The Medical Clown Project quickly became part of the flow of each hospital — medical teams and their patients, even those suffering from dementia, got excited on “Clown Day.” An activities therapist told us, “I love my job. All I do is bring the clowns into a patient’s room and watch the magic and laughter unfold. From the hilarious to the tender moments of wishes come true.” We knew that professional performers could change hospitals for the better; what we didn’t realize was that the hospitals were also changing the performers. Here’s how medical clown Tristan Cunningham explained it: “One day Tristan was on break at a rehearsal with the California Shakespeare Theater, looking over the tour schedule with the rest of the cast. There were three dates at senior centers, along with a lot of schools. One of the other actors pointed out those three dates. “No way we’re doing Q&A on those shows. And we better be ready for no laughs and no applause with a room full of old folks.” Tristan was shocked — she knew older audiences could be wonderful and she had the skills to engage them from her work in hospitals. Tristan allayed the other actors’ fears with stories, taught them some medical clowning techniques and, in the end, the senior center shows were some of the best on the tour.” Other medical clowns have told me that their work in hospitals has transformed their work on stage and in the circus ring — they started really listening to audiences, shaping their performances to the feel of the room; they were using their skills to connect instead of to show off. My own work as a performer, a teacher and as a corporate consultant has been reshaped by medical clown techniques. Unlike the Medical Clown Project, which only works with paid professional performers Risaterapia (Laugh Therapy) works with hundreds of volunteers in 33 Mexican cities. Their “point of service” is the medical clowns themselves. The founder of Risaterapia, professional clown Andrés Aguilar, told me that their work in hospitals is a means to an end; their goal is to grow a generation of civically minded, empathetic and dynamic leaders for Mexico from the ranks of their volunteer clowns.
As part of my series about companies and organizations making an important social impact, I had the pleasure of interviewing Jeff Raz. Jeff has starred with Cirque du Soleil and in Shakespeare’s Comedy of Errors on Broadway, among many other productions. He founded the New Vaudeville Festival, the Clown Conservatory, the Medical Clown Project and led these organizations through key periods of development. Raz’s first book, The Secret Life of Clowns: A backstage tour of Cirque du Soleil and The Clown Conservatory, was launched at the Smithsonian in 2017. His second book, The Snow Clown: Cartwheels on Borders from Alaska to Nebraska, was published last year. Jeff has taken his extensive performing and arts management experience to the corporate world, helping leaders and their teams strengthen communications practices and build more positive corporate cultures. He has worked with many Fortune 100 companies and with executive education and MBA programs at Stanford, Haas, IMD and INSEAD. Drawing from his experiences in the arts world, as depicting in his two acclaimed books, Jeff offers unique experiential keynotes and workshops customized for a wide array of business, arts, and community groups. Jeff continues to write, perform, direct, teach, as well as work globally as a communications consultant.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
It was April 2006, I was waiting for the elevator at San Francisco General Hospital when a nurse walked up to me and said, “Hey, you’re the guy who brought the clowns in, right?” I considered saying, “Who, me?” but she was right, I was the guy who brought the clowns into the hospital. As the director of The Clown Conservatory, I was leading twelve advanced students in a month-long exploration of “medical clowning” in S.F. General’s pediatric ward.
The nurse said, “I run the adult long-term care unit and I need a couple of clowns. Stat.”
I started to explain that medical clowning is for sick children, not adults, but she cut me off. “My patients need clowns more than these kids. The kids have their families with them, 24/7 most of the time; my patients are lucky to get a visitor a month.”
So I sent two of my students to her ward for a few minutes and it went so well that I agreed to send one of them, Summer Shapiro, back for an official visit later that week.
On Friday, when we debriefed the hospital visits, Summer sat slumped in her chair until it was her turn to talk, “It was a disaster. A total disaster.” I was surprised and asked her to tell us what happened. “I worked hard to get ready with songs and jokes and games to play with adults. I had over an hour of material but when I got to the unit they sat me down and told me jokes. The whole time. I didn’t do anything. It was total failure.”
This ‘total failure’ was, of course, a complete success for these adult patients. And it taught me three things that were fundamental and inspired a big vision. Four years later, I co-founded the Medical Clown Project with my wife, Dr. Sherry Sherman, and started sending paid professional clowns into hospitals.
- All patients, adults and children, need playful human connections to help them lower stress and regain their health; they need medical clowns. (During our pilot program, we extended this to include everyone –- nurses, doctors, families, janitor, EMTs, receptionists, every human being that a medical clown encounters is a “point of service.”)
- Medical clowns do what is needed for the people they are there to serve; they don’t necessarily do what they’ve rehearsed. If Summer was in a circus or a theater, what she did would have been a disaster; in the hospital, it was perfect.
- The medical staff, especially the nurses, are our partners. They know their institutions, their colleagues and their patients really well. They know how to take care of bodies, we know how to take care of spirits — perfect partners.
My first book, The Secret Life of Clowns, includes a fictionalized version of that project with S.F. General Hospital.
Can you share the most interesting story that happened to you since you began leading your company?
The Medical Clown Project quickly became part of the flow of each hospital — medical teams and their patients, even those suffering from dementia, got excited on “Clown Day.” An activities therapist told us, “I love my job. All I do is bring the clowns into a patient’s room and watch the magic and laughter unfold. From the hilarious to the tender moments of wishes come true.”
We knew that professional performers could change hospitals for the better; what we didn’t realize was that the hospitals were also changing the performers. Here’s how medical clown Tristan Cunningham explained it:
One day Tristan was on break at a rehearsal with the California Shakespeare Theater, looking over the tour schedule with the rest of the cast. There were three dates at senior centers, along with a lot of schools. One of the other actors pointed out those three dates. “No way we’re doing Q&A on those shows. And we better be ready for no laughs and no applause with a room full of old folks.” Tristan was shocked — she knew older audiences could be wonderful and she had the skills to engage them from her work in hospitals.
Tristan allayed the other actors’ fears with stories, taught them some medical clowning techniques and, in the end, the senior center shows were some of the best on the tour.
Other medical clowns have told me that their work in hospitals has transformed their work on stage and in the circus ring — they started really listening to audiences, shaping their performances to the feel of the room; they were using their skills to connect instead of to show off. My own work as a performer, a teacher and as a corporate consultant has been reshaped by medical clown techniques.
Unlike the Medical Clown Project, which only works with paid professional performers like Tristan Cunningham, Risaterapia (Laugh Therapy) works with hundreds of volunteers in 33 Mexican cities. Their “point of service” is the medical clowns themselves. The founder of Risaterapia, professional clown Andrés Aguilar, told me that their work in hospitals is a means to an end; their goal is to grow a generation of civically minded, empathetic and dynamic leaders for Mexico from the ranks of their volunteer clowns.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
A funny mistake in a hospital can turn grim pretty quickly so I’ll tell you something close; a story that ends well. A couple of months into our pilot project, I was going room-to-room on a pediatric unit with my partner Ben Johnson. That day, the woman who emptied the trash, the janitor, seemed to be in every room and always in my way.
At first, I tried to play with her. She wasn’t into playing. I finally got sick of trying and started ignoring her. She didn’t like that, either. Ben quickly took me aside and said, “You can’t do that. If anyone, even one person on a unit, doesn’t light up when they see us coming, we’ve failed. That janitor is not going to light up when she sees us next week.” I wanted to argue my case but Ben was right. “In a hospital, medical clowns are the only people who aren’t dealing with life or death.” Ben moved his hand like an eel swimming. “We’re the ones who need to be flexible.”
Ben found out that this janitor had been a concert pianist back in the Ukraine so the next week he brought a miniature piano to the hospital. When we saw her, Ben held the piano up and she immediately started playing and singing in Ukrainian. Even with a clinky toy piano, was beautiful.
Every week for the next few years that janitor gave a five-minute Ukrainian concert in the hallway of a San Francisco pediatric unit. Getting to be her old self again, even for a few minutes, lit her up; her music lit up the whole unit. The medical clowns just held the piano and let the magic happen.
Can you describe how you or your organization is making a significant social impact?
“The clowns make such an impact on the kids that the child wants to come back to the hospital. I mean, what child wants to come back — to the hospital?”
- Lori MacDougal, RN, Boston Children’s Hospital*
Not many of us want to go to the hospital, much less go back, but almost all of us will go and go back numerous times, for ourselves and for our loved ones. Imagine if the atmosphere of a hospital was full of joy and positive connections between people; we might want to go back. This is the significant social impact of medical clowning.
Dr. Patch Adams talks about hospitals as serious places — that is, they deal with life and death — but says that there is no research to show that being serious, as in ‘without humor,’ is healing. On the other hand, there are reams of research to show that laughter and human connect are keys to health.
* From Tiffany Riley’s book “Beyond the Red Nose: The Serious Business of Healthcare Clowning”
Can you tell me a story about a particular individual who was impacted by your cause?
I knocked softly on the door of a woman I’d visited many times on the SNF unit. She waved me in and held her finger to her lips, “Be quiet” and pointed to her teenage daughter asleep on the cot next to the bed. I pulled out my newest prop, a clear plastic cylinder full of glitter, whispering, “This is my magic wand. It’s supposed to grant any wish. Can I try it on you?” She nodded “Yes.” “OK, make a wish.” Of course she wanted to go home. I made up a silly, rhyming incantation that ended with “…send her home” followed by a big wave of the wand.
She just stared at me. No smile, no light in her eyes. I felt terrible and started to backpedal, “It’s a new wand, maybe the battery’s broken…”
“I can’t hear you. I’m not here.”
“Oh. Where are you?”
I realized what was going on. “Is it warm out?”
“Oh, honey, it’s hot. Just the way I like it.”
“You want something cold to drink?”
“Don’t you worry, I’ve got an iced tea right here.”
I sniffed the air. “What’s that I smell? Is it…”
“Yes it is — barbeque.”
We went on like that for another few minutes. She was smiling now, eyes closed, feeling the sun and smelling the ribs. I walked out of the room, leaving her to enjoy her trip home.
Are there three things the community/society/politicians can do help you address the root of the problem you are trying to solve?
Yes. Envision a U.S. healthcare system that balances technology and medication with human-to-human healing. There is structural, cultural and personal work to do to bring more humanity into healthcare, specifically:
- in medical schools, where the norms, best practices and culture of healthcare take root.
- in the healthcare structure overall, where the people meet the medical establishment.
- and, of course, where the money comes from and where it goes.
The field of healthcare clowning is engaged with medical schools and with healthcare institutions; the money, while a crucial part of the equation, is not our main jam.
Some medical schools are focusing more on human issues such as culture, communications and empathy. I recently attended both of my niece’s graduations from the University of Washington School of Medicine: the first from her Native Health Pathway program, which immersed the students in native communities with strong support from healthcare leaders in those communities, and then the mass graduation, where the keynote speaker talked about empathy, communication and learning from one’s patients.
And medical professionals keep learning long after graduation. I worked with a group of pediatricians on medical clowning and improvisation. They struggled with an exercise called “Word at a Time Story” where two partners tell a story by taking turns adding only one word at a time to the narrative. This takes a lot of listening, a lot of zigging when you thought the story was zagging and a lot of saying, “yes, and…” when you want to say, “WTF?!” A few days later, I got an email from one of the doctors who realized, after leaving the seminar, that she walks into every room ready to tell her patient a story but not ready to listen. For a whole day, she experimented with the idea of sharing a story, in the spirit of “Word at a Time Story,” with every child and parent she saw. She said, “It transformed my practice.”
“Anything that can be done to help these kids just feel like ‘I am a normal kid and this is a normal day,’ I would say does as much for their health as the medical treatment they are receiving.”
– Dr. Kenneth Heym, Medical Director, Oncology Programs, Cook Children’s Medical Center *
In terms of healthcare structures, we in the U.S. can look to countries like The Netherlands and Israel where medical clowns are woven into the fabric of hospitals and clinics — they have institutionalized the idea that feeling normal, feeling human, does as much for people’s health as medical treatment. We have human-centered professionals in U.S. hospitals, too, but they are often sidelined as “complimentary care” — child life specialists, massage therapists, chaplains, guided imagery practitioners, medical clowns, etc. Many of these modalities are more effective and less expensive than pharmaceutical or high tech treatments and they come with only positive side effects.
How can institutions and insurance providers set their priorities so that everyone can get the care they need with compassion, connection and even laughter (and without going broke)?
* From Tiffany Riley’s book, “Beyond the Red Nose: The Serious Business of Healthcare Clowning”
How do you define “Leadership”? Can you explain what you mean or give an example?
Leadership requires many of the same skills as medical clowning — empathy, flexibility, humility, a strong presence and an even stronger desire to listen and learn from other people.
Great communication skills are a must. As a leader, the question I most often ask myself is “What type of communication is needed right now and with whom?” My go-to is a one-to-one conversation, preferably at a café, where I mostly listen and acknowledge what the other person is saying. But sometimes it’s important to go big: at the Medical Clown Project annual fundraiser I work with Calvin Kai Ku, the Artistic Director, to craft a big, splashy year-in-review, with slides, live music and video, to give our donors a sense of where their money is going and how much we need them to keep supporting the organization.
Being cognizant of, and sensitive to, the huge diversity of human experience is also crucial for a leader, especially when there is conflict. In any conflict, there is my story, the other person’s story and the facts. Three separate things. My story about a situation is NOT the same as the facts of that situation, even if I’m the leader. If I find out the other person’s story before telling them mine, things will almost always go better. This issue of bridging conflicts and cultures is one of the main themes of my book, The Snow Clown.
Another key leadership skill is turning mistakes into gold. I’ve seen over and again how the hardest and often most important moments are when something goes wrong — you accidentally offend someone, you sent the wrong email to the wrong group of people, you lose a client. These are the times for what I call “Golden Mistakes” — opportunities to make deeper connections because things are askew.
One day, a cast-mate at Cirque du Soleil got injured right before the show. After intermission, I found myself in the audience doing a scene that was supposed to end with my cast-mate and me waltzing down the aisle. He wasn’t there, of course, so, to try to save the scene, I turned to a woman in the audience and held out my hand. She was in her mid-sixties so I thought she might know how to waltz. She did, better than me, gracefully spinning out and back into my arms. I spun her out again and this time she gave a curtsy and held her hand for me to kiss. I kissed it and she sat down exactly as the band hit the last note of the waltz. Everyone cheered, the woman beamed and waved like a queen. A dynamic moment, a Golden Mistake that started as just a plain old mistake. I spend a whole chapter of The Secret Life of Clowns on golden mistakes.
What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.
- Creating an organization that supports the lives and careers of freelance performers is tough. To attract great people, in this case world-class clowns, every organization needs to think about the perks. Most medical clowns have mosaic, dynamic professional schedules that include time on stage, in the circus ring, in front of a camera and in a classroom as well as their shifts in hospitals. They value flexibility over consistent work and an “artistic home” over having a corporate ladder to climb.
- Emotional exhaustion is harder than the physical kind. With Cirque du Soleil, I performed a nearly three-hour show ten times a week, leaving me pretty pooped after the last show. Being that tired, physically, was nothing compared to how I felt after a seven-hour shift in a hospital; other clowns, many of whom are professional acrobats, have told me that medical clowning is the hardest work they do.
- Not all money is equally good. Our healthcare partners tap different budgets to fund medical clowning, often having to get creative because medical clown services are not yet covered by insurance. They sometimes pull from one-time or discretionary funds that are the first to go when budgets get trimmed, leaving us all scrambling. After a number of years getting funded from various sources, we now have a ten year agreement with the Department of Public Health to work at Laguna Honda Hospital, a much more stable way to operate.
- Bay Area hospitals are a microcosm of the world. On any give day, medical clowns in the Bay meet folks speaking Spanish, French, Russian, Farsi, Tagalog, Vietnamese, Hindi, Tamil, four dialects of Chinese and many more languages. People from these various cultures have different responses to the hospital and to medical clowns — if you have a sense of the cultural context, you might find a way to connect. For example, I’ve found that Russian families are often at odds with their medical teams; on the other hand, circus is hugely popular in Russia. I’ve juggled my way into quite a few rooms full of Russian families, rooms that the nurses had warned me away from.
- People are creative, even in the hospital. A woman who, for all intents and purposes, lived on a SNF unit and couldn’t speak because of a throat operation, covered her room with origami; a man on that same unit, with the same throat operation, would sing/howl along to my partner’s blues guitar. A cantor sang me very racy Yiddish song, children make up epic dramas with dolls, nurses dance beautifully in the halls.
You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Bring Humanity and Art back into Healthcare. Not just because it feels good or because I’m a huge advocate of medical clowning but because it is cheaper, more effective and helps heal the world.
Of course, humanity and art are the bedrock of many healthcare traditions, traditions that we in the “West” often sneer at, as if humanity and art are the enemy of science rather than its necessary partner.
Let me invite Dr. Ted Kaptchuk to help me make the case for this movement. Dr. Kaptchuk is a professor of medicine at Harvard Medical School and director of the Program in Placebo Studies at the Beth Israel Deaconess Medical Center. I heard him on the NPR show “Hidden Brain” and one of his big ideas was to study the placebo effect when the patients knew they were getting sugar pills; all previous studies hid that fact.
“(My) study was based on an insight — the placebo effect wasn’t just about the pills; it was about an edifice of drama, rituals and the trust between patients and their doctors…Healing is a ritual and drama that everyone in the world knows, at least their cultural forms of it. That drama activates neurons and activates a neurological process…”**
What he’s saying is that the tools of a medical clown — a toy piano, a magic wand, juggling balls, etc. — or the dolls of a child life specialist or the cross of a chaplain are like placebo pills that the patients (and their families and the medical team) all know are not “real” medicine. It is the drama, the ritual and the connection between human beings that activates a deep, healing humanity.
“The placebo effect is…way below and much stronger than thinking you’re going to get better, and you get better.”**
Here’s how Linda Bonanno, a patient in Dr. Kaptchuk’s study, put it:
“Because when you’re really sick…you will do and try anything, anything to get rid of the pain and get back to normal….I went back with Dr. Kaptchuk and he put me back on the placebos, it didn’t even take a week, and (the pain) was gone again. And I’m — I still — when I think about it, I’m stunned.”**
Medical Clowns and Placebo Researchers unite!
** “Hidden Brain” NPR https://www.npr.org/templates/transcript/transcript.php?storyId=718227789
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“If you don’t take the money, you’re of no use to anyone!” Barbara Kibbe, my friend and business mentor, was furious at me for the first and only time. Six months before, in the spring of 1993, we had worked together to help buy the Pickle Family Circus, an iconic Bay Area institution, out of bankruptcy.
I did double duty as a performer and an administrator for the first few months and then handed off my organizational work when the touring schedule picked up. The general manager kept sending me a small stipend for helping to run the organization, even when I was officially just a performer. I felt guilty, wanted them to stop sending the money and I went to Barbara for help.
Barbara went on, “In fact, if you don’t start making more money in general, you should find a new profession. You think you’re being so helpful to the organization, to the other performers who aren’t get paid as much as you, to the ‘New Circus Movement’ in general but you are dead wrong. If you can’t take good care of yourself, you can’t take care of anyone else.”
Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. 🙂
Brian S. Tyler, CEO of the McKesson Corporation is one I’d love to meet. Since he got his undergraduate degree at U.C. Santa Cruz, where I know a lot of the performing arts faculty, we may have some friends in common. If talking about mutual friends doesn’t get us through our omelets and hash browns, I might tactfully mention that there are lots of studies that show medical clowning is a side-effects-free alternative to some medications, particularly pain meds. He might be interested since McKesson recently paid many millions of dollars in fines for their part in the opioid crisis. If this conversation takes off, we might be able to envision a U.S. healthcare system that balances technology and medication with human-to-human healing, with medical clowns, of course, front and center. If we then decide to order cappuccinos, we should have time to figure out how to sell this idea to his board and keep McKesson’s $210 billion top line from sagging too much in the transition to this new human-centered system. The next time Tyler and I meet, we could go out and get the insurance industry and some major hospital groups on our side.
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This was very meaningful, thank you so much!