Lessons from Healthcare Clown Experts

Healthcare clowning is a growing field that brings play, presence, and human connection into healthcare settings. In this blog, we explore insights and perspectives from the world of healthcare clowning. If you are interested in deepening your learning - within Clown Spirit Village, you can find our Healthcare Clown Learning Hub - a curated collection of masterclasses, research articles, and clownversations with healthcare clown professionals. The hub is designed to support both those taking their first steps into healthcare clowning and experienced practitioners looking to deepen their learning and refine their craft.

Healthcare clown duo in action bringing smiles and laughter.

Hospitals are typically not designed to be fun or playful spaces. While modern medicine has allowed us to live longer and stay healthier than ever before, the environments we have created for healing and convalescing are often unwelcoming and de-humanizing. That’s why it makes so much sense that clowning - which is fundamentally about human connection, fun and warmth - is now routinely seen in many hospitals around the world and increasingly recognized as a valuable complement to clinical care.

There is no shortage of folks wanting to put on a red nose and visit sick kids on the ward, it seems. For a certain kind of person it is a very accessible and fulfilling way to ‘do good’ and ‘give back’ to society. But this has led to its own problems, as Dick Monday and Tiffany Riley explained in a recent class on hospital clowning. The main problem from their perspective is a lack of craft: people who have the drive and inspiration to bring the fun of clown to the hospital but without any foundation in clown technique. 

Healthcare Clowns extraordinaire - Tiffany Riley & Dick Monday, co-founders of Laughter League

But what exactly is the ‘craft of clowning’, how does it help in the unforgiving hospital environment, and how does one go about getting the experience necessary to make your first foray into healthcare clowning.

A few weeks back Tiffany and Dick, taught a masterclass - ‘Foundations for Clowning in Healthcare Settings’ -  for the Clown Spirit Village. Tiffany and Dick are co-founders of Laughter League, which trains and supports clowning in healthcare facilities across the USA. And they are also a renowned comedy duo known as Slappy & Monday, who have toured internationally with circuses such as Big Apple and Ringling for years before they started the hospital gig.

Dick Monday sharing about Clown Craft - specifically the components of a gag

The class was fascinating in part because participants ranged from very experienced healthcare clowns to folks who had done none at all. Tiffany began by stating that she feels clowning in hospitals is harder than stage clowning, because unlike a rehearsed routine, “every single time you knock on a door it’s a brand new experience, a brand new audience, and a brand new set of directions it could go in. You have to be ready to turn on a dime in any direction in an instant.”

Every single time you knock on a door it’s a brand new experience, a brand new audience, and a brand new set of directions it could go in. You have to be ready to turn on a dime in any direction in an instant.

“We have a huge responsibility and there are many things that can go wrong, but the potential pay-off is enormous because, if it goes well, a kid who feels very othered and ostracized by the system can see the clown and feel that there is someone that I can connect with, someone who gets me. And that is huge.”

Some of the wonderful healthcare clowns from Laughter League!

Over the course of the class Tiffany & Dick shared many tools and strategies, approaches and recommendations for how to go about this challenging and rewarding business of clowning in hospitals. You can get access to the full recording of the class by joining Clown Spirit Village. But here are some of the main themes and ideas that were shared:

• The Duo Model: working in pairs is the preferred best practice. Partnerships provide safety, allow for dynamic status shifts, and offer a way to build a scene or game together by accepting or “over-accepting” the partner’s offers. When one clown is feeling low energy or forgets a particular limitation (e.g. distance from a patient’s bed) the other one is there to help out.

• Preparation: Effective hospital clowning involves ritualized preparation, such as square breathing to focus on the "here and now" before entering a room. Dick & Tiffany also shared a simple back-and-forth counting game they recommend for getting attuned with one’s partner, sharpening listening skills and building complicity before starting the work on the ward.

• Visitation Stages: think of your visit in a three-stage structure:

  • The Dance: Assessing the room's dynamic and establishing a connection between the clowns before engaging the patient.

  • Engagement: Moving forward to find a shared game or interest, often based on patient preferences.

  • Empowerment: Giving the patient agency by allowing them to direct the interaction, which helps them regain a sense of autonomy in a controlled medical environment.

• Handling Rejection: One of the most important lessons to learn is not taking negative reactions personally, and being prepared to pivot or exit a room immediately if necessary to respect patient boundaries. So much is going on for patients that you are unaware of, usually it’s not about you, and leaving might be the one most generous and meaningful thing you can do for that person.

• Age and Setting Considerations:

  • Adolescents: Try using self-deprecating humor or simple gimmicks, like magic tricks, to break the ice with teenagers who may feel too old for traditional clowning.

  • Dementia Care: The approach should shift to be slower, more tactile, and focused on deep personal connection rather than performance.

  • Infants/NICU: Interactions focus on gentle visual or musical stimuli, often prioritizing the emotional support of the parents present.

• Status Play: It’s helpful, in the context of a duo, to make sure the partners are sharply defined and different, in order to create some tension or conflict that the patient can intervene in. Instead of thinking about traditional status difference, another way to think about this is that one clown is more focused on accomplishing a task or objective while the other one is free to play, support or disrupt the objective.

How do I get started in Healthcare Clowning?

Dick and Tiffany’s most-frequently-received question is about how to get started and how to develop as a healthcare clown. While there is no one way, they recommend that folks study children’s developmental stages, look for opportunities to observe experienced hospital clowns in action, and get as much experience as possible of standing up in front of kids and holding their attention (e.g. any kind of teaching experience).

Healthcare clowning is about breaking the clinical routine and bringing humanity and joy into environments where both children and clowns are essentially "out of place," yet vital to the healing process. While healthcare clowning is growing there is still no established program in many facilities.

The Healthcare Clown Learning Hub is a great way to deepen your craft and learning in Healthcare Clowning!

.If you think you’d like to set one up or get involved in an existing program, hopefully our Healthcare Clowning Learning Hub (pictured above) will help you to take the next steps in your healthcare clowning journey - to access it you can join the Clown Spirit Village.

As always - we would love to hear from you. Feel free to reach out with any questions and add comments about your healthcare clowning journey. Thank you for reading and for the beautiful work that you do!