There is a fascinating discussion about status and human behavior in Keith Johnstone’s seminal book for actors, “Impro“. He maintains that vying for high or low status positions in our relationships is going on constantly and that as audience members we find status differences and changes to be interesting to watch. As such, mastering verbal and nonverbal expressions of status are important strategies for theatre direction and performance.
We also see it’s importance in military or police work where being in a high status role requires physical stance, facial expression, uniform, and perhaps a weapon that clearly state, “I’m in charge here!”.
Status is one of those topics that the more you study it, the more fascinating it is. I wonder how it is connected to power, money, position in society or at work, physical size or strength, educational level, majority culture, etc. I also wonder, when and how it contributes respectful relationships or those that embody fear and mistrust? How is it related to responsible leadership and followership and when is it compromising psychological safety in teams and patient safety in teamwork? Although not her main theme, Suzanne Gordon’s recent blogpost, “More about Introductions and Acknowledgement” discusses important related behaviors.
Being aware of and facile with expressions of high and low status can help us to use them wisely in healthcare (and to not use them unwisely).
- Doctor uses authoritative and directive tone in directing code team’s response to a patient’s cardiac arrest. Wisely
- Nurse uses assertive tone and body language demonstrates high status in raising concerns with a physician about a patient’s clinical status. Wisely!
- Nurse apologies frequently, mutters, and covers her mouth when speaking uses low status when raising concerns about a patient’s clinical status. Unwisely!
- Nurse’s assistant sits down next to patient with dementia while feeding him. Wisely
- Doctor uses dismissive and humiliating language to belittle a nurse who raised concerns about a patient’s clinical status. Unwisely
- Nurse Practitioner speaks softly and is mindful of his body posture in lowering his status to create psychological safety for an anxious patient. Wisely!
Medical Improv is one way to learn more about status behaviors and their importance in therapeutic relationships, collaborative leadership, and interprofessional communication. Learn more about how it works in this video Medical Improv and Status Activities I did with National Association of Independent Medical Practices, NAIMP.org.
And/or check out these status-related posts: