Yes – and

• March 24, 2024
• Esther Waterhouse

One of the core principles of improv is ‘yes – and’. This is taking what is given to you by your
partner, accepting it for what it is, and building on it in some way. On the stage this allows the
improvisers to build worlds and stories. In healthcare, it allows us to work collaboratively with
patients, their families and our colleagues.

We use several exercises to look at ‘yes – and’. The one we start with asks participants to get into
pairs and plan the food for a picnic. To start with, all suggestions are met with ‘no’. Then we
move to ‘yes, but’, followed by ‘yes’. We then plan holidays using ‘yes-and’ – accepting the
suggestion you are given and building on it. The feedback we get is that the differences are
stark. The difference between ‘yes – but’ and ‘yes – and’ is the difference between ineffective
and effective communication. With ‘yes – but’ participants feel dismissed, with ‘yes – and’ they
feel heard.

‘Yes – and’ is not saying yes to everything! As health care professionals we are often asked to
do things that we know will be harmful, or aren’t indicated – such as to give antibiotics for a viral
infection or to give chemotherapy to someone who is too ill to tolerate it. When we say ‘no’ to
these requests, we often get into a conflict with the patient and their family. When we
acknowledge the request (yes) and then build on it with our answer (and) we can often get to a
place of shared understanding and collaboration. So it might look like ‘I can see that you want
the best possible treatment’ (yes) ‘shall we talk through why I think the best way forward is not to
give antibiotics’ (and…). Practising ‘yes, and’ in a content free way helps to understand the
impact of this approach and the way in which it can help. It also gives us a new framework and
language for collaborative working.