Hello, my name is Vadim Rokovsky, I work for Red Hat and one of the major things which Red Hat works on, it's not just open software which is not sufficient these days, it's always about communities where we try to build a group of people interested in our products or rather we want to turn interesting things which people do, basing their community and we're sustain this community so that later on we can sell this as a Red Hat product. But the core of this is always the community, a group of people who are interested. This is why we're having a panel discussion between various members of communities.  So today I think I would leave introductions to yourself because you know you're better than I am and that would be more convenient. So who wants to start with introductions? Let's start. Alphabetodor doesn't work, you're all A's, so. Okay, let's start from me. Hello everybody, I am Alexander, I am a founder of a company which is named Victoria Metrix. Have everybody heard about this company before? Okay, probably you heard about Prometheus, monitoring system. And Victoria Metrix is like Prometheus, but better. And this is also open source. And next one? Hello everyone, my name is Andrei, I work at Flant. And we are developing open source software and help other companies to deploy, prepare and monitor their applications. We have various open source products and we are communicating with the community quite a lot and with the different communities and that's it. Hey, I'm Aneshka and I'm here as a representative of two different communities for this Chesco Digital, which is like only check based community focused on digital technologies and helping NGOs with using digital technologies to its full potential. And the second one is PyLadies, which is a worldwide community focusing on bringing more ladies to open source and to Python language. And I'm a member of a local chapter here in Brno. With that, I think we can move on to more specific topics because the topic of community is very large, but I think we want to focus on a particular time set, which is the last two years where quite large changes have occurred to the whole world and we are interested how much did they affect the communities. So I think I wonder if each of you could look back into what changed two or three years ago and what's how the community looks now, both in terms of success or failures or any kind of changes in how you approach them, the ways of work, remote is a huge thing. How did that affect your particular communities? I understand if you don't have a great look back into this, so it's totally fine to say I'm not sure, I don't know, it's okay, there's no pressure. Who wants to go first? Let's start from me again. Andrei will be next anyway. Okay. As for Victoria Matrix, we see a huge increase in the number of people of our community during the last two years. This is because Victoria Matrix is quite a young company, it is four years, it has been founded four years ago and we are still at startup mode and our community and our user base grows multiple times per year and during the last year I believe that our community has grown almost probably 10 times and this is great and we see that the coronavirus crisis which held during the last two years increased the users' involvement in our project and I believe not on our project but in all open source projects because people have more time working from home and more time for exploring different available projects in open source and have more time to spend the time on these projects and that's great. Andrei, would you like to go next or we can ask some more questions? Yes, sure. I can say from perspective of land because I'm working just half a year in this company but I was working with other open source software previously and we were developing some services which is consuming these projects and I can say that yeah I see that there is more and more people getting involved in these open source projects and I like this because it makes new communities and makes people happy communicating with each other and this is a really beautiful thing and I like, I think in the future most of the projects will turn to be open sourced and all of them will have the community because it's different business model but it's more likely, I would say, people like that and people like open source more than proprietary software and it makes some sense. Or we can pass to Anishka and do another circle. Okay, so I have experienced actually both sides of this coin. I mean with Chesko de Gital, the COVID was kind of a boost for the community because at the time of the first lockdown the community was approximately half a year old, it was really young and at the time we had like 1,000 members of the community and over the first month of the first lockdown it doubled its size to 2,000 and a year later in February 2021 it was 4,000 people so it was really huge growth for us and Chesko de Gital was from the beginning meant as an online community so we're basically living on slack. So by COVID we were affected only in a positive way, not only with the growth but also with the activities in the community because Chesko de Gital is a community of expert volunteers and when they saw the crisis coming there was kind of immediate response for that and people came with a lot of ideas supporting the urgent needs in Czechia at the time. So for example the COVID portal which most of you may be know as the one source of truth for COVID information, it was originally built with Chesko de Gital and Nucket together so these kind of projects and it was really great to saw all the people coming and really wanted to help. Of course it has its downside I mean when the restrictions lifted summer is coming and so we saw the decrease in activity and then in the spring of 2021 again the people came because there was another lockdown so it was kind of like seen the side but overall for Chesko de Gital COVID years were years of growth. It's kind of different story for Pi ladies in Brno because we didn't know before COVID actually how important it's for us to be together face-to-face on site to meet other people because the main purpose of Pi ladies is to create a secure safe space for ladies who want to become involved in IT and it's really really hard to build this online. We tried, we tried with the first lockdown we really tried to switch our courses and workshops online but it didn't work it was just we weren't able to replicate the same safe space the same environment to build the relationships in the community so well as it is when we meet on site so during COVID and it's specific for Pi ladies in Brno I can't speak of another chapter in Czech Republic but in Brno we suspended most of our activities and now we believe the future is bright we're restarting we're pulling a lot of activities for summer and also for autumn stop by on our booth I can tell you more but over the two years of COVID it was really really painful for Pi ladies Brno. I keep hearing the recurring theme that the community is growing when the lockdown started but the question is what I would like to know is do you foresee retaining those numbers as in the lockdowns most of them are lifted in most countries, bonches people go back to walking in the woods and having fun with their kids and so on do they stay in the community how do you help them to stay and keep on working on the fun thing they did during lockdowns Andre now goes first because now is his turn. Okay I think it is really important to show the people that they work if they're making some contributions to show that it is really important and it's really important to show them to give them feeling that they're working on something that you can you know it's always cool when you can say hey my code is working somewhere in Google or somewhere on Facebook yeah just if it's changing few few lines of code that it's like makes me happy and I think it is important to give people the same feeling. Who wants to go next? I think that of course when the lockdown is finished then people tend to do other activities than contributing to open source or involving in open source but we can help people remain in the communities of open source projects by encouraging them and by encouraging them not not only to contribute the code but the most important part of every open source project is documentation and the documentation is easier to contribute and to improve compared to code and this means that wider audience of our community can help us and we should encourage them and we actually encourage them to send us pull requests which fix just typos in our documentation or improve our documentation in a few words on a few sentences and this is a great I think this is a great way to encourage community and to grow it and another important part is Slack chats or Telegram chats where the most active community members can take active part and they like that and we should help answer their questions in this chat and should encourage to ask their questions even if these questions feel not so professional it's okay well for us it's a bit different I mean both of you guys your communities are tied to like specific open source product with just going to tell it's different I mean we are built over the open source principles but we don't have one specific tool or one specific product we are tied to but I agree with Andre with the importance of like this sense of belonging to work on something which is important something which can help or so we experienced actually the the similar boost we experienced with the covid we experienced now with the situation in Ukraine because again it was built on the immediate response to some crisis and the community came together and started working on helping projects and I mean this is a really important thing this sense of belonging the urge to help it's really common for the open source communities while we're talking about the successes over the last couple of years we also must also mention the shortcomings of what happened could have been done better or more importantly even the threats which are critical for the communities to not to be entirely destroyed because it's very easy thing to destroy a community so you're all coming from all different backgrounds so I would like to share what are the threats you're seeing in in how your community functions or even just sustains itself I think yeah our project okay our project contains consists of two parts one is open source which is named open core which contains the most features of the project victoria matrix and also we have enterprise version of victoria matrix and these features are available only for people who pay us money for contracts and I see that the main treat for projects like ours which is named open core is that open source community usually want enterprise features to be pushed to be backported to open source version and they always push us they say why you put this to enterprise version put this to open source version and this is the most challenging part of such project as ours to explain because the community why we did this and in the way so people don't angry on us and continue being our fans I don't know maybe I didn't get the question what's the problems actually we're developing yes the threats and problems and shortcomings of what you did last for the last two years what is the most threatening thing is probably the most interesting question where do you see the threat coming to your community I can say much because again I work in just half a year developing open source software but yeah that's I agree with Alex say Alexander sorry yeah that's it's always problem to understand how to split your software how to sell it actually but there is some options how you can do that and that's interesting like you can develop your open source software and you can try to sell it and we did we do that the different way we actually we prepare the tool which is solving our problems and solving our cases and we just put it into the open source so the main principle how we get the money it's still our clients but we developing our tool which can be used by anyone else and I think this is win-win so when it comes to differences between open core and the full support module we have two different opinions as in you're assuming that the problems you're hitting would be the problems of your customers as well meaning if you put this open source you can support them better this is pretty much similar to red heads model right depends to this correctly while alexander's model is more classical open core where you have to find a very careful balance between paid customers and community okay but that makes perfect sense Anisco of course any yeah I mean for us it's again a bit different but I think we have some similarity to what alexander says which is a motivation motivation of the community which is of course a bit different than when you're working on some big project but to keep keep the volunteers motivated it's the same for all the communities and you can find the the similarities all over for us we have an interest kodigital we have a small core team which actually its function is to keep the community happy to provide all the tools needed to provide support to step in if there is a need or so and to nurture the community which is which can be applied to all open source communities I believe to all communities actually to have those who feel the responsibility of keeping the community alive okay I think that the most important thing which we can do to in order to increase our community and make our community happy is to follow their suggestions on how our project should evolve and this is great and as for victorimetics we always try to follow to listen to our community and to implement features which they mostly want and we see that this is much better than somebody than one person for instance me can decide which features should be implemented and don't listen for community and so we follow the path by listening to the community and implementing features which the community demand not the features which somebody like me want to implement because they like and this this works well because people like when their feature requests are implemented and if these features are needed by a big number of people why the audience then this audience become more supportive for for your project and become even glist of the project and this is great I would also append that it is important to be polite with your community and it's always cool when you're making some bug reports and to get fast reply on that and that's the thing where people what expecting from you and if you see and if you're communicating with the community very well they will like you even more I think we have three minutes left so let's do one last question and then we probably could have the audience ask you a few things so we can always slowly move to the hallway track it's the benefit of the DEF CON of course let's let's make it short I want you to name one thing you are very very proud of which is related to community for the last two years what's biggest thing which immediately comes into your mind when we mentioned success in the community or something like that I have a short one that we survived and and we're going on I know the feeling any other survivors I don't know I just want to say that I like how Google can organize the community they know how to do they actually with the organization terms all these special interest groups working groups and I like the organization I think that organization is important thing to have in communities I have no input we will country as a survivor then good anybody from the audience wants to give a couple of questions so we just slowly move to the hallway track I see that yeah hello everyone so thank you for great discussion like you probably using at least for Alexander you're using GitHub to get an input what is needed but if we're talking about communities we have different channels like Slack forums whatever how you can measure the engagement and how can you actually understand what your community is growing community is dying or it's like a stagnation thanks for the question very interesting question and there are many metrics which we can use to measure the our community for instance the number of issues the given period of time and if we see that the number of issues created and feature requests to which our users create during some period of time during the months increases then this means that our community grows also we have metrics such as the number of downloads of our binaries and the number of visits to our GitHub to our website to our documentation and we can also measure the growth of the community by these numbers and also the number of people in our Slack chats and telegram chats also shows whether the community grows over the time and the one thing we see the the big increase in the number of pull requests from community members for our projects during the last two years especially because if we will see at our project two years ago then the majority of commits and pull requests were from the members of Victoria Matrix team especially from me and if we look at these commits for the last months for instance then we can see that almost half of these commits go from community members not from Victoria Matrix team and this great this shows that the community grows totally I agree with everything said before I can also append that this is might be really cool when not only you talking about your product but when people starting talking about that some discussions and you can find the discussions in some different places in some unrelated forums and sites like that we need to wrap it up but no it's okay I mean it's we have the same metrics as Alexander said so basically the externals and the progress of how many external people are communicating yeah that makes sense okay I think that's all the time we have left even more so feel free to ask additional questions to the people in the hallway track that's why we have it and thank you very much for all of your attention and then the round of applause for our perfect panelists please


Here's an interesting topic. What's worse, sugar, alcohol, or tobacco? Hey there, NJ Route22.com here with an interesting kind of topic that covers a large spectrum.  Is it eating sugar and carbs? Is it drinking alcohol over a long period of time or a lot at once? Or is it tobacco? Chewing tobacco, cigars, cigarettes, or what have you? Which is the worst? And I'll just put this out there. According to what I think the mainstream opinion is, whether it's from news or magazines or medical or just the collective opinion of society as a whole, the ranking would probably look like this. Number one would be the tobacco is the worst. And then number two would be alcohol and then three, a distant third or way off the charts is sugar because no one's really talking about sugar and carbs these days.  Here, I'm going to have some alcohol right now to smear it off by sparkling celtic. Anyway, our opinion is that the list that I came up with, that self-created list, my list would be number one and number one and two would be a close tie. I was going to make the number tied for first, but I think the number one worst thing a human can do is eating sugar and carbs, period. And number two would be alcohol and then the third would be tobacco use. Now, the reason I picked sugars because I believe it truly is vastly purposely under reported in terms of how bad it is. And there's probably dozens of different bad human outcomes that are directly a result of sugar. The obvious ones being, excuse me, I have gas for some reason. I don't know why. Oh, you know why? I'll tell you why. I freaking ate. I did have logged the other day about peanuts and how I'm not going to eat them.  They're just too addictive. They're gone now. I think we've eaten them all and they're not coming back in the house. My fault. Anyway, I think sugar, there's so many different things wrong with sugar. You know, the most obvious being obesity, but I really do believe that sugar leads to other diseases because it just makes the body just ill equipped to heal itself and monitor its own well-being. It's just bad. And obesity definitely leads to all the heart disease and joint failure and organ failure and all sorts of other things. And of course, alcohol would be second because not only is it bad for the individuals that drink too much or have chronic problems over consuming it, they can also end up hurting other people indirectly, whether it's through violent acts or drunk driving or other kind of mishaps on the job mishaps where like the air traffic controller wasn't paying attention to planes crash on the runway. Alcohol is definitely has a has an end date to it. You can't drink alcohol every day and expect your organs to keep up with the workload. And of course, then tobacco, I think, is third. And it certainly is, does have an endpoint too. And there's some acute diseases that can be directly attributed to smoking such as like lung cancer and other diseases. But it may not be all that bad actually too because we strongly believe that sugar is probably the main reason why people get cancer. Because from what I've read and I understand that sugar basically feeds the cancer cells and without the fuel for the cancer, you really can't get cancer. I mean, I'm sure some other bad things can happen with tobacco, even if you don't eat sugar.  So it's not I don't think it's as definite a death as a long term alcohol consumption. So that's that's my opinion. I think you get rid of that sugar and carbs from your body and your life. I think a lot of the other problems will be far away or hard to reach other than accidents and crazy relatives and stuff like that. But yeah, sugar, alcohol, tobacco in that order. If you like my video, please hit like and subscribe and I will see you next time.


Guys, so I am back home, but I just want to give you guys an update. Basically, I filmed other vlog footage that is all over the place and dates like from when I moved into university to some classes to some books that I read and right now it's 17th and I'm on winter break. So I thought I would actually I actually have time to vlog record and get some more content for you guys and read more. So I just wanted to give you guys kind of an update and I have a whole to-do list a little to-do list today that I really want to accomplish and get done because I've been falling behind with my YouTube because of school and because of just other things that have been going on. So I really want to get back into that over the winter break. That's my priority because I have no work to do other than my YouTube stuff. So I'm excited, but I need to tidy my room. I need to put on makeup. I need to clean my camera lens for my other camera. I need to film two videos today. I need to check my business emails, which is a big one. Claire Fox sent me some stuff. So I need to do like a story feature. I don't have... I never have to do those. I just like to do them and then I have to include them in a video. So I have a Claire Fox thing. I have to take... I want to take some Instagram photos because I haven't uploaded in months and then start vlogging. So all just stuff YouTube kind of related and business email related. So I'm really excited to just get all this stuff knocked out today and I hope that I do. I'm also going to give you guys reading updates along the way and stuff like that. There you go, buddy. Get some water. So I just made my coffee and this morning I'm probably going to start the Clevver Fox stuff just because I really want to get that done. Make sure I get that up on time and I answer business emails. I'm going to do that for a bit and then see how things go. I fed my cats. We good.  Yeah, I'm so nervous vlogging again. It's been so long and it feels like it's been so long. So if I'm a little weird, I apologize. What are you doing? What are you doing? Meow? You want water? Water? Water for Ruff? And that's what happens. Hey, sweetie. He loves water only from the tab. Like he'll sometimes drink his bowl of water but most of the time he shows up at someone's sink and waits for that. I tidy my room up quite a bit so that's done which I'm really relieved about. I clean my camera lens so I'm good to go for that in filming and I'm just putting up right now my story post for Clevver Fox. So this is what it looks like. I honestly am not the greatest of these story things but I just did a quick one on my phone. I made a little collage showing it, all that stuff. But yes, I'm super excited about the planner. It's going to be the one that I use in the new year and it's the months, the weeks and it's like all planned out for you. And then at the back it has dotted pages for like bullet journaling if you want to do that. And it just comes with a bunch of stuff and it's going to be perfect for 2020 so I'm really excited to use that. I need to do a video actually showing all my old planners and stuff like that and what I used this year and like what kind of worked for me and what I learned and blah blah blah blah so like that could be a fun video. Did some cleaning. I started vlogging obviously. Cleaning my camera. All that stuff is done. Makeup start filming. Maybe take some photos later. And yeah so today so far has been productive day. It's only like 10 o'clock and I feel like I've gotten so much done so yeah. I've missed waking up early because sometimes when I'm up at uni I don't wake up that early. Or it depends because I go to bed really late up there. I got my cartilage pierced. I can insert photos but yeah I got my cartilage pierced and this is like my first piercing other than like my two. And I love it so. In terms of reading I did read, not last night but the night before I read Dream of the Sun Volume 9. Follow this girl named Shimani who is kind of shy and likes some of the guys that she rooms with and starts falling for some of them and it's about their like friendship together and everything like that. And it's really light and fluffy and fun and it's just like a cute manga romance that I would definitely suggest. It's also by the same artist and author who did Orange which is an amazing manga too. If you're looking for something more heart-hitting that's one to go to. One is really fun and light and fluffy and this particular Volume 9 wasn't the greatest for me. I think I gave it 2.75. It just...it was okay. Like there was nothing really great to say about it. Like I don't think it was the best manga. Like a lot happened in it but at the same time it's just... I don't know. There's certain parts that definitely lack for me and certain things I never like about mongas. Certain tropes I don't like in mongas but they're always going to be in there. Certain tropes are always going to appear and it's like some of them I really hate. Some tropes in mongas and it's like I could do a whole video honestly talking about tropes in mongas but... I just got two packages in the mail so I thought I'd open them for you guys. They're from Simon Schuster but I have no idea what they are. And they're like flat packages so I have no clue. I might have gotten an email. Like I don't remember. So it says it's from Simon Schuster but it's a collection from Andrew Smith Meal publishing a poetry. The complicated notion of belonging when one's family culture and country are at odds with one's personal identity braiding together sexuality, divinity and conflict and redemption. The Lost Arabs is a fierce, urgent collection from a distant new voice. Which this actually sounds really interesting. I haven't heard about this one so I assume it just came out. I'm kind of confused why Simon Schuster sent it from Andrew Smith Meal. But if it's an Andrew Smith Meal poetry collection, Simon Schuster sent it. I'm not sure why that's a thing but I mean cool. Thank you to Simon Schuster. Cool. Oh it's another one. What? I'm so confused. They gave me two of them? So two of these. I might do a giveaway of one of them I guess. Yeah thanks to Simon Schuster. Also really random. I don't think I got an email about this. If I did then I definitely have to check because it's been a bit. Thank you so much for that. I totally appreciate this. Don't get me wrong. It's just I'm really confused because I don't remember. I assume these are unsolicited then. Which is fine. But got these two. Probably look out for a giveaway because I don't need two copies. So it is currently about 12.20. I just finished my makeup and I got so much done already this morning. I tidied my room. I cleaned my camera. I need to check emails. I did the story stuff. Started vlogging. So like I did some things. Had coffee. Had lunch. Like the whole shebang. So I'm good. But I haven't put on makeup in so long especially since it was dramatic. So I use this. I use this new palette that I got which is the Osnap Violet Voss palette. It's really cool and it has this really pretty red shade in it. So that's what I mostly use. I use the two red shades and then a little bit of the black in the crease and fake lashes and then my usual kind of routine if you guys care. But yes I'm pretty happy with it. I'm still not wearing normal pants. These are like PJ pants that I'm wearing today. But because you know filming you only see top up. So it's good. But I'm going to get some photos for Instagram and stuff like that. And yeah I'm pretty happy with today so far. And yeah most days I'm like this because I haven't gotten this much YouTube and social media stuff done in one day. And like my business email stuff. So I'm glad I got today to work on it. But yes I'm going to get some photos taken. Is that it?  First video is done. I'm really happy about it. I think I hope it turned out okay. And it was super randly and like I hope it was okay. I feel super weird. I haven't filmed in so long and like I don't know. I'm also super hyper today. So there's that. But yeah I think it went okay.  And I don't know how many I'm going to film. I plan to do two. So I think I'm going to stick with that and not overdo it. Because then I feel like the other ones won't be as good. And yes but I really hope this one turns out okay. And that this vlog turns out okay. And I don't know I'm just super anxious about uploading again. Because I feel like I haven't uploaded in so long. And it just feels weird. I don't know. I'm sure other content creators can relate. But it's like I don't know. So this video is done. I put on a pink lipstick, tied my hair up, put on a different shirt. Honestly this doesn't bring me the horizon shirt that I didn't even know I had. And I don't like their new stuff. But their old stuff is so weird. So I wanted to wear it anyways. I finished two videos filmed. I have to do some business emails. And I'm also going to relax for the next little bit. Because I've been filming and running around. So yeah. I'm really happy with that. I'm also going to import the photos that I got. My mom helped me take some Instagram photos and stuff. And she always helps me. So like thanks mom. Fun to give a shout out to Harper Collins. Because they sent me, this was a little while ago. In a vlog yet I posted it on Instagram. But Harper Collins Canada sent me a freaking Christmas card. And it was so sweet. And it made my day. So thank you. And they also sent me an anticipated relief. This one is Be Not Far From Me by Mini McGinnis. I really love her book The Female of the Species. So I requested this one. I know it's a survival story about hiking. And there was an infection on her leg. And I just think it's going to be really interesting. So it's probably going to be weird too. I almost dropped it. Because the female of the species was really weird. But I'm excited to give you guys my thoughts on this. And it's pretty little. So hey guys. So it is a few days later. And I just want to end off this vlog just because I forgot to end it. But I'm just going to do this one as like an individual kind of day vlog. Just because that's much footage I have. And I don't know if I can commit to daily vlogging or anything. But when I do vlog for the day, I think I should put it all together and upload it. And then it'll be really cool. But for now, I just want to end this vlog off. Please let me know your thoughts in the comments down below. And if you want to see more videos like this, let me know the update. But I hope you guys enjoy the little haul on this video. If you want to check out the Clever Fox planner, I'll have it linked down below. Because they work great inside it to be. And I actually started using it for the new year already. And started planning a little bit. So I'm really excited for that. And yeah, I hope you enjoyed the hauls. And the little bit of reading. And just the life updates and all that. So yeah, I'll see you guys super soon with a new video. Bye.


Hi everybody and welcome to the AIN big topic. I'm Paul Z. Jackson and we don't get any bigger topics than the one that we're going to be dealing with today. And it's my pleasure to introduce Beth Boynton. I'm going to show her book Medical Improv. Excellent book. And Beth is going to talk to us on that topic and bring us upstate in current circumstances for up to the next 90 minutes. So welcome Beth, it's all yours. Thank you Paul. Nice to see everybody. Thanks for coming. I'm going to share my screen now, correct, with my, and then I'm going to find my slides and then we'll be off and running. Can you all see those slides? So Paul, I just lose myself when I, and I can't see everybody. Is it better to do it this way? We can still see everybody, at least I can. And I haven't seen your slides as yet. Okay. Let's see. Make sure I'm sharing my screen. That's it. You started screen sharing and your slides are pulling into you. Let me, how's that? There we go. That seems perfect. Thank you. I get, I can get very stressed about technology.  Thank you very much. So let me start and just ask what you're curious about. I have some planned things to talk about and share and being dialogue with you, but let's just hear from you first, if that's okay. So we're still a small number and if anyone wants to unmute and just jump in, that's fine. If we get a few more people then raise your hand, either digitally or physically. Let's just ask questions in the Zoom group chat, which is open and we can monitor those as well. Also for comments and ideas and references as we go along so we can build up a layer of other resources. I'm not seeing the chat box. Now I can see everybody. So I'm wondering, I'm going to go out and find, okay, I see it, but I lose it when I go into full presentation. So while we're looking for how we get the chat box on top of the screen, Steve has added a link to an article that is about leveraging improvisation to successfully adapt to disruption. So good article I read it earlier and recommend it. So that's the sort of thing you can put in the chat box as we go along. How are you doing with chat box, Beth? I do not see it. Okay, well, I'll monitor that for you. I'm going to drop in from time to time with the chat comments. Okay, so I think Steve's question about getting improv in with the disruption will come clear over the over the course of our time together, or at least as clear as maybe we can be at this point in time, knowing that there's not like a simple answer, but we will talk about it and we will talk about it. Curiosity. So I'll just dive in and trust that if you want me to stop at any point you raise your hand or do a chat thing and Paul will guide us. So in our time together, your questions, I do want to talk about the elephant in the room, and that is the COVID-19. Most of my work is proceeding that crisis. And yet it's such an international concern. We have, I think we have to talk about it and I do have some thoughts. So we'll see what how that mixes. And I also think that even though it is an elephant in the room, the elephant has been in the room for a while. It's just got a slightly different name on it. I think it's going to be a more urgent call to action for those of us in applied improv. I'll also talk about understanding health care, the culture, the dynamics, the challenges. Give you some examples of how I'm adapting some simple improv into healthcare situations and that seemed to be a bridge to some really good ideas and brainstorming about your ideas and vision for us. So first, you know, healthcare, and now with that cute little picture of the virus. I thought about this a lot. I reached out to a colleague of mine, Diana Crowell, who wrote this book called complexity leadership. It's a leadership book for nurses. She wrote the first edition. I co-authored the third and I do want you to know I forgot to say this earlier this morning. This has a section on medical improv in it as a leadership intervention. It's a textbook. It's not like fun to read, but I think it will help us to legitimize the work in the healthcare profession at least over time. It just came out in January. So anyway, I talked with her about how does this army of social skill builders, what can we do today? And our conversation, I think she had some great wisdom and that is to ask healthcare professionals, what do they need? What are their concerns?  And if you can find a way to connect with that person who's currently working in healthcare and ask them questions like what do you need? What are your concerns? What's it like for you? And sit with them and listen to that and validate it, which is part of the skill building we do in healthcare. But that could be an important beginning to modeling what listening is in a deep way. And I think it will also serve to build a relationship with a healthcare provider who is going to be willing at some point when they're ready to be able to take in the value of the work that we do on a deep level and in a meaningful way. And that's, I guess I just have to qualify that, excuse me, probably right now, it's going to be even harder sell for teen building because it's just two people don't have time. The reality is they don't have time. So if we can make a relationship, model listening, and by the way, when we model listening in a way if I say what do you need, and I listened to that I'm actually helping to build assertiveness and other people. So, leaders who ask that of nurses who don't necessarily have a good grasp on expressing what they need they may advocate for others but they don't know it for themselves. That's a really good way to start to build assertiveness. Then I think we need to focus on using our work for play and stress relief. And I know there's stuff popping up on AI and using virtual ways for playing. I don't know that healthcare professionals are going to respond with to that with I have time because there's a tendency to be caught up in this constant reactionary mode. And yet I also know you AI and people are very creative and that we may have to create opportunities for that and that it's just incredibly important. So keep doing the online dialogue about virtual play and see where we can sneak that in. Then I think we have to be ready probably already are with skill building workshops and to consider that part of excuse my plot. Part of being ready is to understand that we I this is Beth Boynton's personal philosophy that as one system is falling apart we are also building a new one. And so how can we integrate our work into the new system and get it in at the very beginning. That's why in a way this is a really perfect time for for this work and our work. And so the places in healthcare to focus would be educational programs and continuing education orientation programs in hospitals where new nurses are just entering the field or physicians are just starting their practice. And also that I don't mean to exclude anybody that's interested. That's what I've been saying myself for the past couple years I do not try to sell this work to people. And yet I am very open to talking with anybody that's interested. So that's where the receptivity is and the readiness to embark on the work. So any questions or comments or more ideas from that elephant in the room piece. One question earlier when you're asking about questions from Joel very interested in understanding how to approach improv remotely. And I want to point out and welcome to the chain or Caesar. Hi. Hello, who has been absolutely instrumental in all of the online improvisation play sessions and conversations in China. So you may have a few things to tell us about how that worked and indeed whether any medical professionals participated. I don't know if they did or not. Anyone else has got questions then. I've got one comment. When you talked about kind of one system falling apart and building a new one. You know frequently I think of healthcare institutions as very top down and autocratic. What are your perspectives in terms of how we might be helpful in terms of those kinds of things. Well, you're right they are. And part of what applied improv provides is continual practice of pushing those limits to like rubber what I call rubberize the hierarchy, because of the sharing power. That's fundamental in improv. Where we start, we will, I think I think I will answer that question as I go on more completely Steve. Okay. It's complex. So I'm going to offer a definition. This is a little bit different than the one that's in my book it's an emerging definition. It's adapting the yes and philosophy and activities so that we can improve soft skills and critical outcomes. It's a broad definition and that's why I like it because any, any way that improv can be used to help us in any way with our outcomes and our skills to me. That's medical improv. So I think that applied improv in healthcare what language you use is less important to me, but because it has become a thing out there. It's good to have a definition and I think what makes it particularly different is that soft skill and critical outcomes If you look around online you will find there's some different interventions I think Belinda Fu and Katie Watson's definition is more geared to the field of medicine, which is great for the field of medicine. I think we need it everywhere so that's kind of why I lean towards the broad, broader definition. So, for applied improvisers to be effective in health care I think it's important to understand a few things. And first is how do the soft skills that we build and I'm talking emotional intelligence, communication skills, human interactive skills, teamwork, leadership, all the stuff we do. How are they related to key outcomes and we'll talk about that. Then I think it's important that you understand why it's so hard in healthcare to develop and practice the skills. And then third, how do we tweak the rules of improv so that they are most effective for the healthcare audiences and that's just a couple of places that it can be helpful to tweak them. So, first, what are the critical outcomes that I'm talking about. And, and I will qualify that most of my work has been in the states, and most of my research is in the states, however, in talking with other people, like you guys and other places I think the problems are kind of worldwide, but maybe some differences in some different language. But patient safety, number one, patient experience or customer satisfaction is another way to put that language, the health of the workforce, and ultimately cost effectiveness. So those are the critical outcomes. I think that because we teach soft skills they impact everything. But those are the big ones. In my next few slides. Let's look at how our soft skills important in these critical outcomes. So first, why do soft skills matter in patient safety. Well, medical errors are the third leading cause of death in the United States. It's been a known issue for almost 20 years now. And I've seen the statistics bounce around a little bit, fifth place, first place, seventh place, but the medical errors are huge, huge problem. Statistics in this country are as high as 100,000, I mean 1000 1000 deaths per day because of error in the United States. That's the highest number I know but it's a legitimate number and I'm happy to prove that anytime. Importantly underlining underlying those causes of those problems the most common reason we're making mistakes. There's three areas that show up its communication, its leadership and its human factors soft skills. So we have this huge problem and the underlying chronic pervasive reason is the soft skill factor. And it's still true. Even after 20 years of trying to fix it. I've been teaching improv and health care when I got my master's was around the turn of the century, and that was around the time that I was also taking improv classes, and building a consulting business on teaching communication because we were starting to see how important it was. The connection of the neuroscience that will come up later is that we know the fight, flight or freeze is that it's harder for us to access our critical thinking when we're stressed in the health care environment and so we can make, we can have a knowledge base that we can't get to if we're so stressed that we can't think that will make more sense eventually in the environments that we work in are often, often intensely stressful. My opinion, we're not getting at the roots of the problem, the roots of communication problem and human development in a way that's effective. I'm not trying to but not successfully. Questions out there so far so I keep going. Steve has a question. Oh, keep going. Thank you. I have a question. Yeah, like especially in Wuhan like in quarantine time in the peak time like February. We know that the patients crowded in the hospital and that they're quite big tense between the patients and doctors and nurses. So that's what I mentioned here is that like communication and how to release their relief their like tension and also pressure. That's the case. Yeah, I, and I want to I hear you. It sounds like a huge issue. And I want to have an answer for you Chang. I think that it's this place between the difference of preventing that kind of tension. I think that our work is very helpful in preventing it. Because even to the extent that we learn to identify social cues better as a nurse if I if I can read that body language better through practicing improv. I can deescalate. And yet, if we're if I'm trying to help you answer a question with a situation where it's existing right now. I'm not sure how helpful that will be right at this moment to be perfectly honest with you. And then I go back to that. What can we do right now, you know, listen to the healthcare professionals that you know have conversations to build a relationship, and then maybe you are creating the conditions where the teaching can be more effective. It's like, I think sometimes violence like preventing violence is one thing containing it is another, you know, our. So, I hope that's helpful and I wish I had more insights for you. Thank you. There's a couple of other questions, Beth. Oh, yeah. If that's the way to pronounce it has one do you want to speak your own question and I'll come in with mine. You need to unmute. That's it. Hello, hello. Hi, we can hear you. Okay, great. Thanks. Hi, I'm Jebe from Copenhagen, Denmark. I wanted to pose the question. How do you find that medical improv relates to the medical simulation trend tradition I find that I just started in healthcare this month have a background as an actor and facilitator and I find that there's a long and very strong tradition to using these kinds of methods, although it's termed in the use different terms, but, but the medical simulation tradition, I think it's really strong in this, in this area. So I'm just curious how you find that medical improv relates to that to that tradition because I see a lot of links but I'm curious to. Yeah, there are a lot of links. I think it's a matter of the healthcare system, like what medical simulation is for some that might not know is like this these are the programs where we practice clinical like practice a code of practice starting an IB or whatever situation in healthcare they're created so that students get to practice or practicing or clinicians get to practice. I think what we need to do in terms of improv is to create opportunities where the very fundamental skills are being built first because this there are elements of personal growth that don't they probably do get an opportunity for growing in the typical med sim issues people will learn oh I should have thought of that or I should have said this under that situation. The problem is, from my perspective that they're very clinically oriented. And so that's good I shouldn't say that's necessarily a problem. What's missing is this deep personal growth of learning to be more assertive and learning to be better listeners. I have some good examples of that. So it's like, it's like, we need to insert this work as a precursor to that work. Thanks to my question, which is, as you've shown communication is indisputably important in healthcare. And we also know that applied improvisation can raise communication skills. So how can our network, AI and applied improvisers do more to enable these two worlds to meet for mutual benefit, where and how are we already successfully making those connections. I'm not expecting you to answer that straight off the top of your head, but I think that's a good question for us as a community to be addressing and exploring there's a clear need and a clear offer. Which I think are not disputable, but they're not coming together as much as they might as far as I know. Absolutely. And that is an incredibly important question. And I would say, at least as a beginning is that the establishing the relationships and as more as familiar as applied improvisers can be with what they deal what the dynamics are. The bringing the work into healthcare will be like from an informed place. The more informed we are, I think the more effective I think an applied improviser can walk into a room full of nurses and have a positive effect. So it's not like you have to do it, but I think that you will have a more a bigger impact if you understand the dynamics and the nature of the work. Yes, let's ask that question and let's talk about it and I would be very happy to be a resource at any time. Thank you. Keep thinking. So patient. So another critical skill, a critical outcome that soft skills can help is patient experience customer service. We know from evidence that clinical outcomes are better when people feel that they're engaged and empowered that they feel heard. So teaching listening skills, one of what one of the ways to do it is to model them is extremely important. And so, you know, it's funny, you know the activity, same time story, also known as a story mirror where one person talks and the other one says it at the same time. I use that as a listening activity. And I had a nurse tell me once when she did that that was the first time she ever felt heard. And I was like, yes, it was like an awareness for me of where is that where is where do we need to meet them where they are in terms of the skill building. Because how do we expect somebody that doesn't know what it's like to be heard to be a good listener. So big moment for me. So patient experience and soft skills trust and communication are also very important in the placebo effect. And that's that take a sugar pill and you have there's a 30 to 35% improvement in your symptoms in many situations. So we don't really know what that is. There was a good episode on hidden brain a few months ago that had some good examples and healthcare about that might be worth Googling and listening to but ultimately, we know we build trust and improve communication and positive relationships and improv. So that will we can help healthcare professionals be better there. They'll automatically be better in any therapeutic relationship. We also know that patients and families are becoming more vocal about what they want so that this again raises the point of how important it is for healthcare professionals to be able to listen and communicate with folks so that we are hearing them. One of the most well read articles on my blog is called the importance of listening and healthcare. Unfortunately, I did not write it. It was written by Ali Nitsky, but I'm seeing that like more and more people are watching that. So in a way, Paul, I think, maybe there's at least an interest in the soft skill going on out there. And by the way, before this COVID-19 nightmare. Or exciting opportunity or both happened. I was seeing a trend of more inquiries for applied work. So medical improv. So I think there's some energy shifting. And ultimately in the United States hospital reimbursement is dependent on survey results from patients that and many of the questions in our survey have to do with communication. Did you understand the medication that you were given? Was your doctor respectful? Those kinds of things. So we are starting to at least measure them. And the workforce to break this down into physical harm and psychological harm. These are just some reality checks for you to know about. I would not be surprised that they are similar in other countries and happy to hear from you if you know that they are or aren't. Huge chance of being assaulted doctors and nurses more than a cab driver in an urban area. Up to a third of nurses experience back or musculoskeletal injuries every year. And the number of injuries are higher for nurses than construction workers. And so in these statistics that are interesting. There's the violence towards healthcare professionals like for instance somebody running into the emergency room with a gun. That kind of stuff or somebody that's, you know, I had a patient try to choke me once when they were withdrawing from morphine. It's like patient to to nurse. But there's also just the physical demands of the job itself that that are, you know, moving patients around and, you know, we can have protocols but there's not enough staff. I gave the example earlier of boosting up a patient in bed which really should have two people if not more. So I'm in a room by myself with a patient that needs to be moved and they're crying and pain, something urgent is going on, and I'm yelling out to I need help I need help, but we don't have enough staff to come and help me. And so I try it myself and then I have a back injury. Then I go to the doctor's office and I get into the system with the healthcare occupational health and they're saying well what happened you shouldn't have done that by yourself and it's like. It's a staffing issue, which also is related so so the soft skill component are we need to ask for help, which I did in that scenario, I need to be able to set limits which I did not do I could have said no. I can't move you I hear you're in a lot of pain and I want to help you but I can't move you till somebody else comes. So there's an indirect idea that the more healthcare professionals that are able and willing to speak up about what we can and cannot do and respect each other for those those limits that we will start to have a stronger collective voice to get more staffing. Staffing has been an issue since I've been in healthcare and that's like over 30 years ago. So the communication part of the that seems to be indirect but it is definitely there, in my opinion. And then the psychological harm and we talked about this fair amount this morning that there is a serious pervasive problem of bullying and emotional abuse in healthcare. It tends to be you know there's the doctor to the nurse nurse to nurse the higher you are up on that hierarchy that you mentioned earlier Steve. The more likely yours to see that abuse as a as a more aggressive form of disrespect. If you're in nursing or home health assistance or in housekeeping you might see is more passive aggressive abuse. It's, you know, gossiping and undermining. In any case the what what what improv can do for us is to help us learn how to have respectful relationships respectful communication. That's the opposite of all this we are so creative as human beings to come up with all these different ways of being just respectful to each other. That it, you know, so I see improv as a way to start to build healthy, healthy skills and healthy relationships won't help what Chang's talking about right now in this moment but in the long run, it will, I believe. And we also have as you might expect if we have all this bullying going on we have burnout compassion, fatigue, suicide, so there's a doctor whose job now or whose life's work is in helping doctors who are considering suicide because those statistics are growing up. So, and you know what to bring this back to soft skills. You know, if I if we talk about burnout. I need to be as a nurse I need to know how I'm feeling. So I have to have the self awareness that's an emotional intelligence piece. I also need to be able to express that in a respectful way that's an assertive piece. I also have to be able to be expressing it to somebody who's able and willing to listen and validate me. It's another soft skill, often what happens is if I said oh I can't work overtime. I might get a response. Well, I've worked overtime, you know, or there's the door. So we're not really cultivating the skills in the way and I'll say again because the more I say it the more I think the idea of having finding a healthcare professional and modeling listening could really be one of those butterfly effects that has a system wide effect in time. So any questions about that so far the critical outcomes. Yes. So I'm going to invite Kevin to speak he's come up with some research on the UK. Some statistics on medication errors and so forth, and also an example of where there's an opportunity for collaboration. My stats were just to back up your stats basically no more than that. But in the UK there are 200 million medication errors in a year. And, you know, 80,000 nurse injuries into their backs every year in the UK, which are related to work and 3600 are retired, forced to retire early. But the example I have is just to give you my background and help organizations with change and process improvement operation excellence so one piece of work I did was in delayed discharge. So this is when the patients medically fit. But for all sorts of reasons they can't be discharged. And those reasons are, you know, friend, a family and friends not that to look after them. No one said to issue medication that the bathroom can be hasn't been adapted. There's no place in the care home. And what happens is because of a lack of collaboration, then often the people making those decisions decisions make the most costly and maybe the least effective decision because they just need to move this patient on, rather than making the best decision for the patient in the in the in a in a fuller picture. So examples of this, just a very simple example is that friends and family asked to collaborate and asked, for example, could you could you turn up early in the morning before you before you go to work and administer this drug to your mother. And they say yes, I'm happy to do that. Well they can be discharged because someone in the morning will turn up and give the drug but because those questions aren't asked. Then people are moved into into holding positions, which actually don't suit them or anybody else. And that I know for a fact because I've actually spoken to those care workers, you know, interviewing them, and some of them are very good at trying to work out improvise and try and find out the best solution talking to all the different stakeholders. And some of them think, I just, you know, I just, I'm just going to move this patient on and get on to my next patient, you know. Yeah, so I'll pause that thank you. Thank you for sharing that Keaton, hopefully I'm saying your name right that's a, it's a great example I think it helps us to look at, well how did that problem happen in the first place. You know that this was our social system strong enough to support that person I mean that's like a complex quite big question. And that person wasn't ready to go home they would that was like a clinic the clinical problem has been solved, but it's a social problem that's keeping in them in the hospital. Right. And I think we're seeing that and have been forever we have created a system. And I think that has to do with. I hope this is going to make sense because it does. But it's like we are system healthcare providers. Let's talk about nurses and doctors in general that there's a lot others have a tendency to go into that business because there are intrinsic rewards from helping people from taking care of people. Now, if those intrinsic rewards are out of whack and become more secondary gains, like I'm in this business because I'm fulfilling an emotional deficit of some sort and I haven't addressed that, then it gets mixed up with clinical decision making. So, so here's I'll give you an example on a small scale and then ask you to just imagine what it would be like on a big scale. I'm a nurse and I'm taking care of somebody and we have a really nice report going on. And I know that the, let's say I'm leaving that job. And so this now there's this loss of the therapeutic relationship. If I have healthy boundaries, I'm going to do things like, Oh, I want to introduce you to Margaret because Margaret's really a great nurse and I know you're going to have a successful relationship and she's going to be able to help you. She's going to be even better than I am. Sometimes what happens because of those secondary gains is like we're getting something from the relationship that's not necessarily healthy. You know, in terms of being clinicians that we're getting the secondary gain that might keep me from, I might think well, that relationship is telling you that I'm a good girl. I'm a good person. So we thrive a little bit on that. That makes some sort of sense psychologically. So now think about, let's say doctors and nurses on a large scale. I'll probably get a lot of mail now if this people are watching this. But if there is if there was some element of secondary gains that are part of our decision making that that can contribute to a system that's like this, you know, we're we nurture the dependence. You know, we should be nerd. We should be empowering people, but we nurture the dependence and then we resent it. You know, because we don't have time anyway. So complex question complex example and hopefully helpful thinking. I did not put in a slide like I said I would about cost effectiveness and soft skills, but I will just say that when we're not operating as a team and communicating, then we're doing things that and billing for things that we shouldn't and I think your example Keaton that you just said we're going to a higher level because we didn't have an effective communication in a much more simpler way where people are coming into appointments, but we don't have their records yet. So there's a communication issue and the appointments wasted everybody's times wasted. People get resentful because we don't have the time to waste, so on and so on and goes, but there are billions of dollars that gets get wasted in this country, because of what we do or don't do that we shouldn't be doing that have a communication element. So what makes healthcare unique, different from a business of maybe building phones or something. Not to say that those businesses aren't high stress but here in healthcare, almost everything we do is urgent to somebody. And so there is like this chronic nature of urgency that goes on. And we do also think that sometimes our secondary gains give us like this helps us to avoid doing some of the work that we should be doing. But also the high stakes. If we make a mistake, a simple mistake could lead to a huge problem and I mean that horrible outcome for somebody, all those medication errors. And some of the sentinel events they seem absolutely ridiculous that we would in surgery cut off the wrong leg, or do the wrong surgery on the wrong person it seems completely ludicrous. I will show you an activity called overload in a few minutes, or we'll talk about it a little bit but this goes back to the higher thinking, can we access our higher thinking. And you might just make a side note to Google interruption awareness, which is a video from a few years ago, where I use the overload activity to show some statistics although they're dated at this point but they do link to this, the high stress component that we can't think in the moment. And, you know, now that I think of it does a Brigham and Women's Hospital in Boston which is a fairly well known teaching hospital has a simulation department called Spartus.  And I happen to note in his in their annual report a quote from him, and it is about with respect to patient safety he says almost always the answer is in the room. And I think that and so he's in charge of the simulation department will kind of ties everything together that we're not getting at the answer that's in the room. Partly because of stress and partly because of communication skills. He, he understands the problem. I don't really honestly think yet because we haven't gone deep into a conversation understands that how deeply rooted the problem is in terms of social emotional learning. So that and that goes back to that precursor question yet they met some stuff. Anyway, we mentioned blaming and bullying cultures. Soft skills is different from clinical skills. Most healthcare professionals, even the educators in healthcare attempt to be really good at teaching how to start an IV or what are your, what's the anatomy and physiology the much more intellectual things, even though there can be a hand I coordination issue. It's not the same as the personal growth for developing self awareness and self confidence. I see another perspective those are the kinds of soft skills that improv is like so golden for that we so need. But it's different so we don't get that much exposure to it. I'd like to say a minute, talk a minute about the emotional risk in this personal growth. And this is on both sides. Listening and speaking up have an emotional risk that's often either undervalued or not understood or just not even known when I'm learning to be assertive. And that's been part of my life work as a person and as a mom and a nurse and whatever. To take the risk of saying an idea or concern means I'm making myself be more accountable and putting myself out there in a place that can feel scary to me. On the other hand, if I'm learning how to listen, I'm learning to let somebody else in on the equation. There may be liability issues that make that even more complicated. But again, there's an emotional risk of letting go in sharing power. So I think that's one of the reasons why, even though we've been trying to improve communication, we haven't gone down at a depth that has helped us to learn how to share power, which we all know that improv is amazing, provides amazing opportunities to do that. Team composition is changing all the time. I do that working team development know there's a process anytime people come and go in the team, the process begins and ends again. This just makes it be like this constant ongoing change. I probably already made the point that we have don't have experience sharing power that's in that in the hierarchy that it's kind of top down and not more wishing wavy that it needs to be educational programs. One of my books is another a different textbook a successful nurse communication is a textbook textbook for nurse communications. One of the challenges and selling that book is that many nursing programs do not have courses that are for that are just for communication. And the reason for that is that their curriculum is so packed with clinical stuff that we don't have time to focus on it. It's not a, I don't offer it as an excuse my answer is make the time but that's the reality. We need to know that patients are vulnerable. They could be intimidated by the power dynamic. And they have a range of dependency some people an older person might come in who's been taught all his or her life. Oh, do what the doctor says. So we think that that. How do we empower that person versus how do we empower somebody that comes in that in that may actually know more about their diagnosis than we do. It's an interesting dynamic healthcare my feeling is healthcare professionals need to need to be able to respond to this continuum of dependency while always shifting towards empowerment. And also leaders need to be collaborative and directive and be able to shift between the two of those and I know that you know how wonderful and how many activities can help build those skills and improv in the simple ones with mirroring. It's important because we in the hierarchy we have people at the top that are used to just being directive and people at the bottom who are just used to being, you know, following the rules, when in reality we need those people at the top the doctor needs to be able to, or the nurse whoever's in charge of the situation needs to be able to direct a clinical decision making at the same time that they are receptive to getting input so that the housekeeper can say, Hey, wait a minute, there's this blood on the floor or the nurse can say hey wait a minute that's the wrong leg. We have to be able to be able to do both not just one questions on that stuff or comments. I'm writing some stuff about mistakes, which is one thing. Then I've noted some points about this really interesting question that improvisation may have some answers to of how healthcare professionals shift from patient dependency or staff dependency towards empowerment. Kevin says here in the UK GP is often asking first, what did you read on Google, when the patient is presenting in order to connect with patients. Right. And I mentioned that improvisational activities, almost all have some elements that illustrates a non hierarchical way of working. We'll see in your examples later. Yes. Yeah. I think that's a great example of community. That's a great empowering statement to walk in the room you're showing that you're confident. You're in your role as I'm sorry I don't remember what your role is but some sort of a healthcare professional, and you're saying what have you learned on Google so you automatically build a relationship you starting to build trust by saying I want to know my information really is not going to be helpful, unless we have a relationship and hey maybe I'll learn something it's it's a it's that's a confident place to come from onward. I'm going to say just a couple of things about the rules and I'm sure we all have different rules and the rules that I have in my book I sometimes use all of them and I sometimes just use yes and and but there are a couple that are worth mentioning in terms of the difference between health using applied improv and health care. And one is, I don't celebrate failure. And the reason for that is that creates such an emotional reaction with all of the mistakes and all the pressure we have to do things right. I tend to use language that's let's celebrate risk taking we're human we make mistakes so you can get that in there. And that actually helps create conditions so that instead of a blaming culture granted it may take years to get there but instead of a blaming culture we're creating a culture where it's okay to be wrong. And that can be pretty scary if if what you did was wrong caused a big problem for somebody but anyway it's just it's a language thing it's my preference. Avoiding questions I've seen some improved instructors use that rule and some don't and I've come to learn that if I'm working with a group of nurses or or women if it's not health care specific. I am more likely to use that role. And maybe you guys have seen this as well I'd be curious but I know that if I'm building assertiveness. If I'm with a group that needs to build assertiveness, they need to not ask questions because asking questions gives their power away instead they need to ask questions I mean to. They need to make statements declarations. I think you know that. But if I were dealing with a group of physicians, I might not use that rule at all. In fact, I might say it's okay to ask questions because that is part that can create an environment for making room for other people part of a listening of moving over and sharing your power a little bit. So it's just a little dicey in terms of when I use that rule or not. I find that health care professionals need to be nudged to say hey you know it's okay you can make things up and that's just a. Oftentimes, we're so you know our clinical brains and intellectual brains are trying to say the right thing. We're trying to have permission and just kind of, you know, say just relax you can make it up. And lastly, I added this rule observers play an important role, because a woman in one of my classes a psychologist was terrified she was so terrified and doing improv and I do non performance. I guess that that word can sometimes performing is means different things to I do improv for people to play and grow. She said she came up to me after she said she just couldn't do it she was so scared. And it makes me got me to start to thinking that there are people sitting around in the room that I'm much more afraid than I realize. And new new classes I usually say it's okay to watch I asked that you participate in a deep brief so I give them a role to, you know, pay attention and notice what you whatever the context is if we're learning assertiveness or we're building trust or diversity or whatever. Be an active observer, and then maybe later on in the class, invite them to participate so I give a little room for that. You guys, have you found that you use the same rules and healthcare or any thoughts on that. While people are thinking of coming in. I really support these things that you're saying that where applied improvisation thinks it can just take stuff from the stage and there's no adaptation to real life. I'm going to all these horrible traps of, for example, celebrating mistakes, which is just completely inappropriate and is approachable within applied improvisation, and indeed theater improvisation by rewording things, celebrating restaking, encouraging people to have a go being more aware of context dependency than anything that anyone has to say. So some of these traditional rules of improv, as soon as anyone thinks that any kind of universal these to trouble, and you've got some great examples here of how you've modified what's coming there. I think part of what the applied improvisation network should be doing is working out what principles do apply beyond the theater or even better without the theater. So taking performance as well and it's a great step. So I'm sure other people might want to come in on that just to raise a hand and jump in if you would. Yeah, this is Steve. I think I like the reframe there Beth in terms of celebrate risk taking instead of failure. The other term I'm hearing now is for a long time and creativity innovation was like fail faster. Now I'm hearing a reframe of learn faster. And that seems to resonate better with the world, the world that I work in in terms of manufacturing those kinds of things. So I really like your reframe there. I like learn frame learn faster too. And maybe it's a judgment call for the for the vibe that you're feeling in the room a little bit. I think because risk taking is is really where we're asking people to grow in terms of speaking up and listening that it might. Yeah, and I think that industry wide I like risk take celebrate risk taking better because the stakes are so high. So I like the idea of just reframing it. So it's Joel I can see how I really like the reframing of risk taking for the business context I don't. I'm not in the medical field at all. This is fascinating. And how does, how does that go down with people the notion of celebrating risk taking in a medical context on the healthcare context. With my work. It's pretty good. I think my skills, creating a safe environment to begin with and doing low risk activities at first, and then giving an example. Yeah, is a great way to kind of ease into that and then people have the experience. And I usually like, you know, I might make a mistake and go and then we all laugh and it's okay to kind of create an environment Honestly, and another thought along that line Joel is that I think I do think people want to learn and want to have these experiences so as we make it safe, then that there is a relief from it.  Any other thoughts about the like principles or Move on. Catherine here. I really like this. It's great. In fact, I've instantly made some notes and I wouldn't change a couple of things in my own in processions immediately. So thank you. One thing I was one thing I have added to this, which I've started to do is really when I'm very diverse bunch of people is I've asked them to be themselves. And I know that sounds obvious. Why would people not be themselves. But I often say just be yourself all the way. So for some risk taking is not about. I don't know if they're quite become loud. That's not what we're asking risk taking is to within the confines of where they are to take risk, if that makes it makes it for them for me, risk taking, I'm quite a, you know, I guess I'm an extrovert, my risk taking made to shut up, you know, and that's something, you know, often or maybe I don't do and that might be the risk I need to take is to just go quiet and let's see what other people have to say. So I think that's for me I just just a point to make. I think it's a beautiful point because in the magic of improv when you do that, when you have that awareness and you do that your partners automatically going to have the opportunity and maybe a nudge to speak up. So you're teaching each other while you're learning and you're learning different things in the same moment. And that's why I get like, oh my God, that's it can help us in so many ways. I'll have an example coming up that will illustrate that in a video in a second. So thank you. And something into that as well which is that that risk taking that happens in the workshop is different from the risk taking that happens in your real life so we're not training risk taking. What we're doing is training the epimedia that point about psychological safety. So it's, and there's plenty of research that shows that the more psychologically safe the environment, the fewer mistakes get made. And there's a very interesting thing thing here about that there's, there's an increasing amount of understanding that if you can get the team working better, and it takes soft skills to do that. There are fewer errors, and fewer failures, but getting people in the room is great but then they end up going back into their, into their everyday work and you've got the systemic impacts that stop that. And it's almost like we're in this situation where everybody knows this is right. We're going to get past the systemic barriers to, well hang on now you're just going to play as a, as a response because we're really busy and, and, and it's a, it's a thing which. Do you know the idea of square square wheel syndrome. I'm getting it from what you're saying. The square wheel syndrome is there's a guy pushing a wheelbarrow that has square wheels it's really hard. Yeah, and he's there somebody comes running up with a round wheel. And they can look like I've met a round wheel and he goes go away I haven't got enough time to look at that. It's a kind of it's one of those things where if you've been persuade people and get them to slow down. You can massively improve things. I think there's a lot of what you've, you've, you've talked about today has been the kind of, we need to get past that square wheel syndrome because nobody's going to disagree with what, what, what we're saying. But how do we get get past the system to allow it to happen. Well, I don't have, it's a great question. You're not expecting me to answer really, although I do think that this is a helpful step in that direction, because it looks at it from a, it's a systems. It's a leadership book for nurses with a mindset of how do we fix the system. And one of the interventions is improv so and it just came out we're not there yet but I think so this that this every time I think we model. A skill we're helping at what's I guess I tell myself. Just keep doing it just keep going. Just keep swimming. It's not going to be easy we do have we have what the healthcare system needs I believe that intellectually, spiritually, physically I guess emotionally. So, make that come about isn't going to be easy. However, right because even though it's like this crazy nightmare time with the virus and everything all over the globe it's also bringing people together and having conversations. And as one system falls apart and another one is being born week, we can be intentional I believe about making sure this stuff gets into any new system from the very beginning. So I want to be very intentional about that. That's all I know, I'm going to go on to the next slide. So here's an example. This is going to be an example of using extremely simple activity called radical acceptance. You might know it is three things. I learned it from Jude trader wolf. And then when I started trying it I saw wow this is really getting helping us get to the depth of where the learning needs to be. And it's so simple here, but it's quite profound so this is how the game is played this quick clip I'm going to first make it big. So that's how the activity is played. It's you pick any category in this case it was dessert and then you have this increasing responsiveness of affirmation and I cannot under estimate or over value whatever the the value of doing this activity in healthcare is extremely important because it gives people a chance to see what it feels like to feel affirmed, which might be missing you might imagine it missing and in a system where blaming and judging and bullying our predominant the feeling that affirmation from a group. Well at the same time the group is practicing to affirm their colleague. So it's a very fundamental. And in terms of finding your voice, we're also getting to this place of member I mentioned earlier about the neuroscience of being able to get to our higher thinking, and Dr. I have a comment about the answer being in the room. This is where we're going to build those skills. I've done this. I'm going to and I'm going to give you an example in a minute but I'm going to keep talking to I've seen people do this activity, and literally freeze the heart is so scary. Excuse me and again so that's that's that's feedback for me to say oh my goodness I really need to make this activity as safe as, as safe as possible, which I do by telling people you can say the same thing three times. You can say your name or the word pine cone, if that's what you want. There's the group to be patient so they are listening and then they are kind of practice so in this moment. We're diving into this human evolution of where fight flight or freeze exists, but we creating safe opportunities outside the clinical environment to start to practice to work through those impulses that limit our ability to communicate. This in this next. This is the same activity just somebody else doing it. And in these first few seconds you're going to see what I'm talking about in terms of working through this, the deep rooted fight flight or freeze and finding her voice. So let's make that bigger. So did you see were you able to see that first couple of seconds. It's almost imperceptible if you weren't looking for it you might not see it but it's like this. strawberries. Played again sure. Sorry. No, you're welcome or whatever. I love this moment. So that's a type of experience that if you were more extroverted. I might not even have that experience of what might have been hard for you in that moment was waiting to say yes. So we have an introverted person who's finding their voice, they're working through their impulse that keeps them from speaking up an emergency to say that's the wrong leg or that patients are allergic to that or there's blood on the floor. It's the same place, but what we're doing is creating safe opportunities to practice and with our peers. So what we get is a result of a positive experience. Meanwhile, the people that are waiting for her to talk they might be thinking say brownie or you know they might have an idea that they wanted to say. So it's a very root it's at the very root of. I think human evolution, and that's the place that we're not getting with on with the med sim. It's the departments that we already have we're not going that deep. And we should. Any thoughts about that, or questions. Does it make sense. Yeah. Yeah, I was just wondering what the rules are and how you may be set up. Sure, sorry. It's basically pick a category. And could be desserts, it could be fruit. So it's a rising enthusiasm. And usually I will give an example. And, you know, I sometimes will share. I remember a time when I was being open house with my friend Liz. She's in the brown teaches mindfulness. And we had an open house for a while. And this family came in with a couple of teenagers that seem to be very shy. We're playing this activity. And one, and so they got in the circle. And you could just sort of see the anxiety. And one of the guys that was, it was his turn. And he said blueberries. And we all said yes. And he said blueberries again. And we all said yes. And he said blueberries again. And so what I think he was doing, whether he was conscious of it or not, was he was help making it safe for the next person.  And so then what happened was this young man, probably 15 or 16, he did say something. And we all said yes. And the grin on his face was like, I can see it.  Of taking a risk and getting a positive feedback that hopefully that goes in the bucket of social, positive social experiences. See another talk, go ahead. Okay. So I'm going to move on. Is this, I'm not in my same screen, but I guess it's okay. Right. So this is another activity that has a lot of. So this is another activity that has a lot of influence from improv. And application in healthcare. Primarily, because once it can be done fairly quickly. And have a profound impact. Both things are important. What can we do in healthcare that's quick and meaningful. And this comes from the status work. If you've read Keith Johnstone's. Or Kat Coppett's book, they both talk a lot about, they have some great status activities. So my friend Liz and I created this as kind of a, it's much simpler. Basically what it is. I have people in the room walk around in high status, give some language. And this isn't even in my book because it's so, so new.  You know everything. Nobody else knows anything and just walk around. We all as human beings knows, know what that feels like either because sometimes we act that way, or we have been acted like, you know, we've had other people in our lives act that way towards us. Then I go to the other extreme. Okay. What's it like to be inferior? You don't know anything. Everything you say is useless, blah, blah, blah. People automatically, they know what those, those ways of being are. Then I have them get in pairs. So they're facing each other like you can see these two are, and we have one start out in high status or arrogance or whatever the terms language you're using. I tend to stay away a little bit from status because that can be like a edgy point within the hierarchy. So just be creative around your language superiority inferiority. One starts out high, one starts out low. Over the course of like 30 seconds to a minute. They switch. And then I encourage them to come back to the middle and find a place where they feel dignity for themselves and each other. And I have done this several times with different groups and it is incredibly profound. It is a visceral reaction. People, they, when they contact each other and you can see it here. I'll show you another picture that has a couple more, but I'll show you that in a second as an example of it. But look at these different moments. These are the moments where we're finding dignity in ourselves and each other. And it is, oh, can give each other hugs, high five shake hands. There's a lot of ways to express it, but we're either tapping into something that we know as human beings and have maybe forgotten or not used to expressing. Or maybe we're evolving. I really don't know, but it's, it's quite profound. I don't know. I don't know. I don't know. And would you like to see it? I'll show you Liz and I doing it. Doesn't take long. Anyway, so that's, and I honestly, I think if you can include that, try it with your non-health care. If you have groups that are more. Available for, for your work right now, not necessarily healthcare professionals try it. But it is a great way to start having conversations about these kinds of things like how is a hierarchy and how can we relate to each other? If I have to be in a, as a nurse, if I'm supposed to be in that leadership directive place, I can do that. But that doesn't mean I have to give up my humanity or my respect for you. I did a cultural sensitivity workshop recently where I did not mention improv. This was for nurse assistance, but I did that activity early on. And then once they knew how to do it, I could like easily say, okay, just take a minute and do it and find the, the dignity with a new partner. And so I could sort of sprinkle it throughout the activity. So, you know, you just take 15 or 20 minutes initially, maybe a little longer for debriefing. People have a profound experience, but then you have something that you could use a nurse manager. If I were doing train the trainer, which I see being more my, my career path is to help other people teach this stuff. If they were to do that activity, teach it once, then they could be doing that. I'll also, you know, at every clinic, every meeting or maybe not every, so it doesn't get boring, but once every three months, they could say, all right, do that, find somebody that you don't know well or that you, um, that's new that, or just, just do it because it's good to remember that we're human beings too. Any thoughts about that activity? I experienced the activity in your workshop in the, uh, Stony wrote there in conference. Um, it was great. And then I've used it since a couple of workshops. Yeah.  Yes. Um, it could be used as a, a form of greeting in team meetings and that sort of thing. Um, and when people have an experience like that in a workshop, I think it's good to invite them to notice when they're having that dignity relationship in their work over the next few days. It connects very much as well with solution focused therapeutic stance of the client being the expert. In their lives. Yeah. Just a quick question. Is this non-verbal the way you facilitate this exercise? Um, mostly I'm a little vague with that with my instructions. It's not the name, but it's like when I have people walking around in the high. Superiority as they may say a phrase or two. I'd be from for that. But it's not about a dialogue. No, I really like this exercise. Thank you for sharing. Oh, you're welcome. Thank you. I actually have a, a sheet somewhere, a PDF that has like several, that has all of these different people on video, these one minute clips. If you want them reach out. If you want them to reach out to you. If you want them to reach out to you. If you want them to reach out to you. If you want them to reach out to you. If you want them to reach out to you. And I think you could use it in almost any, any team building or leadership. And in fact, Paul, when you were talking about, it's like. This could even be, we could do it from six feet. We can make it a social distancing thing. Or try it anyway. I love it. I love it. I just want, first of all, this is great stuff. And secondly, with that activity is I'm running some mental health groups online. All my things have moved online. Okay. That looks like it'll transfer to an online activity. Very simply. With the depth, the perception of the screening, being able to lean in and just kind of give those ideas. So I'm going to. that it would be really hard to do and I think maybe that's just because I like to be in a room. So I would love to hear that will be a great blog post. Right and I'm not and I'm not excited about moving everything online. I'll tell you that I'm trying to find joy in it right there but I'm definitely trying to create you know those non-verbal verbal communications because as I'm working with clients they're it's very interesting to watch the behavior when I get them on the screen right away you know we have to get over we're watching ourselves but then I decided to teach that into a teachable or put that into a teachable moment where oh look you can watch your body language online now and kind of assess what information you're giving back with my younger clients they're doing a lot of goofy you know faces we're trying to get around that and then with my older clients they're feeling a little bit held back with the screen so I'm trying to go real gentle with you know how our body is sitting how our tonality is and where our eyes are and well that's a great support of me thank you very much. Oh you're welcome I really please please let us know how that goes that'll be that's definitely going to be a blog post. Other feedback or thoughts? So we're like eight minutes I'm going to zip along here um physical phone um this I need some guidance on time management Paul and everybody. I think people are familiar with it as an activity and maybe if you show a few seconds not the full five minutes. Okay so just give you a little context this is in New York we've just talked a little bit about communication and making mistakes in healthcare.  All right so I think this is uh this is about to be the end there were probably 12 or 15 people in the line and Gary and Nancy Mose from the Allen Alde Center are going to show you what Gary started and what she ended up with. This becomes you know how to play you know how it's like and this is a group of people with a lot of theatrical experience so I've done it with nurses their motions are often smaller but then you can still see the people adding and taking away so this becomes a great activity to talk about communication being much more challenging than we realize we think we know what we're doing but we don't we think we know that we're being understood when we're not and the conversation can be um extremely helpful in starting to brainstorm on how can we make our communication better so this for me this isn't really about an intellectual experience as much as it is about engagement what are your ideas and so people will have ideas like we'll do teach back and slow down and you know have a check-in and so then I say okay now you can use all your ideas and do it again and oftentimes it's improved so people have an opportunity to to make improvements and hopefully they have a physical experience that lasts longer and if you want to read more context that eye-opening activity is a blog post with a full video in it and you guys use that activity before okay and handoffs I'll just mention quickly notorious that's maybe a united states term but that is a place where there are notorious errors where we're giving a lot of information about a patient from one clinician to another and here we're just trying to do three pieces of information case in point I referred to this earlier overload if you google on interruption awareness you can find actual video of it one person is charged with counting to a hundred by fours which this person carless she's a nurse she was charged to do well somebody in front of her is acting as a mirror that she's supposed to follow one person on one side simple personal questions person on the other simple math she's got her fingers here probably out she's at like 20 she's counting to 20 and she's already getting frustrated and anxious and somebody says how many children do you have and she's like two so what I've seen in doing this is it opens up the door to experiencing and having a shared experience of how stressed we all are we're all running around being so stressed so we actually it can be it's funny because we're like oh that's how I feel every day so it brings that up but also and paul has some ideas I want to make some room for in a second but it creates opportunities to have self-awareness about our stress limits mine are different than yours which gives us an opportunity to speak up and say as I develop my awareness and my skill at expressing it and meanwhile hopefully we're also creating cultures that are more willing to listen and honor each other's limitations that we're doing all of that and that it also creates a door for conversations around communication skills like delegating and setting limits and constructive feedback which are great workshops in and of themselves so this can be integrated paul what was your comment earlier about I've put it in the chat as well the activity if you allow people to say pause or to say stop they can test their stress threshold practice being assertive and then have another go when they're feeling a tiny bit calmer and see if they can go further so it's a really nice use of the group to improve your skills and awareness awesome so we've got about two minutes if there's some concluding things you want to ask or say and then I'll say what's coming up next in AI and world thank you I will just say this one little vision thing and even in the midst of our crisis it is and it's a lofty vision but I think the applied improvisers have a skill set that we desperately need in healthcare as you can see and that because healthcare also interfaces with all almost all forms of human diversity that if we whatever we can get into healthcare we will have a rippling effect for the world so I there thank you I appreciate everybody's questions and listening and everything wow thank you Beth um I'm sure people can write a few things in the comments by way of thanks for appreciation encourage everyone to do that and there's a round of applause from Gerald as well and would like to remind everyone that there's going to be lots more AI and online both these big topics about once a month AI and 60 minute socials where you can turn up and talk about whatever's on our minds and there's going to be a new series as part of these webinar programs on watching AI and videos and discussing them which Angelina Castellini is currently arranging so thanks all very much for coming your questions and participation thanks again to Beth one more mention of her book medical improv and we'll see you all again soon there's her contact details if you want to get in touch I'm going to stop the recording now thank you all very much indeed