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Welcome to Club 85

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Preface to Prevention

Claiming over 110,000 lives worldwide, COVID 19 is still dominating the news, and rightly so.  Back in the 1990s when working at the University of Kansas and developing the first distance education program for nurse anesthetists, I could not imagine the of online education 25 years in the future.  While computers keep the education process rolling, they also promote a sedentary lifestyle where a playground game of tag is replaced by video games.  Over time, a lack of physical exercise combined with an excess of calories, salt and fat ushers in coexisting diseases, which require medications, which, in turn, suppress the immune system and make the individual less able to fend off COVID 19 or any other infection. 

Healthcare providers are playing catch up and finally getting a grip on COVID 19 while vowing to be fully prepared for the next pandemic should it ever occur.  Warehouses will be refilled with necessary supplies, and best practice guidelines will be developed.  On a logistic level, we will be prepared for the next pandemic threat, but on a personal level, is your body tuned up to fend off the next viral threat?

Club 85

Updated daily, today’s data listed on The Johns Hopkins COVID dashboard indicates that approximately 3.5% succumb to the virus and die.” The percentage of people with full recover is more difficult to to determine, however, whitehouse briefings place the number at 85%. To date, there is no mention of what happens to those who neither fully recover or die.  News reports reveal that the virus has its most deadly effects on the elderly and those with coexisting disease; however, this week’s watchdogs warn not to underestimate the potential deadliness of the virus for killing people at any age.  Conversely, at 104 years, Italian Ada Zanusso proved to the world that a healthy body at any age can beat the virus.  We may not be able to personally establish policies that prepare the nation for the next infectious event, but there are several steps we can take individually to increase the probability that when the next pandemic hits, you and I will be among the 85% with full recovery.

Scientists are working around the clock to develop a vaccine for COVID 19 and individual physicians are trying existing medications “off label” to improve outcome; however, it is the victim’s immune system that often makes the difference between life and death.  Data collected and analyzed by Worldometer affirms the premise that mortality increases as the age and number of co-existing diseases increases with a sharp in crease in the death rate if the individual is age 60 or above.  Co-existing diseases that are linked to increased mortality include cardiac disease, diabetes, chronic respiratory disease, hypertension and cancer.  Those with coexisting disease are most likely to be on medications, and many medications suppress the immune system.

According to an AARP survey 75% of Americans over age 50 are on medications.  Of those who take drugs, 80% are on two medications and 50% are on four or more.  However, one does not need to be over age 50 to have co-existing disease and be on prescription drugs.  These are the 10 most frequently prescribed drugs in America as identified by Becker’s Hospital review, most of which suppress the immune system.

  1. Atorvastatin (Lipitor) suppresses the immune system by inhibiting HMG-CoA
  2. Levothyroxine (Synthroid) does not suppress the immune directly, however, thyroid disease often has an autoimmune component and, therefore, the person may have altered immune function.
  3. Lisinopril (Prinivil, Zestril) lowers vitamin E levels and depletes Zinc which is needed for a healthy immune system.
  4. Gabapentin (Neurontin) suppresses lymphocyte T proliferation and changes cytokine profile release which alters the inflammatory response and inhibits the immune system.
  5. Amlodipine (Norvasc) is known to suppress T cells, mast cells and macrophages.
  6. Hydrocodone/Acetaminophen (Vicodin, Norco) suppresses the activity of NK cells, decreases helpful T-lymphocytes, decreases T-cell function, inhibits B-cell activity and enhances the growth of tumors that may be present.
  7. Amoxicillin (Amoxil) Generally speaking, antibiotics do not weaken the immune system. However, some scientists believe that as organisms develop resistance to antibiotics it leaves the host more susceptible to future disease.
  8. Omeprazole (Prilosec) Proton pump inhibitors do not directly suppress the immune system; however, they alter the intestinal flora which alters the uptake of nutrients and may indirectly affect the immune system.
  9. Metformin (Glucophage) There is no evidence that Metformin weakens the immune system.  However, those taking the drug are pre-diabetic and may have other issues that alter the body’s defense to the virus.
  10. Losartan (Cozar) reduces the white cell count and suppresses T-cell activity.

Like our intentional multi-modal approach to pain control, nine out of ten of the “most frequently prescribed” drugs create the potential for a multi-modal approach to weakening the immune system.  If your prescription drug is not in the top 10, it still may have immunosuppression as a side effect.  Take the time to look it up and become aware.   Is it any wonder that those who are on multiple medications are the least able to fend off COVID 19 or any other infection?  The known threat of a weakened immune system should motivate healthcare workers who are obese, hypertensive or pre-diabetic to regain a fit body and get off the immunosuppressing drugs.  

Connect the dots

Joining the 85% club starts with having a healthy body.  There’s little ROI from buying fire insurance the day after the house burns down, or having good intentions for getting your body into optimal condition to survive the next virus unless you follow through.  Preparation for fending off the next pandemic starts today with a focus on reversing coexisting disease, and reducing/eliminating daily medications that suppress the immune system.   It may sound daunting, but with a few lifestyles changes, you can prepare for prevention.

Preparation for Prevention

Exercise

Your body was meant to move and be active; just look at the non-stop movement of a preschooler.  The high energy of a child slows when he/she becomes an adult and enters the workforce.  The pickup game of hoops morphs into watching videos (while munching high calorie snacks) and over time weight increases and metabolism drops, and the door opens for co-existing disease.  The cure; get up and move.  The Mayo Clinic reports that a combination of aerobic exercise, strength training and flexibility exercises will improve the following conditions: obesity, heart disease, diabetes, asthma, back pain, arthritis, and dementia.  Get outside for a walk or bike ride.  Convert the spare bedroom or empty basement space into a home gym.  Take elastic bands on your walk and anchor them at a light pole for some resistance exercises.  Success comes from commitment to daily exercise and as your weight comes down, you’ll get a boost of energy, you’ll regain self-respect, and be more productive in the other areas of your life.

Nutrition

Millions of dollars are spent every year on sophisticated diet plans to support the latest weight loss gimmick.  Save your money; it’s not difficult to give your body the nutrients that it needs instead of the junk food we’ve been brain-trained to want.  Whatever you put in your shopping cart lands in the larder, so take charge when you shop, and you’ll be in control when you eat.  Harvard Health publishing recommends a diet high in fruit and vegetables for strengthening the immune system and its fight against infection.  EatingWell affirms the Harvard recommendations and notes that a high fiber diet promotes weight loss and cuts the risk of type II diabetes.  Eat lean red meat in moderation and use chicken or fish as primary sources of protein.  You can increase nutrients and fiber by eating a large, colorful salad at least once a day.  The food revolution network advises eating a rainbow of vegetables daily, pointing out that a palette of colors provides the variety of vitamins and trace minerals you require, nutrients that are lacking in prepared and packaged food.  Who needs a multivitamin pill when vitamins come in a salad?

Hydration

Water is essential for cellular function and life itself.  Lucky we are to live at a time when our drinking water is the safest in the history of the world, and it’s delivered to the kitchen faucet at a relatively low cost.  Yet, many people live in a state of relative dehydration that does not allow the body to function at its best.   Explore Health online notes that diabetes, low carb diets, stress, aging and eating too few fruits and vegetables can all contribute to cellular dehydration.  The solution is to put down the coffee mug and pick up the water jug.  Be mindful to limit salt and refined sugar which also dehydrate the body’s cells.  Healthline recommends a minimum of 13, 8oz cups of water per day for men and 9 cups for women to normalize hydration and promote efficient cellular function. 

Sleep

Improving exercise, nutrition and hydration are a good start, but if you are burning the candle at both ends, your body will not be at its best under stress.   Follow the recommendations of sleepfoundation.org, and put yourself on a regular schedule for both bedtime and awakening, and ensure that you get 7-9 hours of sleep.  Plan so that the time leading up to sleep is caffeine and stress free.  Yoga, stretching and meditation are all excellent bridges from the working day to restful sleep.   Value your rest as much as you value your work.

Hindsight provides insight but only proactive planning followed by action will change the outcome the next time we are faced with a market crashing, mind-blowing showstopper like the one created by COVID 19.   For those who are obese, hypertensive or diabetic, now is the time to step up and take action to improve your health and, hopefully, wean yourself from drugs that weaken your immune system.  For those who are disease free but sedentary, now is the time to establish a lifestyle built upon activity, nutrition, hydration and rest to ensure that you stay in club 85.

Final note:   Even with all you may have done personally to boost your immune system via a dedicated healthy lifestyle, and all that you and your employer have done collaboratively to  prevent your being exposed to the next “pandenemy,” it’s possible you may still be diagnosed with COVID 19.  If you should test positive, and you’re girded by excellent health and a strong immune system, I’ll bet my COVID cleaned, best pressed scrubs that you will emerge to become a member of Club 85.

Tom is an experienced leader, author and requested speaker. 

COVID 19; A Call to Leadership

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

The Corona virus (COVID 19) has upended the mundane daily routines that seemed “a bore” just a few short weeks ago.   Fear and panic now drive decision-making and trigger bizarre behavior like visiting Walmart at 3:00 am. for bathroom tissue and an overnight reduction in the sale of Corona beer.  With retirement plans decimated, restaurants empty, national parks and beaches closed, everyday life is on hold and the practice of medicine has changed, probably forever.  In a crisis, effective leadership is necessary at all levels in order to defuse the chaos and develop a reasonable approach to combating the deadly enemy.

From my daily personal conversations with friends across the nation, and a regular review of the CRNA social media, here is a snapshot of the frustration that is being reported by the anesthesia community.

  • My academic friend, a program director in Florida, reports that one hospital converted all CRNAs to 1099 employees, sent them home without pay, and told them they would be called when needed.   His education program converted all coursework to an online format and the University pulled students from the clinical area due to lack of protective equipment (PPE).
  • Likewise, the program director at my alma mater in Arizona reports that all classes are now online, and students have been pulled from the clinical area.
  • Despite the downturn in the surgical case load, the VA hospital in the Baltimore area has kept the CRNAs on the payroll by making them available to assist throughout the hospital as needed and to complete education modules.
  • From several CRNA user groups on Facebook, come these reports; a CRNA posts, “For the first time, I have applied for unemployment compensation.”   Another CRNA posts that her facility has shut down for 4 weeks without pay.  From the GI CRNA user group come numerous reports of GI clinic closures around the country; and the few centers that are open report that, like a growing majority of CRNAs who work in hospitals, they do not have adequate protective gear.   Most anesthetists who work in outpatient surgery centers state that they are out of work, with or without pay. 

Leadership is essential

In times of crisis, someone must be at the helm.  Down the road you may not remember the details of the event, but you will remember how the leader handled the problem and how you were treated.  In today’s turbulence some leaders will flounder while others will flourish, earning both trust and respect from their team.  Here are some ways to ensure that you and your team survive the current COVID challenge and walk away even stronger and more cohesive than ever before.

Stay informed.   Every healthcare organization has developed and dispersed policies/procedures to be followed during the COVID epidemic intending to ensure the safety of workers and clients.   Know the rules and follow rules.

The bombardment of COVID information has filled email inboxes with more information/solicitations/finger pointing than most of us can read.  Select a few reliable sources and check them daily for updates.  Recommended sources for information include the CDC COVID web page, the APSF COVID resource center, and the APSF COVID perioperative recommendations.

Over-communicate.  “I can’t get a straight answer out of anybody and I feel as if I’m being deceived.”   People want to know what is happening and if they don’t hear it from you, they will grasp onto every rumor that is circulated.  Show your respect for the team by being consistently forthright and sharing the good news along with the bad.  Crises, i.e. COVID, are usually fluid and your statements may need to be revised as additional information is gathered.  During a time of crisis, start each day with a short face to face briefing (email doesn’t cut it unless everyone has been sent home) providing updates and listening to concerns.  Avoid overreacting to rumors, hose the hype and quickly address any safety issues that are raised by the team. 

Be resilient.  “I just want to hide in a cave until this whole mess is over and things are back to normal.”  We are in uncertain times and resilient leaders embraces the uncertainty while adapting to change.   After finalizing a plan based on what is known, anticipate a government proclamation or local regulation to issue forth and put the total kibosh on it.  That’s the time to keep your cool and adjust your approach based on the new rules, openly communicating to your team both the new plan and the reason for the change.  Don’t fight uncertainty; take pride in your ability to manage whatever comes your way.

Build trust.  “I don’t believe anything that my boss or the company tells me anymore. They don’t have my back and they think only of their bottom line.”  Teams follow leaders they trust and quickly abandon those they don’t.  Make the personal welfare of each team member a priority and listen carefully to issues that affect either their professional or personal lives. Join your team on the frontline, put on your PPE, and show them that you are all in it together.  If work loss or financial hardship is inevitable, take your share along with the team.  Take all safety concerns forward and your team will see that you are not just working for them; you’re working with them.

Focus on safety.  “How can I effectively care for the patient when I don’t have the equipment that I need to protect myself?  What happens when I get the virus?”  In addition to treating patients with life-threatening conditions, team members must know that their personal safety is your priority.   Make sure that every person has received proper training and that PPE is available.  Take a hard stand and do not allow your organization to withhold safety equipment or force your team into hazardous exposure to the virus. 

Delegate and empower.  “There is so much to do and I’m only one person…I need help.” Professional development is an important component of a great job and the COVID crisis is an opportunity to draw on the talent of your team members.  Whether the need be obtaining supplies, keeping records, providing safety training, or creating a reasonable work schedule, you have people on your team who are eager to help.  Establish the criteria and a timeline and then let team members share the administrative burden.   Keep a finger on the pulse and resist the urge to micromanage.

Be sensitive to individual needs.  “School is closed, and my kids are home until I can’t find day care.  The neighbor is looking in but I’m worried…I can’t keep my mind on my work.”  Working their assigned shift is but one component your team member’s busy life.  Everyone has personal needs that affect the way he/she functions on the job.   For many, childcare during school or day care closures is an issue.  For others, obtaining the family’s basic food and supplies is the bigger difficulty.  Be proactive and adjust/stagger work hours to create the time needed to take care of personal needs.

Keep workers whole.    “I was told to stay home and use PTO if I want to get paid.  What happens when the PTO runs out?  What happens to summer vacation?”  In addition to the virus threatening the physical health of individuals, the economic well-being of the country is also suffering.  Shelter in place regulations have closed businesses and put people out of work.  Healthcare is no different as elective surgery has been banned and caseloads have dropped.  As reported previously, many groups simply furlough the CRNAs without pay.  Take up the mantle and fight for your team, making a strong case for your employer to provide at least partial pay while ORs are closed.  Use every resource including PTO, sick time, or unemployment compensation to maintain cash flow to workers.  There may not be cases now, but once the ban on elective surgery is lifted, employers will want CRNAs to be on the job and eager to go.  Don’t make the mistake of throwing them under the bus now and expecting them to be happy to return when called.  Those who sense that they are not being treated fairly may be using furlough time to find other employment.  Do your level best to preserve pay and benefits for your team during mandated down time.

Look at the big picture.    “Our group is so totally focused on the virus that patients with other problems are slipping through the cracks.”  Healthcare workers, our patients, and our families; we are all in this together and will have a common experience to share once the crisis has abated.  Despite the chaos and disruption to business as usual, review the Mission, Vision and Values of your organization and remain true to them.  Most likely, your MVV describes the role that your organization plays in ensuring the health of your community.  Your purpose for existing will remain long after the virus is gone, serving as a beacon to guide you through difficult times.

Prepare for the future.   “We were not prepared, and many workers have been placed at risk.  Let’s make sure we are ready next time, and this never happens again.”  Preparation requires record-keeping. Make your team a part of the solution by keeping a record of glitches as they occur, challenge your team to find creative solutions, and take notes accordingly.  Push for after-action review with other leaders in your organization and develop a comprehensive plan, including an abundant supply of necessary equipment, that positions you to face the next crisis hidden behind enemy lines.

COVID is a crisis without international boundaries.  But it does not need to be a crisis in leadership.  When the dust settles, teams with a strong leader will feel empowered by the experience, minimizing the burn-out and PTSD while shoring up supplies, improving skills and building relationships.  Your “Call to Leadership” in a crisis demands the will to survive and the determination to thrive.

Tom is a skilled anesthetist, published author and frequently requested speaker.

Get wise to the elderly

Get wise to the elderly

Follow@procrnatom on Twitter

“Age should not have its face lifted, but it should rather teach the world to admire wrinkles as the etchings of experience and the firm line of character.”  ~Ralph Perry

Statistics reported by the Population Reference Bureau revealed that in 2016 over 51 million Americans were over the age of 65, and it predicts that the number will increase by over 50% in the next 20 years reaching 78 million by the year 2036.   This precipitously increasing demographic has implications for current healthcare leaders related to how we interact with our customer base and how we prepare our teams to meet the challenges that accompany the aging population.  If there were ever a fertile ground for honing leadership abilities, this is it.  The rapidly expanding elderly population is a veritable gold mine of opportunities for leadership skill development. 

Emotional intelligence

Emotional intelligence remains a buzz word in the human resources/management community. A highly desired skill for leaders at all levels, it has an internal component that requires you to  gain insight about your personal emotional reactions and their effects on others, and an external component that requires the development of social awareness and of skills related to relationship management.  Working with aging patients opens the door for a leader to connect with and gain social awareness about the features that make this population unique.  Learning to relate to one demographic smooths the path and makes it easier to learn about other populations of patients.

Take a sincere interest, ask questions, listen

Older patients are full of amazing stories and will eagerly share if asked.   Expand your listening skills by asking questions and then listening to the stories that emerge.  Your 74-year-old patient who is next in line for cataract surgery may be the one who scored the winning touchdown in the 1970 Rose Bowl; his wife (and designated driver) might have been a flight nurse evacuating casualties from Viet Nam.  You won’t know until or unless you strike up a conversation.  When you have time to chat with boring old people, consider the following:

  • Those now in their 70’s were the students marching for civil rights in the late 60’s and were back in the streets marching for women’s rights in the early 70’s.
  • Senior citizens were born into a world with hard-wired phones and TV sets connected to an antenna on the roof and receiving only 3 channels.
  • Many Seniors remain actively attached to social activism in the form of “volunteer” at hospitals, museums, schools and civic events.
  • Seniors have traveled to your bucket list places and many have interesting hobbies.
  • Those in their 80’s were children during World War II and remember the air raid drills, food rationing, nighttime blackouts and energy conservation.  Some had relatives who did not return from battle. 

Emotional intelligence involves connecting on a personal level and getting to know the other person beyond the information published in their medical records.  Start a chat session by asking your gray-haired patient a general question about events that happened while he/she was a child and be prepared to hear wonderful, perhaps astonishing, stories.  In my daily clinical practice, I regularly discover what is currently important to them by asking, “Tell me something about yourself that is not on your medical record.”  Often, the answer is tied to their personal identity and response you get may take you by complete surprise.  

Establish best practice guidelines based on physiologic changes

Managers typically publish policies and guidelines related to best practice recommendations.  Subsequently, it is incumbent upon leaders to build a team of knowledgeable workers who want to follow the guidelines and deliver the highest quality of care to all age populations, including the elderly.  When working with your team to create best practice protocols, consider these physiologic changes that are common in the elderly.

  • Cardiac   Atherosclerosis is common in the elderly American population and arises from a lifetime of smoking, hypercholesterolemia, hypertension, type 2 diabetes and obesity.  The result is ventricular hypertrophy, with reduced ventricular compliance, contractility and cardiac reserve.  Normal doses of induction drugs take longer to circulate and may produce significant hypotension.
  • Renal   Glomerular filtration is reduced as is the ability to regulate sodium and potassium.  The kidney is less able to concentrate urine and may have difficulty removing free water from the system.   Elderly patients are less tolerant of hyper or hypovolemia. Drugs dependent upon renal clearance have a longer duration of action and smaller doses are required. 
  • Pulmonary.  Like an old rubber band, the lung loses elasticity with age.  Combined with reduced chest wall compliance, one can expect a reduction in FVC, FEV1, and VC as the person’s age increases.  Small airway collapse is common and presents problems with VQ mismatch.  The elderly patient is at a greater risk for atelectasis and impaired diffusion of gases.  Anesthetic techniques that further suppress ventilation put the elderly patient at risk.  Volatile anesthetics require more time to leave the system and should be used sparingly in reduced doses.
  • Nervous system.   Both vision and hearing diminish as the person ages and eye-related procedures are common in this demographic.  Autonomic nervous system dysfunction makes the elderly patient more susceptible to labile blood pressure and postural hypotension.  In addition, thermoregulation is impaired in the elderly patient making him/her more susceptible to hypothermia and less able to mount a physiologic response.
  • Cognitive dysfunction.   Altered mental status is a common fear among the elderly and causes concern for those awaiting anesthesia and surgery.  For many, the fear of mental decline exceeds the fear of death. Slowed drug metabolism/clearance, hypotension, hypothermia, and hypoxemia are all listed as potential causes of POCD.  More recently, neuroscientists have correlated the inflammatory response with cognitive dysfunction.  Attention to detail and strictly keeping the patient within physiologic parameters will reduce the incidence of POCD.  Opioid-free multimodal anesthesia with little or no volatile agent is the technique associated with the least amount of POCD.

Begin with a thorough pre-operative evaluation and then the development of a plan that addresses the specific needs of each patient.  In general, elderly patients do best when the anesthesia provider has a is gentle and provides a slow induction with plenty of time for drugs to circulate.  A regional nerve block with sedation is preferred over general anesthesia, but when general anesthesia is the only option, a propofol based TIVA technique that includes multimodal pain control and anti-inflammatory drugs is the least likely to cause respiratory compromise or cognitive changes.   Opioids and inhalation anesthetics should be avoided if possible, in the elderly patient.

Leadership

Embrace the rich history and learned wisdom of your simultaneously interesting and fragile older patient by tuning in to their special needs.  Conduct meetings with your team to review the physiology of the aging and mentor them to work collaboratively in developing best practice guidelines.  Listen carefully to elder patients and hone your skills at understanding, treating and enjoying the elderly population.   Lead by example and become aware of the fears and concerns, the strengths and the joys that each of your elderly patients brings to the operating room.  Some day you, too, will be older, maybe even wiser. 

Tom is an experienced leader, author and requested speaker. 

Trash talk; politics and other taboo topics for the workplace

By Thomas Davis, DNAP, MAE, CRNA

follow@procrnatom on twitter

We’ve had four years of political bickering and now the 2020 presidential campaign is barreling down the tracks toward the November 3rd finish line.  As interest grows, people on both sides of the political aisle are digging in their heels and waiving the pom-poms for their preferred candidate and party.  While good natured bantering can be fun, people who are relentlessly backing either party can be viewed as hostile and intolerant of others who do not share their point of view.  On the street corner, it’s called freedom of speech but in the workplace, it’s called divisive and can poison the collaboration needed for effective teams to work smoothly and productively.

For example, James and Susan are both competent, highly skilled anesthesia providers who have earned professional respect from the entire peri-operative team.  James is, above all else, anti-Trump and has publicly stated at the nurse’s station that Trump supporters are uneducated, illiterate, and incapable of understanding what is best for the country.  Susan, a strong Trump supporter, swings back stating that she could not have earned her doctorate degree or CRNA certification without being literate and begins to chant, “four more years.”   The tension that they create between themselves daily spills over and is felt by all who witness the frequent hostility.   Along the way, morale drops and the attention of other workers is diverted from patient care.

Writing for The Balance Careers, author Susan Heathfield notes that in a workplace that values diversity, polarizing topics such as religion and politics should stay at home.   Her position is reinforced by a study done by the American Psychological Association which revealed that political talk in the workplace creates stress and reduces team morale.  The APA findings revealed that when political talk was allowed at work:

  • 15% become more cynical.
  • 13% feel less productive.
  • 10% report that their work quality suffers.

Taboo topics in the workplace

Topics that are tied to deep-seated beliefs trigger emotions when the listener’s viewpoint is challenged.  If you work in the field office of the Republican National Committee or are employed by moveon.org, it’s OK to have strong political beliefs at work; however, in the healthcare workplace, trigger topics disrupt collaboration and ultimately affect patient care.  Three topics that are guaranteed to push hot buttons and therefore must be outlawed in the workplace are:

Politics.  Despite claims to the contrary, very few people are truly politically neutral.  Even those who do not vocally and financially back one candidate versus the other have preferences based on family history, education background and personal life experiences.  Starting a debate and presenting logic from an individual point of view it is unlikely to change the other person’s mind and more likely to make the person feel uncomfortable.  As the conversation intensifies, the other person may feel as if he/she is being bullied.  Regardless, heated political discord creates tension and kills trust.  No matter how right you believe your point of view to be, it is wrong to take it with you to work. 

Sex.   The overt discussion of sex related topics is less frequent than politics in most workplaces but is equally likely to create discomfort and distrust within the team.  Verbalizing sexual expectations is classified as harassment and banned under labor laws.  Most organizations require employees to view learning modules that define gender-based harassment and present options for remedy.   Less obvious and equally offensive are the covert comments and innuendos that are subtle and can be denied if the recipient takes offense.   Gender related comments based on stereotypes fall under the category of sex associated taboo topics.   As operating room workers, we view male and female body parts of all sizes and shapes on a regular basis.  Openly discussing sex-related body parts in the lounge not only violates patient privacy, it creates anxiety in those who prefer to talk about other things.

Religion.  We are Americans and we live in a diverse nation that values religious freedom.  Those with strong religious beliefs will defend the dogma to their death and have the right to do so if it does not interfere with the rights of those who believe differently or not at all.  Follow your faith but make sure you keep it out of the workplace.  Espousing your religion or denigrating the beliefs of others can be viewed as bullying and kill collaboration in the workplace.  

How to dodge taboo topics

The key to eliminating taboo topics from the workplace is to first set standards and then follow with boundaries.  Make rules for yourself to ban participation in the discussion of hot topics and hold yourself accountable without exception.   Once done, apply the standards to others and take steps to squash taboo topics in your workplace.  Here are some tips:

Value collaboration.  Above your personal beliefs or political affiliations, value civility and collaboration at your workplace.  Practice emotional intelligence and consider how your comments will be received by others.  Accept that others on the team may have different opinions and be respectful of the diversity that they bring to the team.  Focus on building trust rather than spreading political dogma.

Know the rules.  Most companies have rules related to bullying and sexual harassment.  Being forceful when verbalizing personal views may be perceived as undue coercion and set you up for a reprimand.  At the very least, your rant most likely will not align with the values of the organization.

Avoid hot topics.   The big three topics to be avoided are politics, sex and religion.  Consciously draw a line and do not allow yourself to be drawn into conversations related to those topics.  It’s OK to say, “yes, I have an opinion, but I also have an obligation to keep it to myself while on the job.”

Be civil.  Civility is a key ingredient for effective teamwork.  Taking others out of their comfort zone by insulting the intelligence of those with opposing views is a sure way to create tension and kill productivity in the workplace. 

Be mindful of social media.  Without question, the first amendment gives you the right to freedom of speech.  Be mindful that others in your workplace may see the comments that you post on social media.  Even if you keep quiet at work, polarized rants on social media that are read by your colleagues will create a rift that affects how they interact with you at work.

Just walk away.  Sometimes you are caught off guard when confronted by a person who demands that you see things his/her way.   Regardless of the choice that you make, hoping on the bandwagon or confronting the person with an opposing belief, you will diminish yourself in the eyes of others if you jump in the fray.  Don’t allow yourself to be drawn into the conversation.  When someone starts to rant, check your watch, say you have a deadline, and move on.

The passion of politics will continue to grow and extend well beyond the November election.  Both parties will try to convince you that American will not continue to exist if the other party is elected. (haven’t we heard that before?)   Issues come and go but your job and your colleagues will remain.  It’s up to you to take the high ground and value teamwork above politics.  Set a high standard and establish boundaries that keep politics out of the workplace.

Tom is an experienced leader, author and requested speaker. 

2019 Best Airline ranking; Lessons for ambulatory surgery centers

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

Four decades ago, I was a neophyte embarking on the challenge of learning to safely administer anesthesia, earn certification, and become a productive member of the profession.   I recall being told several times that delivering anesthesia is like flying a plane; chaotic and high risk at takeoff and landing with hours of boredom in between.

 

Throughout the span of my career, other analogies have compared aviation to anesthesia.  For example, as the patient safety movement gained momentum, John Nance’s book, Why hospitals should fly: The ultimate flight plan to patient safety, took the principles that vastly improved airline safety and applied them to healthcare.  The book made a strong case for collaborative teamwork in the operating room to match that required of the flight crew in the cockpit.

 

An article by Scott McCartney published in the Wall Street Journal on January 15, 2020 ranked US airlines from the perspective of customer satisfaction.  At the top of the list was Delta Airlines with a spectacular on-time record, few flight cancellations, low incidence of bumping customers and efficient baggage handling.   Following closely were Alaska and Southwest with American Airlines at the bottom of the list of 9 companies vying for riders.

 

As an airline passenger, the article caught my eye and reading it triggered me to consider parallels between aviation and healthcare in terms of customer satisfaction.   Re-reading the article, I noted the criteria used to separate the wheat from the chaff.  Below are the standards that were used to rank the air carriers and thoughts on how they would manifest if applied to the healthcare setting.

  • On time arrivals. When buying a ticket, passengers are given a specific time for the anticipated arrival at the destination.  Likewise, when patients are scheduled for surgery, they are given a specific time to arrive the day of surgery as well as a time for the procedure to begin.  Like travelers, patients have arranged to be dropped off and picked up based on the timeline that they were given to them prior to surgery.  For the patient to have an on-time arrival, equipment, personnel and documentation must all be in place prior to the patient’s arrival.  Once the patient has arrived, every effort must be made to keep the person informed and move him/her through the system as flawlessly as possible. Those receiving care in outpatient surgery centers must be ready to depart at the predicted time.
  • Cancelled flights. Airline flights are not cancelled on a whim, but rather only when the system breaks down and it is not safe to proceed.  Broken planes are grounded, and crew rest mandates are strictly enforced.  In healthcare, cancelled surgery is the outward manifestation of a defective system.  Broken equipment, inadequate pre-op workup, and failure to follow NPO guidelines are common causes for cancellation of surgery.  On rare occasions, a conflict in the surgeon’s schedule may lead to cancellation.  Regardless, proactively improving communication with both suppliers and patients will reduce the incidence of cancelled cases.  Equipment requirements must be anticipated, and patients must be informed regarding pre-op expectations.
  • Extreme delays. Being left to sit for hours (or days) in the waiting area of the airport can be as bad or worse than having a flight cancel.  Weather, maintenance or crew rest may delay a flight; however, in healthcare unrealistic scheduling is a common culprit for delays.  Overbooking creates unrealistic expectations and ensures that patients will experience delays.   Procedures must be scheduled based on historical time averages rather than best case scenarios.
  • Mishandled baggage. I remember many years ago when a disgruntled friend had a bad experience with Delta Airlines and said, “Delta stands for don’t expect luggage to arrive.”  They have come a long way and are now at the top of the industry when it comes to baggage handling.   In healthcare, patient belongings are as important as the airline traveler’s bags.  When you lose a pair of glasses or hearing aid and the patient will tell the story for the next 10 years.  In addition, the patient’s driver or family can be considered baggage that deserves to be handled respectfully.  Provide a comfortable waiting area and offer frequent updates to show your regard for their tie to the patient.
  • Bumping.  There is nothing worse than buying the ticket, arriving on time at the airport, surviving the security check and then being told that your seat was given to another person.  The plane takes off, but you are not on it.   In healthcare, emergencies arise and sometimes the surgeon is not available to do the case.  All effort should be made to keep commitments and make reasonable accommodation where needed.  Scheduled cases should not be cancelled at the last minute to accommodate short notice vacation.  A case cancelled because of lack of equipment represents a total breakdown in the system.
  • Complaints.  In both the airline and healthcare industries complaints come with the territory.  Having a smoothly functioning system and engaged, customer-oriented employees will reduce but not eliminate complaints.  The question is not whether complaints will be lodged but rather how you react to them.   Client centered organizations will welcome complaints as a source of insight that will lead to improved service in the future.  Lesser organizations will simply track numbers and learn nothing about their failures in delivering the promised service.

 

Earning a top rating for customer service requires employees at all levels to be fully engaged in their work and be committed to creating a positive experience for the client.   Although cause and effect have not been claimed, Scott McCartney noted that while being rated 2019, American Airlines was in contract negotiation with maintenance and baggage workers.  It was implied that employees were not fully engaged in their job and that worker sabotage was tied to the low satisfaction scores.

 

Customer satisfaction is driven by the front line, not by the front office.   The Board of Directors can build a solid corporate structure, but the passenger/patient remembers the attitude of those they encounter during the journey and whether promises were kept.  Delta’s number one ranking was no fluke and employees at all levels worked diligently to provide the promised service and deliver it with a positive friendly demeanor.   When the rankings were announced, Delta executives were pleased; however, rather than taking personal credit, the Board of Directors showed appreciation for their workers and posted the following: “There’s no higher honor for Delta when our employees are recognized for the work that they do to take care of our customers.”    Clearly, passengers can expect a smooth ride on Delta Airlines.

 

Tom is an experienced leader, author and requested speaker. 

John-the-Boss and the Bag of Tricks

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

I can still vividly remember the day early in my Air Force anesthesia career when Lt. Col. John- The-Boss enthusiastically entered the workroom where our team was setting up the day’s equipment. Like a kid with a new toy, John had excitement written all over his face, wearing a grin indicated that he had something for show-and-tell.  John announced that he had discovered and purchased a tool that would increase our productivity by ensuring that every open project would quickly be brought to completion.  He had our attention and we insisted that he show us the contents of his bag.  John opened the bag and dumped ten round, 4-inch petri dishes on the worktable and then handed one to each person.  With one eyebrow raised and one lip curled, we each opened a glass container and discovered a label inside that said, TUIT.  Ignoring our chuckles and groans, John continued by going down the list of unfinished projects that had been started with good intentions and put on hold until someone got a round tuit.

 

Ideas flow freely from a creative group and projects that are started with the best of intentions often die from lack of follow through.   The implications arising from procrastination are even greater when it is the leader who fails to follow-through because not only is there a loss of productivity, the leader’s integrity is compromised.  Lack of follow through on commitments is demoralizing, destroys trust, and fragments the team.

 

“Be impeccable with your words and speak with integrity. Say only what you mean…”

 ~ Don Miguel Ruiz

 

Observing for follow through on a commitment is an overt way to measure the personal reliability of another person.  Here are two examples, one negative and one positive.

 

One of my friends has a son is in his early 20s and very talented at wood working.  He can flawlessly design and build cabinets, dressers and chairs.  He is a bright young man and has many creative ideas for developing a business that includes opening a woodworking shop, hiring help and marketing furniture throughout his region of the state.  Unfortunately, to date, he hasn’t done much about it.  He has not consistently followed up on many of his promises to customers, nor on any of his own ideas.  The business isn’t thriving and he lives hand to mouth while telling others about his dreams for dominating the furniture market.

 

 

Conversely, a second friend, and professional colleague, is always available and eager to share ideas when either of us is working on a project.  When we brain-storm, he freely shares his ideas and often says, “I’ll send that information to you.”  Without exception, he follows through within 24 hours on whatever he promises, sometimes sending a document before we even finish the call. In the past three decades, he has never failed to follow-up when he promises action.   To his credit, he quickly says no if he cannot accommodate a request. Yes or no, I have the utmost respect for his honesty and reliability.

 

Following through with commitments is a habit that will elevate your status as a leader, develop self-respect while earning respect from others, and contribute to the overall morale of your team.  Here are some tips for aligning your action with your words.

 

 

  • Define the ask. Requests come in many forms throughout the workday; an email message asking you to update a database, a request for information for the annual report, a need for you to champion a project, a personal request from a team member in need of schedule considerations.  Before giving the quick knee-jerk “yes” response, catch your breath and clarify what is being asked of you.  A database update could be a 5-minute quick click or a 3-day deep dive into archived data files.   A schedule consideration could be an easy accommodation, or it could leave a shift unstaffed and demoralize the team.   Because you intend to follow through to completion, it is essential to define what is being asked and the effect it will have on other work that will be set aside when you tackle the new commitment.
  • Make yes mean yes. As previously stated, integrity requires alignment of your words and actions, and you can only have integrity if you follow through on commitments.   After clarifying the ask, assess your resources, including your available time, and make a reasonable decision about accepting the request.   You will gain respect with an honest “no” and conversely, you will lose respect with a false “yes.”  When you say yes, be prepared to explain when and how the issue will be completed because yes without a plan really means no.
  • Commit with decisive language. Your inner dialogue has a powerful effect on your motivation to follow through. Saying “that’s a good idea” or “yes, we should do that” are not calls to action.  Using words such as can and will are more powerful and indicate a commitment on your part.  Think in terms of “we will do this and here is how we will approach it.”
  • Resolve small things immediately. My high-integrity friend with instant follow-up is the role model I use when the ask is small and easily resolved.   If the resources are at hand and the item can be resolved immediately, do it now.  If your resources are in the office or at home, make it the first thing you do when you get to the location.  From personal experience, I can affirm that I have never awakened in the night thinking about promises that were kept quickly; it’s the unkept promises that keep the stress hormones circulating and disrupt sleep.
  • Establish a timeline on your calendar. The workplace can be crazy and chaotic so it is important to write down your commitments lest you forget.  If a project extends over time, make sure that each of the milestones is on your calendar and that you achieve them.  Calendar and planner apps, readily available for mobile devices, are a good place to enter your commitments.   In addition to the target date for completion, schedule the app to send reminders at intervals to hold yourself accountable.
  • Find a mentor. A mentor is a valuable resource person who will help you develop your plan, identify resources, and keep you on track.  In addition to tapping into the expertise of a mentor, check in at intervals and update the mentor on your progress.  Share your timeline and encourage the mentor to hold you accountable for your commitment.  It’s much easier to make yes mean yes when someone is sitting on your shoulder and offering encouragement.

 

“What you do cries out so loudly that I can’t hear what you say”

 

Lt. Colonel John-The-Boss and The Bag of Tricks is a funny but true story with an elementary lesson about reliability.  And reliability is no joke.  Reliability is just as important as ability and a person of action motivated by integrity always follows through with commitments.  Consistent follow-through directly affects productivity and establishes a positive view of your personal ethics among co-workers, which in turn, opens the door to trusting relationships. High morale, elevated productivity, cohesive team, respect, trust.  Maybe we should all get a round tuit.

 

Tom is a skilled anesthetist, published author and frequently requested speaker.

The Future of Healthare: 2020 and beyond

 

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Crafty clairvoyants claiming 2020 vision, can’t wait for the New Year to arrive so they can capture the spotlight and publish their predictions.   However, history reveals that although forecasts from the know-it-all pundits may have sounded logical, many predictions completely missed the mark.  For example:

 

  • In 1876 Western Union Telegraph stated that the telephone had too many flaws and zero inherent value, LOL.
  • In 1954 radio host, Eddie Bond, advised Elvis to keep his day job, predicting the soon-to-be-heartthrob would never make it as a singer. And eight years later, Decca Records opted not to offer the Beatles a recording contract, publicly predicting that guitar music was on the way out and Beatle music would never sell.
  • 50 years ago, when Neil Armstrong took the first steps on the moon, prognosticators said that within 50 years we would have a colony on the moon and that shuttles would take vacationers back and forth. I enthusiastically bought into that concept but have yet to receive my boarding pass.
  • Again in 1954The National Cancer Institute stated that even if excessive smoking played a role in lung cancer, it was only a minor role.
  • In 1988, Dr. Thomas Neff proposed that the newest medical technology – pulse oximetry – would be considered as a basic vital sign along with blood pressure, pulse and respirations. The experts of the day predicted that within 5 years pulse oximetry would eliminate hypoxic brain injury yet, today hypoxic brain injury continues to be a cause of anesthesia related death.

 

Predicting the future is not a foolish pastime; visionary leaders keep a step ahead of the competition by looking over the horizon.  That said, the future is seen through the lens of today which distorts the view of the world that is yet to exist.   Prognosticators use current trends to create a logical foundation which guides the predictions of the world’s wizards, whom I am about to join.

 

In the spirit of full disclosure, I do not possess psychic abilities, nor have I won awards for my spot-on insight into the future.  Rather, I have spent the past several years working full time providing anesthesia, reading professional literature, publishing, speaking and observing trends in healthcare delivery.   Based on emerging technology and current trends, here is what I see when I read the Crystal Ball.

 

Artificial intelligence    Simply put, artificial intelligence (AI) is the use of computer systems to perform tasks normally performed by humans such as visual perception, speech recognition and decision-making.  Computers are being trained to read X-rays better than a radiologist and to read tissue slides better than a pathologist.  The Johns Hopkins has developed and deployed the TREWS system that utilizes AI to detect early signs of sepsis in ICU patients, and other organizations are developing complex AI programs that allow the computer to take a deep dive into medical records and identify trends that predict future healthcare needs for individual patients.   Writing for builtin.com, author Sam Daley gives 32 examples of current uses of AI in healthcare.   Tom’s Crystal Ball reveals an expansion of AI to include computerized a pre-op record review for each patient followed by a prescription for the ideal anesthetic to include choice of anesthetic technique and ventilator settings.

 

Robots    Machines that can replicate certain human functions are referred to as robots.  Factory assembly lines currently use robotic arms to accomplish tasks previously done by human appendage.  The push for automation is extending beyond the factory and managers are actively identifying human functions that can be replaced by machines.   Currently, a robot called TUG is being introduced into the hospital environment.  The TUG device uses programmed maps and complex lasers to navigate its way through the hospital, delivering food and supplies where needed.  Tom’s CB believes that within 5 years, self-directed delivery carts will be commonplace in hospitals.   Indeed, large organizations with multiple buildings covering a medical campus will employ driverless vehicles to transport patients from the parking area to their designated appointment.

 

Pharmacogenetics   The use of the patient’s individual genetic profile to predict their response to drug therapy is termed pharmacogenetics.   For example, anesthesia lore includes the belief that those with red hair require higher doses of anesthesia.  Pharmacogenetics has confirmed that notion and identified the actual genetic cause for the increased anesthetic requirement in red heads.  TCB shows an expansion of pharmacogenetics that includes obtaining cells via a cheek swab on all pre-op patients.  The cells will then be given to AI to determine the patient’s genetic profile and the appropriate prescription for anesthesia will be generated; based on the person’s DNA profile, specific drugs, doses and re-dose intervals will be recommended.

 

Disease targeted anesthesia care   The protocol for early recovery following bowel surgery and the trend for opioid sparing anesthesia technique has shattered the historic one size fits all approach to anesthesia care.  Tom’s Crystal Ball reveals an expansion of anesthesia techniques designed to address patients with specific risks.  For example, anesthesia techniques to reduce recurrence of cancer and protocols to reduce the risk of post-operative cognitive dysfunction are two areas currently being developed.  Over the next few years, additional medical conditions will be targeted for the development of disease specific anesthesia protocols and AI will be used to connect the dots and ensure that every patient receives the best possible combination of drugs.

 

There you have it.  My predictions may prove to be spot-on, or they may result in a disappointing mis-read of the tea leaves.  Robots and AI may join the moon colony in the junk pile of bad predictions, or they may usher in the future generation of healthcare.  But regardless, I think we can all safely predict that Beatle Mania is here to stay.

 

Tom is an experienced leader, author and requested speaker. 

What the patient wants

By Thomas Davis, DNAP, MAE, CRNA

Recently we were discussing patient satisfaction at the desk in the pre-op area.  One of the physicians noted that patients assume they will receive top-notch medical care, so the care itself is not notable.  What the patient does remember, he suggested, is their impression of the facility, the workflow process and whether they were respected as individuals. 

My colleague’s comments triggered personal memories of a recent encounter with the healthcare system.  Last year I accompanied my wife to a medical appointment.  The waiting room was filled with heavily worn furniture, magazines were scattered on empty chairs and there was a generally unkempt appearance.  We were moved to an exam room that appeared to need more than a good cleaning.  When the physician arrived, she did a quick assessment and ended the appointment by dictating a plan that did not work for us.  As you can imagine, all the way home we talked about the importance of patient satisfaction.  Having had a negative experience, my wife did not follow-up with their organization nor solicit contact with the physician again.

Because “overall experience of the patient” has become a meaningful component of quality care that is demanded by those who pay the healthcare bill, simple conformance with regulations and standards is no longer enough.  Elevating patient satisfaction, while simultaneously dealing with shrinking healthcare budgets, requires payors to insist that medical providers deliver state of the art treatments that will be remembered positively.

The Center for Medicare and Medicaid Services (CMS) has reinforced this idea by implementing the Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAPS) which ties reimbursement to patient satisfaction.  Simply put, full reimbursement for healthcare services is being tied to the overall patient experience and his/her level of satisfaction with both the individual healthcare provider and the organization offering the care. 

Improve patient satisfaction scores

Moving from the obsolete mindset of “doctor knows best” to the new paradigm of “shared decision-making,” in which doctors and patients work as a collaborative team, requires that healthcare providers learn what patients really want and then commit to meeting their expectations.   Learning about the preferences of the patient requires observing, questioning and listening during every patient encounter.  Discovered through discussions with patients and a review of literature related to client satisfaction, here are a few ways to improve your patient’s overall experience.

  • Patients want to feel respected.  The red-carpet treatment is not necessary but common courtesy is essential. Timetables that are designed to run behind schedule do not respect or value the commitment made by the patient who arranged child care, hasn’t eaten since midnight, has provided the requisite driver and arrived on time. When patients follow the rules and do as told, they expect to receive care as promised.   Likewise, a one size fits all approach to prescribing patient care does not respect the individual needs of each client.
  • Patients want information conveyed in a manner that they can understand.  We work in an environment that has its own language and acronyms.  Terms that are common to us are foreign to many of our patients.  I recently overheard a patient interview.  Nurse: Do you have A-fib?  Patient:  What’s that?  Nurse:  Do you have GERD?  Patient:  What’s that?   Nurse:  Do you take ACE inhibitors?  Patient:  What are those?  Always communicate on the level of the listener and ask follow-on questions to ensure that the person fully understands you.
  • Patients want open communication with every provider.   Hospitalized patients see their doctor once or twice a day and then spend the other 23 hours with nurses and assistants.   Patients expect and need honest, transparent answers from the nursing staff.  The cop-out reply, “Ask your doctor,” is a sure-fire way to kill trust between the patient and the nursing staff and is a trigger for dissatisfaction.
  • Patients want the staff to be collaborative with one another.  Disagreements between staff in a location where patients can observe and overhear must be taboo in the workplace.  Discord between staff members creates anxiety in the patient population and kills satisfaction scores.  When conflicts arise, make sure that they are discussed privately and behind closed doors.
  • Patients want to be included in the decision-making.  The best-practice treatment plan is one that is described rather than prescribed.  The patient must know what is recommended and why; only then are the patient and provider positioned to agree on a plan to provide the recommended treatment in a manner that affirms the patient and his/her family.
  • Patients want a response to concerns and complaints.   Receiving healthcare can spark anxiety in an otherwise intelligent and relaxed individual.  A glitch that’s the size of a pebble to the worker can be viewed as a boulder to the patient.  When a patient expresses concern, listen attentively, immediately fix what you can and follow-up on items that require additional resources.  Leaving the patient with the impression that he/she was not heard will elevate anxiety and increase dissatisfaction.

Assessing patient satisfaction

Your organization sends a survey to every patient and your workgroup consistently scores above the benchmark of 90%.  Does that mean everything is OK? 

Conducting an ongoing survey is an accepted way to gather information and is required in order to obtain full reimbursement under the H-CAPS system.  Surveys are necessary; however, those who truly seek to improve the patient’s experience constantly dig deeper in search of concerns that may not be exposed by the survey.  Rather than boasting about achieving 90% or 92% on the satisfaction survey, focus additional attention on the 8% who were not satisfied.  Seek common themes that generally fuel dissatisfaction such as lack of privacy or excessive wait times and then solicit patients to suggest ways to address the issues. 

The best way to learn about the weaknesses in your system is through the eyes of those who use it.

After working for a year as an anesthesia provider at a busy GI center, it was my turn to be on the receiving end of a colonoscopy.   Wanting to have the same experience as any other patient, I kept things low-key, and it turned out to be an eye-opener.  After following completing a bowel prep and arriving on time, I sat in the waiting room a full hour past my scheduled time.  The room had nice furniture and a TV; however, the room temperature was so cold that I entered the pre-op area shivering.  Despite receiving top-notch care, I felt as if I was on an assembly line and that neither my time nor comfort mattered.   Based on my feedback, the temperature in the waiting area was adjusted.  However, the manager was not brave enough to tackle the sticky issue of intentional overbooking.  In the end, overbooking was not addressed and excessive waiting times continued to be the top complaint expressed by patients at that center. 

The key to improving the overall experience for the patient and family is to engage them in a non-threatening discussion.   Asking pointed questions puts people on the defensive and seldom generates useful information.   Instead, first engage in a friendly conversation and then ask open- ended questions about their experience.   Rather than asking, “What do we need to do in order to improve?” ask, “If your friends were coming for this procedure, what advice would you give them?”   Instead of, “Where did we fail?” ask, “What was your greatest surprise while in our care?”  Finally, ask the patient, “In retrospect, what do you wish that you (or we) had done differently?”   Ice the cake by asking the patient to identify one or two people on the staff who made a positive impact on their experience, and to follow-up by describing the behaviors that made the worker outstanding.

Patient satisfaction IS notable; and it’s not difficult to achieve.  Design a system that values the patient’s time, one that recognizes the patient’s anxiety, that openly communicates information, that develops a collaborative treatment plan and solicits suggestions for improvement; then your satisfaction scores will take care of themselves.

Creating Culture

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

My 21-year-old grandson recently joined me for a day of painting the walls in the basement of my home.  He is a gifted artist who works in a print shop and creates original artwork that is printed on clothing and marketed to specific demographics.   Because of his talent and ability to connect with clients and print shop staff, he is taking over as the manager and is on track to become the owner of the business.  While painting walls (and resisting the urge to feature Captain America), he told me that his primary objective was to create a print shop in which people want to work and where clients want to hang out and spend time.  Without using the word, he described an inclusive and empowering culture in which employees willingly give their all and where clients enjoy their relationship with the business.  He is convinced that a positive relationship with employees and clients will help generate income and a thriving business. His concept of culture is spot on.

“Corporate culture is the only sustainable competitive advantage that is completely within the control of the entrepreneur.  Develop a strong corporate culture first and foremost.” ~David Cummings, Entrepreneur, Atlanta GA

Wikipedia defines organizational culture as “values and behaviors that contribute to the unique social and psychological environment of a business.”  This cultural lay of the land “influences the way people interact, the context within which knowledge is created, the resistance toward change and, ultimately, the way in which they do or do not share knowledge.”  

Whether the work environment is in business, academia or healthcare, organizational culture is the key ingredient that either binds or destroys an organization.  A review of literature related to the importance of a strong and positive organizational culture revealed several common themes.

  • Positive culture attracts the best talent. A knowledgeable applicant will come to the job interview armed with questions to assess the culture of the organization.  Employers who are articulate and give examples of how the workplace is empowering will attract fully committed and loyal people to join the team.        
  • Positive culture improves engagement and retention. Replacing disgruntled employees has a negative effect on both team morale and the bottom line on the financial page.  Developing a culture that empowers workers will improve productivity, improve customer satisfaction and augment profits.
  • Positive culture fosters happiness and job satisfaction. Employee satisfaction research affirms that organizations with a positive culture score the highest on loyalty and satisfaction surveys.  Those working in a workplace with a positive culture tend to remain on the job even when nearby competitors offer better pay and benefits. 
  • Positive culture reduces stress. A positive culture creates a sense of community where people know what is expected and can count on colleagues to have their back.  The ensuing team mentality gives a sense of security and lessens the risk for individual failure on a project.

My grandson is very insightful by placing his primary focus on establishing a positive workplace culture.  His youthful energy and enthusiasm for success will give momentum to move his philosophy in the right direction.  No doubt as he takes over as the manager and implements his plan, many of the following actions will be used to animate his vision.

  • Promote employee wellness. Business moves at the speed of relationships and clicking on a personal level is essential for building a lasting network of colleagues and customers.  Take a personal interest in the mental and physical wellness of each employee.  Encourage personal fitness and support those who want (need) to lose weight or quit smoking.  Plan group activities like hiking or cycling to combine fitness with team building.  Whatever you choose, make it fun.  For workers on the job, make sure that the workload is reasonable and that those who work extra hours to complete urgent projects are compensated with recovery time.
  • Provide meaning to the work that is done. Creating a sense that the work is important beyond the task at hand gives workers a sense of pride and builds a relationship with those who benefit from their work.  My grandson must let his employees know that they are not just printing, selling and shipping items to a client; they are providing an important product that will contribute to the success of the client’s business.  In the process, fulfilling each order in a timely manner will create trust and loyalty with the customer base. Trust and loyalty will create return clients and referrals. In healthcare we are not just performing a medical procedure; we are influencing and contributing to the health and welfare of the patient while earning the trust of the primary physician.
  • Create goals. While painting, my grandson was a chatterbox describing his goals for creating new designs, marketing, and production of products.  As a leader, he will regularly share his goals and work with his team of employees to achieve them.  Likewise, an engaged and innovative healthcare leader will move beyond streamlining today’s task and establish comprehensive goals that elevate the practice and better serve clients.
  • Set a positive tone. The leader sets the tone for the workplace and others reset their attitude accordingly.  How you act, react and interact with others establishes the norm for the expected behavior of the workers.  Be positive and let your attitude go viral through your team and the entire workplace.    
  • Nurture connections. One aspect of a highly desirable job is that individuals feel linked to one another and to the organization.   What may look like coffee talk to you may be two individuals bonding on a personal level and establishing a relationship that will lead to a highly productive synergy of effort.  Likewise, casual chatter with a client is the first step to a relationship that promotes a loyal customer base. 
  • Listen attentively. In a positive workplace culture, employees at every level of the chain of command feel as if their ideas are heard and respected.  Never blow off someone who wants to tell you something that is important to them; listen with the intent of understanding the message that is being sent.  To fully engage, move beyond being defensive while listening and instead of arguing with the speaker, ask questions until you fully understand what they are saying and why it is important.
  • Empower champions. Workplace champions are those who voluntarily grasp onto something that will improve the group and then work relentlessly until changes are made. When a worker has a creative, doable idea, put the person in charge and encourage others to support the initiative.  Encouraging a champion will improve and the loyalty of the person you empower and will support your goal of creating a positive workplace culture. 

Every team and workplace has its own unique personality.  Some workplace cultures are intentionally developed through the foresight and efforts of a leader, whereas others morph by default based on the whims of the most vocal team members.  Successfully creating a positive workplace culture begins with visualizing the desired outcome, hiring only those who share your vision, being a role model for the desired behavior, taking a personal interest in each team member, giving importance to the work and having zero tolerance for those who detract from the goal.  If my grandson remains true to his vision, there’s a good chance he will develop a dynamic business in which his employees and clients all feel welcome and well-served – a business they trust and a place they look forward to spending their time and dime.

Contact tom@procrna.com to book a speaking engagement.

Encore Symposium: Sedona 2019

post card 1

Meeting Date: November 4-7, 2019

Meeting location:  Hilton resort, Bell mountain, Sedona, AZ

Meeting sponsor: Encore Symposiums

Strengths of the meeting: 

Person #1  Very informative and I really liked the speakers.  Encore staff was very pleasant and helpful.  I would really recommend Encore for future CME.  Sedona was the perfect site; I really liked the outdoor activity and the perfect weather.

Person #2  Great location with lots of activities and perfect weather.  The speakers were top notch and presented a variety of topics.  The information from this meeting will help my case management and has also given me ideas for improving teamwork in our anesthesia group.

Person #3 regarding the CPC review:  I did the CPC Review and the Sedona Red Rock & Grand Canyon Program November 2-7. Sedona is an absolutely beautiful location for a fall conference. While I was there the weather was perfect….blue skies, upper 70’s. The Hilton Resort Sedona at Bell Rock is a beautiful and well kept resort. The Hilton staff were very helpful and accommodating. The meeting rooms were comfortable and spacious. Encore Symposiums provided a delicious breakfast with many choices each morning. The night before the seminars started there was a stargazing welcome reception. It was wonderful to have time to socialize with other CRNAs and their spouses. Nancy and her staff at Encore provide a professional and well run Symposium!!! The the topics were applicable and informative. The speakers were very knowledgable, friendly, approachable, interactive and presented their topics clearly. The CPC review was a well thought out review. Yes, I knew the majority of the information presented, but it never hurts to review the anesthesia information with the CPC examination happening in the next few years. I am looking forward to my next Encore Symposium Program!


Suggestions for improvement: 

Person #1  none

Person #2  I don’t have any suggestions for the meeting itself because it was excellent.  At a place like sedona I suggest offering a group hike or bike ride in the afternoon for those who are interested.

Value for the money:  

Person #1  excellent

Person #2  excellent

Workplace champions

champion post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

On the sports field, the champion walks away with the trophy; in the workplace, the champion scores high points for being the catalyst that converts an idea into the modus operandi.   When introducing a new protocol or implementing a policy change, having a champion who is all in for the change and works with personal passion can make the difference between success and failure.   The person who champions a cause is not always the designated leader, rather, he/she is a person who has a deep belief that the change is both necessary and possible to achieve.  In contrast, a change agent is a person hired to implement a new policy and often lacks the internal drive and commitment that is found in a champion.

Workplace Champion; a person who voluntarily takes extraordinary interest in the adoption, implementation and success of a cause, policy, project or product.  The person will force the idea through entrenched internal resistance and will evangelize it throughout the organization.

~businessdictionary.com

Speaking on the topic of implementing an opioid sparing anesthetic technique, Dr. Gary Brydges, former president of the AANA was asked what to do when resistance to change came from within the workgroup.  First among his recommendations was assuming the role of champion and then locating and teaming with a surgeon champion and a nurse champion.  Then, move forward as a team of champions to educate all stakeholders about the necessity for and the benefits of the change.

During my tenure as Chief CRNA at The Johns Hopkins, I witnessed first-hand the wisdom of Dr. Brydges’ recommendation to engage champions who are committed to implementing change.   The institution was entrusted to develop and implement an early recovery protocol for patients receiving bowel surgery; a plan that required a radical change to the usual perioperative flow, including the anesthetic technique.   To move the strategy forward, champions, including an anesthesiologist and a nurse anesthetist, joined surgery and nursing champions and formed a united front to overcome resistance and implement the new plan for bowel surgery patients.  Meetings were held, a protocol was developed, and champions from each area aggressively marketed the new plan to their respective groups.  The champions were essential and, with their dedication to the project, the protocol was successfully implemented.

In 1996 John Kotter introduced an eight-step model for implementing change and although he did not specifically use the word champion, several of the steps in his model describe actions that are commonly taken by those who are the driving force for change.   The Kotter model calls for the leader to create a sense of urgency, build a coalition of supporters, create and communicate a vision, and push for buy in from stakeholders…all actions commonly taken by a champion.

Building on the John Kotter’s recommendations, the University of Georgia published a white paper outlining the role of a change champion to include:

  • Streamline implementation/reduce complexity
  • Take ownership and build accountability
  • Enhance speed of project completion
  • Maximize productivity
  • Promote understanding
  • Advocate position change
  • Explain “what’s in it for me?”

So, you want to be a champion…

A key to job security and promotion is becoming the person that the workgroup can’t live without and being a driving force for change places you in the coveted position of being indispensable.  First and foremost, you must believe in the new protocol that you are striving to achieve and then actively work to develop the skills required to create momentum and achieve the goal.  Writing in People Development Magazine, author Julie Gordon lists the essential personal traits of a successful change champion:

  • Willingness to listen
  • Skilled at networking
  • Understanding of the workplace culture
  • Not afraid to take risks
  • Openly markets the positives
  • Solicits help from colleagues and other champions
  • Emotionally intelligent/sensitive to people needs
  • Openly supports the goal, quickly correct misinformation
  • Driven by the value of the change

Recognizing a need for change and having a desire for it to occur is not enough; follow these steps and become the workplace champion who elevates your team and organization.

Be knowledgeable.  Keep up with current best practice guidelines, attend meetings and communicate via social media with colleagues who have a professional practice like yours.  Recognize techniques that produce the best results and then review your current method looking for alterations that could be made in order to improve results.  In addition, keep a keen eye on the culture of your workplace and the receptiveness to change.  Finally, tie your proposed practice upgrade to the stated vision of the organization to increase the likelihood of buy-in from upper level management.

We can do better.  Always work with the mindset that there is room for improvement.   As a change champion, your belief in the new method must be apparent and contagious to those around you.   Be vocal in convincing others that there is a different method that will produce better results.

Team with another champion.   The ultimate outcome is often dependent upon the work done by many parallel workgroups with a common interest.   In the previous example from The Johns Hopkins, implementing an enhanced recovery program affected the workflow of the surgeon, pre and post-operative nursing and anesthesia.  Having champions from each area who were equally committed to achieving a positive result increased the likelihood for success.

Develop a plan.   Work collaboratively and develop a comprehensive plan that works best for all and explain the plan to your workgroup.  Remember, the best plan for your individual workgroup may not be the best for other stakeholders.

Market the change.   Here is where you must have superuser knowledge and exude passion to persuade colleagues that the change is essential.   The first pitch to the team will let them know about the project; however, the ongoing push over the next days, weeks and months will take the plan across the finish line.

“Change does not roll in on the wheels of inevitability, but comes through continuous struggle”

~ Martin Luther King Jr.

Change doesn’t happen in a vacuum, nor does it happen by default.   There must be an apparent need, a belief that it can/must occur, and an individual with the stamina to push the project forward.  The next time you think, “we ought to,” take the next step and commit to making the desired change happen.   Become the champion who looks back and says, “this is what we have done.”

Tom is a noted author, speaker, educator, and dedicated clinical anesthetist specializing in leadership development and team building.  Contact tom@prosynex.com to book a speaking engagement.

Discover the right job

right job post

By Thomas Davis, DANP, MAE, CRNA

follow @procrnatom on twitter

One of the most important aspects of rewarding and fulfilling employment is to find the right job; all too often people opt for a preferred location or higher paycheck only to find that they are in the wrong job.

At the August 2019 AANA annual congress, I presented a talk titled “How To Get The Right Job and Keep It” to a group of students who would soon be graduating and looking for employment.  For those who missed the original talk, here are the keys navigating the maze of potential employment opportunities and locating the job that is right for you.

Know what you want

Before finding the needle in the haystack, it’s important to know what the needle looks like and it’s helpful to know which pile of hay to search.  Likewise, you don’t want just any job; you want the right job and therefore you must know what you want before you can find it.  Day dreaming won’t get the job done so it’s important to create a written list of the essentials for the new job to include your preferred location, type of practice, and lifestyle essentials.  Also consider your personal values and the needs of those who are significant to you.  If there are any deal breakers, such as location or lifestyle essentials, add them to the written list.

Know the characteristics of an engaging workplace

Finding the right job begins finding the right group dynamic.  Many different workplace cultures exist, running the gamut from preferred to toxic.  An organized search will help you eliminate the bad teams and zero in on the good teams to consider.  Throughout the application/interview process, keep your radar active and learn all that you can about the following essential elements of a rewarding workplace.

  • Approachable leadership
  • Open communication
  • Honest feedback
  • Professional development
  • Collaborative teamwork
  • Alignment of personal and corporate values
  • Social interaction among staff

Know the leadership style of the boss

Working for the right boss will make or break your job experience.   The Harvard Business Review affirms the adage that is found throughout human relations literature; people don’t leave a job, they leave a boss.   Many leadership styles exist, and leaders often blend several styles into a format that works for them.   During the application/interview process it is your job to discover how he/she runs the team. and how it may potentially affect you.  In an ideal job, your boss will be:

  • Supportive
  • Understanding
  • Empowering
  • Respectful
  • Mentoring

Finding the needle in the haystack

After reviewing your written list of essentials and filtering the job boards, select several opportunities that look the most promising.  Go online and learn about the organization, then activate your network of colleagues to find someone with inside knowledge about the job.  A friend in the State association may be able to refer you to a current employee at that location.  Don’t be shy, be a detective and discover what others know about the job.

The job interview is your best opportunity to reveal the culture in the workplace and the leadership style of your next boss.  Unfortunately, applicants are often so focused on impressing the interviewer that they forget that the discussion is a two-way process.   At some point you will be asked whether you have questions about the job and that presents you with an opportunity to control the interview and gain insight about your next employer.  Candidates who are serious about the position will go armed with a list of written questions to help determine what goes on behind the scenes.   Your questions should be non-threatening and open-ended to encourage your future boss to talk…and divulge the true working conditions.  Try these questions to get started.

  • What are the most enjoyable aspects of the job?  This is non-threatening and gets the discussion going.   Empowering leaders will talk in terms of “we” and teamwork, whereas, authoritarian leaders will focus on “I” and tell you about their personal accomplishments. Caution; some leaders use we when they’re proud of something and they when they’re not.
  • What do your most successful people find satisfying about the job? This question opens the door for the leader to reveal his/her opinion about what makes a person successful.  Is the worker successful because he/she is collaborative or because orders are followed precisely?  Regardless, it provides a platform for the interviewer to list the positive aspects of the job.
  • How would your team describe your leadership style? Asking, “What is your leadership style?” is threatening.  “How would your team describe you?” is not.  It softens the question and opens the door for the boss to talk about his/her approach to leadership.  Tune in for key words that indicate collaboration versus heavy handed guidance.
  • What type of training/professional development do you offer? Even poorer jobs offer a little money and time for continuing education, whereas preferred workplaces offer ongoing mentoring and opportunities for employees to gain experience in new areas.  Spearheading a project or representing your team by participating in an interprofessional initiative are but two examples of leaders empowering team members.
  • Is there opportunity for promotion in this job? Authoritarian leaders are control freaks but empowering leaders constantly seek opportunities for rising stars to shine.  In preferred workplaces, the leader has team members in designated positions to share management tasks such as scheduling, education or inventory.
  • How would you describe the work culture here? As the leader answers, tune into verbiage that would indicate high stress, production pressure, or strict compliance to directions.  Do team members have each other’s backs, or do they independently follow regulations?
  • How are high achievers recognized and rewarded? This addresses the issue of fairness.  If everyone receives the same reward regardless of contribution, the incentive to excel is removed.  The question can also send the subliminal message that you anticipate being a high achiever.
  • What is the most important challenge that your team faces right now? This open-ended question could reveal deep seated problems with the institution, or it could give additional insight about the team culture.  If the interviewer skims over or downplays an issue, follow-up by asking, “Tell me more about…”
  • A year from now we are discussing my first year on the job and I exceeded your expectations. Describe behavior that made the year exceptional.   In order to answer the question, the leader must first imagine that you were hired and then did a superb job.  It is a strong subliminal message to plant and one that may work in your favor when hiring decisions are made.  Listen carefully to the answer because it will tell you about the behavior that the leader values the most.
  • May I tell you a little more about why I am attracted to this job? This is a polite way to get the interviewer to ask you to summarize your strengths as well as review how you are a perfect match for the job.   Rehearse your 2-minute pitch ahead of time and make sure to connect your strengths to specific points in the job description.  Give examples of how your personal values align with corporate values.   Caution:  If the interview is a bust and/or you don’t want the job, omit this question.

If you leave it to chance, it is likely that you will never find the needle in the haystack.  In my role as a hiring manager, I found that applicants who were organized, knew what they wanted and discovered that our group was a solid match for them turned out to be the best employees.   Arm yourself with a plan that starts with writing down the essentials of the new job then be a detective and discover all you can about the employer and the leader.  When it’s finally time for the job interview, enter with confidence and don’t leave until your questions are answered.  McJobs abound, even in healthcare; preferred jobs are hidden treasures that are reserved for those with the insight and tenacity to find them.

Note:  If you are the hiring manager, these are the criteria that the best prepared and most talented workers may be using when they assess your job opening.  Be ready for them.  Build a workplace culture in which empowered collaboration is the modus operandi and high-quality applicants will enthusiastically get in line.

Tom is a noted author, speaker, educator, and dedicated clinical anesthetist specializing in leadership development and team building.  Contact tom@prosynex.com to book a speaking engagement.

Feel the Burn

burnout post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

Last week a headline in the Linkedin daily update caught my eye; Millennials are experiencing job burnout at a high rate.  My initial gut response was; “Really? You are too young and it’s too early in your career to be burned out.”  When I stepped back and considered the topic, I realized that burnout is not tied to advanced age or a person’s position in the chain of command.  “The physical or mental collapse caused by overwork or stress” is the full-blown Webster definition of burnout, and it can happen to anyone at any stage of his/her career, including millennials.

 

I recall talented athletes from my youth with parents who thought that with a little more effort, their kid would be wearing Olympic Gold.   Even after Betsy upped her gymnastics practice to four times per week and Jason increased his swimming to two-a-days, neither made it to the Olympics.  Both young people longed for high school graduation, not for the diploma, but for the termination of the unreasonable expectations for achievement.  In short, what began as fun turned into a physical, mental obsession that took its toll and left both individuals flat, weary, and burned out.

 

Employee burnout is real, unrelated to age or years of experience and the affect can be devastating to both the employee and the employer.

 

Young workers are fresh out of college, excited to start a career and eager to pay off student debt.  Most intend to pull their weight on the team and want to earn respect for ability and tenacity.  What they find is a workplace that welcomes their enthusiasm by piling on the long hours, offering advancement by combining two jobs into one, and frequently offering inadequate support.  Many young workers are running out of the energy that got them hired in the first place.

 

 

 

Burnout arises from unrealistic expectations and can happen when production pressure becomes excessive.  Sometimes the burden is placed on the individual by the organization and other times the individual places unrealistic expectations on him/herself.  Either way, as the burden becomes unbearable, the victim breaks internally and does one or both of two things:   He/she pauses to refresh and/or moves on to a different job.  Writers at Workplace Strategies for Mental Health identify the following as personal perceptions or actual causes of professionals becoming burnout victims.

  • Expecting too much of themselves
  • Never feeling that their work is good enough
  • Frequently feeling inadequate or incompetent
  • Feeling unappreciated for their work efforts
  • Working in a role that is not a good fit

 

 

Pushing employees beyond their mental or physical limit has consequences.  In addition to fatigue, stress and anger/irritability, other health issues may develop.   For the employee, high blood pressure, heart disease and type 2 diabetes are correlated with burnout as well as alcohol and substance abuse.    Consequences for the employer include high employee turnover and the financial cost of filling vacant positions.  Overall, there is a loss of productivity and a general deterioration of morale among the work group.

 

Extinguishing burnout is a shared responsibility and there are actions that both the worker and the leader can take to cool the embers.

 

What the worker can do

Ultimately, it’s up to you to monitor your stress level and make changes before falling victim and externally acting out at work or internally developing a physical illness.  The Adult Health Department at the Mayo Clinic offers you these suggestions for assessment or prevention.

  • Evaluate your options both with your current job and finding a new employer.
  • Seek support from co-workers, friends, family or professional counselors.
  • Engage regularly in a relaxing activity such as yoga or meditation.
  • Exercise consistently to help you better deal with stress.
  • Value your sleep and let it restore your well-being.
  • Develop friendships with one or two colleagues at work.
  • Become mindful of your activity, energy, and feelings every moment.

 

 

Creating a culture of burnout is opposite of creating a culture of sustainable creativity…This mentality needs to be introduced as a leadership and performance-enhancing tool.

~Ariana Huffington

 

 

What the leader can do

There several behaviors that can be incorporated into your leadership style to take the fan off the flames and prevent the fire.  Combined, all will elevate team morale, boost productivity and improve employee retention.

  • Provide clear expectations and ensure that they are understood by workers.
  • Make sure that expectations are reasonable and align with priorities.
  • Furnish necessary resources including the training required to meet expectations.
  • Enforce fairness in reasonable work hours including sending people home on time.
  • When overtime can’t be avoided, mandate that those who work extra hours are given time off to recoup.
  • Utilize mentoring and professional development to create a sense of personal value for the worker.
  • Strongly encourage breaks at work away from the workplace.
  • Encourage friendships and social support among the group.
  • Provide a sense of purpose by linking employee tasks to the greater mission of the organization.
  • Encourage physical activity by planning stretch breaks at work, encouraging gym memberships, and arranging group activities away from work.
  • Encourage employees to use rather than save their vacation time.
  • Know your team and adjust your leadership to a style that fosters collaboration.

 

 

Employee burnout is a very real equal-opportunity threat.   Both the high school swimmer doing two a day workouts and an ICU nurse working 4 twelve-hour shifts per week (and being kept over at the end of the shift) can easily perceive that the work is never ending and whatever they do is not enough.  Whether it’s a monster workload, a paucity of resources, or sense of being overwhelmed and isolated, burnout is a constant threat best addressed by frontline leaders who are directly linked to the team.  Sometimes, the quick solution can be as simple as showing you care by providing resources and giving compliments where appropriate.  The long-term remedy, however, must involve an emphasis on physical and mental well-being while instilling a sense of purpose and worth in each worker.

 

 

What was once thought to be the consequence of being in a job too long is now known as a threat to workers at any age or stage of their career.  The cure for burnout starts with self-awareness within the employee and a commitment by leadership to create a climate where the workload is reasonable, resources are available, and employees gain a sense of self-worth from the work they accomplish.  Look beyond the crisis of the day and treat workers today in a manner that leaves them fulfilled and wanting to return tomorrow.

 

Tom is a noted author, speaker, leadership developer and dedicated clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

 

Artificial Intelligence; Be a Transformer

AI vs leader post

By Thomas Davis, DNAP, MAE, CRNA 

 

Follow @procrnatom on twitter

 

The exponential growth of AI (artificial intelligence) has proven that computer-driven software and robotic hardware are the future for business and industry, including healthcare.  Factoid:   People cost a lot of money and a growing number of jobs can be done better by computers or robots than by expensive humans.  Replacing us with AI is a no-brainer.   Writing in ddiworld.com, author Menggiao Liu, Ph.D. notes that by the end of 2020 five million jobs will be replaced by technology and that by 2055, fifty percent of workplace activities will be automated.  From trading online to driving driverless cars, to robotic assembly lines, the need for human decision-making and skilled labor is vanishing like a wave at high tide washing up on the beach.

 

Our healthcare industry has always considered itself immune from the threat of job loss due to technology; however, that will rapidly change over the next decade in a number of ways.  Much of it is already evident in the places you work. As scheduling becomes automated, fewer office staff will be needed to coordinate patient visits.  Electronic records that feed into the billing department will continue to reduce the need for medical coders.  AI analysis of patient records will detect changes in the patient’s condition early in the hospital stay and recommend treatment long before the person becomes seriously ill.  With AI driven protocols, the length of hospital stay will be shortened as will the need for nurses to staff the diminished patient load.  As AI proves its ability to read tissue slides and X-rays faster and more accurately than pathologists and radiologists can, fewer physicians in those specialties will be needed.  Even the field of anesthesia will be affected by technology as AI uses pharmacogenetics to prescribe and administer the perfect anesthetic based on the patient’s specific gene composition.

 

The transition from a human to a digital workforce raises the question,

“What happens to the leaders?”

 

Those who have an eye to the future believe that leadership will always be essential.   Traditional leaders focus on getting the team to do tasks that AI and robots will do in the future.    Leaders of the future will focus on connecting one on one with workers and forming an important bridge between those who directly serve the clients and upper level administration.   Moving into the technology-based future, traditional leadership will transform into a new style that welcomes and capitalizes on technology while maintaining a focus on the so-called “soft skills” that the computer lacks.

 

Technology, including AI, is here to stay and institutions are investing millions of dollars to position themselves ahead of the competition.  Employers expect their leaders at all levels embrace and utilize the new technology to the fullest extent of their capability.  Moving forward, it is essential to leverage the things that AI can do better than human workers.

 

What AI does best

Gather data   AI isn’t limited by the time and hassles of a manual literature or data search.  It can connect to every article ever written on a subject and collect large volumes of information in a short period of time.   Likewise, AI can filter information and gather data on a specific patient population or disease entity and sort data as directed.

Analyze data   In 2017, scientists at Mount Sinai trained AI computers by feeding 700,000 patient records into the system and then allowing the program to analyze and make conclusions.  They found that AI was very good at predicting disease including psychiatric disorders, in their patient population.   Similarly, the TREWS system at The Johns Hopkins uses AI in their ICU units to detect the earliest signs of sepsis, triggering treatment before the disease becomes life threatening.

Interpret results   Lab, X-ray and pathology findings have traditionally been reported as facts and reported as real numbers or descriptions. AI looks at slides and images, describes what is seen and then makes a diagnosis.  In addition, AI can look at trends and predict future diseases.

Recommend a course of action   Building upon interpreting results, AI takes the next step and recommends the treatment of choice based on best practice guidelines.

Implement a course of action   Depending upon the nature of the disease, AI can put recommendations into action by making follow-up appointments or scheduling future treatments with the proper specialists.

 

What Humans do best

Never fear.  R2D2 isn’t replacing you with its clever technical achievements, but you will have to compete to stay in the game.   Those who wish to emerge as the top leaders will need to focus on the human aspects of the job.  Leaders must demonstrate the instinct for what clients want from the organization and what workers need in order to ensure their continued engagement and loyalty.  Your job security will depend upon your skills in the following areas.

Emotional intelligence   As noted on Forbes.com by author Falon Fatemi, emotional intelligence starts with the ability to understand and control our own emotions followed by the ability to recognize, understand and influence the emotions of others.

Adaptability   Computers are programmed, whereas, people can sense their environment and the reactions of those around them.  As we are bombarded with fresh information, leaders must be able to capitalize on opportunities and learn from mistakes.  Being willing and able to change course based on new data will be a valuable strength.

Vision   As new technologies are developed in a parallel fashion, lasting leaders will be able to assess many different platforms and establish a vision that combines several modalities; and they will do so in a manner that best meets the expectations of the client base.  Mission statements will be revised to address needs as seen through the eyes of the consumer.

Professional development    A database can store information related to continuing education, but it takes one on one interaction with a worker to learn what is important to him/her and develop a plan for personal growth.  People mentor people and AI will have difficulty functioning as a counselor or a coach.

Humility AI is what it is; highly intelligent but programmed, sterile and lacking emotion.   Admitting errors and admitting that others may know more than you do about a specific issue introduces a human emotion that computers can’t match in the high-tech workplace.

Feedback    Computers spit out numbers and report discrepancies but lack the ability to determine the cause for non-compliance or help an individual chart a course to correct a problem.  When it’s time for the boss to have a difficult conversation with an employee, human interaction is essential.

 

The workplace of the future will be rich with technology and have instant access to large volumes of information.  Algorithms will quickly assess data and either suggest or implement an appropriate action.  Many of the hands-on tasks that were historically done by workers, such as scheduling appointments, billing for services, or ordering supplies will be automatically done by computers.  As the nature of the work shifts, so will the role of the leader.  Rather than competing with AI, a Transformer will focus on the elements of leadership that that a bot cannot; understanding, motivating and connecting with clients and workers.

 

Tom is an experienced leader, author and requested speaker. 

Contact Tom for an appearance at your next meeting.

Visionary innovation

visionary intelligence post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Visionary leaders are hot commodity.  How can you go wrong with a leader who can see into the future and position an organization to stay one step ahead of the competition?

In 1995, Jeff Bezos saw the potential of the internet marketplace and visualized a virtual bookstore that would be open 24/7 and could deliver reading material either in print or online with the click of a mouse.  Naming the company after the famous South American river, Amazon books was established and rolled out from the founder’s garage in Seattle.  The Bezos vision expanded via the kindle reader eventually developing into the shopping market that we know today as amazon.com.

The creator of Amazon was not lucky nor was he unique.  There are other leaders in business and industry, including healthcare, who share the traits of a forward-thinking individual.  In working to build a better future for the clients they serve and for themselves, the more successful leaders are able to strike a balance between creative thought and observable action.  They listen keenly to clients and co-workers and use emotional intelligence to learn what people really want.  They establish a desired end point, formulate a plan, and work relentlessly until the goal is achieved.  They favor innovation, accept responsibility, and regard a setback as a learning experience.  “…glad we don’t have to do that again.”  In some cases, new technology must be created to address a need but at other times the leader with an eye to the future finds new applications for existing technology.  Bezos did not invent the internet or the bookstore; however, he did foresee that readers would flock to the convenience of online access to any book in print with immediate delivery to a mobile device.

 

CRNA inventor

Diane Miller is a pediatric CRNA and inventor whose life was changed by her inner drive to develop a playful way to initiate general anesthesia for pediatric patients.  Motivated by an experience inducing anesthesia on Zeke, a 4-year old “frequent flyer” with PTSD from previous anesthetic inductions, Diane felt compelled to develop a lighthearted induction technique.  Rejecting the decades-old tradition of “cyclo-brutane” used on fighting children, Diane developed the Pedia device for induction of anesthesia.  Widely accepted by young children, it resembles a balloon with a whistle and makes induction of anesthesia entertaining for the pediatric population.  Pedia has been awarded a patent and has been cleared by the FDA.  The Pedia device is a game changer for pediatric induction of anesthesia and I predict it will quickly become the standard for our industry.

Diane’s story and device are featured on the pedia web site

 

Point of care ultrasound

Ultrasound imaging can identify the gender of an unborn child, determine the size and shape of a tumor or locate nerves prior to placing regional anesthesia.  However, the device comes in size extra-large and it frequently isn’t available where the patient is located.  These handicaps opened the door for Dr. Jonathan Rothberg to introduce an ultrasound system that did not require transport of a cumbersome machine to the patient’s bedside.   Rothberg selected a team with whom he shared his vision and together they worked tirelessly to create the butterfly point of care ultrasound device.  The device uses a standard sized ultrasound probe with quartz crystals and, uniquely, connects to a smart phone, pad or other mobile device to display the image.  The probe can be carried in a holder on the individual’s belt and literally anyone with a modern phone can keep a personal ultrasound system at their fingertips round the clock.

You don’t have to be an inventor to foresee uses for existing technology as evidenced by anesthesia leaders who have quickly adopted the butterfly system to enable immediate ultrasound images of their patients.  In addition to the obvious use of facilitating nerve blocks, the system is being used to assess gastric volume, vascular access, ventricular movement, pulmonary fluids, bladder retention or other conditions where an image could alter the anesthetic plan.  Those boarding the butterfly bandwagon appreciate the flexibility that comes with having immediate access to ultrasound images and forecast improved patient outcomes due to information gained by this creative device.

More information can be found on the butterfly web site.

 

Some think of visionaries as having a crystal ball while others picture the mad scientist busy inventing things in the workshop.  Although there may be a touch of truth to each stereotype, the truth is that most visionaries are ordinary people visualizing extraordinary things in order to solve both ordinary and extraordinary problems.  Their mantra is, “We can do better!” and their work ethic is indefatigable.  Sometimes, a new product will emerge, and other times new uses will be found for existing technology.  Jeff Bezos developed an online marketing system that has changed the world economy; Diane Miller developed a playful way to induce pediatric anesthesia, and Dr. Jonathan Rothberg put real time ultrasound imaging into the hands of every healthcare worker.  Now it’s your turn.  Use your visionary skills to discover resourceful ways for making the new technology a standard of care in the workplace.   Identify a need, imagine the best possible outcome, develop steps to get there, communicate your plan and work relentlessly until your goal has been achieved.  When the new standard has been set, you will join the ranks of visionary leaders.

Tom is a noted author, speaker, leadership developer and dedicated clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Goal for the Gold

boys in the boat post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

The Boys in the Boat by Daniel James Brown (pub. 2013) is a true story of nine, rugged college age boys who united as a formidable rowing team during The Great Depression and became destined for glory.  From earning a spot on the team, to winning the collegiate championship to bringing home the gold from the 1936 Olympic games, this non-fiction best seller, released in June, 2013, continues to keep readers on the edge through the final stroke.  Simultaneously, heart-rending and poignant, heart-pumping and uplifting, this book is packed with valuable lessons for leaders and life, and proves that striking gold is more than a stroke of luck. Put “The Boys In The Boat” on your must-read leadership list and look for the following lessons as you enjoy the journey to Berlin.

 

Select the right people

(STORY) Refusing to succumb to the distraction of The Great Depression, University of Washington Coach Ulbrickson, maintained his ‘vision with a plan’ for winning a national rowing championship, a plan that started with selecting the right people.  From the pool of able-bodied young men who hoped that rowing would provide a scholarship to help pay for their educations, the coach carefully selected a crew that had physical size, cardiovascular stamina and mental grit.  Throughout the trial period, the coach had a keen eye out for those with a focus on teamwork.

(LESSON) Likewise, in the modern workplace, selecting the right team is the first step toward success. Along with having the proper credentials, each new hire must have a solid, proven work ethic with a focus on teamwork.  To go beyond learning about the person’s clinical skills, talk personally to the applicant’s references; ask questions that validate a work history of collaborative teamwork.  During the interview, clearly share your vision with the applicant so you can determine whether he/she is in alignment with your goals.  It’s always preferable to fill the empty seat on the boat with someone who rows in sync.

 

Establish a goal

(STORY)  Coach Ulbrickson was not shy about sharing his determination to form the right team, substituting or eliminating rowers, then training them to work as one to win the national championship.  Everything he did in his personal and professional life supported this goal and drove his thoughts and activities 24/7. He had neither time nor patience for distractions. 

(LESSON) The best leaders and most productive teams have a committed goal.  Sometimes it’s specific to the workgroup and other times it’s an organizational goal. For example, a healthcare team was having trouble hiring and retaining qualified people until the leader set a team goal ‘to be the employer of choice for nurses in that region.’  She gathered her team and they defined what a preferred workplace would look like; then the team committed to building such a place.  The culture changed, within 18 months there were more applicants than openings, and the leader’s vision was fulfilled.   Having, sharing and working for a goal can turn your team around as it gives them something to look forward to achieving.  Taking a line from the song happy talk, “If you don’t have a dream, how ya gonna make your dream come true?”

 

 

Train incrementally with a purpose

 (STORY)  The varsity crew members were not selected so they could sit in a gondola with a girlfriend; they were each placed on a coveted seat labeled “perform or lose your position.”  The coach established a purpose for every workout and made certain the proper equipment was available.  In return, each person was expected to be all-in every day working in common.  As they trained together, the team became inter-dependent and trusted that each man in the boat was giving 100% every day.

(LESSON) The best leaders are coaches who set high expectations, provide the resources and insist on trained teamwork.  They educate the team to align with the stated mission, vision and values and instill a confidence in the group that they can use collectively to handle day-to-day adversity. Those who lead and those who work in preferred workplaces have coveted jobs that come with expectations that must be met on a daily basis.  Purposeful training provides the team and team leader with two-way protection.

 

Embrace adversity

(STORY)  Neither the coach nor the aspiring oarsmen could have predicted the depression of the 1930s, nor its depth and duration.  Neither could the team foresee the unfair treatment that it would receive from the home team Germans after earning a spot in the 1936 Olympic championship race.  Hitler’s control of the Berlin Olympics enabled race organizers to place the American boys in the least favorable lane, created issues and events totally beyond UW’s control and could have justified abandoning the vision altogether; however, this remarkable team took adversity in stride, did everything they could with what they had, and discovered that overcoming layers of obstacles made them even stronger.

(LESSON) The modern workplace is a hectic place and the fight for resources today can feel as challenging as finding a hot meal in the 1930s. But, those who stay focused will survive the hard times and come out stronger, more determined to achieve success.  While always ensuring that goals are known and people are trained to do their jobs, great leaders empower the team to create viable solutions for overcoming obstacles.  Each problem you solve together positions your team to handle the next challenge.

 

Build and leverage trust

(STORY)  In the book, the coach built trust through physical conditioning of the oarsmen and teaching strategy to the coxswain or navigator.  The team started each race with a general plan delivered by the coach, but it was up to the navigator to read the field and make appropriate adjustments.  The coach trusted the judgement of the coxswain as did the muscle movers powering the oars.

(LESSON) The same philosophy applies in the workplace when the leader develops trusted relationships with the team, then steps back and allows the team to read the field, apply principles and make independent decisions.  Avoiding micromanaging and encouraging creative thinking shows that you trust your team.  A sure-fire way to ensure that your team performs at a high level when you’re away is to give them the latitude to make decisions while you’re there.

 

And there you have it.  A captivating real-life story about a group of determined young athletes who conquered adversity, earned victory, and left lessons in their wake that remain meaningful over eighty years later.  High quality work teams share the principles that brought victory to the University of Washington varsity rowing team in 1936.  Today, either through intent or serendipity, leaders are selective in the talent they recruit, the goals they set and the latitude they give to those whom they trust. And teammates are looking for preferred workplaces managed by talented leadership. Get on the varsity team then grab an oar and hop on board with a goal for the gold.

 

 

Tom is a noted author, requested speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Encore Cliff House Resort, Maine

Cliff House Final post

Meeting Date: September, 2019

Meeting location:  Cliff House Resort, Cape Neddick, ME

Meeting sponsor: Encore Symposiums

Strengths of the meeting: 

Person #1  Location is unsurpassed on beauty.  Speakers were varied in style and were all able to hold my attention.  They used research based evidence.  I apprecate the thumb drive that contains the lectures and cited research studies.  It also included the practice CPC questions for the pharmacology portion.  It was a relaxed environment with a full breakfast every morning.

Person #2 I really enjoyed the entire conference! I have not attended a conference that had such a nice “Meet and Greet” before the week began. Crabcake and duck sliders?! Yum! But, the sole purpose for going was to attend a conference and get up to date information. Which, I did! I will say that 90% of the lectures were very informative, current, and thought provoking. The 10% would really only be related to hearing about the anesthetic implications of an E.X.I.T. procedure, which I hope to never do. It was interesting, but, it didn’t update me on current topics that are relevant to my practice. There were many lectures that truly refreshed old knowledge – who thinks about the intricacies of the uptake and distribution of volatile anesthetics on a regular basis? The Post-Operative Cognitive Dysfunction lecture hit home as I’ve seen it personally. I literally texted my co-workers at our rural hospital every day of the conference to plant seeds in their heads as to how we can improve our practice.


Suggestions for improvement: 

Person #1 The 7am start was a bit early for me, I would prefer 8am.  Without the bonus credit we would still be done by 1:15.  The hotel and Ogunquit were extremely expensive so I wouldn’t attend there again unless I stayed in a neighboring town which would make the 7am start even more of an issue.

Person #2  Just change a couple of the lectures to more current topics – perhaps more opioid free anesthesia information? “Cocktails” to utilize as we trend even further away from opioids? Even more ERAS protocols?

Note from Encore:  Thank you taking the time to share your positive comments and suggestions.  Encore offers a flexible schedule for those who want to begin early and end early and the option to stay later to earn bonus credits.  The 7:00 a.m. scheduled was requested from the majority of CRNAs who prefer an early start to earn more credits or exit early to enjoy the area.Response from Encore Symposiums:

*Note from editor:  The schedule for this meeting and all Encore meetings are posted online and include the 7am start time in the morning.  Likewise, the cost for accommodations is known prior to registering for the meeting.

Value for the money:  

Person #1  Seven of ten only because of the cost of accommodations.

Person #2  I know people complained about the cost of lodging, however, it was worth it! I don’t go to conferences every year so saving my CE money from last year and using that to offset the cost of the lodging was a bonus! Pictures don’t do this place justice.

Testamonial submission from attendee: 

Hi Nancy, Well, you did it again. This was my 6th Encore Symposium and every one has been at a great location. I do have to say that Maine was such a delight and has moved into first place for me. I loved the weather, scenery and the peaceful sounds of the ocean. What a perfect backdrop to hear spectacular speakers who had a wealth of knowledge and information. Love the balance of both Pediatric and Adult focused lectures. Looking forward to my next Encore experience. Thank you for what you do to make these meetings so enjoyable!!! – New England at the Cliff House 2019, Cape Neddick, ME

Speak easy; The art of overcoming glitches

speak easy post

 

By Thomas Davis, DNAP, MAE, CRNA

Lt. Col (ret) USAF

Follow @procrnatom on twitter

Recently I was scheduled to be the last faculty speaker on the final day of meetings at Encore Symposiums.  Attendees had various reasons for checking out ahead of my presentation – prior engagements and airline connections among them – but having spoken to this group for several other sessions throughout the weeklong meeting, I felt entirely comfortable with this schedule. Practically speaking, I anticipated an audience somewhat diminished in size and just hoped Leonard’s joke would not materialize.

 

Leonard’s joke:

After the morning coffee break on the last day of the meeting, there were two talks left before the meeting adjourned.  In the meeting room were the speaker and only one other person.  The speaker suggested sitting together at a table and going through the slide set.   The other person replied, “I don’t care what you do, I’m the last speaker.”

 

 

If you’re a healthcare speaker, or a public speaker in any industry, no matter how well prepare you are, the potential for glitches is ever present.  It’s your job as the leader of that moment to “speak easy.”

 

Recover Fast

In mid-September, our local Frederick Art Club, featured the well published women’s rights advocate, Edith Mayo, Curator Emeritus of The Smithsonian to speak to its membership. In anticipation, twenty additional guests were invited to join the audience at a luncheon enhanced by several displays by the iconic clothing designer, Claire McCardell.  This was a “not-to-be-missed” presentation.  According to attendees, Edie introduced herself and quickly announced without apology that her computerized presentation materials had not arrived, and she would be relying on her slides and an old-fashioned, borrowed projector. Without any further mention, Ms. Mayo reportedly immediately launched her spiel while the enhanced audience ate their meal.  Edith gave the audience of art lovers a lot to remember and only a little to forget.  At dinner that evening my wife gave the glitch a scant dishonorable mention, then talked about the pics that had been shown, the new museum being built and other interesting tidbits.

If your props or materials do not arrive, if the sound system fails, or even if the dog ate the homework, recover fast; think on your feet and do what you have to do to move forward, acknowledge the road hazard only if necessary and then get on with it. That’s leadership and leadership makes it look easy.

 

Tough Love

What do you do if it’s a tough audience?  The best advice is to prepare the fall-out shelter.  In addition to knowing your stuff and using cutting edge material, be there ahead of your scheduled appearance long enough to sit in on other speakers with the same audience.  Get a feel for them. What makes the audience laugh, what annoys or bores them, are they text savvy, senior workers, foodies? Where are they from, why are they there, how are they dressed, is the sunny or gloomy weather affecting their attention or attendance? If you can’t be there early or if “sitting in” doesn’t apply or isn’t appropriate, get the answers from others.  As a last resort, be a politician and ask the audience.  “Good evening O-kla-ho—ma-how-are-you?!”  Whatever you do, do not tell these pay-on-demand customers they’re a tough nut to crack. Along with disrespecting your whine, chances are they can get tougher after that. They can walk out.

 

Shift Gears

Nancy LaBrie, founder and owner of Encore Symposiums tells the story of the group of attendees and faculty whose driver delivered them to the Pier AFTER the cruise ship had sailed. Oops! The creative faculty made a seamless transition into delivering their presentations for two hours – outside, – while the ship returned to retrieve them.  The speakers became the Captains of the situation with a truly captive audience! A solid optimistic leader can almost always pull up, even if your ship has sailed.

 

L.O.L

Speakership is leadership and if you intend to make public speaking part of your professional profile, you must handle glitches, tough audiences, unwelcoming venues or schedules along with all other unforeseen events, as part of the routine, with professional grace and aplomb. Indeed, a little humor could be called for.  My wife loves to tell about the wide-girthed MS Vocal Mus Ed candidate back in the day.  The singer, whose half-slip fell to the floor during her graduate performance of O Mio Bambino Caro, kicked it to the side of the grand piano while completing the aria to the roaring applause of the audience. Grace.  Aplomb.  It’s not the glitch you want the audience to remember; it’s the way you handle it.

My last two Encore presentations during the last two hours of an intense four-day schedule went very well. I could have encouraged the down-sized group to gather closer to the podium, but instead I walked out into the group, avoiding reliance on notes and focusing on the individuals in attendance. We communicated interactively with a professional phone texting activity. It was fun, it was professional, they stayed, and the speaking was easy.

Tom is an experienced leader, author and requested speaker.  Contact Tom for an appearance at your next meeting.

Your Professional Meeting: Plan the Adventure

meeting post

By Thomas Davis, Lt. Col. (Ret.) CRNA, MAE, DNAP

 follow@procrnatom on twitter

Professional meetings are a golden opportunity to socialize and expand your network of colleagues while updating your knowledge and skills.  Originally published in 2018, this article has been updated to provide a roadmap for getting the greatest personal benefit from attending a state or national meeting.

 

If you’re one of those thousands of dedicated workers who’ve survived the intense summer heat, enjoyed and endured the daily demands of children on break and dutifully covered many extra shifts for your vacationing colleagues, it’s your turn to take a break.  Attending your fall state or national meeting enables you to combine business with pleasure while renewing old friendships and making new ones.  More importantly, planning for an upcoming meeting, places you in an advantageous position to learn more, to expand your network and to get optimal enjoyment during your post summer escape from the daily grind.

 

Organize

Prior to departure, spend some time on a google search. You can select the meeting based on location, content, name-brand speakers or proximity and ease of travel, but during or after selection, do a google search.  Activities in the area such as hiking, biking or walking may be appealing as well as dining, shopping or shows.  Tours, walking, biking or by bus, are typically plentiful at destination locations, and attending sporting events or meeting at a sports bar may be the perfect venue for renewing friendships with classmates. Every community is unique and history buffs, amateur archaeologists and birdwatchers may all discover something of interest in their pre-travel search.  If you’re including your family as part of a business vacation, be sure to include their interests in your google.  Whatever your pleasure, it has become incredibly simply to research and reserve the activities that will make the memory of your experience more than a blip on the radar.

 

Note:  Well before the flight, confirm your hotel and reserve transportation for arrival at and departure from the destination airport; review the meeting agenda and download the meeting app if there is one.  During flight, spend your time reviewing information regarding the meeting and local community to ensure that you take full advantage of both.

 

 

Some attendees are sponsored by employers and are required to submit documents for reimbursement while others pay out of pocket and need documents to claim a tax deduction.  Either way, “travel-by-tech” allows you to submit documents seamlessly.  Here are some tech tips for organizing your travel.

  • Use your phone to organize travel information that you will want at hand. Upload flight information and boarding passes as well as the airline’s customer service phone number. Using the note pad app, store the address and phone number of the hotel where you will be staying to simplify the process when Uber arrives.
  • Use your computer to set up a folder in the document section specifically for the meeting. The folder can have sub-folders for travel, lodging and daily expenses and for personal expenditure.  When you book your flight and hotel, immediately drop receipts in the folder.   At the hotel check-out, request an email receipt and when it arrives, save it in your meeting folder.  Excel has several pre-made templates for spreadsheets to collect travel expenses such as meals or Uber fare; download and use them to simplify the tracking of reimbursable expenses.   I find it useful to create a word document that highlights flight, hotel and rental car information and then email the document to myself so that it is easily retrievable on my phone as I travel.
  • Stay current Functionality of our devices, especially phones, is developing and advancing almost daily. Yesterday it was email driven but today its app driven, and new phones and function are introduced annually. Stay ahead of the curve and don’t hesitate to try new and useful concepts.

 

Socialize   

Your professional meeting offers the gratification of renewing acquaintances with former classmates and coworkers along with the networking opportunity to meet national leaders and those who are recognized in education, innovation or leadership.  Your physical presence at a meeting makes it possible to match faces with names and achievements, as well as providing fertile ground for expanding your network of peers.  Be social at gatherings, extend a hand to the leaders of the organization and open yourself to the concept of connecting with new people who may add depth to your network.  Securing their information gives you more certainty that follow-up will take place.

Members of many professional organizations have created user groups on social media.  If you belong to an online community, consider scheduling and posting a user group meet-up to interact with one another during your educational excursion.

 

Customize

Although there’s social value in “Hello” and a handshake, the real value of networking is in establishing a conduit for connection in the future.  For starters, have business cards readily available.   To avoid packing a stash of newly acquired cards, create a business card photo album on your phone.  Once you’re back in your hotel room each day, take a snapshot of each business card you wish to keep and save them in your card photo album.  To by-pass using business cards, simplify and facilitate the smooth sharing of contact information by adding yourself as a contact on your phone and then quickly exchange information by sending your contact information directly to those whom you meet.  Remember, securing contact information gives both of you and your colleague more certainty that follow-up will take place.

 

Optimize   

Prior to the meeting highlight the sessions that are most appealing and seem most beneficial based on your personal interests and educational needs.  When two concurrent sessions capture your interest, enlist a friend to attend one talk while you attend the other, then share notes by phone call, phone mail, phone text or over a drink at dinner.

Scan the meeting room and try to sit with new acquaintances you have just added to your network. Getting out of your comfort zone adds to your confidence and satisfaction and enhances the stories you can tell when you return to work.  Everyone has worked with, gone to school with or served in the Military or on a committee with someone who turns up at a meeting.  Plan to enjoy the adventure and become part of the connection.

Optimize the time you spend with vendors by first assessing your department’s greatest needs for equipment before you travel then seeking out vendors with products that coincide with need.  The larger the meeting, the more eager vendors will be to introduce innovative equipment and updates to existing devices. Sign up for samples and demonstrations and if you discover a must-have, collect vendor contact and follow-up quickly after the meeting.

 

Summary

Whether your autumn plans include a national meeting, a state gathering or both, your return on investment will be enhanced by pre-planning.  Beyond earning continuing education credit, a live meeting provides a wealth of opportunities to connect and grow professionally, and to have a great time doing it.

 

Tom is a noted author, motivational speaker, superior leadership developer and dedicated clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Be a social (media) climber

social media climber post

 

By Thomas Davis, CRNA, MAE, DNAP candidate

 

Work completed for my DNAP degree and conversations with colleagues has taught me that just about everybody knows what social media is, and that many people use it in one form or another to socialize with friends, family or colleagues.   What many people fail to appreciate is that social media is a powerful tool that can either enhance or kill your career.  Leveraging the power of social media will position you to be recognized, rewarded and promoted within your profession.

 

Advancing professionally in all industry requires that you are known and respected by your peers for the quality of your talents and interests.  Marketing is essential for the success of any venture and social media is a great launching pad for gaining recognition.  Careerbuilder.com notes that over 50% of employers use social media to recruit the best talent, and that of those entities seeking highly qualified workers, 35% will not offer an interview to a person who has no online presence.  To sell yourself locally and globally, it is critical to be seen online consistently creating a positive professional and social image.  

 

Build your online image

The first step in building your image is discovery and damage control.  Even if you have never used social media or posted a comment online, you may appear online linked to your profession, employer or social group.  Begin by searching yourself on google and click on any link that is connected to you.  If you like what you see, update the content and make sure that others can find it easily by doing little things to ensure that the information is linked to you.  Tom S Davis immediately pops up as CRNA while Tom Davis labels me as a former University of Iowa basketball coach!  Even small changes like adding a middle initial to a common name will help direct readers and save time.  After viewing what others see, take note of anything that is not flattering.  If you don’t like what you see, rebuild or clean up all unflattering content. If you posted a blog years ago that is embarrassing to you or anyone else, take it down. If you posted a less than professional picture or used offensive language, delete it.  A selfie from the college kegger will not score points when viewed by a potential employer.  If some other entity controls the material you have previously posted, contact them and ask that the outdated material be removed. Your profile must be spic and span clean and professional.

After the D&D is complete, continue the rebuilding by making sure that current professional postings are easily linked to you.  If you have completed a degree, published an article, or have recent pictures from a professional meeting, make sure they appear online and are linked to your name. Recognizing the achievement of others, garners their appreciation, elevates both of you in the online community and raises the level of activity on your own site.

 

Use multiple platforms

Because there is not a single best platform for creating a professional image online, gaining exposure requires that you appear on multiple platforms.  Start by opening three essential accounts and update them frequently.  Give time and attention to completing the profile information when establishing an account.

Twitter.  Due to the 280-character limit on Twitter, tweets (posts) are short and to the point.  Open an account, let colleagues know your username, and always being positive and professional when you tweet.  You will earn a reputation for being a “thought leader” by posting URLs for articles that inspire colleagues and elevate your profession.  Be sure to follow other leaders in your profession and “like” or “retweet” as the case may be.

 

Facebook/Linkedin.  Originally, Facebook was designed as a social site and LinkedIn was viewed as a Facebook for professionals.  Both now have user groups specific to just about any profession.  Create an account on each platform and join at least one user group related to your profession. Read what others are posting, comment where appropriate, and when you gain a little comfort and courage, start posting original topics.

 

Professional site.  Many professional organizations have online discussion boards where members of the vocation can share thoughts and debate issues.  For nurse anesthetists, the AANA connect forum is an excellent place to interact with colleagues.

 

Social media is meant to be interactive, so don’t hesitate to add material or continue conversations. As you read other’s comments, your interest may be piqued and your intellect challenged, and you may wish to join the conversation to expand the topic and share your thoughts with the online community.  Regardless of the breadth of your interaction, sometimes all you need to do is like another person’s comments and your name will be linked to the discussion thread.

 

Tips for posting on social media

Update your profile.   Social media sites encourage you to create a personal profile and as you gain followers, your profile becomes your identity.  Post a professional picture, accurate contact information and links to professional work that you have accomplished.  You are creating an online identity so use your real name and get full credit for your contributions to the cyber world.

Be authentic.  Online scholarly articles are not in short supply.  Social media is your opportunity to show colleagues that you are informed in a less academic way.  Be yourself and have a short conversation with your readers, leaving the lectures for the classroom.   If your natural self tends to be academic, work on altering your language enough to sound relaxed and to be engaging.

Set the tone.  Emotional intelligence is a current buzzword and a concept that encourages readers to look beyond the words and sense the emotion tied to the topic.  As you post online, avoid sounding authoritative, dogmatic or robotic.  You are a professional responding in a social climate so choose positive, empowering words with an optimistic tone, even when you’re addressing an industry problem or potentially heated topic.

Involve other posts.  Jumping in to contribute to an ongoing discussion thread, or to comment on a blog post, creates an online presence.  If you don’t have time to develop and post an original topic, make a quick remark or give a thumbs up to something that a colleague has posted.

Stay out of a rut.  Always talking about the same topic is about as exciting as repainting the fence every weekend.   Social media is fast paced and redundancy is guaranteed to turn off and turn away your readers.  Likewise, always talking about yourself, or never talking about yourself, lowers reader regard and should be avoided.  It’s okay to share your personal experience when it’s clearly appropriate to the conversation, but don’t be a prima donna (or primo uomo)  by making yourself the focus of your social media post.

Don’t shoot yourself in the foot.  What you post is out there for everyone in the world to see, including your colleagues and potentially, your next employer.  Keep it professional and avoid trigger topics such as politics, religion or alternative lifestyles.  Your readers have their opinions and you are unlikely to change any minds; however, you will be forever linked to dogmatic rhetoric.  Never forget, bashing or otherwise bad-mouthing individuals whether they are coworkers, political figures or competitors of any kind (and whether or not you refer to them by name), is unprofessional, unbecoming behavior.  Stay about of the mud and be squeaky clean.

 

Having a dynamic online presence does not guarantee employment, promotion or popularity; however, you are invisible without it.  Social media offers many interactive platforms that enable you to create or reinvent a public identity as you connect with colleagues and promote your profession.  If you have earned an advanced degree, achieved professional certification and been granted a license to practice, shine a light on yourself by joining the Global Country Club.  As card-carrying, informed and connected member, you can tweet, blog, post online and harvest the rewards.

 

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Non-disruptive by design

Disruption post

Thomas Davis, CRNA, MAE, DNAP candidate

follow@procrnatom on twitter

Disruptive behavior cuts a wide swath in the workplace and, left unchecked, it will kill the morale and productivity of a team.  Conduct that is viewed to be disruptive runs a spectrum from minor sarcastic comments to full-blown toxicity of a colleague whose ability to put a negative spin on just about anything is worthy of an Oscar.  A working definition of disruptive behavior is:  Any ongoing personal conduct that disturbs the work environment.  Lainie Peterson, contributing author to Chron, notes that “disruptive behavior kills group morale, drops team productivity, increases workplace stress, increases employee turnover and creates a negative reputation for the employer.”  The effects of disruptive behavior are potentially pervasive, and leaders have a vested interest in drawing a red line.

“An ounce of prevention is worth a pound of cure.”

~Ben Franklin

 

 “Stay Out of Trouble…”

My mother liked to address my youthful indiscretions by saying, “It’s easier to stay out of trouble than to get out of trouble.”  In the workplace, those words of wisdom support the proactive approach of developing a system that attracts and hires workers who value collaboration and congeniality, rather than one that tolerates malignant behavior.

Recruiting.  You are not seeking a warm body to fill a position with your group, you want the right person.  Make sure that your job description touts collaborative teamwork that adheres to the mission, vision and values of the organization.  Use the JD to let applicants know not only what you want them to do, but also how you want them to do it. Making supportive teamwork a job requirement, puts you on solid ground should the need arise to address poor conduct of an employee in the future.

Hiring   Determining the right person for a job must include an interview format that includes a two-way dialogue about job expectations.  An interview technique that I have found to be particularly revealing is to provide the applicant with a list of the organization’s core values and discuss them during the interview.  Conclude the interview by saying, “if these values are not who you are, this is not your job.”  By discussing teamwork and values at interview, you further establish a solid foundation for addressing disruptive behavior should it arise.

Feedback   Schedule a one on one discussion with each new hire at the end of each of the first six months of their employment.  Each month, review the values that were discussed at interview and ask the person to relate their daily work to the organization’s values.  If negative feedback about the person’s behavior has been put forward by co-workers, give the employee a wide berth to answer to the accusations followed by a frank two-way discussion to clarify expectations.  After reinforcing your anticipation of supportive teamwork, ask for a re-commitment to the shared values of the group.

Teamwork.  Those who are already on the team deserve the same opportunity to discuss team values that you had with the job applicant.  Dedicate a team meeting to conversation about the core values of the organization and open the floor for your team members to identify behavior that would support the values.  Decisively tell the team, just as you did the applicant, “if these values do not represent who you are, this is not the right job for you.”

 “Get Out of Trouble.”

If hire-prevention hasn’t kept a bad actor from slipping into the ranks and general morale is suffering, it’s time to roll out the fire-hose.

Look for the cause.  Before you pull out the big guns and start firing, look for the cause of the disruptive behavior.  The person may be suffering unusual stress from satisfying the needs of a sick child or an infirmed elderly parent, or the worker may be experiencing critical financial woes causing internal stress that has been allowed to affect their external behavior.  Counsel your team member and look for options such as flexible work scheduling, or a leave of absence, to enable the person’s resolution of issues.

Give direct feedback.  Workers who disrupt the workplace by lack of personal restraint must be given a clear description of the problems they have created. Again, meet privately with the offender and provide an accurate review of the complaints lodged against the individual and precisely identify the consequences created for the team as a result the bad behavior.  If you are concerned for your personal safety or anticipate passive aggressive spin on your words, have a second person in attendance at the meeting.  Caution: Try not to create an environment in which the accused feels as if the boss is “ganging up.”

 

Be specific.  Giving negative feedback can be uncomfortable and it may be tempting to talk in generalities. …don’t.   In order to ensure that behavior changes, you need to be specific and define your expectations.  Be your confident self as you state, “When you do…, it has this effect…”  If you’re dealing with and angry bird, point out the far-reaching effects on those other than their target. Those who witness the encounter, either patients or colleagues, become collateral damage of the disruptive behavior.

Set boundaries.  After establishing the behavior that is to be eliminated, move on to discussing the desired behavior.  Review the mission, vision and values of the organization and make it clear as to how the behavior did not support the core values.  Challenge the person to describe how they might have handled a situation differently had they kept the core values in mind.  Make it clear that the worker’s behavior moving forward must align with core values and that deviation will mandate dismissal from the team. End the session by setting dates for two follow-up sessions.

 

Follow-up.  If behavior has changed, use the first follow-up session to extend kudos and encouragement. Give feedback from the team to promote a feeling of inclusion. If progress has been made but more work is required, congratulate the improvement and have the person identify additional measures that will continue the momentum.  If no progress has been made, move forward with termination.

A disruptive team member can create a very uncomfortable environment for both leader and co-worker.  Emotions run high in the healthcare workplace inherently and the work environment certainly doesn’t need the friction created by bad behavior within the team.  Rather than avoiding confrontation, see bad behavior as an opportunity to implement decisive leadership. In the process you will eliminate the disturbing personal conduct and earn respect.  Your failure to act with authority will allow the obstructive behavior to weave itself into the fabric of the team, creating a negative culture that will eventually require outside intervention.

Hire congenial, collaborative people and don’t hesitate to deal with disruptive employees you inherited.   Design a system that has zero tolerance for disruptive behavior, and you can stay out of trouble before you get in trouble.  Both my mother and Ben were right.

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

After Halftime

halftime post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

It’s the first week in July and the half-time show is over. If you joined the throng of hopefuls in January by writing a list of initiatives to accomplish by year’s end, it’s time to revive and resuscitate, or discard and delete.   Here’s how to recover your footing and breathe new life into dead projects.

  • Review your goals. Reflect thoughtfully on the list you generated so enthusiastically six months ago and decide which things are keepers and which ones can go to the bin.  Which items can potentially have a positive effect on your workplace if achieved?  If the team or the organization has moved on and a listed item no longer applies, delete it or store for later; however, if a particular goal remains pertinent or will set you and the group up for future success, leave it on the list.
  • Condense your resolutions. Following your review of goals, shrink the “good list” further to those that will have the most impact. Notate your priorities and commit to accomplishing them within the remaining time frame.
  • Re-write your goals. Your notated priorities must be realistic, specific, and written in a format that is easily understood.  For example, “improving efficiency” is nebulous; but, adding “as evidenced by” provides clarity and focus to the intended outcome.  Rather than having a goal “to improve pre-op efficiency,” you might clarify the goal by adding “to speed the pre-op workflow as evidenced by a 50% reduction in the number of first case delays.”  A goal to ensure that supplies are available could be stated as “ensure the availability of supplies as evidenced by completion of the inventory every Monday, and submission of order form every Tuesday.”  Put into writing both the goal and a quick description of what constitutes success.  Review the list at established and realistic intervals – weekly, bi-monthly, monthly – to maintain your focus on a positive outcome.
  • Change your mindset.   Proactive, asset-based thinking turns your attention to what resources are available and what can be accomplished.  Dismiss all thoughts about what or why goals were not achieved in the past and laser-beam on what can be done in the upcoming months.   You have already reduced your goals to one or two achievable items, now block the extraneous distractions and stick with the plan.
  • Develop the plan. If the majority of your expectations during the first half of the year are still unfulfilled, something needs to change.  Start again by developing and following a realistic, results-oriented plan over the next 6 months. A viable plan should help get you back on track while teaching you valuable lessons about organizing future projects.   Other aspects of a solid plan should ensure that you have the necessary resources available.  It should include modifying your environment to remove clutter and fill the void with items that support achievement of the goal.  Acknowledging that time is a valuable resource, your plan should create a new schedule eliminating activities that sabotage, while adding a block of time for activities that support achievement.  Stay aware that some activities are mutually exclusive; if you have a personal plan to increase networking by engaging in more one on one time with colleagues, you may have to reduce the time you spend answering email or doing other administrative tasks.
  • Work for small victories. Your desired outcome can seem daunting based on today’s new starting line of six months out.   To stay grounded, remember:  Completing a 26-mile marathon is an overwhelming concept for many people; however, celebrating the passing of each mile marker generates an image of progress and makes the goal seem attainable.  Acknowledge each challenge and celebrate each milestone.

 

Among the many benefits of having a personal vision for improving the workplace are two significant ones – improved team morale and elevated respect for the leader.  Being the driver for those improvements should empower you and trigger a thirst for even greater success.  If you have brought closure to your professional initiatives for 2019, kudos to you; start another list.  If you reached halftime with your goals stalled in spam, revive, reboot and get back in the game.  July first is chance to double down after halftime.

 

 

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Workplace Patriots

Fourth of July

By Thomas Davis, CRNA, MAE, DNAP candidate

 

Following closely on the tails of the summer solstice is the celebration of our day for patriots, the Fourth of July.  It’s the entire nation’s holiday to enjoy summer activities with friends and family while honoring the memory of the dedicated patriots who put country ahead of self and drew a line in the sand, demanding, “Give me liberty or give me death!”   The great experiment of government of the people, by the people and for the people was put into motion by the courageous acts of defiance in 1776 and we are still reaping the rewards from their Herculean sacrifices.

 

As a summer celebration, the Fourth frequently includes having a picnic at the park, out at the lake or right in the back yard followed by fireworks after sunset.  It’s a day of relief from business as usual and an opportunity to kick back, relax and have some fun with friends.

 

For many people, the workplace is an extension of personal life and co-workers are viewed as extended family.  Expanding the holiday celebrations to the workplace is healthy, promotes the development of a sense of community, strengthens teamwork and stimulates creativity. Seize the opportunity to use the holiday theme for teambuilding by challenging your group to create entertaining ways for having some fun at work in the days leading up to the 4th…here’s what others have done.

  • Dress for the occasion. Designate the 3rd of July as a casual dress day at work and encourage workers to wear red, white and blue.  Encourage RWB hair accents, holiday jewelry, or other adornments to add to the festive feeling.   Have a patriotic hat contest with rewards for the creativity of your team. Challenge those with the time and resources to wear full patriotic costumes and have a good chuckle as George Washington, Betsy Ross or Paul Revere walk through the door.
  • Decorate the workplace. Decorate halls, doors and desks liberally in RW and B.   Find a funny holiday poster for the bathroom wall.  If you have personal space such as a locker or a cubby box, decorate it for the occasion.   Don’t forget your patients!  Make their trip to the operating room fun and memorable by decorating the side rails on the cart.  When it’s time to mark the surgical site, give the patients colored markers.
  • Play 4th of July music. Substitute a 4th of July playlist and spice things up a little with fife and drum. You can play Sousa marches, Springsteen, Madonna or Simon and Garfunkel tunes to set a patriotic tone; or take a road trip down the golden oldies lane to generate some enthusiasm worthy of the holiday.
  • Have a Patriotic Workplace Picnic. Workplace potluck lunches are the frequent response to celebrations throughout the year and the 4th of July is no exception; what a great opportunity for decorating the lunchroom and serving a community meal with a theme. Bring hot dogs and watermelon to simulate picnic fare and ask team members to bring their favorite picnic salads and side dishes to augment the dogs.  Don’t’ forget to enlist the bakers on your team to whip up some red, white and blue desserts.
  • Wear lapel flags. Show your patriotic spirit by wearing a lapel flag.  Better yet, supply lapel flags for everybody working during the holiday week.  If you can’t find them, get a roll of flag stickers and make sure everybody has one.  Include patients in the festivities by giving them flag stickers for their hospital gowns.
  • Play games. A picnic just isn’t a picnic without games.  Set up some games for your team members and give prizes.  A workplace scavenger hunt is fun and can be done individually or in teams.  Fill a jar with RWB jellybeans and have workers guess how many are in the jar.   Set up a bean bag toss or a mini nerf ball basketball hoop in the break room and keep a leader board with scores.
  • Engage in a Community service project. Consider sponsoring a community service project in honor of the 4th or any holiday.  A children’s bicycle rodeo or a picnic for the members of a nursing home are two teambuilding activities that are sure to present your organization in a positive light while enhancing community relations.

 

Our nation was united by Patriots who developed a strong loyalty to one another by working hard and playing well together.  Likewise, a good leader can unite a hard working team by offering activities that promote collaboration and that free the people to enjoy themselves.  A great leader creates an environment of loyalty enjoyed with liberty, bound by justice and united by loyal Workplace Patriots.

 

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Tech Savvy Leadership

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By Thomas Davis, CRNA, MAE, DNAP candidate

 

“The first thing we ought to recognize is that mobile is now part of the fabric — every day in everybody’s life. So, if you’re not looking at mobile solutions, then you’re not really looking at all solutions.” ~Mal Postings, Global CTO

 

The world is wired.   From preschoolers to grandparents, cab drivers to health care workers, our lives are infused with digital technology in both obvious and subtle ways.  We locate directions and connect with friends, we take online courses and purchase real estate, we buy groceries and have them delivered, we organize, strategize, socialize and generally utilize technology to run our lives.  We make business choices based on the company’s online presence and, as noted by PatientPop, 80% consumers search for healthcare information online and 41% say that social media affects their choice of healthcare provider.  Healthcare workers provide a vital service to patients; however, healthcare is a competitive business that must generate a positive cash flow to remain operational.

 

The Harvard Business review reports that the most digitalized corporations see an increase in profits two to three times the average rate of less digitalized competitors.  Likewise, healthcare organizations with a user-friendly digital platform are easy to find, easy to use, easy to forward to a friend, and attract loyal clients.  Your digital presence makes a difference.

 

Writing for Linkedin, product marketing director, Mark Hughes, offers these thoughts about increasing the digital presence in your workplace.

  • Abandon old stereotypes about IT geeks.  Healthcare leaders usually arise from a medical or nursing background and lack sophisticated knowledge about digital technology.  Combine your leadership with a personal relationship and create a techno-partnership with the IT department.    Collaboration enables you to blend your ideas with their technical expertise and develop web-based applications that enhance the patient experience.  The first step to becoming a tech-savvy leader is developing a first name relationship with a skilled person who can create the programs that you need.
  • The customer has the final say. Team leaders must follow hospital policy and remain mindful of the patient’s HIPAA rights.   The patient, however, has no limit to the things that he/she can post on social media.  They can and will rate both the quality of care that they received and the ease of obtaining it.  Part of your job as a leader is to create a client experience that the patient will want to share in a positive way.  The things your patients post on social media can make or break your organization.
  • Understand why a platform works. Rather than becoming distracted about how to use a social media platform, explore the various platforms and figure out why they work.  Why does one platform target a certain demographic more effectively than another?  Select the right platform and then challenge your IT support to make it work for you.  In some cases, you may need to use multiple platforms to target different demographics.
  • Always look to the future. Whatever technology works to connect your team with clients today will be replaced by something else tomorrow.  Never rest on your laurels.  Constantly remain aware of new social media platforms as they arise and always question how they can be used to the advantage of your patients and your staff.

 

Becoming a tech-savvy leader is a great way to connect with existing clients and attract new business to your organization.  However, technology can become impersonal and create a buffer between you and your team.  Author Inger Buus, leadership developer at JP Morgan, offers suggestions for solidifying the connection with your team as you add technology to your workplace:

  • Value human connections. The best teams are those that value interaction and collaboration between the team leader and team member. As you increase your digital presence, make sure that personal relationships are maintained.
  • Embrace change. Adding technology to the workplace requires that the workflow be altered to adjust to the change.  Take the lead and set the example for your team to follow by willingly modifying your routine to accommodate the technology upgrade.
  • Encourage diversity of thought. A recurring theme in Leader Reader 1, Authentic Lessons in Leadership is “The best idea arise from many ideas and yours may not be the best.”   Review your goal with the team and listen as they describe the ideal app that would best accomplish the goal.  Not only will the final concept be stronger, team members will have a sense of inclusion and will be more likely to participate in bringing the project to life.
  • Ask for help. Patient safety advocate Dr. Peter Pronovost notes that everybody is fallible, including the leader.  The best leaders acknowledge that they don’t have all the answers and rely on a working relationship with team members to help find solutions to challenges.  When developing new technology, rely on your team to identify and correct glitches.  Have a goal, create a vision and then ask the team to help develop the plan.  Active participation shows trust and builds engagement.

 

Patients and their families are hungry for technology that will enhance their healthcare experience.  They desire appointment scheduling similar to booking seats on an airline and appreciate GPS based assistance when navigating the halls of busy medical centers.  Families want to connect to nurses via mobile device rather than pushing a call light and wondering when it will be answered.

 

User-friendly digital connections produce impressions and influence decisions to do business with the vendor.  Confusing or cumbersome technology is quickly abandoned leaving you to look elsewhere for goods and services.   Bond with IT specialists and develop cutting edge technology in a user-friendly format that you would enjoy using.  Chances are that your patients share your expectations when using web-based sites, including those related to healthcare.  Be a catalyst for digital technology and keep your organization a step ahead of the competition.

 

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Micromanagement; A lens on leadership

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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

“Train people well enough so they can leave, treat them well enough so they don’t want to”      ~Richard Branson

 

Control is a funny thing.  It’s necessary and can improve results when the boss wields it, but it is oppressive and demoralizing when you’re on the receiving end of the heavy-handed version.  Keeping the boss informed as a project is tackled is one thing but having all the small parts directed is quite another.  Unfortunately, many well-intended supervisors become over-zealous while attempting to produce exact results, crossing the line from coach and encourager to micromanager.

 

Micromanaging is the enemy of both collaborative empowerment and creative thinking and can have devastating effects on a team.  Writing in Careeraddict.com, author, Chris Leitch lists the following as consequences of micromanagement.

  • Employees develop more health problems
  • Staff turnover is increased
  • Productivity is reduced
  • Personal relationships suffer
  • Job security is questioned
  • Progress is slowed
  • Teamwork is destroyed
  • Morale is lowered

 

Clearly, micromanaging blocks any attempt at creating a preferred workplace and must be avoided; yet Market Watch reports that over 50% of employees feel as if they are micromanaged.  Keeping out of the micromanagement swamp starts with self-awareness and a sincere desire to release the creative energy in team members.  Not sure whether you are a micromanager?   Try the online self-evaluation offered by The Workzone.

 

Managing by “control patrol” is a sign of insecurity and often originates from fear; fear of losing control, fear of project failure and fear of not being viewed as the authority figure in charge of the team.   To escape the fear, a leader must develop a keen sense of self-security that is clearly evidenced in the way he/she interacts with the team.  Leaders who are secure in their position seek to gain stature through the empowerment of others.  Author Goeffrey James offers the following insight for those who want to abandon the micromanaging style of leadership:

  • Rethink your role as a leader. Visualize yourself as a leader who is meant to guide and develop your team rather than a boss charged with controlling behavior.  View your team members as the capable and competent people they are and individuals who desire is to meet your requests and serve the organization while developing their own personal skills.
  • Delegate projects. Assigning responsibilities to others eases the burden of leadership and sends an important message that you trust your team.  When you delegate, make sure that the assignee understands the goal, the parameters within which he/she must work, and the timeline for completion.  Agree on checkpoints that keep you in the loop then set the boss’s binoculars aside and trust that the team will come through on the project.
  • Ask how he/she plans to proceed. As the project or assignment takes off, remember that the goal is to go from point A to point B.  Anticipate that someone else may solve the problem differently than you would, allow the individual to select the route and be okay with it.  The intent is to bring the project to closure, not to dominate the process.
  • Establish reasonable check in via email. Check in must be appropriate for the complexity of the task and the experience of the person assigned to complete it.  Requiring a person to check in more than necessary does not convey trust in the person’s capability and implies that you don’t trust your own decision to assign him/her the job.        Limit yourself to checking in once a week by email so as not to intimidate the person you delegated for the project.  Keep the tone cordial and collaborative.
  • Focus on developing others and giving them credit for their work. Micromanaging and empowering are polar opposites and mutually exclusive.  The best and quickest way to change your reputation as a micromanager is to re-direct your attention to developing others.  Be a thinking partner as well as a support system for team members who seek additional responsibility and have the desire to learn new skills.

 

Many people describe the “worst boss I ever had” as the controller who managed everything and everyone through a telescopic lens.  If your team has trouble with high turnover, low morale or other consequences associated with micromanagers, consider the possibility that you may be one.  Turn the lens on yourself, loosen your white-knuckle grip, embrace the concept that there is more than one way to achieve a goal and more than one person who can do it.  Ironically, by releasing authoritative power, you strengthen personal power and emerge as the recognized leader of a loyal and productive team.

 

 

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.