“Yes And”: A Vital, Versatile, And Visionary Leadership Tool


                                                  By Beth Boynton, RN, MS, CP

Patient safety, patient experience, workforce health, and cost-effectiveness are critical outcomes that share important common roots. They are all impacted by our ability to communicate effectively and respectfully. This can be challenging, in part, because communication involves underlying emotional intelligence, which is hard to develop and practice, especially in high-stakes, high-stress work environments or toxic cultures.

Furthermore, our ability to communicate affects our capacity to establish healthy professional relationships, collaborate in teams, and be effective leaders. All of these aspects involve individual, group, and organizational behaviors that are notoriously difficult to change.

Wouldn’t it be fantastic if leaders had a time-efficient and cost-effective tool that could teach a range of skills, offer opportunities for ongoing practice, and improve morale? Simple “YES AND” activities from the world of applied or medical improv offer a potential solution. To understand how, we can examine such an activity and break down its complex learning components that “YES AND” provides.

Word-at-a-time story

As any improv teacher, book, or Google search can inform you, there are variations in terms of the number of players, words, and title prompts. However, the basic idea is that two or more people tell a story one word at a time:

Doctor: “One” Nurse: “day” Doctor: “a” Nurse: “beautiful” Doctor: “tree …”

And so on.

The process inherently involves collaboration, as each person contributes to the story building upon their partner(s)’s previous words. Neither participants nor observers know what will unfold, much like outcomes in healthcare or any team effort—everything depends on everyone’s input.

Amidst the words, individuals think on their feet, let go of ideas, practice being present, develop confidence, empathy, patience, and more. If possible, please watch this 1.5-minute video clip of Certified Mindfulness Teacher, Professor Liz Korabek-Emerson, and the author telling a story one word at a time. Observing these learning moments unfold in the video will help the subsequent discussion make more sense.

More about “YES AND”

As you might be aware, “YES AND” is the golden rule of improv, meaning you accept what someone else offers (the “YES”) and then add something to it (the “AND”). On the surface, it might seem simple, and its playful nature might cause its value to be underestimated. However, this practice offers intricate and vital learning that can be analyzed through various lenses. Let’s explore four of them: emotional intelligence, communication, teamwork, and complex adaptive systems.

YES AND – Emotional intelligence

The “YES” encourages me to be attentive to what Liz is saying, thinking, and possibly feeling. This awareness of others is tied to developing empathy. The “AND” helps me cultivate self-awareness and confidence. Also, as we let go of our ideas and build upon each other’s contributions, we practice perspective-taking.

YES AND – Communication

One of the most apparent lessons with “YES AND” pertains to communication. “YES” necessitates practicing active listening, while “AND” requires honing our ability to articulate our thoughts. In fact, full participation in an improv activity isn’t possible without developing these skills.

YES AND – Teamwork

Fostering collaboration is another evident growth opportunity. The “YES” prompts us to incorporate the other person’s idea. This entails relinquishing our own plans, making space for others, and ultimately learning how to share power by granting it to others. The “AND” compels us to contribute ideas and step up to take on more responsibility.

YES AND – Complex adaptive systems

Complex adaptive systems, like flocks of birds, schools of fish, and healthcare teams, exhibit many relational properties. Examples include adaptability, flexibility, the butterfly effect, and self-organization. It’s reasonable to assume that when our relationships are built on trust, they positively impact the outcomes of the systems they’re part of. Conversely, when trust is lacking, the impact is often counterproductive or worse. The “YES” aids in developing trust in others, while the “AND” facilitates self-trust.

Moreover, “YES AND” offers other learning frameworks, such as presence, attunement, creativity, acceptance, coping with change, and more.


Facilitating experiential activities necessitates some practice in creating psychologically safe environments, teaching the principle of “YES AND,” and integrating learning objectives into the process. However, once accomplished, facilitating, observing, or participating in an activity like the “word-at-a-time story” doesn’t have to be time-consuming or expensive. There are numerous activities that can be varied over time and significantly contribute to the staff and organizational development that leaders seek and that we all desire!

Beth Boynton is a nurse consultant and author specializing in research, training, and writing about emotional intelligence, communication, teamwork, and complexity leadership. She’s a pioneer in developing medical improv as a teaching modality for health care professionals and the founder, Boynton Improv Education.


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