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Teaching, coaching, and mentoring; the key to effective leadership

By Thomas Davis, DNAP, MAE, CRNA

In his classic book, The 5 levels of leadership, author John Maxwell notes that in the lower levels, people follow leaders first because they must and later, if earned, because they want to.  However, in the modern workplace, truly memorable leaders take the next step and achieve level 4 status by shifting their focus on developing the talents of members of the team.  

The Gallup Q12 staff engagement survey is the gold standard for assessing staff engagement in the work environment.  Reviewing the content of the survey reveals that aspects of teaching, coaching, and mentoring are present in half of items assessed, which reinforces the importance of professional development in the workplace.  The Q12 survey reinforces the concept that teams with Maxwell level 4 leaders who focus on developing the strengths of its members are the groups with the highest morale and productivity.

Take your team to the next level through teaching, coaching, and mentoring

Teaching

Teaching is designed to impart academic information and instruction to a group of learners.  In most cases, the material is presented in a pre-determined manner and is designed to fulfill a specific need.  Communication is frequently one way and directed by the teacher.  Presentation of information is focused on content related to the goal.  In the workplace, leaders are called upon to assemble the team, explain changes in policies or workflow, and solicit support from team members.  In addition, teaching sessions may be held to update the team on best practice guidelines for various procedures.  Depending upon the size of the group, discussions can open the door for feedback however the bulk of the information is presented as one way communication from the leader to the group.

Coaching

Whereas teaching takes place in the classroom, coaching occurs in the actual work environment.  Typically, the coach uses his/her knowledge and experience to teach skills to less experienced people on the team.  Picture the little league coach who, in addition to teaching baseball strategy and teamwork, works one on one with each child to improve their personal skills at various tasks.  In the workplace, the level 4 leader works one on one with team members, or they may hit a home run by matching the lesser trained person up with a senior person on the team who fills in as the coach.  In this case the leader not only ensures that the newbie is coached, they also develop the coaching skills of the experienced person assigned to be the coach.   In this case, two people walk away with a sense that the leader has an interest in their professional development.

Mentoring

Mentoring is a special relationship between two people in which the senior, more experienced person helps the underling define a vision, develop a plan, and achieve a goal.  The relationship is built upon trust and often develops into a lifetime friendship between the two individuals.  A key element of mentoring is for the senior person to be committed to helping the younger person achieve their goal.  Often, effective mentoring enables the up and comer to become a leader somewhere else in the current organization or with another organization all together.  One word of caution, a relationship in which the senior person attempts to build a clone of him/herself is doomed for failure.   The key to success is helping the other individual to be the best person that they can be and encouraging their promotion.

“As we look ahead into the next century, leaders will be those who empower others”  ~Bill Gates

Frontline leaders are constantly pulled in many directions at the same time and in the chaos of crisis management may find it difficult to carve out time for developing individual members of the team.  The savvy leader knows that accomplishing the workload and staff development are not mutually exclusive.  Through teaching, coaching, and mentoring, members of the team are trained to pick up leadership tasks resulting in a reduced workload for the leader and more time available for additional staff development.  The investment of time and effort spent on developing others improves morale, increases productivity, creates a pipeline of capable future leaders.  In addition, it elevates you to “best boss” status.  Expanding the capabilities of others is a cost-effective win-win activity for the team and the organization.  Step up and capture the rewards of level 4 leadership.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Develop leaders on your team

By Thomas Davis, DNAP, MAE, CRNA

Leaders don’t create followers, they create leaders.

~Ralph Nader

Having the right leader in the right position is a key to success for any organization regardless of the type of business or industry that they represent; but where do leaders come from?  Recruiting and hiring leaders is time consuming, expensive and a bit risky because you never know that the person is a good fit until he/she is on the job.  Often, a better option is to promote from within and that requires a pool of workers who have the necessary skills to be successful in a leadership role.  Developing leaders from within is a great opportunity for professional growth for both the current leader and the workers being groomed to step into a leadership position.

Writing for The Training Associates, author Rebecca Gendron notes that 77% of organizations are experiencing a leadership shortage due to the great resignation triggered by COVID and the retirement of baby boomers.  Her data estimates that by 2025, 75% of the workforce will be composed of millennials and surveys reveal that 63% of millennials self-report that they are not prepared to assume leadership roles.  Insightful leaders will jump on this opportunity and incorporate leadership skills into the professional development plan for the team.

Advantages of internal leadership development

  • Enhance your position as a leader.   John Maxwell’s classic book, The 5 levels of leadership identifies a fourth level leader as a people developer.  Placing emphasis on professional development to include mentoring future leaders elevates the team while taking the leader to level 4 on the leadership scale.
  • Improve staff engagement.  The Gallup Q12 has been the gold standard for measuring employee engagement for several decades.  A review of the 12 indicators of employee engagement as outlined by Gallup finds that 6 of the 12 markers are enhanced by developing staff from within.
  • Cost savings for the organization.  The process of advertising, interviewing, credentialing, and onboarding is both expensive and time consuming.   For licensed professionals, the cost of finding and hiring a new person can exceed their annual salary.  Internal leadership development takes time and commitment while saving money for the organization.

Identify your future leaders

Keep your eyes and ears open and your future leaders will identify themselves.  They are the ones with a positive attitude, solid work ethic and who are skilled in the use of emotional intelligence to connect with their colleagues.  A review of business literature identifies characteristics of the workers who will be your future leaders:

  • Aptitude for motivating others
  • Perseverance to overcome obstacles
  • Skill in building trusting relationships
  • Ability to create a culture of accountability
  • Insight to make balanced decisions that will benefit the group and the organization

Create an opportunity for growth

The key to successful leadership development is a sincere desire to enhance the strengths of the other person and the quickest way to knock the train off the track is to try to clone yourself.  Trying to make the other person a better version of you ignores the talents that they bring to the table and is a recipe for disaster.  Instead, connect with the other person, become aware of their talents, and then build on their strengths and interests. 

Leadership developer Michael Page identifies the following activities as great ways to stimulate leadership skills in others.

  • Create opportunities for wider exposure in the group and organization
  • Change their roles and responsibilities to create an opportunity for developing new skills
  • Challenge with increasingly difficult projects
  • Provide a support system that includes mentoring and coaching
  • Give frequent feedback
  • Reward completed projects

Professional development with a focus on leadership skills is a win, win, win for you, your team, and your organization.

Start the ball rolling by understanding that regardless of how good you are at your job, your way is not the only way.    Tap into the talent on your team by assigning tasks to those who show an interest.    Give guidelines, criteria, and determine the desired outcome then step back and allow others to solve the problem.  Make sure that resources are available and take an active role as a mentor when the person tackles the problem.  Appreciate and reward creative problem solving after criteria are met regardless of the approach chosen by the person.  Finally, reap the benefit as team morale skyrockets, your workload is shared with others, and the future leaders of the organization are ready to step in.   Down the line when members of your team are asked to remember the best boss that they have ever had, your name will be the first to come off their lips.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

10 Behaviors that generate powerful results

By Thomas Davis, DNAP, MAE, CRNA

People are always looking for an edge; a way to position themselves a half step ahead of the crowd.  To that end, they throw caution to the wind, use money or power to get their way, and rationalize their extreme behavior because it justifies the results that are achieved.   For example, Lori Laughlin made the headlines when she was caught paying thousands of dollars in what is now referred to as the college admission cheating scam.

Leaders at all levels who are climbing the chain of command can fall into the same trap as Lori by using their current position to bully their way to the next level.  Ironically, instead of positioning themselves for promotion, their bullying creates a toxic workplace environment that becomes a roadblock and prevents promotion.  Rather than flexing political muscle or throwing money at a problem, the savvy leader wins the day with behavior that costs nothing.   Start on the road to success by eliminating negative behaviors and quickly follow with positive actions to affirm and unite your team.

Eliminate the negative

Travis Bradberry, author of emotional intelligence 2.0 notes several behaviors that generate ill will must be avoided by those who want advance in their career. Activities to be shunned include:

  • Overworking people
  • Lack of empathy for co-workers
  • Taking credit for other’s work
  • Banning socializing / punishing fun
  • Making stupid rules
  • Letting others struggle / withholding help
  • Controlling the agenda / ignoring feedback

Rather than using heavy handed authoritarian leadership to bully those on your team, ease up and remember that the most effective leadership behaviors are free.

It does not take a heavy hand, threats, and bullying to get the results that you want. An article in the archives of prosynex.com titled Scout for a promotion leveraged the boy/girl scout code of conduct with hot tips for grassroots leaders who want to create a preferred workplace  Similarly, an article by Molly Fletcher posted in Linkedin lists behaviors that require zero talent, are cost free, and enhance your position within the organization.  Combined, the two articles are a treasure chest of behaviors that are based on common sense and reap huge rewards.  Incorporate these principles into your leadership style and you will become a preferred boss.

  1. Be on time.  Legendary basketball coach John Wooden had three rules for his team and one was punctuality.  He felt that being on time was an overt display of respect for others so he always started and finished workouts on time.  Being where you need to be in a timely manner creates a foundation of trust and finishing on time respects the personal needs of your team members solidifies their sense of being valued.
  2. Demonstrate an honest work ethic.  The most trusted grassroot leaders know the job and frequently pitch when needed.  Schedules, payroll, and supplies are important however working shoulder to shoulder on the front line to ensure that the mission is accomplished sends a powerful message and contributes to team morale.
  3. Give full effort.  Leadership is not an 8 hour per day job, rather, it is ongoing.  The best leaders pitch in and do whatever needed to support team members including responding to team member’s personal issues even when they arise in off hours.  Tireless work to guarantee that goals are met reflects positively on the team as well as the leader.
  4. Use appropriate body language.  How you show up in the morning matters, as does your aura that others perceive throughout the day.  Your appearance and behavior sets the tone for your team so stand tall, put a smile on your face and some pep in your step.  Let your image portray you as a competent and capable person.
  5. Increase your personal energy level.  Personal wellness is important for you and for each of your team members.  Adequate rest, healthy nutrition and focus on goals all combine to boost your energy, stamina, and positions you as a positive role model for your team.   Your energy level is contagious and will elevate the morale of your team.  Conversely, dragging in with low energy and a negative attitude is equally contagious and will draw your team down with you.
  6. Improve your listening skill.   Move beyond forming your rebuttal while listening and focus on hearing to understanding the message that is being sent.  It’s more important to grasp the other point of view than to defend yours.  You don’t learn anything new while you are talking; you only learn new information when you are receptive and listening.
  7. Focus on emotional intelligence.   Accept and appreciate how your words and actions affect the members of your team.   Face to face discussions, preferably without masks, allows you to view expressions and judge the reaction of others.  Email and texting quickly transmit information but blocks your awareness of the person’s emotional response.
  8. Be receptive to feedback.  Creating diversity in the workplace includes encouraging diversity of thought and learning from one another.  You hire the best and brightest people for your team and now it’s time to showcase their talents and encourage their creativity by being receptive to their ideas.  By actively listening, you may find novel ways to solve a problem and leave team members feeling as if they are valued.
  9. Role model loyalty.  Loyalty is a two-way process and starts with the leader being loyal both individually and collectively to team members.  Never take credit for the work of others and never throw a team member under the bus just to save your ego.  When you establish that you have their back, they will have yours.
  10. Have fun.   Nobody says that work can’t be fun.  Celebrate birthdays and holidays by decorating the break room and supplying a cake or other food.  Reward the team when goals are achieved.  Sponsor quarterly events that promote teambuilding and create and opportunity for team members to know one another outside of the work environment. 

Leadership can be lonely especially for an authoritarian boss who feels that success or failure rests exclusively on his/her shoulders.  Rather, use the tips above to connect with and promote the talents of your team members.  Being interested in the team rather than forcing them to be interested in you opens the door to diverse thinking and new solutions to old problems.  Being a great leader does not arise from your knowing all the answers, instead great leadership arises from the trust that develops when team members feel valued, and their ideas are rewarded.   Replace authoritarian power with common sense and watch your team soar to new heights.  It’s true, the best approach to leadership is free.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Show your face; Empathy and Trust in the mask-wearing workplace

By Thomas Davis, DNAP, MAE, CRNA

This article is not intended to make a political statement, pass judgement on the CDC, or coerce healthcare providers to do anything that would compromise their safety or that of their patients.  Rather, the article is written to increase awareness about the negative effects of face covering when interacting with patients and to stimulate thought about creative ways to enhance connectedness while maintaining a safe environment.

The importance of emotional intelligence in both your personal and professional life was documented in a recent article published on prosynex.com.   The article noted that emotional intelligence is built upon a foundation of trust and empathy, both requiring connectedness between two individuals.  Development of those core elements is enhanced by being sensitive to verbal and non-verbal cues that are sent including tone of voice, body language and facial expressions.  Barriers such as facemasks and personal protective equipment (PPE) inhibit sensing the full message that is being sent and negatively influences the development of trust, empathy, and connectedness between providers and patients. 

Learning from the past

Over a decade ago, family practice physicians realized that they were constantly being exposed to every contagious organism in the community and opted to protect themselves by wearing facemasks when interacting with patients.   In the ensuing months/years family practice patient satisfaction, trust and compliance scores dropped and many speculated an association between facemasks and the relationship between physicians and patients.   A 2013 (pre-COVID) study done by Wong et al and published in BMC Family Practice found that a physician wearing a mask during a patient visit had a significant negative effect on the perception of the doctor’s empathy.  The study demonstrated that when doctors wear facemasks during patient appointments, there is a decline in empathy and relational continuity.

Fast forward to today’s mask wearing COVID society and there is concern across the board about the negative effects of blocking non-verbal cues for the detection of feelings which affects the provider/patient relationship.  Writing in Psychology Today, author Cara Goodwin PhD notes that infants only a few months old begin looking at the mouth for visual cues about emotions and we continue to assess facial cues throughout life.  Her research demonstrated the wearing masks makes positive emotions seem less happy, thus making children less likely to perceive positive emotions from mask wearing adults.

In an article recorded in the National Library of Medicine, author Felix Grundmann explored the effects of mask wearing on the elderly population noting that we tend to deduct a stranger’s trustworthiness and likability from facial expressions. Remarking that neuron density and neurotransmitter changes in the elderly already impede the perception of emotions, the author found that mask wearing hides facial cues and makes the detection of emotions even more difficult for elderly patients.

Being mindful of the negative effects mask wearing on the physician/patient relationship, Kratzke, Rosenbaum, and Cox conducted a study published in JAMA Surgery, 2021, where clear, see-though masks were compared to traditional hospital masks when surgical residents interacted with patients.  With the clear mask, facial expressions were visible and, as expected, those wearing transparent face covering were rated as being more understandable, empathetic, and trustworthy.

Improving provider/patient trust

Evidence-based medicine that predates COVID clearly demonstrates the wearing a mask while interacting with a patient has a negative effect on the provider/patient relationship.   Addressing the issue begins with the awareness that you are already at a disadvantage for building trust solely due to the requirement to wear a mask.  Therefore, being animated with eye and hand expressions will help the patient perceive your sincerity and mood.  Assume that your voice is muffled by the mask so speak loudly and solicit feedback to ensure that you are understood.  When possible, use a clear mask that reveals facial expressions.

Be COVID cautious and resist crossing the line to COVID crazy.  If you are working in a COVID unit or other area with high risk for exposure, full PPE may be appropriate.  However, if you are in a controlled environment where the risk for exposure is low, consider a plexiglass divider separating you from the patient and remove your mask during an interview.  When it’s time for hands-on contact, put the mask back on.  Ask your materials manager to order clear plastic facemasks for use when talking with the patient.    If your patient is at low risk for having COVID, consider removing your mask and maintaining the recommended 6 feet of social distancing from your patient while doing an interview.    However, if local protocol always requires the use of a traditional mask, speak loudly, have expressive eyes, and maintain an energetic, upbeat attitude.  The COVID pandemic has created safety requirements that impede the ability to use emotional intelligence when interacting with patients.  Be aware, be creative and develop a positive relationship with each patient.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Emotional Intelligence; The Holy Grail for Successful People

By Thomas Davis, DNAP, MAE, CRNA

Imagine that you are the coach of an NBA team and it’s your job to turn great players into a championship team.  Because only the best of the best are drafted into the league, you know without question, that each person on the team is a super star in his own right.  Leading a team of super stars should be easy, right?  You learn very quickly that while individual talents are important, it is converting unique skills into collective teamwork that wins the game.

Now imagine that you are a program director for a nurse anesthesiology program, and you are selecting the students for the upcoming class.  Like the basketball coach, your applicants are the super stars from ICU, and you select those with the strongest credentials.  Teaching a group of super stars should be easy, right?  Like the coach, you learn that the most successful students aren’t necessarily those with the best credentials, rather, those who have a positive attitude and the capacity to connect, and work collaboratively with classmates and instructors.

In both scenarios emotional intelligence trumps talent.  It is the receptiveness to learning/coaching, networking with others, and the desire to work collaboratively that creates the best results.

Emotional intelligence; Buzz word or formula for success?

In 1990, Psychology professors John D Mayer and Peter Salovey coined the term emotional intelligence and noted the following:

“The most effective leaders are all alike in one crucial way: they all have a high degree of what has come to be known as emotional intelligence. It’s not that IQ and technical skills are irrelevant. They do matter, but…they are the entry-level requirements for executive positions. My research, along with other recent studies, clearly shows that emotional intelligence is the sine qua non of leadership. Without it, a person can have the best training in the world, an incisive, analytical mind, and an endless supply of smart ideas, but he still won’t make a great leader.”

What does emotional intelligence look like and how can it be developed?

Simply stated, emotional intelligence is the ability to identify and regulate one’s emotions and to sense the emotions of others.  Those with high emotional intelligence have better mental health, job performance and leadership ability as evidenced by their ability to build relationships, reduce stress, and defuse conflict.

Professors Mayer and Salovey outlined 5 basic components characteristic of those who have high emotional intelligence:

  • Self-awareness
  • Self-regulation
  • Motivation (defined as “a passion for work that goes beyond money and status”)
  • Empathy for others
  • Social skills, such as proficiency in managing relationships and building networks

Tools for improving emotional intelligence

Writing for leaders.com, author Colin Baker offers tips for expanding one’s capacity for emotional intelligence:

  • Improve self-awareness by talking with colleagues and actively listening with an open mind.  Be mindful of your mood and develop a morning routine that puts you in the right frame of mind before going to work and be aware of events that change your mood during the day.
  • Improve self-regulation by becoming aware of what you can and cannot change.   Plan to pause when confronted with an emotional situation and never make a decision when you are emotionally stressed.  Refuse to participate in gossip or other toxic behavior.
  • Improve your capacity for empathy by assuming that there is more than one side to every story and open your mind to understand the other point of view.  Set aside your knee jerk response and list all possible options for resolving a problem.  Get to know your teammates and thank them for their opinions and completed work.
  • Improve motivation by being passionate about the job while keeping an optimistic attitude and instilling the belief that goals can be achieved.
  • Improve social skills by being an active listener and enhance your skill at reading non-verbal cues given by the other person.  When in a conversation, strive to be interested rather than interesting. 

The bond that fuses your work team does not arise from having the same employer, rather it grows from mutual respect and encouraging the advancement of one another

What you say and do affects those around you in either a positive or negative way.  Author Michele Borba emphasizes the importance of developing an emotionally intelligent vocabulary and suggests the following:

  • Label emotions:  Intentionally name the emotions that you feel and those that you observe in others.  “I am happy.” “I am nervous.” “You seem angry.”    Share your observation with the other person, “you seem tense”, then listen attentively while they either validate your observation or explain how they really feel.
  • Ask questions:  When a person lodges a complaint, ask “how did that make you feel?”   Listen attentively, validate their feelings, and let them know that it’s OK to have emotions.
  • Share your feelings:  Stating “I’m frustrated with this new policy” validates that you have emotions too.   The goal is not to eliminate emotions, rather to understand and control them.
  • Notice others:  Pay attention to facial expression and body language.  Enhance your awareness by looking at another person and questioning yourself, “how does that person feel?”

If it’s important, make personal contact

Every tip in this article is based on personal interaction with another individual.  Face to face contact reveals facial expressions, tone of voice and body language.   Delivering an important message via text, email or social media make it impossible to perceive non-verbal cues and creates a barrier to using emotional intelligence to connect with the other person.  When face to face is not possible, a video connection is next best followed by a phone call.  Never text or email an emotionally charged message.

Like learning to shoot a three pointer, emotional intelligence is a learned skill that takes practice.  Begin by being a better listener and asking follow-up questions when you are engaged in conversation.  Dare to have and share emotions without becoming emotional.  Label and validate the emotions that you perceive in others and use them for mutual benefit.  With a little preparation you can become the leader that you have always wanted to work with.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Stay out of Jail; Avoid billing fraud

Stay out of jail; Avoid billing fraud

By Thomas Davis, DNAP, MAE, CRNA

Nobody goes through the rigors of professional education and certification intending to end up in jail, but that is exactly where you could spend time if convicted of billing fraud.  Whether you plot, plan, and intentionally defraud the payor or you are unintentionally complicit with a scheme, you could face incarceration and a hefty fine. 

Going back to the days of the civil war, the US government implemented the false claims act to address fraud in goods sold to the US government to support the war.  Those who sold lame horses and boxes of sawdust to supply the troops were fined, jailed or both.  Over the subsequent century and a half, the false claims law has been expanded and applied to everything purchased by the government including healthcare. 

Whereas it is easy to look at a box of sawdust and know that it’s not ammunition, it is much more difficult to look at patient care and determine whether the service was actually performed and, if so, whether the care rendered was of acceptable quality.  In healthcare, those who submit bills for reimbursement for services must meet a standard of care and be able to validate the veracity of the claim for reimbursement.   

One of the greatest risks for nurse anesthesiologist to commit billing fraud arises from billing for services that were not provided

There are several practice models for the delivery of anesthesia services and each model has a unique modifier designating the type of provider administering the anesthetic and triggering the payment for service.   Of the anesthesia billing modifiers, using QX when the patient received QZ care is a violation of the false claims act and carries penalties for those submitting the claim.

Modifier Description
AA Services performed alone by a physician anesthesiologist.
AD Medical supervision by a physician: over 4 cases
QK Medical direction of two, three or four concurrent cases
QX Medical direction of a non-physician anesthetist
QY Medical direction on one qualified non-physician anesthetist
QZ CRNA service without direction of a physician

The QX trap

The QX modifier designates medical direction by a physician of up to 4 non-physician anesthetists.   When this model is applied, the physician is awarded 50% of the amount that he/she would be paid if doing the case alone for each of the cases being directed at the time.  Because CRNAs complained about anesthesiologists billing for medical direction and having no direct involvement in the case, CMS established criteria for medical direction of anesthesia services.   The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 was released to define criteria that must be met when billing for medical direction of anesthesia services.  The 7 requirements for medical direction are: 

  1. The physician must perform the pre-anesthetic examination and evaluation.
  2. The physician must prescribe the anesthesia plan.
  3. The physician must personally participate in the most demanding procedures in the anesthetic plan including being present for induction and emergence.
  4. The physician must ensure that a qualified person performs the anesthetic plan.
  5. The physician must monitor the course of anesthesia administration at frequent intervals.
  6. The physician must remain physically present for all key and critical portions of the procedure and be available for immediate diagnosis and treatment of emergencies.
  7. The physician must provide post anesthesia care as indicated.

When the QX modifier is used and all seven TEFRA requirements have not been met, billing fraud is occurring.  Hey, wait a minute…I’m just doing the cases, someone else is submitting the bill.  In the eyes of the law, ignorance is not an excuse.  When the case is being reimbursed based on your name, you must ensure that all the requirements are met before applying the QX modifier.  If you are unsure, ask those who submit the bill about the modifier being used for the cases you perform and make sure the code is in alignment with the services provided.

Examples of billing fraud

An operating room suite has 12 rooms with 12 CRNAs and 3 anesthesiologists to cover the department.  Each physician anesthesiologist is assigned to provide medical direction for 4 CRNAs and is following the TEFRA rules for medical direction.  Midafternoon, the final cases are going in all the rooms, and everything is stable.  One of the anesthesiologists is due for an early out so he transfers supervision of two of his room to each of the remaining anesthesiologists.  At this point, the remaining anesthesiologists are supervising 6 rooms each and the cases no longer qualify for the QX model.   In this case, billing for medical direction of any of the 12 cases in progress is billing fraud, however billing using the QZ modifier is perfectly legal and appropriate.

A busy GI center has 4 CRNAs and one physician anesthesiologist.  The center uses the QX model for billing however, CRNAs complete about 50% of the preoperative evaluations and the physician anesthesiologist is not present for induction.  Because the physician anesthesiologist does not see patients preoperatively, does not prescribe the anesthetic plan, and is not present for induction, the seven TEFRA rules are not met and submitting a claim using the QX modifier is billing fraud.

Protect yourself

Awareness and attention to detail will protect you from spending time at the big house.  Determine who does your billing and verify the appropriate billing modifier that is being used.  If your cases are billed as QX, make sure that ALL SEVEN of the TEFRA requirements have been met.  If the TEFRA requirements are not being met, use the QZ modifier and your bills will meet the legal standard.

CRNAs spend years preparing themself for admission to an education program and then sacrifice several years of their life to the knowledge and skills necessary for certification.   Your credentials and your reputation are valuable assets…remain diligent and protect yourself from billing fraud.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Personal wellness; The first line of defense against COVID-19

By Thomas Davis, DNAP, MAE, CRNA

Webster’s dictionary defines wellness as “the quality or state of being in good health especially as an actively sought activity” implying that wellness is not something that happens by accident.  Wellness requires commitment and effort. 

In healthcare and specifically within the field of anesthesia, provider wellness has traditionally focused on prevention of or recovery from substance abuse, depression, and suicide.  Residents and CRNAs alike are taught the dangers of drug diversion and given resources to help address stress related issues.  After graduation, professional organizations offer support through wellness pages on their respective web sites.  Click here for AANA peer assistance and click here for ASA peer assistance. 

COVID-19 and provider wellness

The emergence of COVID-19 as a world pandemic expanded the scope of anesthesia provider wellness initiatives.  Early in the epidemic, data indicated that people with coexisting diseases were at greatest risk for hospitalization and death. Specifically, the CDC lists diabetes, hypertension, obesity, smoking and immunosuppression as conditions that increase the risk of poor outcome should the individual become infected with the virus.  In response, wellness programs originally designed to address drug diversion, depression, and suicide, have taken on new importance with an emphasis on strengthening the body by promoting healthy lifestyle choices.  The AANA, State associations, and proactive employers recognize the impact that wellness makes on personal health as the first line of defense against COVID and encourage activities that calm the mind and strengthen the body.

Be active, Be well

If you are fit, kudos to you.  Make a commitment never to lose your current level of fitness and plan activities to maintain your health.  However, if you are like many people who are out of shape and have coexisting disease, regaining health can seem daunting, especially after years of sedentary lifestyle.  Regaining health starts by making a personal COMMITMENT to increase activity, control the diet, and develop a positive expectation that effort will be rewarded.  Start your journey on the road to improved heath by developing a reasonable and attainable PLAN.  Locate an online workout program, hire a personal trainer, or incorporate new activities into your schedule and get the ball rolling. Enlist a friend or join a group of coworkers to share your new activity, and to benefit from a support system that includes accountability for staying the course.

Your personal wellness program can be as simple as walking around the block, substituting water for carbonated drinks and eating nutritious snacks.   At first, lifestyle changes will be something you do and over time they will become an essential part of your day.  Select something that you enjoy, link with an exercise buddy, and get moving.  Remember and repeat:  Wellness is more than what I do.  It’s who I am.

Walk or run   All you need is a good pair of shoes and the desire to get moving.  Start with a short walk and add distance as your endurance improves.  Numerous apps are available to track your activity, to suggest routes and to connect you with other walkers.  Strava, Map my walk, and footpath are three of many options.  Make it a year-round activity; bundle up in the winter and strip down in the summer but keep moving.  Walk daily and consider joining a walking group to meet new friends and enjoy the camaraderie.  If you are a runner, you will cover more distance in less time, but the same tips apply.  Commit to a local 5K or 10K walk/run and enjoy the exercise as you work up to the full distance.  Share your plan with colleagues and motivate them to join you.

Cycling In addition to being a great cardiovascular workout, cycling allows you to enjoy the scenery while you hone your senses of vision, hearing, and balance.  Invite a co-worker to join you or tag along with a local cycling club.  If you are not comfortable riding in traffic, city and state parks offer quieter places to ride.  Designated hike/bike trails are being developed across the nation spearheaded by the Rails to trails conservancy.  Routes can easily be found on the trail link app, and apps such as strava and ride with GPS will record your ride data.  Set a goal to complete an event ride and join other anesthesia providers who will participate in the Erie Canal bicycle ride, July 2022.  Click here for information about the event.

Hiking   Although this requires more preparation than walking around the block, hiking is a great outdoor experience.  State parks abound across the country and offer hiking trails rated from easy to difficult, and the all trails app will help you locate hiking routes in your area.  Whether hiking around a lake or up the side of a mountain, being surrounded by fresh air and wildlife lifts the spirit and makes exercise fun and enjoyable.  Take hiking to the next level and build up to a European hiking event.  The 10 day  trek around Mount Blanc is well known and a worthy route for your bucket list. 

Swimming   This is a fantastic no impact activity for those who have access to a lap pool.   Instead of completing a set distance, start by swimming for a designated time.  Swim 3-5 minutes, rest for 1 full minute and repeat.  As you become stronger, increase the time spent swimming, and reduce the resting time.  My swim pro and swim.com apps will track your progress and for those who want tips on swimming form, the swim coach app provides useful tips.   If you are up for a challenge, combine swimming with biking and running and complete a local triathlon.

Water aerobics is a great low impact, high resistance activity for those who are not lap swimmers but love to get wet.  A gym or YMCA with a pool will likely have water aerobics classes that you can join.  If you have a pool at home, the pool fit app will coach you through water exercises, poolside.

Court activities Basketball, volleyball, and tennis are group activities that are readily available in most communities.  Pickleball is the new kid on the block and has quickly become the fastest growing sport in America.  What was initially nicknamed “tennis for old people” has become a magnet for exercising and socializing and enjoyed by active people of all ages.  Regardless of the sport you select, engage friends to join you in pick-up games or join a league.  If you have colleagues who enjoy the same activity, form a team, and enter local competition.

Join a fitness club.   In most communities, gyms have re-opened following the COVID shutdown and patrons challenge themselves with weightlifting, cardio, yoga, and Pilates.   Many gym rats who were shut out during the COVID closure opted to set up a home gym and continue to pump iron on demand in the basement.  Personal trainers are available at public gyms and many will come to your home for personal workout sessions.  Apps are plentiful for in-home workouts.  Fitness buddy and Jefit workout planner are apps that put a personal trainer in your pocket.

Combating COVID involves more than receiving a vaccination and wearing a mask.  It involves developing a fit body and strong immune system which serve as important barriers to the dreaded virus. Activities that strengthen muscles and stimulate the cardiovascular system will reduce coexisting disease, reduce the need for medications, and form a solid foundation for a healthy mind and body.  Nutrition, sleep, and a positive attitude are additional keys to overall wellness.  Commit to a lifestyle change and then get up, get going and get out the door.  Personal wellness is the big umbrella that covers us from the fallout of COVID-19. 

If you are in a leadership position at any level, inspire your team to make wellness a priority.  Create group activities and encourage your team to participate.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

How COVID has changed the healthcare workplace

By Thomas Davis, DNAP, MAE, CRNA

COVID-19 has changed the way we live, work, and interact with one another.  For some, the hype and hysteria connected to COVID lifestyle changes are oppressive whereas to others it is viewed as the way we should have been conducting business all along.    I remember my early days in healthcare when being fitted for PPE was an annual event and something that did not really affect day to day life.  Fast forward to the present and PPE is the barrier that we demand and use daily to protect ourselves and ultimately our families from the dreaded pandemic.

In January 2021 President Biden signed an executive order directing OSHA to issue safety guidelines for businesses and created implications that transcend to the healthcare workplace. Writing for McKinsey and Company, author Susan Lund notes that work environments with the greatest physical proximity to clients will be affected the most by COVID changes.  The hands-on care that we deliver to our patients puts healthcare workers at the top of the list for proximity to clients.   Visit your primary care provider, lab, radiology, or surgery center and you will likely be greeted by a person wearing a mask while working behind a plexiglass barrier.  In come cases, you may be required to show evidence of a recent negative COVID test before receiving treatment.  Yes, delivery of healthcare is a one-on-one frontline hands-on environment that has changed to protect both providers and the patients we serve.

How the healthcare workplace has been changed by COVID

The physical environment has been re-defined.  Regardless of where you work, look around and you will see barriers and social distancing that was not in place pre-covid.  I work in a surgery center where the once crowded waiting area is essentially empty because only patients are allowed through the door.  Family members or drivers are on call for return to pick up the patient but not allowed to wait in a common area.  Once admitted, patients move to the pre-op area where every other bay is closed to increase social distancing.  Healthcare workers preparing the patient for surgery are all wearing masks, as are the patients.      Likewise, every other bay in the recovery area is closed to increase the distance between patients.   Once adequately recovered from anesthesia, patients are wheeled to the pickup area and helped into the awaiting car.  In discussions with CRNA colleagues from around the country I realize that the changes made in my workplace are not unique and have been adopted by many other workgroups.

The workflow has been re-defined.  Social distancing and PPE is the name of the game in the current covid environment.  We do not want healthcare workers to become COVID infected nor do we want our patients to become infected while under our care.  As describe above, distancing and wearing masks has become part of every-day life.  Once in the operating room, the greatest risk to anesthesia providers is related to airway management.   The N-95 has replaced the traditional OR mask for anesthetists working with airway management.  Likewise, the video laryngoscope has replaced the traditional laryngoscope in many workplaces and enables the anesthesia provider to maintain a greater distance from the patient while intubating. 

In some operating rooms, anesthesia providers use a plexiglass shield in addition to the video scope and create yet another barrier between the provider and the patient.   COVID has increased the use of the video laryngoscope to the point that many providers recommend it as a standard of care for all intubations.  When COVID goes away, the video blade will remain as a foundation for airway management.   Extubation at the end of the case requires similar precautions in order to prevent the potential spread of the COVID virus and some workgroups require a minimum number of room air exchanges before the doors are open and the patient is taken to recovery.

Leadership agility is essential.   Writing in the World Economic Forum, author Sarah Kirby notes that COVID has changed the way leaders interact with workers to include a new emphasis on leadership agility and transparency.  At the top of COVID related leadership challenges is dealing with worker fear and uncertainty.  Workers fear for their own welfare and that of their families and are uncertain of job security.  At the height of the pandemic, many anesthetists were given the choice of furlough or working in ICU when elective cases were halted.  As healthcare workers, collectively we are needed to provide many levels of care for those infected with the virus.  In addition, many healthcare workers face personal challenges created by home schooling for children.  Effective leaders, including Chief CRNAs, must develop the emotional intelligence to be sensitive to the needs of the workers and maintain the flexibility to alter scheduling to accommodate the new needs of the workers.   Trust and transparency are the keys to effective leadership in the COVID environment.  With mandates and regulations changing almost daily, workers must trust that their leaders will be honest and open with them regarding required changes and will always keep the welfare of the worker as a top priority when altering workflow.

Online interaction will continue to expand.   In the early stages of the COVID pandemic, many healthcare clients rejected the concept of connecting with providers online and vice versa.  Now, after more than a year of online appointments, many patients and providers prefer the format and appreciate that the video connection can be scheduled for a specific time, and eliminate travel and time in the waiting room. 

Professional development for healthcare workers has transitioned to an online format.  Those seeking doctorate level degree completion are doing so via asynchronous online education and others who need CME are finding it online rather than in-person meetings. 

In many cases, employers have converted to a video interview for prospective candidates with contracts being offered without an actual face to face meeting with the applicant.  The format offers a cost savings to the employer and protects the applicant from exposure to the virus while traveling.

Without doubt, COVID has changed our individual lives in many ways including how we interact in the workplace.  At some point, the COVID pandemic may be reigned in and reduced to the level of other threats such as the flu, however, the workplace changes triggered by the virus will remain for many years into the future.  As mandates and restrictions are eased, many workplaces will view some of the changes as the way we should have been doing business all along.  Regardless of your individual situation, remain vigilant, cling tightly to the changes that will protect you in the future, anticipate creative use of computer-based expansion of healthcare, and continue to develop your emotional intelligence skills which will enable you to connect with patients and colleagues.   COVID has changed how we live our lives and in many ways the changes have been positive.  Be safe.

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Set boundaries at work and in your life

By Thomas Davis, DNAP, MAE, CRNA     

It’s 11pm and you are finally ready to collapse into bed…just another day in your hectic life.   You resisted the urge to smash the alarm clock at 5am, got out of bed and hit the floor at full speed.  The clock is ticking. You have one hour to shower, dress, and get breakfast ready before getting the kids up at 6am.   At 6:30 your phone rings, an early case was added to the schedule, and you live nearby so they assumed that you wouldn’t mind doing it.   You can’t disappoint your colleagues, so you double the pace, drop the kids at pre-school early and race to the hospital.  At lunch your boss flags you down… a policy must be revised, she is in a time crunch, and you always say yes, so she gives you the job then drops the bomb… it’s due tomorrow.  You realize that your cases will go until 4pm and that you will be spending your evening re-writing a policy.  At 3pm, a colleague lets you know that there is an add-on case and he can’t possibly stay to do it because his kids have a soccer game…you say yes again.  Finally leaving at 5:30pm your phone rings again, your neighbor is tied up in a business meeting and needs you to pick up her kids on your way home.  On and on it goes until you are totally burned out.  What is the problem with this picture?  You have no boundaries, and everybody knows it.  Something must change.

Writing in Forbes.com, author Melodie Wilding notes that boundaries remove chaos and distractions from your life and serve as armor to protect you from unwanted invasions on your time, talents, and resources.  It’s nice to be helpful on your terms, but taking on the responsibility for solving other people’s problems crosses the line and must be stopped. She notes that establishing boundaries begins with self-assessment to include making a list of areas where your life is being encroached by others and include the tasks that you do but can and should be done by someone else. 

The first step in re-defining your life is openly admitting that the status quo is not working, and the second step requires making a commitment to set boundaries knowing full well that there will be pushback from those who enjoy your willingness to take on their responsibilities.  Your commitment must be firm and not just something that you try out for a short period of time. 

Buying or selling property requires a survey of the land to clearly mark the boundary between what you own (your responsibility) and what belongs to others (their responsibility).   Take a survey of your daily life looking specifically at things that cause you stress, make you feel uncomfortable, or push you to exhaustion and then draw property lines to separate your responsibilities from those of others.   Ask yourself what it would look like if you stayed on your own property and did not accept ownership for the problems of others.   Put up a fence and stop mowing the neighbor’s lawn.

Set boundaries at work and in your life

Identify priorities.  Earning a paycheck is essential and gaining professional recognition and respect are very important for many workers.   Beyond that, we all have things that are essential for our wellbeing.  Whether it be connection with family/children, hobbies, activities or social interaction, everybody has things that are crucial to their happiness and wellbeing.  List your essentials and note areas where a lack of boundaries has kept you from the things that are important for your wellbeing. 

Say NO and mean it.  Determine where you need to build fences to identify your property line and then close the gates to keep intruders out.  Without being an obstructionist, say no when others want you to fix their problems.  To get you started with boundaries, here are three key phrases for protecting your time and space:

  • What did you mean by that?  When you sense that others are dumping work on you, clarify by asking what they meant and exactly what they are requesting from you.  Make the other person verbalize the work that they are asking for from you.  Hopefully, they will realize that they are imposing on you and will back off.
  • That doesn’t work for me.  This simple sentence says it all and is most effective if it is stated decisively without an explanation of your reasons for saying no.  Just say no.
  • How am I supposed to do that?  Delivery is everything with this phrase.  Your tone of voice must send the message that you sympathize, but the request is not reasonable.  It is essential that you NOT sound sarcastic when using this phrase.  Use a monotone voice and ask it as a simple question.

The three responses above work best when they are followed by silence…for as long as it takes.  Discipline yourself and wait for the other person to respond.  If you get uncomfortable with the silence and start to defend or explain your position you lose your power and the statement is meaningless.

Communicate clearly.  Setting boundaries involves establishing new rules for both yourself and for others to follow.  Just as you would be upset if the speed limit changed and nobody posted the new maximum, others will be upset if you change the rules without telling them.  For people who frequently encroach on your space, send a message that clearly states your new boundaries.  Below is an example:

It’s really important to me to be able to prepare a nutritious dinner and spend time with my children in the evenings after work, and as a commitment to my family I will no longer be available to pick up add-on cases at the end of the day unless it is my designated day to stay late.  I’m writing now so that you are not surprised when I decline to relieve you at the end of the day to enable you to attend your children’s events.

The message is clear but only has meaning if your action follows your words…just say NO.

Don’t skip breaks.  It may seem like a small thing, but your breaks are earned and in many States they are required by labor laws.  When you skip or rush through short breaks you open the door for people to take advantage of you in other areas.  Taking a full break creates a boundary and tells others that you are off limits for the duration of the break.

Prioritize tasks.  Regardless of how good you are, you can’t do it all and spreading yourself too thin invites others to dump even more work on you.   Learn to prioritize tasks and focus on what is important while discarding the rest.  The Eisenhower matrix recommends identifying urgent/non-urgent and important/non-important when prioritizing tasks.

Limit distractions.  Setting boundaries starts with imposing limits on yourself.  Identify things that distract you and eliminate or greatly reduce them.  In our technology rich society, we are constantly being distracted by personal devices.  Things that pop up on your phone invade your personal space and distract you from your priorities.  Review the settings on your phone and turn off notifications.  Plan several times per day to check for messages and email then stay off your device at other times.   Breaking the tie to your phone will keep you from going down the Google black hole, will reduce stress, and will free up your time.

If you sense that your life is out of control, it probably is.  If you blame others for causing your life to be out of control, think again.   There will always be people who would be happy for you to take on their responsibilities and the more you accept, the more they will give you.  When you are overwhelmed, it is not because others are bad, it is because you have not established boundaries.  Follow the advice in this article to sort out what is important in your life and use the simple techniques to build and enforce boundaries.  The only alternative is burnout. 

Tom is an experienced leader, educator, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Workplace Wellness: Important and achievable

By Thomas Davis, DNAP, MAE, CRNA

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“Leadership is the ability to get others to do what you want them to do because they want to do it.”

Effective leaders tend to be savvy resources managers and recognize that their workers are the most valuable resource that they manage.  The health of each team member is directly tied to morale, productivity, and retention, all indicators of effective leadership.  Therefore, the leaders who place value on team wellness tend to be the ones who gain appreciation from both their team members and the organization.

Writing in 15Five, author Pamela DeLoatch notes that both mental and physical health are important in an effective wellness program.  She notes that designing activities into the workflow that encourage movement and defuse stress are creative ways to infuse wellness into your workgroup. 

Building on the theme of workplace wellness, author Steven Aldana notes that lifestyle choices are correlated to 70-90% of chronic diseases challenging healthcare workers including stroke, cancer, heart disease and diabetes.  Creating wellness in the workplace begins with awareness and then, driven by motivation from leadership, morphs into a culture change that encourages healthy habits.   This all sounds great, but how do you create the culture change necessary to make wellness a priority in the workplace?  Read on.

Promote physical wellness.

Our bodies were meant to be active and in motion.  As healthcare workers, we are aware of the devastating consequences when ICU patients become immobile.  Similarly, over time, a sedentary lifestyle will impair the body’s mobility and eventually prevent the person from participating fully in activities that they once enjoyed.   Make a commitment to personal health and extend that commitment to practicing healthy habits both at home and in the workplace.  Here are some ways to improve physical wellness in the workplace:

  1. Eat healthy foods for lunch.  Pack a nutritious lunch from home and avoid the high salt/high fat fast foods at the drive-through on the way to work.  Skip the 800 calorie Starbucks super-deluxe beverage and drink more water at work.  Keep candy, cake, and cookies out of the employee lounge.  Challenge your team to a vegan challenge where only vegan foods are allowed in the break room for a week.
  2. Sit less.  Select a lunch spot on the other side of the building and enjoy a brisk 5 minute walk each way during your lunch break.  The change of scenery will give you a mental break and if you can find a sunny spot, you have the additional benefit of sunshine.
  3. Stretch.  Operating room workers sit for long periods of time during challenging cases and then race between cases to get the next patient going.  While in a long case, set your watch to alarm every 30 minutes, stand up, and stretch.  Touch your toes, stretch overhead, twist at your waist.   Stretch every 30 minutes each day for a week and note the increase in flexibility.
  4. Promote sleep awareness.  Use a team meeting to have a healthcare professional talk to the team about the importance of sleep.  Design work schedules to allow full recovery after a demanding night on call.
  5. Encourage sick employees to stay home.   If a person were in a car accident, you would figure it out and get the cases done.  Have the same consideration when a colleague is truly sick and should not be at work.
  6. Design group activities.   Have a monthly group activity on a Saturday or Sunday morning that promotes both activity and a sense of community.  Meet at a park for a hike, bike ride or swim.  Participate as a group at a local 5K race/walk or charity bike ride.   Have several members of the team take up a new activity together such as pickleball, tennis or volleyball.

  Promote Mental wellness

  1. Speak candidly about mental health.  Let your colleagues know that you are aware of the effects of stress on mental health.  Make it OK for others to express their anxiety or concerns by listening in a non-judgmental manner.  Avoid offering solutions or telling the person how to fix a problem and remember that they need a sympathetic ear, not a lecture.
  2. Invite a mental health professional to a team meeting.  Have the person describe the resources available to team members who are experiencing stress and how to access them in a confidential manner.
  3. Encourage walk breaks.   The surgical suite can be a noisy, hectic place that is driven by production pressure.   When possible, encourage colleagues to take a 5-minute walk break between cases.  Finding a hallway with windows that provide a sunny view is uplifting and provides the mental break that will put you back on track.
  4. Provide a quiet place.  Have one area where employees can quietly sit and reflect on the day.  Encourage meditation, yoga, or other activities to refresh the mind.
  5. Encourage relationships.  Colleagues who chatter with one another and share experiences unrelated to work form social networks that are essential during stressful times.
  6. Defuse production pressure.  This is a tough one and requires a culture change.  We are taught early on that the most important thing we do is to get the next case going.  We are encouraged to cut corners where possible and move as quickly as possible.  Leadership at all levels must value the safety of the patient and the mental health of the worker enough to slow the process and allow team members to move at a reasonable pace between cases.  Courageous leaders and workplace champions are necessary for this culture change to occur.
  7. Get outdoors.  Where possible, ensure that you and your colleagues spend time in the open air.  During good weather, encourage people to eat lunch outside and plan weekend gatherings at a local park.

Historically, wellness programs in the nurse anesthesia community were designed to prevent or treat those who developed an addiction to drugs or alcohol.  Over time, the concept of wellness has expanded to include the daily mental and physical health of workers.   Research has documented the positive effects of wellness programs on the morale and productivity of workgroups both in healthcare and the business communities.   As healthcare providers, we take pride in the application of evidence-based medicine in our practice.  Now it is time to apply evidence-based wellness programs in the workplace to protect our most valuable resources…our workers.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Emotionally Intelligent Teambuilding



By Thomas Davis, DNAP, MAE, CRNA

follow@procrnatom on Twitter

A review of the literature from the business community reveals that having and using emotional intelligence is one of the most important skills of a successful leader, both at work and in the individual’s personal life.  Simply stated, emotional intelligence (EI) is the ability to recognize and control emotions in ourselves and in others.  Writing in PositivePsychology.com, author Elaine Houston notes that EI is the interface between the emotional and thinking centers in the brain.  Having emotional intelligence increases our capability for resilience, motivation, empathy, reasoning, stress management and communication…all desirable traits.

Think back and recall your favorite boss and then ask yourself what made that person stand out compared to others you have worked for over the years.  Most likely, your chosen best boss was a person who was easy to talk with and seemed to understand and accept you as a unique person. This person could probably sense your need for professional development and connectedness with the team.  In short, your favorite boss was most likely a person who was strong in the area of emotional intelligence.

Why emotional intelligence makes a difference?

Writing in the American Journal of Pharmaceutical Education, authors Romanelli, Cain and Smith reveal that those with strong EI skills are better able to make sound decisions, build and sustain relationships, manage stress, and adjust to change.  It is for those reasons that hiring managers across the country are assessing the EI capabilities of applicants during the interview/hiring process in hopes of building a strong and collaborative workgroup.

Recently I had the privilege of teaching a course for an exceptional group of nurse anesthesia students.  In a discussion with the program director, I learned that when evaluating students, the selection committee placed greater value on EI than academic credentials during the interview process and that the class of students was selected based on their emotional intelligence skills. 

Like the savvy program director, Chief CRNAs across the country are placing value on building teams filled with collaborative workers who are empathetic toward one another and resilient when faced with a challenge…emotionally intelligent teams.  Hiring managers have learned that it is better to leave a position open rather than fill it with a “bad apple” who will demoralize others on the team.  Gone are the days when positions were filled out of desperation and those who lack EI are finding it more difficult to find a job.

Tips for building an emotionally intelligent team.

Strong, collaborative teams don’t happen by chance, they are developed by leaders who can visualize what they want, develop a plan to achieve it, and stick to the plan without exception.  It takes foresight, preparation, and follow-through to achieve the desired results.  Let’s get started.

Truth in advertising.

When posting a job opening, include a job description that describes not only the work that is to be done but also the personality traits that you desire.  Weave the core values of the organization into the job description and state up front that you are seeking a candidate with a strong history of collaborative teamwork.

Check references.

Typically, applicants submit three references, forms are sent, and prior work is documented.  Basically, the form documents that the person held the job and was not fired due to incompetence or moral deficiency.   Take the next step by calling the reference and asking questions that would reveal the applicants EI abilities.  Ask “what is the applicant’s greatest strength?” and listen for indications that he/she works well with others.  Ask whether the applicant has overseen projects or mentored others and what was the outcome.  Talking with a reference gives insight into the applicant’s people skills.

At the job interview.

Start your interview with a review of the mission, vision, and values of the organization and clearly let the applicant know that if he/she is not in alignment with the values, this is not their job.  Rather than discussing case management and work schedules, use the interview time to learn about how the person interacts with others.  Ask leading questions such as:

  • Describe your ideal workgroup.
  • Which of the organizations core values do you most identify with and why?
  • Tell me about a time when you disagreed with your supervisor, how did you handle it?
  • Tell me about a time when somebody criticized your work, how did you handle it?
  • How would you resolve a dispute between two colleagues?
  • What was your greatest success in your last job?

These questions will get the ball rolling…add others that fit your specific job situation.  Listen carefully and if you get a superficial stock answer, ask follow-on questions.  “Tell me more about” or “what happened next” are ways to reveal how the applicant works with others.  Listen for we versus I when the applicant answers questions.  Strong team players credit others for participating in success whereas those who lack EI brag endlessly about themselves.

Success.

Strong teams and preferred workplaces don’t happen by accident, rather, they are the product of insightful and effective leadership.  Screening applicants and hiring based on emotional intelligence will produce a highly productive and collaborative team that pulls together during stressful times and is a pleasure to supervise.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.



Evidence-based Leadership

By Thomas Davis, DNAP, MAE, CRNA

During my four decades as a nurse anesthetist, I have seen many changes in our profession and our day-to-day management of surgical cases.  Back in the day, I was just as proud of my hospital-based diploma as our current doctorate level graduates are of their terminal degree.  Upgrading entry level education first to the master’s degree and now the Doctorate level has mandated that nurse anesthetists be active players in gathering and applying evidence to case management. 

The Johns Hopkins describes evidence-based practice as the integration of research, clinical expertise, and patient values to ensure the safest and most effective outcome for patients.  Throughout our workplaces, policies and procedures have been developed based on scientific evidence obtained through peer reviewed research and patients have benefitted from the upgrade in practice.  Now it is time to apply the same evidence-based activities to the process of leading and managing perioperative teams, including nurse anesthetists.

Leadership matters.

Employee engagement and morale affect patient safety, satisfaction and ultimately the outcome from the treatment that they receive.   Worktango.com notes that leadership is the driving force in determining employee engagement and productivity.  Connecting the dots, effective leadership drives employee engagement which, in turn, improves patient safety, satisfaction, and outcome.  Truly, leadership matters and healthcare leaders at all levels, including Chief CRNAs, must incorporate the principles of evidence-based practice to their leadership style as they interact with their team.  Let’s get started.

Identify your needs.

Improved team dynamics starts with an awareness that the status quo can be changed and that those changes will augment both morale and productivity.  What are the greatest challenges dragging your team down?   Common barriers to high productivity include poor communication, lack of resources, unfair work assignments, production pressure, inappropriate leadership style, or workplace drama.  To address your unique challenges, designate a team meeting to openly identify and discuss the changes needed to improve your greatest needs.  Listen attentively and take notes.

Gather evidence.

Only a scant amount of literature has been published specific to frontline healthcare leadership, however volumes of articles have been written about workplace dynamics.  The Harvard business review, Forbes magazine, and Psychology Today are but three sources of information related to workplace dynamics…many more exist.   Just as you would complete a literature review before updating best practice guidelines, use the same process to learn ways in which businesses have addressed issues like the ones that you face.  A solution to your problem may already exist.

Develop a hypothesis.

Select a workplace issue that could be improved if you were to become a champion for change.  Use the format commonly employed by Doctorate level students and create a hypothesis that includes the planned change as well as the desired outcome.  Writing your theory in the PICOT format will clearly identify what you plan to change as well as a desired outcome that can be measured.  Engage several allies on your team to review your plan and assist the implementation. 

Implement the plan.

The best chance for successful change in the workplace requires buy in from team members.  By including the team when identifying the problem and creating a solution, each member has skin in the game and a personal interest in the success of the proposed change.  Conversely, surprising the team with a plan that they did not help develop is a sure way to provoke passive-aggressive behavior and sabotage.

Gather data.

Establish milestones that indicate progress and track numbers as you implement your plan.  Take a “null hypothesis” mentality and assume that the change will not make a difference in the workflow or staff engagement and then gather data to prove yourself wrong.  Some things such as compliance with the time out policy or postoperative handoff checklist can be tracked immediately whereas indicators of employee engagement, such as reduced staff turnover, may not be apparent for several years.  Regardless, track numbers to document the effectiveness of your leadership.

Share your findings.

As previously stated, there is a paucity of research related to frontline healthcare leadership.   By using a research approach to implementing change, you position yourself to collect data that can be shared with your peers.  What may seem like a simple change in workflow to you can become valuable information to others who share similar challenges.  Publishing in a peer reviewed journal is the gold standard for evidence-based practice however, sharing in a blog format can be equally helpful to other frontline leaders.  Regardless, take an active role in expanding the body of knowledge by sharing your experience with others.

Join the movement for evidence-based practice by gathering evidence to support your leadership decisions.  Rather than shooting from the hip, take a scientific approach to implementing change, develop a hypothesis, engage your team to develop a plan, collect data, and share with your profession.  You can make a difference.

Tom is an experienced leader, author, and requested speaker…invite him to your next meeting.  Click here for a video introduction to Tom’s current speaking topics.

Coming june 13th; Tips on using emotional intelligence in the hiring and teambuilding process.

Running circles around patient safety



By Thomas Davis, DNAP, MAE, CRNA

According the USA today, 42,060 people died due to auto accidents in the United States in 2020.  In comparison, Yale University used revised criteria to define death due to preventable medical error and found that 22,000 patients were lost in 2020 due to needless mistakes.   Both the auto and healthcare statistics are causes for alarm and have prompted professionals in each area to develop methods to reduce the tragic and unnecessary loss of life.

For decades, traffic engineers have struggled with developing “crash proof” intersections as a way to improve safety.  Knowing that the two most common causes of highway death are the high impact head on collision and the T-bone type of crash, roadway designers in Scandinavia shifted their thinking away from trying to prevent all accidents and focused on eliminating those that cause death.  Suddenly, traffic circles were installed throughout the region and the results were impressive.

The magic of traffic circles

Traffic circles are unlike traditional intersections with or without stoplights.  The approach to a traffic circle is well marked and traffic must slow before entering the circle. Once at the circle, drivers must observe other vehicles and coordinate with other drivers to safely enter the flow of traffic.  When mistakes are made, the result is a low impact fender bender rather than a full impact crash.   Cars may be dented, and drivers may be bruised but serious injury and death seldom happen in a traffic circle.

Safety circles in healthcare

What would be the result if proponents of patient safety took the Scandinavian approach and developed healthcare safety circles?   What would it look like if our patient flow in the operating room resembled vehicle flow through a traffic circle?

  • We would be alerted when we are approaching an event that is known to have risk to the patient.
  • We would slow our pace and become more attentive.
  • We would communicate and coordinate with others involved in the process.
  • Our activities would merge with others involved in the process and we would share a common interest for getting everybody safely through the event.
  • We might experience fender benders now and then, but fatalities would be eliminated.

Converting the traffic circle safety concept into patient safety circles requires a commitment from healthcare providers to value patient safety above production pressure or maximum efficiency.  Here are but a few areas where we can slow the pace, become more attentive, collaborate with others, and merge our activities to ensure patient safety:

  • Preop handoff from the prep area to the anesthesia provider
  • Preparation of drugs and equipment
  • limiting noise and distractions during induction
  • The surgical timeout prior to incision
  • Postoperative handoff to PACU or ICU

Be an advocate for your patients and control your workflow as if you were driving your car through a traffic circle…we can greatly reduce preventable medical errors.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.



Cognitive reframing; Reduce stress and increase productivity



By Thomas Davis, DNAP, MAE, CRNA

Healthcare delivery is stressful for both leaders and workers regardless of the title behind the person’s name or their position on the chain of command.   Ever-increasing expectations from patients and their families combined with demands put forth by physician colleagues creates a high-pressure environment for leaders and workers alike.  Chief CRNAs, OR managers and rank and file workers all experience production pressure in a high stakes environment and are all susceptible to work related anxiety and depression.  Rather than succumb to the pressure, a little cognitive reframing creates a different perspective and changes the internal dialogue in the person’s mind.  Here is what you need to know.

What is cognitive reframing?

According to the Wikipedia, cognitive reframing is a process by which a person identifies and then changes the way situations, experiences, events, ideas, or emotions are viewed.   It is a process by which thoughts are challenged and then changed.   Simply put, it is looking at a stressful situation and consciously opting to consider alternative perspectives and then visualizing a positive outcome for the problem.  It is a process that requires changing the internal dialogue in one’s head and replacing negative, fear-provoking thought with options that support a positive outcome. 

Choose your thinking framework

We can’t always control the problems that are thrown at us, but we can control the way we respond to them.  You have choices as to how you mentally react when stressful situations emerge.

Asset-based versus deficit based.  Asset based thinkers step back, assess the resources that are available and consider ways to leverage them to achieve the goal.  In contrast, deficit-based thinkers focus on what is lacking and throw in the towel.

Proactive versus reactive.  Proactive thinkers take control, rally support from others, and implement solutions to the problem.   In contrast, reactive thinkers are at the mercy of others and often view themselves as a victim of the system.

Reframe your thinking

Whether in your personal or work life, the ability to reframe a stressful situation sets you free from being dragged down by the problem of the day.  Start by asking yourself, “If I knew ahead of time that things will work out OK, how would I respond?”  Then proactively assess the situation and intervene as appropriate.   The online resource leadership now offers the following suggestions for actions to take after you reframe your thinking.

Structural changes.  This requires looking at the process, redesigning the workflow, re-writing policies/procedures, and engaging colleagues to embrace the changes.

Coaching.  Assume that you are surrounded by good people, but not all are fully capable in every area.   View the situation as an opportunity for career development and either work with the person yourself or assign him/her to a supportive mentor.

Political.  When discord within the group is causing stress, step in as a peacemaker.  Review the mission, vision, and core values of the group and enforce a code of conduct that includes civility and bans gossip.

Motivation.  Teams function most efficiently when they have a sense of common purpose.  Reduce stress by creating goals and ensuring that the team sees the connection between the goals and the overall mission of the organization.  Generate milestones to assess progress and never miss an opportunity to celebrate success.

Take control

You can proactively ward off some situations however you can’t deflect every problem in either your personal or professional life.  Rather than viewing yourself as a hopeless victim, take charge and reframe your thinking.  Focus on what you can do with available resources, seek additional help, and focus on a positive outcome.  You will be amazed at how your productivity increases and your stress evaporates after you alter your outlook and confidently take charge.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.



Values-based Leadership



By Thomas Davis, DNAP, MAE, CRNA

The healthcare workplace is fast-paced and often a hectic arena that challenges the skills of leaders and managers at all levels.  Frontline leaders who work at the grassroots level where provider priorities collide with the patient’s needs and expectation are especially challenged daily to keep the train on the tracks.  Values-based leadership brings stability and predictability to the workplace.

What is values-base leadership?

Values-based leadership is a philosophy that teams do their best work when they share common values and apply them to every interaction in the workplace.   Indeed.com career development blog notes that following a shared set of beliefs increases employee collaboration and increases productivity.  Writing in Forbes.com, author Harry M. Jansen Kraemer Jr. notes the four pillars of values-based leadership:

  • Self-reflection; knowing who you are and what motivates you.
  • Balance; the ability to see a situation from different points of view.
  • Self-confidence; knowing that your decisions are based on a solid ethical foundation.
  • Humility; respecting the values of other individuals and of the organization.

Clearly, building a team that knows, embraces, and lives the mission, vision and values of the organization will level the playing field and form a solid foundation for decision-making.

Implementing this powerful leadership style begins with self-awareness and an understanding of the values that most effect the way you make your decisions both at home and at work.  Several values assessment tests are available for free online and offer insight into your personal principles.  Knowing who you are and what you believe will increase self-confidence in all your interactions.   Encourage your team members to gain awareness by also taking the values assessment test.

Values-based team building

The rubber hits the road when the principles of this dynamic style of leadership are applied to the daily operation of the team.  Dedicate a team meeting to discussing the mission, vision, and values of the organization.  Encourage a “what if” discussion…what if we conducted our business in alignment with these values?  Build a consensus within the team that going forward, the core values of the organization will be the norm for the behavior of every team member.

Incorporate values-based leadership into the recruiting process.  Ensure that job advertisements contain verbiage that reflects the core values of the team and re-write job descriptions to include the core values.  At interview, discuss core values with the applicant and have the candidate discuss examples of how they have aligned with the values in past situations.  End the interview by saying, “these are the values of our team.  If this is not you, this is not our job.”  You will be amazed at how applicants are attracted to a job where values are known, and people are respected.

Values-based daily management

New hires learn the nuances of the workplace very quickly and the orientation process is your opportunity to show that your team lives the values that were discussed during the interview.  Assign the new hire to a team member who role models the values that you desire within your team.

Review your policies and procedures to ensure that they are in alignment with the core values of your team. Where possible, incorporate key words that reflect your values into your written material.

The annual performance review is an opportunity to review the core values with the individual.  Ask the person for examples of how he/she aligned with the core values over the past year and discuss behavior that will reflect core values in the upcoming year.  Occasionally, negative feedback or even discipline is needed to correct bad behavior.  Rather than resorting to accusations or finger pointing, review the core values, point out where the person was out of alignment, and have her/him discuss their plan to re-align with the values.  End a disciplinary session with the statement, “if these values are not who you are, this is not your job.”

Be a values-based leader

Values that are shared by the leader, team and organization provide a sturdy foundation that will withstand the tremors and earthquakes that occur frequently in the workplace.  Dignity, respect, enhanced collaboration and improved productivity all thrive when values are shared and people work toward a common goal.  Increase your value by being a values-based leader.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.



The Doctorate degree: Do I need it?

By Thomas Davis, DNAP, MAE, CRNA

In 2004, the American Association of Colleges of Nursing (AACN) announced a bold recommendation that the Doctor of Nursing Practice (DNP) be established as the gateway for entry to practice degree for all advanced practice nurses.  Several years later in 2007 the Board of Directors for the American Association of Nurse Anesthetists affirmed the AACN proposal by recommending that all nurse anesthesia programs be at the Doctorate level by 2025. 

Why a doctorate degree and why now?

In response to the initiatives by both the AACN and the AANA board of directors, the Council on Accreditation of Nurse Anesthesia programs established a mandate that all nurse anesthesia education programs offer a doctorate degree to every person graduating in 2025 or later.  Over the past decade, most nurse anesthesia education programs have upgraded to the doctorate level with the remaining programs in the final stages for conversion to the new degree.  Because nearly all programs require 36 months for completion, new students starting their education in 2023 must be enrolled in a program that offers a doctorate degree upon completion in 2025.  Clearly the clock is ticking as the final programs scramble to meet doctorate level accreditation standards.

Currently certified and actively practicing CRNAs will be able to continue to deliver anesthesia care using their existing credentials.  However, many experienced anesthesia providers desire an education level comparable to new graduates entering the profession.  Therefore, a push is underway among veteran providers to upgrade their credentials by participating in a degree completion program to earn a doctorate degree.

Be a student as long as you still have something to learn, and that means all of your life.  ~Henry Doherty

Does the Doctorate degree make me a better anesthesia provider?

Clinical competence remains the foundation for the safe and effective of anesthesia care regardless of the type of practice.  Student nurse anesthetists must learn the sciences of physiology and pharmacology related to anesthesia practice, and in addition, the neophyte must spend countless hours gaining the hands-on skills necessary to acquire clinical competence.  History has proven that master’s level programs have done an exceptional job preparing students to assume a role as an independent anesthesia provider.

The doctorate degree does not necessarily make the new graduate more skilled at delivering clinical anesthesia, however, the degree does make the person a more knowledgeable and versatile healthcare worker.  The doctorate degree expands the curriculum to include an understanding of leadership, healthcare policy, systems management, and the application of evidence-based healthcare.  Writing in the AANA Journal, Hawkins and Nezat list the following as subjects learned while earning a doctorate degree.

  •  Scientific foundation for practice
  • Organizational leadership and systems management
  • Clinical scholarship for evidence-based practice
  • Information systems and technology
  • Healthcare policy
  • Interprofessional collaboration and networking
  • Healthcare policy
  • Advancing nursing practice

Which doctorate degree is best for me?

The type of terminal degree that is best for you depends upon where you are currently working and your professional goals.  Advanced practice nurses, including CRNAs, have a variety of options when earning a doctorate degree.  Although completion of any of the terminal degrees will put Dr. on your nametag, they are not master keys that open every door.  For example, the DNP is the preferred degree for those who want to teach in a school of nursing, the PhD is more appropriate for those with an interest in scientific research.  Writing in nurse.org, author Mariam Yazdi recommends considering the following when deciding upon which is the best degree for you.

  • Where do I want to work?
  • What are the credentials of others applying for the position that I want?
  • Will a PhD make me more competitive than a clinical doctorate degree?

Earning a doctorate degree builds upon clinical excellence and positions the learner to be an expert in evidence-based medicine and healthcare policy development.  Consider the following when applying for admission to the program.

  • PhD, Doctor of Philosophy   The PhD is the most common type of doctorate degree and is awarded by the majority of academic fields.  The degree is earned by producing sophisticated work that significantly adds to the body of knowledge for the profession.  In healthcare, the PhD commonly requires completing, presenting, and defending original research.
  • EdD Doctor of education    An EdD is an advanced degree designed specifically to prepare the candidate to assume a role in educational leadership.   In contrast, a PhD in education prepares the candidate to conduct research related to the education process.  The EdD is most applicable for University teaching outside the schools of medicine and nursing.
  • DNP Doctor of nurse practice     The DNP is designed to produce leaders in clinical nursing and nursing education.  Graduates with this degree learn to influence healthcare outcomes through effective leadership and organizational policy implementation.  The DNP was identified by the AACN as the preferred degree for nursing school faculty.
  • DNAP Doctor of Nurse Anesthesia practice     The DNAP is a doctorate degree specifically designed for practicing nurse anesthetists.  The degree has a focus on utilization of research to develop evidence-based practice, leadership for the implementation of change, and business management related to nurse anesthesia.
  • DMPNA Doctor of management practice for Nurse anesthesia     This very specialized degree builds upon a master’s degree in healthcare management and expands it to a doctorate level practice management degree with a focus on the business of nurse anesthesia and healthcare administration.

What is my next step?

For those who are content with the status quo, fear not, you will continue to recertify for practice based on your current credentials.  For those who seek to complete a terminal degree, the process starts with self-assessment and a critical look at personal goals and capabilities.  Once done, the second step is to select the type of degree that best positions you to achieve your career goals.  Finally, find and apply to a University that offers the degree you desire.   To help you with your search, the AANA Council on Accreditation offers a list of accredited programs.  The key to finding a program that welcomes practicing CRNAs is to look through the list and search for the word “completion”.  Online doctorate programs are common and allow the working CRNA to remain on the job and pursue the degree during personal time.

Whether your goal is to keep up with the newbies, expand your knowledge, or position yourself for a leadership position, the doctorate degree is readily available to those willing to put forth the effort to earn it.  Are you smart enough?  If you can pass your certification exam and safely practice anesthesia, you have the intelligence to earn a doctorate degree.  All that is required is time, money, intellectual curiosity, and the tenacity to see the endeavor through to completion.  Go for it.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Halloween Leadership Lessons

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

“Halloween is not only about putting on a costume, but it’s about finding the imagination and costume within ourselves.”

— Elvis Duran

Halloween is exciting and full of surprises; however, it is no surprise that the festive event also contains several lessons which will enhance team collaboration, staff engagement and the overall effectiveness of the designated leader.  Look beyond gawdy makeup and treats in the lounge and heed the wisdom arising from Halloween leadership lessons.

Identity matters.  At a costume party it is challenging to guess who the person is concealed by the costume and not knowing the identity until the masks are removed.   In contrast, at the workplace, a team must always know who the leader is in terms of the personal values and leadership style.  Honesty, integrity, and consistency must be your hallmark characteristics and they must be apparent regardless of the color of your hair or the funny glasses that you wear.  If you want to scare and demoralize your team, show up as a different person every day.

Creativity generates empowerment.  Policies, procedures, and protocols; they are essential but can leave workers feeling like robots.  Give team members the latitude to decorate the workplace and wear work-appropriate costumes on Halloween.  Reward creativity and then let the spirit of the holiday be a catalyst for the team to apply inventiveness to problem solving.  Not only will the mood of the team be elevated, but the team will also feel empowered to resolve outstanding issues.

You can be whoever you want to be.  Once you decide the character you want to be for Halloween, it is not difficult to find a costume and props to transform yourself into the new person.  Likewise, once you decide who you want to be as a professional, a little time, effort and planning will enable you to acquire the new role.  Halloween is a great opportunity for a leader to learn about the desires of workers and then arrange professional development to take each person to a new level of performance.

Ghosts can only scare you when you let them in.  Do not let your workplace become a haunted house by allowing evil spirits to mingle with your team.  Fear and paranoia are paralyzing and kill staff morale. Behaviors such as gossip, blaming, and passive/aggressive activity are the evil spirits that make everybody leery about scary things that could jump out at them.  Ban gossip, outlaw blaming, and diffuse fear by openly discussing problems; never ignore the elephant in the room.

Collaboration fosters courage.  In the famous scary movie, Nightmare on Elm Street, Freddy Kruger only had power when people feared him, and he always selected a person separated from the group to be his next victim.  In the workplace, collaboration produces a sense of community and knowing that others have their back inspires individuals to address challenges that they otherwise may have avoided.  Team members who work together to plan and pull off a workplace social event will stand united to solve other workplace challenges. Say yes to reasonable Halloween activities, then turn it into a teambuilding event.

Teambuilding is enjoyable.   The purpose of teambuilding is to enhance personal relationships and foster collaboration among team members.   Halloween is an occasion that begs for workers to collaborate by decorating the workplace, donning an altered ego, and planning a festive day.  The best workplaces reward strong performance by planning special days to recognize the effort that the team puts forth daily. 

Halloween is a holiday that can be spooky but do not let it spook you.  The gremlins and goblins who lurk in the shadows are no match for a united group so focus on teambuilding reward your team with a festive day.  While you are at it, plan for celebrations and teambuilding activities for the upcoming Thanksgiving and New Year holidays. 

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Encore Symposium Bar Harbor 2020

COVID 19 put a halt on the Encore meeting scheduled for Bar Harbor, however, Nancy LaBrie and the Encore faculty could not be daunted. To support the educational needs of loyal CRNAs, the meeting converted to a live, online format. Here is feedback from attendees:

From B M-G
I recently attended a webinar conference, held with Zoom, presented by Encore Symposium on October 19 the 22nd 2020. The expertise of their presenters were stellar. All were CRNA\’s with their DNP. One presenter was from the NIH and gave excellant information on COVID-19\’s history, pathophysiology and management. Another was a former board member of the NBCRNA and spoke of the CPC requirements and answered all questions and clarified misunderstandings about the requirements. The Zoom meeting could not have been easier. I already had Zoom attached on my computer. The Saturday before the conference an email was sent with a link to each days\’ conference. I only had to click on the link to bring me straight to the conference presenter. Encore set it up without video of the participants, just audio. So…I enjoyed the conference without having to \”get ready\”. There was extra time at the end of each session for question and answers. I will continue to attended Encore\’s conference because of it\’s high quality presenters and killer destinations (this was suppose to be in Bar Harbor, Maine & Acadia National Park). Hoping to see old friends at next years conference in Cape Neddick, Maine @ the Cliff House.

From KG
Knowing we all have education commitments to accomplish , the Encore Anesthesia staff have been a shining star in sea of darkness. The office and the lines of communication remain open and questions are answered by a real person. Thank you for providing that service in the most tumultuous times. It is greatly appreciated.

Core Competency for Leaders

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Core Competency: A defining capability that distinguishes an individual or a company from others.  Mastery of an essential skill.

In the business world core competencies identify what an organization can do better than anyone else and why.  Similarly, in healthcare, core competencies validate skills that healthcare providers have mastered; proficiencies that are necessary for the delivery of safe and reliable treatment to each patient.    Likewise, effective leaders must master essential skills and competencies, and, as with professional proficiency, leadership expertise can be learned.

Leadership competencies are specific observable skills and behaviors that are necessary for motivating a team to accomplish goals in a manner that aligns with the company mission, vision, and values.

Throughout the healthcare industry, frontline leaders are often promoted to their position based on demonstrated clinical competency.   Decision-makers in the chain of command assume that workers with exceptional clinical skills will also be great leaders, which may or may not be the case.  Just as mastering core competencies is essential for excellence in clinical practice, mastering leadership competencies is essential for excellence for those who manage a team of workers.  Gaining competency in the following areas will position you for success in your role as a team leader.

Skillful leaders have a vision.  Develop the ability to formulate a picture for your workplace of the future by acknowledging where you currently are related to where you want to be.   Look for areas where minor changes can produce large results moving you toward the workplace you envision.   For example, in my personal experience, I visualize creating a preferred workplace, therefore, I am constantly seeking ways to promote collaboration, mutual respect, and professional development within the team. 

Skillful leaders use communication to motivate.    Communication is the transfer of ideas and highly effective leaders take this skill one step farther.  They share information in an open and transparent way ensuring that the listener both receives knowledge AND is inspired to achieve the goal.  Using good humor, warmth, and civility to create a sense of imperative as you communicate helps establish a can-do attitude within your team

Skillful leaders are fully committed.   Meaningful change takes time and having the capacity for all-in commitment is both convincing and contagious.  Anything less than a commitment to achieving the vision, regardless of the amount of time it takes to get there, will be viewed by your team as a passing fad. An all-in focus on achieving your vision for the team will inspire them to commit along with you.

Skillful leaders resolve conflict.     When humans interact, occasional conflict is inevitable.  The best leaders are not the ones living in a conflict-free zone.  They are the ones who quickly and confidently address issues and achieve resolution. When faced with a disagreement, assemble all the parties, listen to all sides, and discuss behavior/agendas in terms of how the vision and greater goal of the group are affected.  The best solutions involve compromise and align with the vision that the team is working to achieve.

Skillful leaders acknowledge and reward success.    Whether the project is big or small, determine milestones and give recognition to those whose work was important in achieving them.   Plan rewards for the entire team as well as for key individuals and take the time to celebrate.  Public recognition of success is motivating and makes your team eager to take on the next project.

Skillful leaders display personal integrity.   You cannot achieve your goal alone and the quickest way to kill support from your team is to compromise your integrity.   Honesty, transparency, and fairness every day in every interaction establishes trust.  Integrity is both a value and a skill that is foundational to leadership.

Superior leadership is more than wearing a title; it requires demonstrating core competencies, and also requires life-long learning to keep them current.  The best leaders learn from every daily interaction, constantly honing their skills at establishing a vision, communicating a plan, motivating the team, and celebrating success.   The workplace that you create for your team of tomorrow starts with the leadership skills you employ today.  

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Bucket list leadership lessons

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

I am an avid cyclist to the point of being suspected of having a personal relationship with my bicycle; after all, we have spent over 40K miles together on the road.  In addition, I have a deep interest in healthcare leadership development and last weekend my two major interests collided while doing a bucket list bike ride on the 150-mile Great Allegheny Passage bicycle trail from Pittsburgh, PA to Cumberland, MD. 

As our group of 10 loaded the shuttle van to transport us from Cumberland to Pittsburgh, it was evident that Greg, owner of 2wheel escapes and coordinator for the trip had his act together.  Assisted by his wife Rhona and paid helper Lynn, each new person arriving for the trip received a warm welcome and, with efficiency, luggage, bicycles and passengers were loaded onto the trailer and van, respectively.  In short order, anxiety of the unknown challenge ahead turned into lively conversation among the new group of friends. 

As we traveled toward Pittsburgh, Greg openly shared his vision with our group explaining that the trail is beautiful, but it is the support provided for the riders that converts the ride into a memorable experience worth repeating.  He explained that his goal is to be the number one GAP trail tour organizer and create an experience that people would want to repeat and that they would recommend to friends.  Everything from that point forward was designed to bring his vision to life.   We were told up front that his services were intended to be second to none and that it was up to us to make him even better…please offer suggestions.

Greg put words to action and delivered on the pledge that he made to the group.  Every aspect of the trip was on time and as promised, often exceeding expectation.   The format for our journey included camping overnight; Greg set a high standard and only stayed at campgrounds with flush toilets and hot showers.  Because COVID has closed many restaurants, 2wheel escapes provide an exceptional dinner on site every evening followed by an ample hot breakfast in the morning.  Each day started with a briefing and a printed list of landmarks along the way.   The scenery was different every day and particularly magnificent in the Ohiopyle area, however, riding into the campground each day consistently found Greg and Rhona set up and ready with afternoon snacks for the hungry riders.  They aimed to please and hit the bull’s eye.

As I pedaled toward the Eastern Continental divide, I could not help thinking about the importance of creating a positive and memorable experience and then extrapolated the concept to healthcare.  The outcome of my amazing weekend was much more than rolling along a wooded trail, it was having an experience that I am eager to repeat.  Likewise, a positive healthcare encounter requires more than a nice facility and creates a responsibility on healthcare workers to deliver a positive and memorable experience for each patient. 

Having a positive experience is important in healthcare and this is why

Builds trust   Creating a positive experience requires healthcare workers to connect one on one with each patient and learn about what is important to them.  Taking Greg’s attitude of “make us better” sends the message that what is important to the patient is also important to the provider.  The experience of feeling valued creates trust that the other person has your back.

Enhances confidence   Most patients do not have a medical background and do not fully understand best practice guidelines; they are at the mercy of the healthcare provider.  Those who have a positive experience and trust the provider are more likely be compliant with treatment protocols and achieve a better overall outcome.

Improves patient safety   A solid, trusting relationship between patient and provider creates a bond where both are more vigilant, communicate more frequently and ward off problems before they arise.  Writing in BMJ, Authors Doyle et. al. affirm the connection between the patient’s experience, safety and ultimate outcome.

Job security    Greg knows that to earn a profit in a competitive market, he must deliver the goods reliably and in a manner that generates repeat business.   Similarly, in the past, patients were tied to their local community for healthcare, however, our digital world has broken geographical barriers and opened the door to shop anywhere for medical services.  Healthcare is a competitive market and by creating a positive experience, a loyal customer base is developed.  Patients share their experiences, both good and bad, on social media so the environment that we create will be revealed to the world.  Ultimately, those who create the positive experience for the patient will thrive and those who do not, will not survive.

My weekend ride did a lot more than check off an item on my bucket list, it opened my eyes to the importance of creating a dynamic and memorable experience.  Taking an interest in a patient and placing value on the feedback that you receive is the first step in creating a culture that knows the importance of the patient’s overall experience.  Be bold and create a bucket list experience for each of your patients.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Encore Synposiums Online

Well known for vacation meetings at resort hotels across the country, Encore Symposiums has temporarily converted to an online format due to COVID 19 restrictions. Although participants are not able to enjoy the luxury hotel, the quality of the meetings has been preserved by knowledgible and dynamic speakers giving live presentations via the Zoom platform. Participant response has been positive as indicated by the comments below.

Nancy LaBrie and the Encore faculty look forward to returning to live meetings as soon as restrictions are lifted.

“I attended my first “webinar conference” this past week; Encore Symposium Aug 3-6, 2020. While I prefer an in-person conference, I was pleasantly surprised at how well it was done and how easy it was to participate. I think attendees were more apt to participate and dialogue in an on-line “chat” discussion vs in person at a face-to-face conference. I will strongly consider the webinar venue again. I have attended several, and often recommended Encore Symposiums to other colleagues. Nancy always has excellent speakers and a wonderful potpuri of interesting topics and when in person, the venue is unmatched. My favorite portion of the Encore’s conference is always the legal presentations. The attorney speakers are consistently phenomenal. “

From AS. ” I recently attended the Newport virtual seminar. Speakers were excellent and with wealth of knowledge.   I will definitely attend encore seminar again.  Hopefully it’s in person next time.   “

5 ways to get more from your video meeting

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Social changes put into motion by the COVID 19 virus have mandated that we find innovative ways to conduct both personal and professional business, including how continuing education is delivered.  As a result of travel restrictions and limits on the number of people allowed to congregate in one place, providers have either cancelled or moved meetings to an online format.  Although traditional meetings have been put on hold, the requirement for continuing education has not, and those in need of recertification must obtain the required education credits.  Responding to the ongoing need for continuing education, many CEU providers have quickly shifted to an online format with the intent of providing a high-quality learning experiences equal to that presented at live meetings.

A personal conversation with Nancy LaBrie, owner and director of Encore Symposiums revealed a deep commitment to continue service those who have been loyal to her organization for over 20 years.  To ensure the ongoing flow of continuing education, Nancy has temporarily moved to an online Zoom format with live presentations with her faculty covering the identical content provided at in-person meetings.  In addition, she hired a technology expert to moderate the meetings and eliminate technical glitches.  Nancy is not alone in her dedication to provide continuing education in the face of COVID restrictions as evidenced by State and National organizations that have converted to an online format.

The recent AANA annual congress scheduled to be held in San Diego was converted to an online meeting.  On the downside, social networking and renewal of acquaintances was absent, however, the video format enabled every CRNA in the nation to participate if they so desired.  The annual business meeting that previously was restricted to those in attendance at the meeting was offered online to the entire membership of the organization.  Those who chose to participate were able to vote on critical issues and to receive valuable continuing education credit for the online learning sessions.

Likewise, many state meetings have converted to an online format until in-person meeting restrictions have been lifted.   Hawaii and Maryland are but two of the many states that have made the switch.

“Tell me and I forget.  Teach me and I remember.  Involve me and I learn.”
— Benjamin Franklin

Missing out on a well-deserved vacation meeting does not mean that you must settle for second best when obtaining continuing education credit.  Regardless of the effort that the sponsor makes to ensure a top-notch educational offering, participants must actively engage in the process if they are to receive the full benefit of the program.  With a little preparation, you can enhance your knowledge and obtain continuing education credit from the comfort of your home office without sacrificing the quality of the experience.  Here are some tips.

Know the technology.  My recent article, Ace your video interview, stressed the importance of becoming familiar with the video conference platform ahead of time and the same is true when attending a video meeting online.  When you register for an online meeting, the sponsor will send login information which will identify the platform that is being used.  Well in advance of the meeting, take the initiative to google “how to” information about the selected format.   If an account is required, sign up and obtain a password several days before the meeting.  Waiting until meeting time to login to a new platform places you at risk to miss the first part of the session.

Make your own meeting room.  When attending an in-person meeting, you dress for the occasion and expect the facility to be comfortable and inviting.   You expect to see the screen, hear the speaker, and have space to jot down important points.  Attending a meeting via a personal computer does not change those requirements.  Prepare your space by removing clutter including things that will distract you during the online presentation.   If you will be visible to others, position a desk lamp so that it illuminates your face and position your camera at eye level.  Use the selected video conference platform to do a dry run with a friend and make sure to test your camera and microphone.  If your computer has a built-in camera at the base of the screen, consider buying a small camera to plug into a USB port and position it at eye level.   

Do your homework prior to the meeting.   Know as much (or more) about the speakers and content for the video meeting as you would for a live meeting.  Obtain the agenda, objectives and speaker biographies then use the time saved by not traveling to search online and prepare yourself for the meeting.  Know each speaker’s background as well as best practice guidelines related to the scheduled topic.  Prepare a list of questions that you would like to have answered and either submit them prior to the talk or post them to the speaker if there is an opportunity for audience participation. 

Be mindful of social graces.   You would not show up late, chomp on a wad of gum or slurp coffee if you were at a live meeting so hold yourself to the same standards when meeting online.  Mute your microphone when not speaking; I have personal memories of the sounds of toilets flushing, dogs barking, babies crying, and chips being munched during online meetings.  Focus on the speaker and the topic being presented.  Do not do anything in the privacy of your home office that you would not do if you were sitting in a room filled with your professional colleagues.

Follow-up after the meeting.  Ensure that you receive credit for attending the meeting by completing meeting evaluation forms and submitting any documentation required by the meeting sponsor.  Obtain contact information for speakers and follow the session with a personal email with feedback and questions that you have about the topic.  Quick and thoughtful feedback opens the door to a dialogue with the speaker and could potentially expand your network of contacts.  Finally, visit the Meeting review page on procrna.com and complete an online review of the meeting.

Like awaiting the return of flowers in the spring after a harsh winter, participants eagerly anticipate the return of live meetings at fabulous getaway vacation resorts; however, until restrictions are lifted, virtual education is a reality that need not compromise quality.  Although not as fun or relaxing as a trip to a sunny beach, education via computer-based learning provides the safety of your home, eliminates public travel, and saves both time and money.  Virtual meetings are today’s reality so prepare and ensure that the quality of continuing education remains high in our COVID restricted environment.   Stay home and stay well. 

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Three Essential B’s for Effective Teambuilding

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

The role of boss is a daunting proposition that causes self-doubt in some but motivates other individuals to master the skills required for successful leadership.  Your ability to manage the inevitable surprises that pop up frequently will determine your ultimate success, and with a little self-confidence and focus, you can do it.  Finding those key behaviors necessary for inspiring a team to achieve greatness is like Harrison Ford seeking the holy grail in the 1989 Indiana Jones movie classic.  And like the movie, becoming successful at leadership is a challenging journey that requires commitment and focus while navigating through a maze of complicated barriers.  The holy grail for leadership does not exist; however, there are behaviors that, when mastered, will make you and your team champs.   Forget about winning the leadership lottery or gaining overnight success; rather, spend time and attention to mastering the 3 B’s to improve your effectiveness as a leader.

“Your job as a leader is to stay as close in touch as possible with those closest to the action.”

~Kat Cole

Be present

To be a leader, you must have followers.  The title you have as the designated boss gives you the authority to implement policy, but you cannot truly lead a team without its consent.  Becoming the person whom the group wants to follow requires that you have an active presence with the team.  Writing for Forbes magazine, author Carol Kinsey Gorman notes that it is not about how you perceive yourself; it is about how others perceive you.  Having a presence with your team requires interaction daily and a special connection with each person.   As you interact with your colleagues, here are a few behaviors that will help you to be present:

  • Set the tone for your workgroup by showing up every day with a positive attitude.  Your mindset and energy level are contagious and will be imitated by your team.  Do a self-check, put a smile on your face and some pep in your step before welcoming your team to the workday.
  • Personal relationships create a foundation for trust.  Be as interested in the person doing the job as you are in accomplishing a task.  You do not have to be best buddies but it is important that each employee know that he/she is unique and appreciated.
  • Use body language to display confidence in yourself and your team.  Stand straight, hold your head high, pull your shoulders back and put a pleasant look on your face.  When you own your space, your team will feel as if you can protect theirs.
  • Use the word “because” when making a request.  It may sound trivial but when you simply tell people to do something, they feel micromanaged; however, when you tell them why it needs to be done, they feel privy to inside information, see that their work is important, and are more likely to willingly comply.
  • People will not always remember what you say, but they will never forget how you make them feel.

Be empowering

Show me a workplace with extreme productivity and high morale and I’ll wager that employee empowerment is a part of the culture. Workers who perceive that they are empowered feel as if they are vital and that their effort supports the goals of both the team and the organization.  In addition, empowerment creates a bond of trust between the worker, the boss, and the organization.   Here are some steps that you can take to be an empowering boss:

  • Clarify goals and guidelines.  Having a goal creates a common purpose for your team and gives them something to collaboratively work toward.  A former friend who was active in his church explained that adding a room to the church gave his parish a goal, united church members and injected energy into the group that had previously been lacking.  Clearly communicate goals so that all oars are paddling in the same direction.
  • Create opportunities for workers to take charge.  Workers are empowered when they are given responsibility for a task and then given guidelines, resources, and the latitude to complete a task without the fear of micromanagement.  By allowing a person to be responsible for an assignment or an entire project, you are saying, “I trust you,” and he/she will likely take ownership. 
  • Assign authority along with responsibility.   There is nothing more demoralizing than to be given responsibility to complete a task without being given the authority to do what needs to be done.  When assigning tasks and projects, make sure that the person has the resources and authority to bring the assignment to closure.
  • Encourage communication.  Healthy teams have open communication at all levels.  When brainstorming, all voices must be welcome, and creativity must be rewarded.   Equally, there is a place for small talk that promotes socialization in the workplace.  Through casual conversation, workers create friendships that will pay dividends later when they work together on a project.
  • Promote mentoring and coaching.   Professional development is high on the list of characteristics in an empowered workplace.  Coaching is a process to teach practical skills to new workers as they join the team or to experienced team members as technology changes.  Mentoring can be a long-term partnership in which an experienced person shares knowledge and life experiences with a rising star on the team. Coaching can be a short-term interaction to teach a specific skill.  Both coaching and mentoring send the message that you care about the worker and want him/her to reach their full potential.
  • Encourage self-improvement.  Anything that expands the knowledge or skills of a worker adds depth to what they can contribute to the team and supporting their effort shows that you care about their personal growth.  A former colleague signed up for a Russian class at the local community college.   The leader adjusted the schedule so that he could be out early every Wednesday to attend the class.  Not only did the person learn a language, the mood of the entire team was lifted when they saw the support that was given to a colleague.

“A hero is an ordinary individual who finds the strength to persevere in spite of overwhelming obstacles”

~Christopher Reeve

Be resilient

Despite our best efforts, not everything can or will go smoothly and you must be resilient if the train is to be kept on the tracks.  Resilience is the ability to meet adversity and then recover and restore business as usual.  The healthcare workplace is constantly changing as are the personal needs of team members.  Sometimes a head-on collision is inevitable and you, as the leader, may be part of the collateral damage.   Setbacks can shake one’s self-confidence and create a sense of personal hopelessness.  If left unchecked, your negative vibes will transfer to the team and kill its morale.   Here are some behaviors that will help you to develop resilience.

  • Learn from mistakes.  Conflict seldom just happens; someone or something put the problem into motion, and it came to a head under your watch.  Take ownership of the problem then step back and reflect on the flawed process that caused the event to occur.  Creatively think of ways to avoid recurrence of the problem, develop a plan, and implement the needed change.
  • Have positive self-talk.  Your internal dialogue is a powerful tool that will empower you to solve the problem or will stifle your self-confidence and ensure your demise.  A problem does not make you a poor leader or a bad person; it gives you an opportunity to resolve an issue.  Remind yourself of your strengths, sources of support and your expectation that you are up to the task of implementing a solution.  Use confident body language, assure yourself that you are highly qualified, and then fix the problem.
  • Re-define your purpose or goal.  When problems arise in the workplace, often it is because people have lost sight of the purpose of the organization and the team.  Pause to reflect on your goals and question whether they have changed.  If so, update them to reflect the current reality.  If not, the team must be brought back into alignment with the goals.  Regardless of the source of the glitch, decisively communicate targets and expectations to the team.
  • Be a champion for the cause.  Show your resilience by becoming the person to champion the changes necessary to ensure that the problem does not emerge again.  Determine a desired outcome and focus your activity on achieving it.  Use your energy and position to create grassroots support among team members and solicit their help as you move forward.
  • Be a realist.  Avoid giving a knee-jerk, fix it now response to a situation.  Rather than coming in with guns blazing, first visualize a best-case scenario for resolving the issue and then temper the vision by assessing resources.  An OK plan that can be quickly implemented is better than an idealistic plan that is unrealistic and doomed for failure.

Leading a healthcare team presents challenges that are quite different from those experienced by Indiana Jones; however, like the archeologist, the three B’s will help you navigate the traps that would defeat a lesser person.  Being present gives you visibility and enables communication that will bond your team into a collaborative unit.  Being empowering ensures that creativity is tapped and that the team works toward a positive goal rather than being paralyzed by the fear of making a mistake.  Being resilient enables you to climb out of the pit, regain your composure and continue your quest to find the holy grail.   Use the three B’s to be all you can be. 

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.

Ace your video interview

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Social distancing requirements related to COVID 19 forced many companies to close the office and develop an entirely new workflow to include working from home.  Major organizations such as Facebook, Uber, Reuters, and Google have extended working remotely and some jobs may never return to the traditional office.  Successful companies are conducting busines through online marketing followed by email and video conferencing.   Technology is filling a void and using video conferencing for virtual recruiting is becoming the norm for many workgroups.  Rather than fearing the prospect of a long-distance interview, embrace the opportunity to demonstrate flexibility and your comfort with technology. 

Ace your virtual interview

All job interviews require preparation; however, a virtual intervieweliminatesa lot of logistics, giving you more time to prepare and total control of the meeting environment.   Leverage the home court advantage that you have been given by removing distractions, creating a professional interview room, and learning all that can be determined about your next employer and the job that you will be expected to do.  Here are seven simple ways to set yourself up for success in a virtual interview.

 Take the interview seriously.  Before the interview, learn about your future employer and become familiar with the organization’s mission, vision, and values.  Read and jot down key points on the job description.  Prepare a list of questions with the anticipation that at some point you will have the opportunity to ask them.

Learn the technology.  Although platforms such as Zoom and GoToMeeting are popular for video conferencing have a large user base, other lesser known platforms such as Join.me, Ready Talk, and OnStream meeting offer fully functional alternatives.  Your future employer will send you an invitation to the video conference and identify the platform.  It is your job to go online and learn to use the format well in advance of the interview.  Do this by establishing a subscription, soliciting a trusted friend to do the same, and recording a mock interview as a test of the technology prior to the formal interview. 

Prepare the environment.  Many people opt to do video interviews from home, others arrange office space for the event.  If you have a friend or relative with an office that appears professional, ask to “borrow” it for the afternoon.  If you are planning to use a dedicated office at home, remove all clutter from the desk, arrange your professional books on the shelves and remember to straighten all the wall-hangings.

Those who have created work/study space in a bedroom must prepare it as if your next boss were doing an inspection of your personal work area.  Make the bed meticulously, remove clutter and memorabilia, and make sure the closet and bathroom doors are closed.  If your office opens to common space in the house such as a hallway, make sure that there is no traffic or noise during the interview.  Review the mock interview and examine it closely for visible or audible distractions in the background.

Lighting is extremely important and should be positioned to illuminate your face. Place a lamp in front of you and behind your computer so that it brightens your face.  Overhead lights or lamps behind you will put your face in a shadow and make you less visible on camera. Different types of light bulbs (daylight, soft glow, warm, relaxed, etc.) produce quite different effects.  When reviewing your mock interview, take note of the lighting and change bulbs if necessary.

 Dress for success.  Dress as if you were meeting in person. Business clothing will help you develop a professional mindset and boost your confidence, as well as impressing your potential employer with your sincerity and business sense. Do not make the mistake of wearing professional attire from the waist up with the assumption that nobody will see the gym shorts under the desk.  To do so is deceptive, makes the interview feel less formal, and if it comes into view, is not a good way to break the ice with your future boss.  

Personal hygiene is even more important during a video interview because the camera will show the leftover lunch between your teeth and the hair in your nose.   Hands and fingernails must be clean and excessive makeup or jewelry should be avoided.

 Make a strong first impression.  The reputation that you create begins with those who work behind the scenes to arrange/facilitate the video interview.  As a Chief CRNA, my administrative assistant did all the logistical work to arrange applicant interviews. She kept me informed when applicants “just didn’t get it” and had to be given the same information several times.  When you coordinate your video interview with the facilitator, ask all your questions at once, take notes and get it right the first time.

Bring it all together at the interview.   On interview day, be tech savvy and on time.  Smile and be upbeat from the first connection and speak loudly and clearly.  If you have anything to display during the interview, have it minimized on your home screen so that it can be easily located and presented as a screen share.  Remain positive, upbeat, relaxed, and pleasant.  Look directly into the camera while speaking and avoid the temptation to watch your computer screen.  Be mindful of your hands and do not create a distraction by fidgeting, playing with a rubber band or clicking a pen.  Have a clock next to your computer and do not look at your watch during the interview.   Use a book stand to hold a clipboard with your cheat sheet or other interview notes and keep them out of view of the camera.

Follow-up after the interview.   As you approach the conclusion of the interview, ask about your next step and their timeline for filling the position.  If additional material is requested, send it promptly at the end of the interview.  If you are instructed to complete an online job application, do it the same day.

Finally, have a touch of class and send a handwritten thank you note for the opportunity to interview and the interest that they have shown in you.  An immediate email is okay but will be more effective if you follow it with a written note on a high-quality blank card in the regular mail.  Caution: this is a thank you and not a platform for you to restate your strengths. 

“The difficulty lies not so much in developing new ideas as in escaping from old ones.”

~John Maynard Keynes

COVID 19 has changed the way mainstream business is conducted and innovative uses of technology, such as the video interview, will be with us long after the viral threat has subsided.  Regardless of the format, the personal interview will remain an important part of assessing applicants for a position and successful candidates will be those who show self-confidence and professional competence via the video platform.  Follow the Seven Simple ways to ace the video interview and land the offer.

Tom is an experienced leader, author, and requested speaker.  Click here for a video introduction to Tom’s talk topics.