaneity in building cooperative relations and defusing conflict. The associate executive director of psychiatric nursing said, “Performance of a Lifetime has gotten through and helped nurses (and other medical staff) where other methods have failed. Their innovative method of theater and social therapeutics helped my people to grow and change for the betterment of the team and the patients.”