First, build trust and a good relationship between the clowns and the medical personnel: The medical team often saw Pallapupas assisting in medical procedures in the Hospital de Dia – distracting children when they were getting injections or lines put in. They were impressed by their level of professionalism, and by the fact that it made the nurses jobs easier (less anxiety, less attempts to put a line in because the child is relaxed/not moving). Staff saw that this approach could easily be transferred to a surgical setting
Take things slowly, be patient and keep talking: Initially the clowns just visited children as they were waiting for surgery. But they found that the moment of separation (as they were taken to surgery) was made worse, as the children had built relations with the clowns.
Follow your instincts and trust in your skills: One time, the medical team suggested that the clowns come into surgery too. They changed quickly and went in. It was a success.
Learn from your mistakes and ask questions - never go home with a question unanswered: The team focussed in on what needed to happen with each child using trial and error, hand in hand with the medical team. It didn't always go smoothly, but now they have a clear methodology that works for everybody.
The Pallapupas surgery programme was a total collaboration between medical team and the clowns, and this is very clear to see. It works because it grew organically, with trust and with time - and becasue everybody wants it to work.
I am a therapeutic clown and performer. Writing here is part of my wider practice and maybe some of my thoughts will trigger some thoughts of your own and I hope that helps.