EGrowth Edge Leadership Podcast: Dr. Michael Smith
Laurie Baedke:
Well, hello and welcome to another episode of the Growth Edge Leadership Podcast. I am your host, Laurie Baedke, and I am excited to welcome Dr. Michael Smith to the podcast today.
Mike is an academic hospitalist, medical educator, and the founder of Healthcare Improv. More than a decade ago, an unexpected gift of improv classes sparked what would become a completely new dimension in his work.
Today, he helps healthcare professionals strengthen communication, leadership, and teamwork through the deliberate practice of improv, showing that some of our most important leadership skills aren't learned through lectures, but through experience.
So, Mike, it's great to have you on the show. Welcome.
Mike Smith:
Thanks so much, Laurie. I'm very excited to be here, and I'm always very excited to talk about improv and its relation to every aspect of life.
Laurie Baedke:
Awesome. Mike, when most people, and probably most of your physician colleagues, hear the word improv, they picture a comedy club or a theater, not necessarily leadership development. But you've built an entire movement and a business around using improv to help clinicians and other healthcare professionals become better communicators.
So I'm going to ask you maybe the most obvious question right up front: What do most people misunderstand about improv?
Mike Smith:
I think there are lots of different misunderstandings or ways that it can be interpreted. Some people see those comedy improv experiences, like Whose Line Is It Anyway?, or maybe they've been to a show in New York or Chicago.
The way I like to compare it is, if you're out in the woods and you saw a wolf, you'd think, "Wow, that's pretty great, but I don't want that in my home or in my work. But I would maybe like a dog."
The evolutionary example is the same, but it's built for that specific context.
Improv really, at its heart, is about the skills of listening, active empathy, and practicing that. Each time you practice improv, you have to practice those skills.
When people see those comedic examples, they think, "There's no way I could ever do that." In reality, they're doing it all the time. The skills of improv come up every day, and people are doing it constantly.
The biggest misunderstanding, I would say, is that people think they can't do it, they're not creative enough, or they're not that type of person. Seeing really high-level examples is great, but it can contribute to this feeling of, "There's no way I can get there."
In reality, we all do it every day and experience those moments of improv throughout every aspect of our lives, especially professionally.
Laurie Baedke:
You mentioned listening and empathy, which are hugely important. And so much of improv, when I think about it, comes with this bias or mindset that it has to be related to comedy or theater, and therefore it's not necessarily for me.
But when you say listening and empathy, or being able to think, respond, or adapt on the fly, I think about getting put on the spot in a meeting when you might not know the answer.
You're an academic hospitalist. It's early August when we're recording, so there's a fresh new batch of trainees who just arrived in the hallways that you're perhaps rounding with. If that medical student or resident gets put on the spot by an attending with a question and they're stumped, what are the skills that improv equips us, or them, with that we might not necessarily have thought of as improv?
Mike Smith:
The idea that you respond in the moment or are creative is one of those things where people see high-level improvisers coming up with things on the spot and say, "I could never come up with that."
What they're really doing is saying yes to what's happening and then just building off of that.
The improv recommendation is: Bring a brick, not a cathedral.
They're building each scene one by one. They're really focusing on being present and asking, "How do I respond and add to this?" It's recognizing what's happening and contributing what you can.
That new medical student or new resident is thinking, "How do I give the perfect, 100 percent right answer? It's got to be perfect. It's got to be exactly what this person is thinking."
The tenets and skills of improv are: Let me recognize what's happening and respond with the best that I can, and go from there.
As an academic hospitalist, patients throw loops at me all the time. I might have an idea of how a visit is going to go or how their treatment plan should work, and then they say, "Yeah, and I've been having chest pain as well," or, "Yeah, and I don't have electricity at home."
No matter what I read in a book, I need to be able to respond in that moment. I can't say, "No, no, it's fine," or, "Well, good luck figuring it out," because that's not going to connect with the patient and their needs and actually help them.
Being able to respond in the moment in an honest and helpful way really drives that connection.
That's the main learning point that I bring to a lot of our events: connection first, communication. Really trying to connect first rather than show how smart you are.
In improv, it's trying not to be funny. If you try to be funny in an improv show, it really tanks the scene because it comes at the expense of your scene partner. It's disconnected from what's actually happening. It's making you the center of it, as opposed to the improv style, which is, "How do we build something fun together and find connection with each other?" Then the audience gets to enjoy that.
Similarly, in the hospital, finding connection with a colleague to help a patient, finding connection with a patient's family member to help them, all of those are ways that the improv mindset is cultivated.
You get immediate benefit in improv, whereas in real life you may or may not see the benefit, or the harm, of doing or not doing it.
Laurie Baedke:
Really amazing. To me, that tells the story that this isn't necessarily an individual sport. It's a team sport because you're taking what someone else has offered and you're trying to bring a brick, and then give someone else the ability to add to it.
Am I connecting those dots accurately? What does that look like in improv, or how do you teach around that? And how has that changed the way you show up as a physician?
Mike Smith:
In the improv world, we'll say, "I'm not going to control the scene, and also I have to bring something to the scene."
It's not like I'm showing up empty-handed. I'm bringing this little bit, and I'm ready to see what we're going to build together.
I can't count the number of times I've either witnessed my fellow improvisers do that or felt like I've been a part of it and looked back and thought, "How did we come up with that? That was so funny, and there's no way I could have come up with that on my own."
It creates magic, really, because you think, "I have no idea how this happened."
Similarly, you bring that to the hospital and clinic. You may have an idea of how something should go, but if the patient isn't included in building that reality together, it'll either be brushed off or not applicable, or you may be missing large, important sections of the story.
Bringing what you're thinking and allowing them to tack onto that and build it together, from a patient-care perspective, builds much more powerful care plans that they feel invested in.
From a leadership perspective, everyone talks about getting everyone's involvement in problem solving and bringing everyone to the table. I think the improv mindset really demands that you do that because you're bringing your perspective, talents, skills, and ideas to the table, and everyone else has a similar idea: "Let's hear what Mike's idea was, and then I'm going to add on top of that."
To build momentum from a leadership perspective, I think it's an absolutely essential way to build something that you can't come up with just by yourself.
Laurie Baedke:
You pointed out that it's you and your active engagement of the patient and perhaps their family members or caregivers. But I have to imagine it also invites and really intentionally involves a multidisciplinary team as well.
When you're rounding on the floor, it's not just you and the patient. There are nurses involved. There are pharmacists involved. There are a host of other individuals involved.
Tell me a little bit about what that looks like in the workplace, but then also, I'm guessing, that's the reality in your workshops when you're working with healthcare organizations as well?
Mike Smith:
Absolutely.
In the clinical space, that's huge. I know what the book says the treatment plan is, but then the physical therapist says they can't walk, so that obviously won't work. The pharmacist says, "Well, actually, this drug costs X amount of dollars, and they're already paying this amount."
One of the most essential parts of my job is understanding everyone's perspective. It's not just my idea. It's how my ideas connect with each of those parts. I have to do it.
In the workshops, that's been one of the biggest benefits for me personally: understanding different professions' perspectives.
I started doing workshops in 2018, and they were designed around how improv has helped me as a physician. It was, "This helps me communicate. This helps me listen. I'm more empathetic when I'm talking with patients."
Then the people who signed up were from the business office or non-patient-facing professions. I thought, "Okay, well, we can still work from this."
That's been one of the best parts about it because you hear their perspectives on these problems and issues that face all of us.
I'll do an exercise with a group of people, and they'll have really brilliant insights about how it applies. Then I'll do the exact same exercise with a different group, and it might be the thousandth time I've done the exercise, and someone always says something new where I think, "Man, I've never thought of that. That is so true."
It's been an education for me because I get to hear everyone's perspective in these situations where five minutes ago they were laughing hysterically, and now they're talking about really deep ideas about what it means to be in their profession and practice it, and the challenges they face.
They're not serious conversations, but they're important conversations. That dichotomy in each workshop is one of the true blessings of it, I would say.
Laurie Baedke:
I love that so much.
As you and I have chatted before and as I was thinking about our conversation today, one of the improv framings is "Yes, And," right? I think it's a fairly foundational element of the improv model.
Tell us a little bit about what "Yes, And" is and how it's used in improv.
Mike Smith:
In improv, we step out on stage and we don't really know what's going to happen, so we have to have a superstructure to guide us. "Yes, And" ends up being one of the more essential principles.
If we come out on stage and you say something, I'm going to say yes to whatever that is and then add something onto it. That's the bare-bones description of it.
But there is a lot of confusion or assumption that when you say something, that means I have to like it. It doesn't mean I agree with it. It doesn't mean that's how things are going to go.
It means that your character believes that, or thinks that, or that's part of reality.
You could say, "We're cowboys," and I don't want to be cowboys. I wanted to be an astronaut. But I guess we're being cowboys today.
That's accepting your reality and then building off of it.
That is so applicable to all of the communication that I do in healthcare, and there's nuance in not agreeing with someone or not saying that's the right answer.
If someone says, "I need a month's prescription of opiates," I don't have to say, "Well, yes, and don't sell these, please."
It's more, "You're in a lot of pain, and I want to address that pain. I'm going to do everything I can to help you treat that in the most effective way."
I think in leadership it's also super important because the adaptability piece, to me, is saying yes to the reality that you're in and really understanding it.
Again, you don't have to like it. It doesn't have to be what you want or what you anticipated. But that's the reality you're working in.
The "and" piece is: What are your principles? How do we add our principles into what's happening in front of us and grow from there, as opposed to blindly pushing your principles despite them not being applicable to the reality?
In an individual conversation, it hugely adds to empathy and connecting with people that you may or may not otherwise connect with, or that you disagree with. It still allows for connection.
Then, in the leadership piece, it's seen as adaptability, but it's really just principled development in whatever area your group hopes to go.
Laurie Baedke:
I like that. Thank you for digging into and explaining that a little bit more because it helps me realize how that's applied in the workplace and, again, in a multidisciplinary team.
You gave a couple of examples. You're prescribing a plan of treatment upon discharge, but then your patient says, "Yes, I hear you, and I have no power at home."
Or you recommend a medication, but then the pharmacist or social worker says, "Yes, and that particular medication is unavailable," or there's not a generic, or it's not covered under the formulary for this particular patient.
It's this constant building, and that is so important and true in an interdisciplinary team-care environment.
One thing that I heard you say is that several things can be true at the same time. That's one of the dissonances or tensions that's so difficult for all of us. It's difficult in our day jobs, in diverse teams, and in our society around us when people have beliefs or perspectives that differ from our own.
It's acknowledging that two things can be true at the same time.
You're helping me understand why improv is so incredibly important. I'm also glad you pointed that out because I think a lot of people might think "Yes, And" means we have to simply agree with everyone. That doesn't necessarily have to be the case.
You can be space cowboys, right?
Mike Smith:
There you go. Exactly.
I do a workshop at UNMC on the med students' first day of school, which I think is so funny. They're like, "I'm ready for med school. Here I come." And then they get improv.
Within that, they write essays, and they'll talk about how they used "Yes, And" with a family member they've been disagreeing with or with a roommate they've been disagreeing with. It's not anything to do with medicine.
They'll say, "I used 'Yes, And,' and I didn't change my mind. They didn't change their mind, but they saw me listening to them more, and so they listened to me more. It felt like we understood each other better."
It might have been headed toward a really contentious moment where they were going to argue with someone they love or who is important to them, and instead it turned out to be productive.
Again, no one changed their mind. Nothing materially changed about how they approach the world. But they took the stress of arguing and seeing division where it would have otherwise existed, and now they're having a moment of connection despite disagreeing.
To me, it's very meaningful to provide that skill at the start of medical school, when they have so much stress in their lives. If they have a framework for communicating with people that lowers the stress level in other aspects of their lives, they can focus on the stresses of medical school.
That's a very clear example to me of people using this in ways where you're not agreeing with everyone around you, but you're really seeking to find connection and understanding as a first principle and going from there.
Laurie Baedke:
Totally agree.
You mentioned very early in our conversation the word empathy, and there are a variety of different definitions for empathy. One that I appreciate a lot is just the pursuit of understanding, or seeking to better understand someone else's perspective.
That comes through active listening. It might not mean I believe the same thing that you believe, but I understand better what you're saying.
I'm so glad you teach that on the first day of medical school or very, very early in that journey.
I'm a huge fan of the research that Dr. Helen Riess from Harvard Medical School undertakes. I've had Dr. Riess on the show and love her research on clinician empathy and how it can be taught. I think there's so much strong alignment between your work and hers.
Mike Smith:
Her book is great. I think I reference it, or have referenced it, in workshops. It's very well connected to that.
Laurie Baedke:
I'm a big fan of Dr. Riess's work. I'll link to it in the show notes.
But let's pivot for a second. Let's rewind and go way back to the beginning.
You teach improv now, but this was actually an unexpected Christmas gift that changed your trajectory. Tell that story, if you would.
When you walked into that first improv class, did you have any idea that it would become part of your life's work?
Mike Smith:
How it started was my wife and I were finishing our residencies and work in New Orleans. It came time to decide where we were going to move.
I wanted to move to another big city. We're both from Omaha, and I knew eventually we'd be back in Omaha, but I wanted to move elsewhere. She did not. I was outvoted. Back to Omaha we go.
I had recently torn my ACL, and my main identities, I would say, were physician, husband, father, and adult sports player, for lack of a better term. That was my main activity outside of work and family.
I was kind of mad about coming back to Omaha. Not mad, but it wasn't my choice at that time. And my main identity outside of work and family was taken away from me.
I wasn't in a good headspace.
Then that Christmas, she got me Level 1 improv lessons at the theater here in Omaha, which I did not know existed.
I had no theater experience. I was not a theater kid. I often say that I'm the youngest of six kids, so I crave attention, but I never had a formal outlet for it.
It also wasn't like I was talking about wanting to be a comedian or do stand-up. It was totally out of the blue. My wife does give excellent, heartfelt gifts, so this was in keeping with that.
I can still remember that first class. I was so nervous and very uncertain. I didn't know what to expect. I just kind of went through it and had moments of fun where I thought, "That was awesome. I'm definitely coming back."
It was a weekly thing. The business model, somewhat related to these classes, is you go to the classes and then you have a class show. They're like, "Tell everyone you know to come to the class show. It's going to be great."
I was like, "No chance. I am not telling anyone. Especially the people I work with. I'm not telling anyone about this."
That proceeded on. I was still very nervous at the classes, but I was having fun and enjoying it.
Then there was a particular exercise you do in class called a three-line scene. One person walks out and says a line. The other person walks out and says a line. Then the first person says a third line.
Within those moments, you're supposed to figure out who, what, when, where, why, and what's going to happen in this scene, establishing that very quickly and very early.
I took that and applied it to my patient interactions.
In doing that, I realized how many assumptions I'd made about what the patient understands or what's important to the patient. I turned it more into actually communicating. We'll say I actually communicated rather than talking at patients.
During that time, my patient satisfaction scores improved more than anyone in my group. They announced it, and I was like, "Look at me. Improv is helping me."
But I also remember walking out of that meeting and thinking, "I thought I was really good at these skills at baseline. Why did they have so much room to improve?"
That was kind of a shock to me.
It told me there was something there about these skills that I was practicing.
Then I started doing some of the exercises with med students and residents. They're kind of a captive audience, so they would participate, and it would get positive reviews or they'd speak fondly of them.
I had the idea that this could be a good way to teach a lot of these skills to med students. I told the guy whose office is next to me, and he said, "I don't know if that's a good idea. Has it ever been done before? Is there research on it? Is anyone else doing it?"
I said, "Let me get back to you on that."
Then, I think the next week or within the month, the Annals of Internal Medicine had an article published by Belinda Fu and Katie Watson talking about improv for medical students.
I was like, "We did it."
There have been all sorts of things like that, where I just kind of put a feeler out and someone says no, but then something else happens that helps push it along.
It definitely wasn't, "I'm taking this for my career," and it definitely wasn't, "I'm doing this to gain a particular skill."
It started at random and then truly snowballed.
But I essentially "Yes, And-ed" all the way into what it is now, which is that it affects the way I see more or less every event in my life.
So, truly by accident.
Laurie Baedke:
I love that.
It sounds like initially this was something you were just going to hide. You weren't going to talk about it when you went to the hospital. It was something you were interested in on the side.
It sounds like it took a while both to convince yourself that it was creating an impact for you, and then how fantastic to have research support your hypothesis and your inkling that this was something you wanted to pursue.
One thing you've also shared with me over time is a finding from your work: Improv can be a great way to equip individuals who don't have formal leadership authority with actual leadership skills.
Can you tell me a little bit about that for the listener?
Mike Smith:
For sure.
That was also part of my believing in these skills. I would be put in positions where I would practice these skills of improv, where I'm deeply listening, where I'm really trying to understand the situation and adding my contribution, not overrunning the situation, but contributing my part back and forth.
There were a handful of high-stress situations where I would do that, where I would really try to recognize the reality of the person who was in distress.
Even though I didn't have a leadership title within that position, people were looking to me to help solve the problem. They were putting me in the leadership situation because I was practicing these skills.
That's definitely something I've noticed.
All of the skills that I talk about in my improv workshops, if you read leadership content, it's like, "You need to do these exact same things, and here's why."
And I think, "Well, this is exactly what I practice when I'm practicing improv."
The skills that I need in my Wednesday night improv class are the exact same skills that I need when a patient is yelling at me, or when my colleague is frustrated with some aspect of our work.
All those things are guaranteed to come up.
It's not, "Am I this person who can solve it?" It's, "How do I apply these skills in this moment, in real time, when it's stressful and when there's some amount of vulnerability on both parts?"
When I step into the vulnerability of being on stage in front of people, that's a stressful situation that has very low stakes.
Then, in stressful situations that have higher stakes, I'm able to practice those skills in that moment because I've had fun practicing them.
Laurie Baedke:
I think that's so important.
When you mention the themes that are consistent in any HBR article or leadership book, I'm hearing the word vulnerability come out of your mouth.
It takes courage to think about someone stepping into one of your workshops, or any of us entering a difficult conversation with a colleague or a patient.
We want trust in our teams, but trust doesn't just magically appear. It's built painstakingly slowly.
One of my favorite themes on this podcast is that leadership growth almost always feels uncomfortable before it feels natural.
What's one uncomfortable practice that you wish every leader would intentionally put themselves through, based on what you've learned or what you teach?
Mike Smith:
I would say it's just the act of doing something uncomfortable.
There are certain aspects of improv that I'm good at, but the practice of it requires me to be able to produce all of them.
There are times in my life where I'm going through discomfort and I revert back to managing the discomfort that I'm comfortable with, if that makes sense.
But the situation really requires me to address the thing that's actually causing discomfort, even though that's not the discomfort that I'm used to.
On an improv stage, someone may ask me to sing. I hate singing. I'm bad at singing. There's no redeeming quality for anyone to hear me sing except the discomfort that it's providing me.
But if I'm on stage and someone says, "Sing that song that you always used to sing," I kind of have to do that in that moment. Everyone knows that's a part of it.
Forcing through that because that's what the situation demands, being aware of what you're comfortably uncomfortable with and what's uncomfortable-uncomfortable, and being okay with, "I can push through that," I think improv has provided that.
I think leaders would benefit from that sense of: Do what the situation demands, not just what I'm the best at.
Laurie Baedke:
I love that.
It underpins or validates so many things that I believe. We probably all wish things were easier, life was more comfortable, and things weren't difficult.
But everything that we want in every domain of life, excellence requires sitting in a moment of tension.
To be physically or nutritionally where we want to be, financially, professionally, relationally, all these things, we don't necessarily always want to do the things that we know we need to do.
Embracing that discomfort in pursuit of what is on the other side of it is an important discipline.
Our time is running short, and I have a couple of rapid-fire questions I'd love to wrap up with. Are you game?
Mike Smith:
Yeah, let's do it.
Laurie Baedke:
Biggest communication mistake physicians make?
Mike Smith:
I would say assuming too much that the people they're communicating with share understanding, worldview, et cetera.
That was true for me. I came to realize that I made too many assumptions and needed to clarify each time I communicate.
Laurie Baedke:
The curse of knowledge. Physicians are some of the most highly educated, knowledgeable individuals, but there's always something more, isn't there?
All right, second question. What's one improv principle everyone could practice tomorrow?
Mike Smith:
"Yes, And."
"Yes, And" forces you into a position of empathy, and if you do it effectively, you'll receive an immediate benefit from it.
It's not always as rewarding as the improv stage, but I promise you it will be rewarding and improve the state of your conversations immediately.
Laurie Baedke:
Leadership lesson you learned the hard way?
Mike Smith:
The assumptions piece, both with colleagues and, less so, with patients.
I think that leads to a lack of trying to understand, and that promotes disconnection.
It's the assumption that people see the problem the same way that I do, or that I have the sole answer to the problem.
Laurie Baedke:
What's something you're still practicing yourself, Mike?
Mike Smith:
I would say listening and empathy. Those are the areas with the most immediate benefit.
Improv brings an awareness of when I listened well and when I was effectively empathetic, but I still find areas where I need to improve or think, "I did not do that very well. I can improve there."
Those are the highest-yield and most immediate benefits from improv, and yet also the areas where I'm fine-tuning constantly and wish I was better.
Laurie Baedke:
Last question. Complete the sentence:
Great leadership is...
Mike Smith:
Exactly as you said: helping others push themselves through discomfort to feel the benefit at the other end, which in turn creates more leaders.
Laurie Baedke:
Love it.
Mike, thank you so much for this conversation. Thank you for your important work.
I'm going to include links in the show notes to where people can find you and your website. I can't recommend Mike's work highly enough. You work with a whole host of healthcare organizations all over the nation, and I'm hopeful that people will follow your work and perhaps reach out and collaborate with you.
I'm grateful to know you.
Mike Smith:
Thanks so much, Laurie. This was great.
I enjoy having these conversations, and your perspective on it helps me understand the things that I'm doing.
So thank you.
