Being Seen and Heard
Being Seen and Heard
Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast, exploring empathy and patient experience. I'm today's host Steph Bayer, Senior Director of the Office of Patient Experience here at Cleveland Clinic in Cleveland, Ohio. And I'm very pleased to have Kelly Leonard here. Kelly, welcome to Studies in Empathy.
Kelly Leonard: Thank you for having me. It's great to be here.
Steph Bayer: It's great to have you. Kelly Leonard's the Executive Director of Learning and Applied Improvisation at Second City Works overseeing the Second Science Project with the Center for Decision Research at University of Chicago's Booth School of Business. His book, "Yes, And," was published a critical acclaim by Harper Collins. Kelly has spoken at Aspen Ideas Festival, Microsoft, Ted and Broadway, and hosts podcast Getting to Yes, And for WGN in Second City. For over 20 years, he oversaw Second City's life theatrical divisions working with such talent as Tina Fey, Stephen Colbert, Amy Poehler, Seth Meyers, Keegan Michael Key, and others. Wow, talk about star power we have with us today. Thank you so much.
Kelly Leonard: Name dropping like mad. You can feel it dropped everywhere.
Steph Bayer: Well, I think Kelly Leonard's the only name I need to drop, but I'm excited.
Kelly Leonard: Great.
Steph Bayer: What led you to branch out from an already wildly successful comedy career into realms of leadership and communications in skill building?
Kelly Leonard: I had a midlife crisis. I wish I was making that up. It's maybe a bit more complex than that. After I wrote the book "Yes, And," although I had worked with our corporate division, that was not my area. I was the writer brought in and Second City storyteller, but you write a business book, you go on book tour, you start going to different bookstores to see if your book is there. I start looking at all these business books. At the same time that I was about to come off of book tour, there was a lot of changes at Second City in terms of our ownership group. The autonomy I'd had for many decades was slowly slipping away. I was like, I don't want to do this. I actually quit, and God bless the owner at the time, he knew I was unhirable anywhere else. He said, "Why don't you stay on for a year as a consultant. You can build a bridge out or build a bridge back in."
Kelly Leonard: I stepped down from producing and didn't have anything to do. I'm a restless human being. I was talking to the guys in our corporate field and they said, "Look, you're famous for doing all these collaborations." I did a program with the Lyric Opera, Renee Fleming, Harvard Street Dance, and other places. "What would you do if you could do this for the corporate division?" Thinking about the book tour, I was like, "Well, look, there's a ton of books on the art of negotiation, but they all mention improv but none go any deeper. What if we found a academic in that area?" And so I did. After I met Heather Caruso at the University of Chicago and we got the funding to do the Second Science Project, between that and then hosting the podcast, all of that happened at the same time.
Kelly Leonard: I'm reading a business book every week and interviewing that author. Most of them are academics. Then we're building out this program at the University of Chicago. Then we start working with my friend, Ai-jen Poo, at Caring Across Generations blending improvisation and caregiving. All that happened at the same time. I just got thrust into this world, and it turns out it's the perfect pivot. Heather, as an academic, said, "There's actually research to back this up." That if you stay in your job, basically you have the singular kind of expertise, and people who don't pivot are less happy. People who, like I was in my fifties at the time, actually do pivot to something that's adjacent but challenges them, there is plenty of evidence to back up that makes you happier. Indeed, for me, this was a perfect move at the perfect time, and allowed me to take all the knowledge I had about putting improvisation on-stage successfully to then pivot to improvisation off-stage. How do you take all this work to make you a more successful human being walking through the world?
Steph Bayer: I love that you created your own journey path there.
Kelly Leonard: Yeah. I had to.
Steph Bayer: Right. It's amazing how the universe will provide it sometimes.
Kelly Leonard: Yeah.
Steph Bayer: When you need it.
Kelly Leonard: That's right.
Steph Bayer: Now, we're in healthcare here and that's one of the things that we're talking about with empathy. There's so many skills that you've helped show us from improv that can translate into communication. Can we talk a little bit about how your own experiences with healthcare has impacted your thoughts and beliefs around the role of empathy in patients, families, and caregivers?
Kelly Leonard: Yeah, for sure. Well, the first was when my mother had dementia, I did not have the skill to navigate that successfully. Very frustrated and sad by the conversations. Kept trying to get her back into the room that we were actually in. This was after she passed and was many years ago, I was driving in the car, and an episode of This American Life comes on. There's an improviser out of Maryland or something talking about how he applied the principles of "Yes, And" when dealing with his mom who had dementia. I literally had to pull over sobbing because I wrote the book "Yes, And" and I didn't do it. I didn't know of the connections. That was my first foray.
Kelly Leonard: Then, quite tragically, our daughter, Nora, got diagnosed with cancer when she was 16. My wife and I have done all this work together, and we utilized all those skills in navigating the complexity of a hospital setting. Whether that was recognizing that it was vitally important that all the different people treating her saw her as Nora and as a human being. That way they would actually be better at treating her which is exactly what happened. In terms of they knew the tells. They knew when something was right and when something was wrong. They only knew that because they understood what could happen when they came into that room. We actually have very specific exercises that we created to teach people this that we applied in that hospital room. Sadly Nora passed away two years ago.
Kelly Leonard: One of the things I say about that time period is, I'm sad about everything, but I don't regret the year we had with her when she was ill because we made the most of it. We laughed a lot. We made great friends who are still friends today. The only reason we were able to do that is because we had this training and this expertise that we had built and a very specific thing around what it means.
Kelly Leonard: The burdens you feel as a caregiver, that all of us... Because all of us are either going to be caregivers, have been caregivers, or we've had caregiving given to us, so this is universal to all humans. It's applicable to all humans. The skill at not just being seen but being heard, and also the resilience it gives you to manage what seems impossible. The only way we do that is with other people. I think when people are in these situations, sometimes they turn in, when in fact you need to turn out. There's science to back this up that we have this reluctance sometimes to ask for help because we think people don't want to give it. The opposite is true. I mean, I know that for me. If someone turns to me because they need something, it's like, "Yeah, I'm here to help." One of the scientists we work with, Nick Epley, says, "If you're in a bad mood, do something nice for someone." I think that's good advice.
Steph Bayer: That's great advice. I'm sorry to learn about Nora. I do, from other speeches that you've given, and I would recommend for anyone that hasn't had a chance to listen to that virtual keynote you gave with Cleveland Clinic and HIMSS Patient Experience Summit, it was brilliant.
Kelly Leonard: Thank you.
Steph Bayer: I do know that you had certain communication techniques and you referenced it now. Do you mind sharing some ways that you built in empathy?
Kelly Leonard: Yeah. One of them is an exercise that my wife created called universal unique. This is based on that research that I was just talking about where people are reluctant to share with other people details of their lives. Even minute stuff. The research shows that when you do you build better relationships more quickly. In the exercise, we pair two people, and we say, "Pick a benign topic like going grocery shopping. Person A, you're going to tell person B, in about a minute, how people grocery shop." They go and they do that. Then we say, "Okay, now take a moment. Think about how you personally grocery shop. Now you're going to tell that person that, in a minute. Go." What happens when we do that leg of the exercise is it's funnier, it's quirkier because we're all weirdos. We have our little things that we do, and they're very specific. It's a completely different experience than the first.
Kelly Leonard: The way we applied that in the hospital room was when any new caregiver came in, whether it be a doctor or a nurse or anyone, we would say, "This is Nora. She also goes by Eleanor. I'm Kelly. This is Anne. We've worked at Second City for over 30 years. We also have a hundred pound Bernese mountain dog who's a jerk. Who are you?" They would immediately get this snapshot and then they tell us. They then felt this and a connection was formed. That is a technique, and when my wife Anne talks about this, she's like, "This is easy for Kelly because he's a such an extrovert." My wife is an introvert. It was not easy for her. She really had to force herself to do it. She was paid back because these people then were present with us, as humans, and not just present with the disease. You probably know yourself the studies that they've done with radiologists when they show them a photograph of the scan that their accuracy goes up like 40% or something. I mean, it's just absurd, but it's a fact of the human mind.
Steph Bayer: It's a beautiful way to incorporate your background into the care setting.
Kelly Leonard: Yeah.
Steph Bayer: It's fun and it's humanizing. I love that advice. What are some ways that organizations can foster that creativity, that we can collaborate? Especially with a pandemic where employees are working remotely and more tired, how can we find ways to connect?
Kelly Leonard: I think there's a few fundamental flaws and problems with modern society in the modern workplace. That is, we crave innovation on behalf of our people, but what we don't understand is that to have innovation you need creativity and creativity is inherently messy. Both require practice. First buttoning up the creativity and innovation thing. You can have creativity with no innovation. Screwing around, playing around, that's fine. You can't have innovation without creativity because that's where it stems from. When people need to be their creative selves, they have to be free to fail. They need to work from a place of abundance. They have to be in a fun disconnect and connected spaces. They sometimes need quiet and different things like that. Our workplaces aren't set up for that. They just aren't. Everyone wants the innovation. Again, you can't get it the other way.
Kelly Leonard: This other element of practice is probably even more important which is if you want your people to be more resilient, to be more collaborative and communicative, you have to build their skills. They need to practice these things. There's not a single peak performer in sports, in music, in acting, in all these other fields all peak performers practice. The best baseball players in the world play catch before every single game. Lives are on the line in hospitals, and how many people are practicing? I know you do as a student, but it doesn't end when you become a surgeon. It does not end. You still need practice. I think it's crucial that... That's why we get brought into a lot of businesses and, actually, in a lot of healthcare situations because we'll, and especially now because we can do it virtually, we'll hold these sessions where we're basically giving people skills building practice in better listening, in more empathetic communication, in being others focused.
Kelly Leonard: One of the things I loved about the Second Science Project that we discovered, we've always in improvisation talked about the need to be others focused. Putting your attention on what the other person is saying. There's this idea that was introduced to us by Heather Caruso at the University of Chicago called self verification theory. It's a professor out of Texas. The idea there is that most people think we want to be seen as our best selves or prettiest selves. Not true. We want to be seen as we see ourselves. If I see myself as clumsy, it's really important that you see me as clumsy so you don't throw me a ball. Of course, I'm a human. I'm not going to tell you that. What that means is that the only way you can actually get to understand how someone sees themselves is asking them a lot of questions and getting them to the place where, at some point, they're going to open up and reveal it to us a little bit because they've talked. That's a very different way to be others focused.
Kelly Leonard: For me, when I'm seeking to make a connection with another human being, this idea of I'm going to ask a lot of questions, and I'm going to get down to this because the act of being seen is transformational. Anyone who's been in a successful relationship knows this. My wife's writing a book on comedy theory, and she sent some chapters off to this professor who we greatly admire at Harvard. She just got back this incredible note that is just like, "Anne, I see you. I see you. You're this, you're this, you're this within this book." Anne sends me the note. She's like, "I am welling up over here." I'm like, "Of course you are. You've just been validated by a brilliant Harvard science professor, and she's seeing you for how you see yourself."
Kelly Leonard: That stuff is absolutely vital. Get your people to have sessions where they can practice. It doesn't have to be three hours a week. It could be 20 minutes a week. You think about it in the same way that we should work out every day. A little bit of practice in give and take and communication could make a giant leap of difference.
Steph Bayer: Man, there's a lot you said that I want to pick up on. I'm trying to figure out which thread to pull.
Kelly Leonard: Yeah, I'm sorry I dumped all this stuff together.
Steph Bayer: No, I love it. I'm going to take this skills practice because we just left there. I think that's really interesting. One, it's just the language you're using. You're not calling it role playing. You're calling it skills practice. Talk to me about that.
Kelly Leonard: Yeah. Here's the problem with role playing is you're jumping to all scrimmage. Let's use the sports' analogy. The greatest soccer teams, baseball teams. They have batting practice. They have fielding practice. They practice the elements of the game because you have to build up those muscle memory to then apply it in a game context. When people go straight to role playing, they are missing all the other stuff that needs to be paid attention to to then get in the game. Again, it's not like Yo-Yo Ma does his scales. I guarantee you every morning Yo-Yo Ma does his scales. Is there a better cellist on the earth? I don't think so. Just apply that if you're thinking you need to be a peak performer in your place of work, in a health space, or whatever.
Kelly Leonard: How important is it to get the truth out of a patient? Probably pretty important.
Steph Bayer: Very.
Kelly Leonard: All right, so what we know is most people don't tell us the truth. You being able to create that rapport by asking a lot of questions, by sharing some details, and they don't have to be intimate details. My examples were very minor that we've got a Bernese Mountain dog who's not nice. That's unusual because they're the nicest breed ever. Except for ours, only nice to us. It was funny. I actually have this memory because we love our dog and we always get pictures of him. He's really beautiful, but he's a jerk. There was rounds one day where we made every single doctor take out his phone and show us a picture of their dog. It was a very equaling moment between everyone because they're all comparing their dog, and we all thought they were cute.
Kelly Leonard: I'm not saying role playing is necessarily bad, but what I'm saying is if you don't do the skills building alongside then you're just play acting. You're not deepening the muscle of the thing you need to do which is better listening, better communicating. Recognizing to that we don't just communicate with our words. The ability to lean in and sit with someone, or recognize your status in a situation so you lower it or you raise theirs. All the different things that you do in order to... And this is the thing too about everything I'm talking about, I have a phrase I say, which is, "If it can't be used for evil, it's not a superpower." Everything that I'm telling you is also what con men use. I don't want to undercut my message but it's true. They see people. They know what they feel underneath and like, and they use that for bad. It can also be used for good, and that's the way I'm talking about it.
Steph Bayer: I want to keep using it for good. I appreciate breaking it down into the elements and showing us some ways that we can do that. You also talked a little bit about making sure that we see people and that is important and validating. Are there ways to practice that skill, that element?
Kelly Leonard: Yeah. There's a number of different exercises that we employ. One of the things that we note is that human beings can be reluctant to jump in and save somebody. There's been studies on this. We actually have an exercise where we put people in a circle, it's called statues, and we have two people make the front of a statue together. Then at any point someone from outside the circle can come in and tap one of them, say thank you statues, and then that person gets to leave.
Kelly Leonard: When we just explain the game, no one moves. No one goes in to save it. Then we say to the person in the middle, "What did you want?" All they wanted was someone to come in and save them, tap them out. That's all they wanted. We asked them on the outside, why did you not do it? They're like, "I thought someone else would, or I got bashful about it." It's like you have one thing to do here. Then when we instruct them that their job is not to think about just jump in and everyone does it. It feels great. It is a group feeling, and it's an individual feeling. That is fantastic. That's when I talk about embodied learning. That's the best learning. When you can feel in your body what it means to help and be helped, you are so much more likely to apply that in your actual life.
Kelly Leonard: There's a great book out, recent book, called The Extended Mind by Annie Murphy Paul which is all about how we get thinking wrong. She's a science writer. Basically our metaphors are bad. Our metaphors for thinking which include that it's like a muscle, you can just make it stronger and stronger and stronger, or it's like a computer is not actually how thinking works. Actually, we think with our bodies. I personally am scared of heights, so when I'm scared of heights, the wobbling in my knees, that comes before it goes to my brain. That's not the way we think. We do this, actually, in a lot of our inclusion work which is we'll have people play this exercise called Justin Little. The exercise is we pair up two people. Like we'll have Kelly and Steph. Kelly, you're going to describe your career in a minute. Just the arc of your career, what you do. Then Steph, you're going to recite back to me basically what I said, but using the words Justin Little. Like, Kelly, you have this little theater thing that you do, and you just wrote this book. It is so diminutive. It is so demeaning to do. It's such a male thing to do to a woman. Especially when men are having it happen to them. It feels terrible if you have any sense of empathy to actually do it.
Kelly Leonard: That's what we need is for people to feel it in their bones. What it means to say words like that or receive words like that because we're not going to do it. Once we know that, lesson learned. This is the real scared, straight aspect of this stuff. I just think we're missing the point if we don't do the practice of the individual moments and recognize that they're going to change based on the context you're in. When you have a suite of these skills that are built up, you are then pretty deftly able to move from situation-to-situation to understand maybe I need a little bit more here, a little bit more listening here, a little bit more talking here. There's no five point plan anyone can give us to deal with everything.
Steph Bayer: I love this so much. You mentioned too, earlier, about free to fail. That in improv there's some permission to fail. In healthcare, failure, it can feel like it's not an option because errors can be life and death.
Kelly Leonard: Yep.
Steph Bayer: What recommendations do you have for how healthcare can learn from failures and use the knowledge to make improvements with being free to fail?
Kelly Leonard: Yeah. This is why, because we're selling to corporate America, we don't call our exercise games, but they are. That's the point of games. Games give us a place where we can try out different things that don't have a life or death outcome but the actions are the same. Essentially you folks need to be doing more game playing. There needs to be spaces where you can play a game that someone can win, someone can fail. It won't matter. It replicates the situation. Different industries have found this. Whether it's war games that exist to where no one's dying in a war game, but it gives you a chance to figure out what's it going to be like if I'm in this drone situation or whatever it is in that. There's flight simulators that people use before that. I imagine there's some level of that in the training that you all get.
Kelly Leonard: The problem, again, is that everyone assumes you're trained you're done, and you're not. We don't stop learning, and we shouldn't want to stop learning. I'm so blessed that I had this midlife crisis. That I was able to then get to a place where I am learning so much either by reading a book every week for the podcast or by our various academic partners. It's such a gift because you realize if turn... I'm 55. Anyone who's my age who thinks that they know it all, I am telling you that person is a sociopath or a psychopath. The thing you totally learn by the time you're my age is that you don't know anything. There's miles to go in terms of even just general knowledge. Not to mention all the specific knowledge that different experts carry around in their heads.
Kelly Leonard: We live in this complicated world and complicated things happen to us. If you can arm yourself with knowledge and with practice, some of all these other things, you at least got a fighting chance. Then knowing the future of work is going to be one in which we're probably seamlessly interacting with AI. I'll just say computers, robots. The skills of being a human are the ones that are going to have the most value. Storytelling, problem solving, improvising, humor which causes warmth and connection. All those things because the computers can do the rest of it. The computers can do both the road test, but the computer's going to be doing the surgery. It's not just the factory floor people who are going to be looking out of their work. There's some surgeons who are not going to be so happy because we all know what surgeons are like when the robots are doing that.
Kelly Leonard: I don't think that's going to happen in the next five years, but it could in the next 25. The ability then to sort of like, okay, so what is it that makes a human a human. It's all those things I'm talking about. Those are the things that really bear. This is why then a liberal arts degree is going to be important. It's why HR might become the most important division when they used to be one that everyone would crap on because that essence of why humans do what they do and how humans can get out of their own way. We all have biases. That's not going away, and just knowledge that you have biases doesn't do a lot. If you can figure out a way to reveal them or upset yourself before you move to that, we have a phrase in our work that you have to replace blame with curiosity.
Steph Bayer: Oh, that's good.
Kelly Leonard: If you enter a space curious, you're going to have people who are upset in front of you. If you can just be in the head space of I'm more curious why you're upset than taking it personally. We all know hurt people, hurt people. Someone has got some hurt and that's why they're acting the way they are. Perhaps, if your approach is empathetic, which is curious, you could save the situation.
Kelly Leonard: Actually I have another extra that builds on that if you want to hear about it.
Steph Bayer: I would love to.
Kelly Leonard: Most people know about "Yes, And" because it's the stickiest of improv concepts. Essentially the idea is you get nowhere in a scene by saying no, or even just saying yes. You have to say yes, and.
Kelly Leonard: When we were working with the scientists at the University of Chicago, they're like, that's great. We actually have the science that backs that up. What happens when you have an intractable problem, a seemingly intractable problem, a core disagreement? The example I always use is people who are against vaccines. I've been talking about this well before the pandemic. I had this issue before then. We didn't have an answer and they didn't either, but in working together over the course of basically a year, we discovered this idea of thank you, because. The idea there is, if I'm talking to someone who...
Kelly Leonard: I have a specific story about this. One of my daughter's friends, her parents were against vaccines, so the daughter was unvaccinated. I like them, and Nora wanted to stay friends with her friend. In talking to them about this issue, I was able to say, "Thank you." That sets off the gratitude part of their brain. They're not scared of what's coming because I just thanked them. Because it's crucial, I find some point of agreement, no matter how small. The point of agreement I found was I said, "Thank you because you care for your daughter so much you don't want to get her hurt. I have the same thing. We are connected in this way, and we're trying to protect our daughters." We figured out a way that they would chat, text, zoom, and do other things until hopefully Nora would get better. That was an amazing way of us taking this idea.
Kelly Leonard: By the way, there's a paper coming out next year about this because we've done this exercise with tens of thousands of people. The numbers are off the charts in terms of the ability for people to stay in that conversation longer, and actually find an outcome that's useful as opposed to just blocking each other and being done with it.
Steph Bayer: That one is just phenomenal.
Kelly Leonard: Well, especially because it applies to everything that's going on right now.
Steph Bayer: It really does. Speaking of what's going on right now. Healthcare organizations, unlike the world with staffing shortages, but maybe some of the differences with healthcare is that we're two years into a pandemic.
Kelly Leonard: Yeah.
Steph Bayer: It's causing great exhaustion.
Kelly Leonard: Yeah.
Steph Bayer: It's causing burnout and stress related for the staff.
Kelly Leonard: Yeah.
Steph Bayer: What suggestions do you have for how leaders can support and encourage their teams to keep up that morale? Are there lessons we can borrow from your work?
Kelly Leonard: Yeah. Well, I mean, I think again, recognizing that humans want to be seen. Taking, and it doesn't have to be an hour long meeting with everyone, five minutes... The Second City got sold last year. I have a new boss, and it's the best boss I've ever had at Second City. I'll tell you why she's the best boss. We meet every two weeks for 20 minutes. The very first time we met she goes, "Tell me where you're stuck because I want to try to help you get unstuck." I was like, oh my God that is the greatest gift you just gave me. She sees me, and she will check in and be like, "What's going on in your world? How are you? Are you taking care of yourself? This is the stuff that's important." These small, real check-ins. Recognizing that we are told we're supposed to bring our authentic self to work, but that doesn't always feel safe. Leaders who can provide real safety in knowing that you can be who you are here because we're adults. We get the fact that doesn't mean that we're throwing a rave at work. If I can be honest about who I am, my sexuality, my orientation I have, the details of my life, I'm going to be working in a place that's accepts me and that helps reduce burnout.
Kelly Leonard: My wife actually created a exercise because early on in the pandemic we were getting hired to do a lot of resiliency workshops. This is an exercise called wish which is about resiliency. We have everyone take a piece of paper and make three columns. In the first column, write down a wish you have. Something that you want to do that you can't do right now because of the pandemic. For me it was swimming in the salt water because I was not able to travel. In the second column, write down the emotion that you think you'd have, the feeling you think you'd had. I wrote down refreshed. Then in the third column, write down something you can do right now to have that feeling. I wrote down splash water on my face, exercise, go for a run, go for a walk. The idea being we have agency over our emotional response to anything. It doesn't mean the bad thing isn't happening. It doesn't mean that it doesn't feel overwhelming. We have agency over our emotions and how we're going to respond to anything. I can't swim in the salt water.
Kelly Leonard: There's a lot of great thinkers who, Viktor Frankl comes to mind in terms of man's search for meaning, went through horrific situations, but chose as much as they could to bring hope, light, humor, care, and curiosity. All the things we've been talking about. You just have to remind yourself and then, again, recognize that you don't do it alone. Using your community, staying in touch with your community, making sure your teams are behaving team like.
Kelly Leonard: This is crucial. You're not going to solve this problem company wide. It's too hard going person-to-person. I'm obsessed by people just looking at teams. If we just focus on various team-by-team, put a little focus in there, make sure they've got their stuff that they need, that they've got their practicing, all that, then move to your next team. That's how we can, I think, realistically employ all these ideas I'm talking about for effective use inside an organization. Don't think about... Because you're never going to get everyone on board at the same time. Individual too hard. Go team.
Steph Bayer: I am so bummed that we're coming up on our time because I want to talk to you for a lot more.
Kelly Leonard: Well, we can always do it again.
Steph Bayer: Please, can we? This is so great. I've taken so much out of this today. I'm really grateful for the time and the energy you offered.
Kelly Leonard: I'm happy to do it.
Steph Bayer: Thank you.
Kelly Leonard: Yes. Thank you.
Steph Bayer: This concludes the Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcasts. Subscribe to the Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.