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One Week in January

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

 

CRNA weekCRNA week is an opportunity for our healthcare employers to showcase the value that our profession brings to the industry.  Though we are effective at educating the public through media campaigns and public service projects, CRNA week is the opportunity for Nurse Anesthetists to be recognized and thanked for our services.  We welcome the banners and gestures of appreciation that are gifted during CRNA week but they don’t always leave us feeling valued and visible long term.    Here are some signs that an employer truly understands and respects an employee and his professional contribution.

  • The employer says thank you. When you successfully complete a particularly challenging day, or if you’ve brought a project to closure, your boss notices and thanks you for your effort.  Ideally, your boss will deliver the thanks in person.  A creative leader will find a way to leave a thank you note or token to let you know that he is aware of your effort.  Even a thank you email or text lets you know that they noticed.
  • The employer recognizes you and rewards your effort. Smart leaders give public credit to workers who go beyond what is normally expected.   Whether or not the extra effort was required in a challenging case or voluntary in a project, being recognized and rewarded at a meeting or highlighted on social media shows the employer’s pride in your work.
  • The employer asks for your opinion. CRNAs are on the frontline of patient care and you are the expert on how to do the job.  When your employer solicits your opinion before making a decision, she sends a clear message of respect for you, your knowledge and judgment.
  • The employer affirms you. Public affirmation puts a broader spotlight on the CRNA profession.  Marketing the services that the organization offers the public provides an opportunity to tout the talents of all healthcare providers, including nurse anesthetists.  The anesthesiology department chair who identifies and recognizes the talent and professionalism of CRNAs on the department website is making a public statement of respect and gratitude.
  • The employer includes you in the planning. Rolling out new policy (eg, changing workflow, installing new equipment) without consulting the those affected interrupts the workflow and adds chaos to an already stressful occupation.   And it naturally leads to sabotage and resistance.  However, if the employer values and includes employees as plans are being developed, the leaders validate the workers and up the odds for a smooth rollout of the new plan.  Win-win.
  • The employer is available. Being available with a welcoming attitude whenever we have questions or concerns shows respect for us and for our time.   In the hectic workplace, time is an asset and by giving his freely and appropriately, your boss clearly indicates high regard for the individual.
  • The employer promotes your professional development. Ongoing professional development is basic to employee engagement which translates into a preferred workplace with better customer service.  An employer who is truly interested in development of the individual will provide time year ‘round as well as financial support for growth to take place.
  • The employer respects your personal life. Employers who value you and your contributions know that work/life balance is foundational in sustaining high performance over an extended period.   Respectful employers assign you extra work only when it’s necessary or you request it, always ensuring that you are compensated for your effort.

 

CRNA week is only one week each January but the overall behavior of valuing another person is year ‘round, and it’s a two-way street.  While being aware of the employer’s engagement in exemplifying respect and appreciation, implement those values yourselves when you interact with everyone at work, giving as good as you expect to get.  Doing your job as an anesthesia provider throughout the year in a collaborative environment where each person values the other makes one week in January that much sweeter.

 

Special thanks to Liz Sanner Davis for editing and collaboration.

 

Thomas Davis is a noted leader, educator, speaker and clinical anesthetist. 

Join Tom and a group of leaders for the values-based leadership webinar.  Click here for information.

Get Fit for Duty

Get Fit for Duty

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

 

fit for dutyObesity is today’s smoking.   In an article published in USAToday, authors O’Donnell, Barry and Covington make the case that obesity and inactivity could outpace smoking as a cause of cancer in the upcoming decades.  Further, a video accompanying the article presents evidence that childhood obesity greatly increases the probability of depression as an adult.  Connecting the dots, if you are inactive and obese with an elevated risk of cancer, and if your children are also obese, their risk for adult depression greatly increases as well as their risk for cancer.  Nobody would consciously wish cancer or depression upon themselves or their families and yet the bad news is that obesity with its co-morbidity is rampant in our profession and our society.   The good news is that you are the one who can change the course of your personal history with three simple steps; get motivated, change your behaviors and use technology to stay on track.

 

Get motivated

If you’re obese, you have more than a few extra pounds to lose, a task which you may view as a daunting.  Make it manageable by tuning into your thoughts becoming aware of your inner dialogue.  Are you thinking I Can or I Can’t?  I Hate exercise or I Can Learn Some Exercises I like?   Thinking I should is not a call to action; however, thinking I will sets you up for success.   Here are some tips for motivating yourself to re-claim a healthy body,

  • Have a reason Write down a purpose for changing your lifestyle and read it every morning and evening.  Use affirming words like can and will and focus on what you know you get out of it, not what feel you’re giving up.  Make it your goal to gain health and avoid focusing your attention on losing weight.
  • Get a buddy. Share the accountability with a friend who has a similar desire to improve his/her health.   Team up, check in frequently and support one another.
  • Keep a Journal. Writing a daily entry in a journal helps you track your success while providing a frequent reminder of your goal and the many reasons it’s important to you.

 

Change your behavior

Behavior that is repeated becomes a habit.  Here are some behavior changes that you can make today and when repeated daily for 8 weeks will become healthy habits.

  • Morning workout/stretch. Wake up your body by getting in motion in the morning.  An early morning gym workout is optimal however many people don’t have the time or resources to make it happen.  That’s OK but it’s not an excuse for inactivity.  Develop a plan to do a short home workout, stretch and crunch every day before you start your morning routine.  Check out the 7-Minute Workout..
  • Park at far end of lot. Every step you take counts so park where you can take the most steps.    While walking in from the lot, think about why you’re doing is and what other things you can do that day to support your goal.
  • Take stairs. Take the stairs whenever possible.   Only take the elevator if the distance is more than your legs will tolerate, in which case, take one set of stairs and then the elevator.
  • Drink water. Your body needs water to function properly.  In addition, when you are well hydrated salt is cleared from your system which reduces water retention.  Your digestion and metabolism both improve when you are well hydrated.
  • Eliminate sugary drinks. Sugary drinks will sabotage your wellness efforts.    It only takes a few high-sugar drinks to double your calorie intake for the day and consuming them diverts you from what your body really need – water.
  • Bring your lunch. Control the number and quality of calories that you eat by bringing your own food.  Pack a high-nutrient low-fat low-sugar lunch and do not eat anything that you do not bring with you.  Avoid the temptation of making your lunch an appetizer before eating lounge food.
  • Ban lounge junk food. It’s not always possible to control the behavior of others however banning junk food from the lounge raises the level of awareness of your colleagues and may motivate some of them to join the new healthier you.  At the very least, don’t be the one bringing the junk.

 

 

Use technology

Harness and use to digital technology to your advantage when developing a healthy lifestyle.  Texting and social media connect you with friends who can offer support as you share your progress.  As well, there are countless apps you can use to develop your exercise and nutrition program and track your progress.  Following are ten apps as described by their advertisements.

Keas   Keas is a web-based, holistic wellness program, focusing on health goals and activities. Just imagine a site where you combine social media, fun interactive games, informative quizzes, and a little bit of healthy competition between you and your peers. You can choose to focus on whatever is important to you.  https://itunes.apple.com/us/app/keas/id432425118?mt=8

Fitbit  Live a healthier, more active life with Fitbit, the world’s leading app for tracking all-day activity, workouts, sleep and more…track basic activity and runs on your phone or connect with one of Fitbit’s many activity trackers to get a complete picture of your health—including steps, distance, calories burned, sleep, weight, and more.  https://itunes.apple.com/us/app/fitbit/id462638897?mt=8

Endomondo  track all your workouts using GPS, check your stats, and reach your fitness goals.  https://itunes.apple.com/us/app/endomondo/id333210180?mt=8

My fitness pal   MyFitnessPal makes it easier to log your food and activity. The more you log, the more you’ll learn about your habits and how to make healthier choices. And, best of all, logging gets easier the more you do it.  https://itunes.apple.com/us/app/myfitnesspal/id341232718?mt=8

Daily burn   A new workout streamed to your mobile device every day.  https://www.amazon.com/DailyBurn-Daily-Burn-Streaming-Workouts/dp/B00HAPXDWK

7 minuteWorkout   Become your own personal trainer to lose weight and get fit with fast, simple daily workouts.  12 high intensity bodyweight exercises. 30 seconds per exercise, 10 seconds rest between exercises.   https://itunes.apple.com/us/app/7-minute-workout/id650762525?mt=8

Fooducate   Fooducate is a diet coach for people who want lose weight and keep it off by eating healthy, real food. Track your food, activity, sleep, hunger, and mood.  https://itunes.apple.com/us/app/fooducate-nutrition-tracker/id398436747?mt=8

Map my run   Track and map every run with MapMyRun and get feedback and stats to improve your performance. Discover the best running routes, save and share your favorites, and get inspired to reach new running goals.   https://itunes.apple.com/us/app/map-my-run-by-under-armour/id291890420?mt=8

Shop well   ShopWell lets your food do the talking. The free SHOPWELL app tells you what’s in the food you’re buying at the grocery store and offers suggestions of new foods to try that fit with your lifestyle.  https://itunes.apple.com/us/app/shopwell-healthy-diet-grocery-food-scanner/id393422300?mt=8
Meditation studio   Meditation Studio is the award-winning, 5-star app with over 300 guided meditations from more than 30 leading experts. Whether you want to relieve stress, ease anxiety, improve sleep, ease confidence or simply feel a bit more calm and peaceful, this app is for you.  https://itunes.apple.com/us/app/meditation-studio/id1066018502?mt=8

 

We are an obese society, rapidly expanding.  A large number of us in healthcare need to be wide awake and ready to roll as early as 6:30 a.m. and obesity is not society’s best friend.   Throw out the stress and the excuses and focus on improving your health.   Do something every day to support that goal, get a buddy to have some fun and share the load; adopt new behaviors two at a time until good health is a habit.   Be a healthcare role-model for the respect we have for society, for our careers, for ourselves and our children.

 

Special thanks to Liz Sanner Davis for editing and collaboration.

 

Thomas Davis is a noted leader, educator, speaker and clinical anesthetist. 

Join Tom and a group of leaders for the values-based leadership webinar.  Click here for information.

Stop It!

Stop It!

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

 

 

Al Franken to resign… New York times

Moore says it (abuse) didn’t happen…  The Daily News

Matt Lauer…axed   New York Post

 

Over the past few months the headlines in the news have been filled with stories of abuse of power related to sexual harassment in the workplace.  Victims sense that now is the right time and the support structure is finally in place for them to step forward and tell their stories and be believed.  Many high profile perpetrators have been held accountable and the culture of the workplace is starting to change.

Bullying is a less sensational form of harassment that plagues the American workplace and it can have equally devastating effects on workers.  In some cases, the designated leader is the bully with a heavy hand that is used to micromanage, complete with stiff consequences for offenders.  In other cases, the weak leader turns a blind eye while the dominant team member abuses co-workers.  Regardless of who is doing the bullying, a culture where abuse exists is toxic and will ruin the morale and productivity of the entire group.

Every system is perfectly designed to produce the results it gets.

We think of a bully as the tough guy who controls the playground by punching the little guys in the nose.  The same schoolyard abuse in the workplace is more expansive and includes any activity in which one person asserts his/her dominance in a manner that is harmful or demeaning to another person.  With bullying, there is repeated, abusive behavior which usually involves threatening, humiliating or intimidating.   Here are some examples.

  • Spreading rumors, gossip and innuendo
  • Making personal threats
  • Sabotaging work
  • Withholding necessary information
  • Removing responsibility without cause
  • Making pointed jokes about the person or their family
  • Belittling the person’s work or opinion
  • Constantly criticizing
  • Establishing impossible guidelines to ensure failure
  • Tampering with personal property
  • Direct verbal attacks or unverifiable accusations

 

In addition to creating potentially devastating psychological tension, the monetary cost of bullying can be immense.  When bullying is allowed, productivity drops not only by the victim but for other team members who fear being the next victim of the bully.  Now there are multiple victims, many of who will find another employer as soon as they are able, creating a staff shortage which in turn, requires the organization to spend time and money recruiting and training replacements.  Equally costly is keeping an unfortunate victim in place who is not financially able to leave and continues to show up every day like a zombie with little productivity to show at the end of the day.  As a master bully gains power, he/she will form a team of gangstas that taint the reputation of the workplace making it increasingly difficult to attract qualified applicants for the increasing number of openings. Without adequate personnel, per diem and locum employees must be hired at huge expense.  Permitting a pervasively oppressive work culture is downright costly.

 

Behaviors that are repeated will become habits and habits define who we are.

 

The onset of bullying is often insidious and the first negative behaviors may be barely noticeable.    However, aggression builds on aggression and as the bully gets away with demeaning behavior he/she will push the limits of civility until reigned in.   The first and most crucial step for eliminating bullying is for the designated leader to establish a zero tolerance for any and all harassment in your workplace.   Here are some ways to convert your environment into a bully-free zone.

  1. Stop Enabling. Turning a blind eye or rationalizing that the bully is just having a dreadful day ensures that the problem not only continues, but grows.  When bullying is present, do a quick self-assessment and determine ways in which you or others on the team have enabled the situation.  Frequently, enabling takes the form of remaining silent and not getting involved.  You don’t have to be a terminator to stop an intimidator. You just need the courage to address what everyone sees.
  2. Commit to accountability. When bullying is seen or reported, it must be addressed ASAP.    The need to dominate has an emotional component and bullying may be a manifestation of the person’s fear and insecurity.   As soon as possible have a private discussion with the offender and focus on engaging the thinking brain rather than pouring kerosene on the already smoldering emotional brain.  Review the observed/reported behavior with the person and make them think by asking the following questions:
    1. What was your desired outcome?
    2. How did your behavior advance your goal?
    3. How did your behavior affect the team?
    4. How else could you have approached the situation?
    5. How does your behavior support our goal to be a workplace of choice?

The person may acknowledge the behavior and agree to stop it or he/she may deny it.   Either way, he/she knows that you know and that you are expecting specific changes in behavior.

  1. Build civility. Team meetings and retreats are perfect venues for discussing common values and generating enthusiasm for the development of a preferred workplace.   Freely discuss the core values of the organization and guide a discussion that links them to collaborative teamwork.  Openly call it what it is – abuse, intimidation, harassment, bullying – and challenge the team to adhere to zero tolerance for incivility of any sort.

 

As with other forms of abuse of power in the workplace, the time is right to stop bullying your fellow teammate.  Just stop it!  Heighten your awareness, confront offenders quickly and engage your team in building a community of collaboration.   Civility is one key component of a preferred workplace.  Demand civil behavior from yourself, your teammate and your leader because behavior that is repeated becomes a habit and habits define who you are.

 

Special thanks to Liz Sanner Davis for editing and collaboration.

 

Thomas Davis is a noted leader, educator, speaker and clinical anesthetist. 

Join Tom and a group of leaders for the values-based leadership webinar.  Click here for information.

Step It Up

step it up, Jan 2018

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

 

Regardless of whether you call them resolutions or goals, many people start the new year seeking self-improvement in both their professional and personal lives.  Leaders hope to find ways to do a better job guiding and motivating their team and team members hope for professional development that will earn them respect and recognition for their work.

 

“Hope rarely enters into it. ‘Tis action moves the world.”

From:  The Winter Sea by Susanna Kearsley

 

Whether your official role be leader or team member, here are some ways to convert hope into action.

 

Ask   I recently worked at a clinic where OR personnel wore a color-coded paper hat – blue for staff, red for vendors and pink for students.   A popular anesthesiologist with 30 years of experience who commonly served as clinical coordinator frequently opted to wear a pink student’s hat.   When I asked him why, he replied, “I am a student and learn every day.”  His commitment to self-improvement was contagious, setting the stage for everyone to learn.   When working with him, there were no dumb questions so the entire team was able to benefit from his commitment to sharing knowledge.   As a part of your personal professional development plan, learn from everyone you encounter during the day and freely share your knowledge so that others can learn from you.  You will be amazed at the things they know about their jobs and a free exchange of information enhances collaboration.  Over the years, I have learned things by listening to my anesthesia colleagues, anesthesia techs, OR nurses, and from housekeeping.  Create a pink-hat environment in which all are free to exchange information without the fear of being belittled for asking the wrong question.

 

Listen to understand    In the high stress healthcare environment people don’t want to make mistakes or be blamed for an undesired outcome.   When issues arise, it is easy to default into the it’s-not-my-fault mode and build a wall that stops communication.  Open your mind by assuming the other person has a valid point and then listen carefully to understand his concern.

Tactical Empathy is the ability to share someone else’s feelings while executing a plan to achieve a goal.  In his book Never Split the Difference: Negotiating as if your Life Depended on it, Author Chris Voss uses the term tactical empathy to describe a preferred approach to listening.  According to Voss, listening is more inclusive that just hearing words; tactical empathy includes listening to the emotion behind the words.  After attentively listening, state the emotion that you sense and allow the other person to agree or clarify.  For example, say, “I sense that you value teamwork and have concerns about our team.”  Then be quiet and let the person respond.  It is likely that the person will validate the emotion that you sense and shift their concern/anger from the problem at hand to a discussion of the underlying problem.  If you are wrong with your assessment, the person has your attention and can provide additional information.  Another way to show tactical empathy is saying, “I sense that you have a deep commitment to patient safety and fear that someone will be injured.”   As before, listen to the response and open the door for additional information.  The key is to detect to the emotion that is driving the words, state the emotion, then listen.  You will add depth to your understanding by having the person describe the desired behavior they would expect if things were going well.  When done, you will have a new perspective on the issue and the person will feel as if his/her opinion was valued and understood.

 

Be positive   We are social creatures and our attitudes affect those around us. Develop the habit of approaching issues from a positive point of view.  Instead of reacting to a situation, be proactive and view a problem as something that is temporary and correctable.  Keep the desired outcome in mind, identify resources, and tap into the collective wisdom of your team.  A We Can Do It Together attitude quickly spreads throughout a team and stimulates creative solutions.

 

You’ve already stepped up to the plate by being a leader, now step up your game.  The New Year is here and it’s a great time to convert good intentions and high hopes to tangible action by changing your status quo.  In a recent interview, investment advisor, Tony Robbins, suggested, “Leaders anticipate; losers react.” It’s impossible to know the details of the challenges that will arise in the upcoming year, but one thing is sure, you can’t anticipate all of them, and being a lifetime learner, effective listener and optimistic problem solver will position you for success.

 

Tom is a noted anesthetist, leader, educator and speaker.   Join Tom and a group of frontline healthcare leaders in the Values-based leadership webinar series.

Resolution Reality

 

Resolution Reality

(The art creating change)

By Thomas Davis, CRNA, MAE, Lt. Col, (ret)

Follow @procrnatom on Twitter

 

Santa has completed his aerial delivery, gifts are in use and empty boxes are in the recycle bin.   With the new year rapidly approaching, attention quickly shifts from Christmas to football, New Year’s Eve parties, and finally to resolutions for the new year.   Ah yes, resolutions…so easy to make and so easy to break.   The good intentions put forth as the Rose Bowl is being played are but distant memories by Superbowl Sunday.  Resolve to make this the year that you keep your resolutions.  Here are 3 tips to get you going and keep you on track.

 

Work from the positive

Our brains work best and our chances for success are the highest when we make our own decisions are in control. Self-control is empowering and is most easily achieved when it arises from a positive point of view.  When making resolutions, visualize the new desired state and the positive benefit that you will experience once your goal is achieved.   Use proactive, empowering language with your internal dialogue and think in terms of what you can and will do with available resources.  Conversely, avoid a negative approach and thoughts about what you must give up or stop doing.   In his book, The Upward Spiral, author Alex Korb discusses the brain chemistry related to establishing new habits.  Korb says that electric pathways for the old habits never truly leave the brain but fade when they are not actively used.  Replacing old habits by establishing new behavior creates new pathways in the brain and makes the old habits irrelevant. Like learning any new skill, it is necessary to repeat the desired behavior many times to establish it as the new norm.

 

Work from your personal values

The most effective resolutions are a reflection of your inner character and the things that are most important to you.  So before you make them, take time to reflect on the values that guide your decisions.  Rather than trying to create a new you, the most effective resolutions are those that put you in alignment with the character traits that you value the most.   Instead of thinking, “I need to lose 50 pounds,” tell yourself, “I value my health and, therefore, I will alter my behavior to align with my value.”   Instead of thinking, “I need to be less critical,” tell yourself, “I value collaboration so I will align my behavior to create a collaborative environment.”   If you are having problems identifying what matters the most to you, click here for a list of personal values and use them as a foundation for making resolutions.

 

Focus on today’s behavior

New Year’s resolutions tend to be global statements describing the new way of life that you imagine in your future.  Your goal may be admirable however, jumping from A to Z can be overwhelming and cause you to abandon ship somewhere between B and D.   Keep the final outcome in mind, focus on today and identify behavior that supports the goal.  Step outside yourself and view your actions through the eyes of others by asking yourself   what they see when they observe you.   If your goal is to recover your health, how would others assess the decisions you made today?   If your goal is to empower others, what would it look like to those around you?  

 

Putting it all together

Resolutions must reflect your character.  They must be well thought out, bringing your behavior into alignment with your ideal self.  Resolutions that are made to please others or that do not reflect your values will fade before the January thaw. 

 

Once meaningful resolutions have been developed, make a list of behaviors that will support achieving the goal.  State your activities in the positive and align your values with your desired future state.  Rather than, “I can’t have sweets,” a better behavior would be, “I choose to eat only things with nutritional value.”    Once you have established a list of behaviors to support your goal, commit to 2-3 things on the list and start implementing them today.  At the end of each day, take time to reflect on your success, identify areas for improvement and keep notes in a journal.  When the new behaviors become habits, select another item from the list and make it a priority, then repeat until all the items are ingrained as new habits. 

 

Here is your self-dialogue for success:  My resolution for the new year is ___ and it supports my value of _____.    To achieve the desired change, I commit to ___ and ____ for the next 60 days.   Friends and family will recognize my commitment to change when they observe me ____.

 

Whether you are building an ideal self, a desirable workplace or an empowered team, start by identifying values and then aligning behavior in order to achieve success.  Choose resolutions thoughtfully and make a commitment to the behavior that will make you successful.   By establishing new habits, you will turn your imagined future state into today’s reality.

 

Tom is an experienced clinical anesthetist, educator, speaker and teambuilding coach.    Participate in the next values-based leadership webinar and take your team to the next level.   Contact tom@procrna.com for details.

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Infuse the Holiday Spirit

Infuse the Holiday Spirit

By Thomas Davis, CRNA, MAE, Lt. Col. (ret)

Follow @procrnatom on Twitter for leadership tips

 

holiday postThe Christmas season is a time for family and friends to gather and share the excitement of the season.  With store fronts decorated, neighborhoods lit up at night and jingle bells in the shopping malls, children start squirming with excitement while adults develop a sense of kindness and generosity.  For the savvy leader, the holiday season is a golden opportunity to build the team.  And there’s no better place to start than by building a workplace of choice.

 

Think of your team as your extended family and give them a gift they will enjoy throughout the upcoming year – the workplace of choice.  Make a commitment to create a preferred workplace and start today by leveraging the spirit of the holiday season.   In your ideal workplace, team members will:

  • Feel as if they belong
  • Sense that they make a difference to the organization and the team
  • Have a spirited team spirit
  • Know that their work is recognized and appreciated

 

Exude the mood of the season then commit to carrying the new attitude into the upcoming year.  Team collaboration and production will soar as your workplace gains a reputation for being the best in the organization.   Here are a few ideas to make the season memorable for your team.

 

Make it fun and festive

A team that has worked diligently for a full year since the last holiday season has earned the right to feel good about themselves and their accomplishments.   Break the monotony of business-as-usual and usher in the joyous season by changing the face and the tone of your work area.  Try these ideas to lighten the mood and unite your team.

 

In the break room

  • Encourage team members to post holiday pictures of family and pets.
  • Post a joke of the day and encourage team members to post funny holiday stories.
  • Post a riddle of the day and encourage team members to work together to solve it.
  • Bring treats several times in the week leading up to the holidays.
  • Bring a nerf basketball and small hoop. Have a contest for the most buckets in 1 minute.
  • Set up a new challenge every day such as counting red jelly beans in a jar and provide a prize for the winner.

 

At your team meeting

  • Have a non-business meeting and encourage your team to identify ways to have fun…then follow-up.
  • Have a laughing contest…it’s contagious.
  • Create a New Year fun committee and plan quarterly events.
  • Ask each person to name another team member and state something that they appreciate about the person.
  • Discuss team accomplishments from the past year.
  • Finish the fun meeting with a holiday “shift exchange.”

 

One on one

  • Show an interest in each team member’s holiday plans.
  • Focus on positives and point out things that the person does particularly well.
  • Give each member of the team a hand-written holiday note and that expresses thanks for something specific that they did for the team in the past year. Deliver it in person or mail it but DO NOT leave it in their box at work.

 

Creating the ideal workplace takes time and commitment.  Holidays are a special time of the year for each person on your team regardless of religious beliefs or family heritage.  Use the season as a platform for building a team, one that everybody wants to join in an environment where people want to work.   Haul out the holly and have some team-building fun.

 

Tom is a skilled anesthetist, author, speaker and leadership coach.

Leader Reader 1, Authentic Lessons in Leadership.  “The book that goes beyond theory and provides hands-on leadership skills.”

The Social Media Connection

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twittersocial media post

Communication, collaboration and effective teamwork are essential ingredients for highly effective workplaces and insightful leaders must find creative ways to connect with the people on their teams.   Use of social media has been woven into an essential piece of the fabric that shapes our lives.  Rather than putting a ban on the use of electronic devices in the workplace, fire up your team by uniting them through social media.   Login and get stoked!

 

Event scheduling   Neither word of mouth nor notices posted on bulletins boards are reliable sources for disseminating information.  Online calendar apps, however, are abundant and many are free.    Instead of sending email schedules that require downloading, use an app and create a calendar that can be shared with your team.  Your community calendar will always be available for reference and posting a calendar removes the I-didn’t-know excuse.

  • Teamup is one of several apps that offer a platform to create a shared calendar. It offers sub-calendars, it’s simple to use and it’s free. https://www.teamup.com/apps/

 

Employee recognition   Employee contributions often exceed expectations and team members deserve recognition for their achievements.  In an ideal workplace the employee feels valued, appreciated and has a sense that he/she has contributed to the overall success of the team.  Follow up the hallway thank you with a brief post on social media to recognize each individual and each achievement.   Several social media platforms encourage the reader to forward the message to others in their network thus expanding the number of people who are notified of the success.

  • Open a twitter account and have your team members follow you. Tweet each achievement and encourage re-tweeting.   https://twitter.com/

 

Support   Teamwork is enhanced when people feel that they are part of a larger community and that they have the support of their peers.   Professional communities exist online that encourage individuals to connect with others who have the same credentials.  Members of a virtual community can pose questions, share experiences and learn from the collective wisdom of others in the same profession.

  • AANA connect is a private virtual community for nurse anesthetists and has sub-communities with different focuses. https://connect.aana.com/home
  • Facebook is the go-to platform for connecting friends and interfacing spontaneously. Within the Facebook platform, user groups have emerged to unite people with special interests. In the nurse anesthesia Facebook community, dozens of sub-groups exist for everything from CRNA moms to CRNA brewers.  https://www.facebook.com/

 

Team communication   Keeping up with your profession is helpful.  Communicating with your team is essential.  App based programs are readily available that allow your group to connect through text messages, providing instant communication for time sensitive issues.  This option requires each team member to download the app and join your user group, making the effort to connect worthwhile.  .

  • Groupme is a text-based app that provides all member instant alerts by “ping.” It’s free and easily downloaded.   https://groupme.com/en-US/apps

 

Video chat    When the crisis of the day arises and instant communication is imperative, live video chat is a great option.  Similar to SKYPE, LVC connects key members simultaneously for brainstorming and quick resolution.

  • Group video chat by Camfrog is an app that allows groups of people to connect via cell phone with live video and audio. https://www.camfrog.com/en/

Leadership requires powerful communication that effectively unites the team, and the most innovative leaders find creative ways to utilize social media in the process.   Younger members of your team who were raised with technology will feel right at home with social media while the senior members of the team will experience personal growth as they master the technology.  Everyone will be connected. Everyone will feel connected. Take an important step toward creating a workplace of choice by developing a sense of connectedness through the use of social media.

Thomas Davis is a noted speaker, author and team building coach.

“The book that goes beyond theory

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Don’t Be Distracted

Don’t Be Distracted

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

Little Alex is finally a big boy.   Now that he is age 5, mom and dad eagerly sign him up for T-ball visualizing their future big-league hall-of-famer hitting a home run in the final game of the World’s series.  Wearing his new T-shirt and oversized hat, Alex crouches standing ready to catch the ball in center field waiting for something to happen and then it does.  A butterfly flits by drifting with the breeze and lands nearby. Five-year-old Alex abandons his position in center field and starts chasing the butterfly just as the slugger at the plate rolls one through the infield directly to the spot where Alex once stood.  The distraction of one player effected the outcome for the entire team.

When children grow and mature into adults, life’s distractions increase as does the consequences of diverting attention away from the task at hand.  The National Highway Traffic Safety Administration reports that in 2015 a total of 3,477 drivers lost their lives and another 391,000 were injured due to a lapse of attention while driving.

Distraction in the healthcare workplace is common and can cause mistakes that have devastating effects on our patients.  Because interruption of attention has been linked to the injury or death of many people who entrusted their safety to the healthcare community, the Anesthesia Patient Safety Foundation assembled a panel of national patient safety experts to evaluate the harmful effects of diverting attention away from the patient in the operating room.   An article by Maria van Pelt and Matthew Weinger published in the October, 2017 APSF newsletter reviewed the findings of the panel.

Personal Electronic Devices are the elephant in the room when the topic of distracted operating room workers is addressed.  Although the use of PEDs remains a threat to the focus of attention on the patient, there are many other less obvious causes for concern.  Here are 5 common causes for distraction in the operating room taken from the APSF:

 

Patient-related activity poses a risk by shifting focus from the technical aspects of ensuring safety for the patient at hand (ventilation, hemodynamics) and is diverted to considering the needs of other patients or new activities related to the current case.  Attention is diverted when:

  • PACU or pre-op calls with questions about your previous or next patient.
  • You set up for the next patient during the current case.
  • Ultrasound is used to place a block after induction.
  • Another physician comes into the room to consult with your surgeon during the case.

 

Technology-related problems divert concentration from the patient to a computer that stores data and maintains records.  Technology compromises patient safety when:

  • Either the anesthesia or the operating room computer malfunctions and requires re-booting or calling the help desk.
  • The required data entry is excessive and time consuming.
  • Time is spent searching data bases for lab or consultation reports.

 

Noise and alarms make conversation difficult or interrupts the train of thought of workers in the operating room.  Noise and alarms divert attention from the patient when:

  • Alarm activation occurs due to inappropriate alarm limits or faulty equipment (loose wires on ECG or pulse ox).
  • The sound level of music is excessive.
  • OR workers and vendors participate in unnecessary chatter unrelated to the case.

 

Interpersonal dynamics cause drama and stress thereby disrupting collaboration between members of the operating room team.  Interpersonal factors steal the effectiveness of team members when:

  • Threatening attitudes stifle communication and creative thought.
  • Hierarchal power structure inhibits the sharing of information.
  • Team member complain and engage others to talk about personal issues.
  • Disruptive behavior such as swearing, throwing instruments or disparaging others on the team is tolerated.

 

Self-induced distractions include unnecessary activity that the individual willingly brings into the operating room.   We distract ourselves when we:

  • Use personal electronic devices while caring for a patient.
  • Read books or solve puzzles to fill the time on a long case.
  • Participate in unnecessary chatter about our personal or social interests.

 

One-hundred- fifty years ago vigilance in the operating room was the hallmark for safety. In the high technology operating room of today, vigilance is just as important as it was when ether was dripped onto cotton gauze.   Regardless of your position on the healthcare team, be an advocate for your patient and keep your finger on the pulse when distractions emerge.  It is up to you to commit to patient safety by reducing distractions and maintaining total focus on the patient.  Keep your head in the game and your eye on the ball when the butterfly flutters by.

 

Thomas Davis is a noted author, speaker, leadership coach and clinical anesthetist.

 

Be Thankful, It’s Healthy

Thankful postBe Thankful, It’s Healthy

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

Thanksgiving is over but it shouldn’t be.  A national day of reflection and giving gratitude is healthy for your mind and is also a great excuse to indulge in food, football and family.  Likewise, in a preferred work environment, insightful leaders create a healthy environment for their team members by being grateful and thanking them publicly and privately on a regular basis.

Writing in his book The Upward Spiral, author and neuroscientist Alex Korb connects being grateful with brain activity that elevates your mood.  The book goes on to offer tangible suggestions for alleviating depression.  High on the list of mood elevators is the act of being grateful which triggers the release of dopamine in the hypothalamus and creates a sense of wellbeing.  Even on a terrible day, the act of imagining things to be thankful for has the effect of elevating your mood.

Being grateful and giving thanks is as important in the workplace as it is in your personal life.  During a chaotic and stressful, pressure-driven day on the frontline, stopping to reflect on the positive events of the day breaks the anxiety cycle and shifts attention from problems to achievements.  In my book Leader Reader 1, Authentic Lessons in Leadership I recommend an end-of-day routine which includes reflecting on the activities of the day and giving thanks to those around you.  The activity has the double benefit of increasing your sense of wellbeing and ensuring that your team feels validated and appreciated.

In a contribution to Forbes.com, career coach, Nancy Collamer, offers the following tips for giving thanks in the workplace:

Just say it.  As you wind down the day, seek out people who have made a difference and give them a sincere thank you tailored to their contribution.  Walking through the work area and shouting, “Thank you everybody!” has very little effect.  Taking an individual aside and telling him/her “I really appreciate the work that you have done today.”, sends the message that you noticed and appreciated their effort.

Send an e-note.  It’s not always possible to see everybody face to face at the end of the day to affirm their work.  Sending a short email that thanks a worker for something specific that he/she has done is the next best thing to saying it in person.

Send a written card.  This old-fashioned method of giving thanks takes time and effort but sends a powerful message that the person is recognized, appreciated and worth the energy required to send the card.  Cards are appropriate when large projects have been completed or a person has sustained high performance over a prolonged period of time.  To make the card even more effective, send it to the person’s home address.

Recognition, reward and a sense of being appreciated are all elements of a workplace of choice.  Be grateful and give thanks to those around you to create a powerful double effect.  First, you will receive the benefit of changes in your own brain that elevates your mood and gives you a sense of wellbeing.  Second, you will reward those around you and take a step toward creating highly desirable workplace.  An intended consequence of giving thanks is that it is contagious and those on your team will follow your example by thanking one another when they collaborate to complete a task.

Be thankful, it’s healthy.

Thomas Davis is a noted leader, educator and leadership coach.

The OR Blame Game

fault post

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

The modern-day operating room is a miracle machine where diseases are cured and lives are changed.   The nature of the work carries inherent risk and any deviation in protocol can have devastating consequences.  In addition, the operating room is a business that requires efficiency in order to maintain the positive cash flow that supports the essential work that takes place there.  When medical mistakes are made or schedules are not met, rather than asking, “What went wrong?” all too often healthcare providers ask, “Whose fault is it?” and launch into the blame game.

I recently worked in an operating room where the standard for turnover between cases was 20 minutes.   At the end of each case, when the patient was wheeled out, the clock started ticking and a flurry of activity was put into motion aimed at hitting the magic 20-minute standard.  Many requisite tasks had to be completed during the brief turnover time to prepare the room for patient #2:

  • Patient #1 settled in recovery, report given, paperwork completed
  • Room disinfected, new instruments obtained and set up
  • Preoperative evaluation and lab work for patient #2 completed and on the chart
  • Surgical consents signed and site marked by the surgeon
  • Transfer of care for patient #2 from pre-op to the operating room team
  • Transport of patient #2 to the operating room

During the 20-minute turnover time, glitches could easily occur at any point in the process and despite the sincere desire to meet the standard, more often than not the turnover time exceeded the expectation.  If a patient entered the operating room behind schedule the most important question was always, “Whose fault is it?”  I quickly learned that assigning blame was a greater priority than establishing a system where the standard could be met.

Blaming is a defense mechanism that enables an individual to avoid responsibility for a negative event.  By blaming others, we can divert attention from ourselves and reduce the chance of being exposed as part of the problem.   When we point out the flaws of others, our egos are inflated and our own deficits can be hidden. For bullies blame can be a powerful weapon in establishing superiority.  Whether you are diverting responsibility or establishing the upper hand, blaming has a destructive effect on collaborative teamwork and is toxic in the workplace and here is why:

  • Blame places the entire group in a defensive mode. Avoiding incrimination becomes the overwhelming motivation and the group loses sight of the positive goals that they had once worked to achieve.
  • When blame is anticipated there is a reluctance to take a risk and creativity is killed. Instead of seeking new ways to solve a problem, ironically, the group clings to the safety of the way it has always been done.
  • Blame blocks learning from mistakes. When culpability is certain, people are reluctant to admit mistakes or point out flaws in the system thus creating an attitude of professional stagnation.

There is a more productive way to conduct our business and interact with each other in the operating room. Switch from blame to shared responsibility.  A medical mistake creates an opportunity to work together to find a solution that, in turn, opens the door to innovative teamwork.  Adopting a no-blame attitude will benefit your team in the following ways.

  • Team members can remove the lens from the problem and focus on the greater goal, taking steps to move toward the desired outcome.
  • Removing the fear of being made the scapegoat when the system fails encourages disclosure. When there is no need to divert attention and assign blame, people openly admit mistakes, share thoughts and offer suggestions that will lead to resolutions.
  • The common goals and interactive problem-solving that result from no-blame environments encourages collaboration and teamwork.
  • Removing blame builds the element of trust along with the security of knowing that when problems occur, your team will come together to find a solution instead of throwing an individual under the bus.

A no-blame workplace does not remove accountability.   Individuals are still held accountable for repeated or blatant violations of protocol.  However, in most cases, accountability goes to the team to find proactive, outcome-oriented solutions.

In the high risk/high reward environment of the operating room, collaboration and effective teamwork provide the key to success.  Blaming an individual for a flaw in the system is divisive and ultimately undermines the success of the organization, whereas, goal-oriented problem solving brings the team together and improves overall outcome.  There are no winners in blaming or gaming.

 

The Satisfaction Connection

By Thomas Davis, CRNA, MAE, Lt. Col (ret)

Follow @procrnatom on Twitter

In 2013 the Centers for Medicare and Medicaid Services published a report that stated 6 in 10 patients were not respected or heard during their hospitalizations.

Throughout the country, healthcare providers are using evidence based practice to deliver the highest quality of care to an aging population with a growing list of coexisting diseases.  At the same time, reimbursement is being reigned in requiring providers to see more patients and provide greater service with fewer resources.   To that end, healthcare providers focus on completing tasks efficiently and the simple act of connecting one on one drops through the cracks.

Last week I made a quick trip to the grocery store for a few items and was in the express checkout with two ahead of me.  The clerk was efficiently scanning and bagging when she noticed that the person in line behind me was her personal friend.  Immediately, the clerk engaged her friend in an animated conversation about their children, vacations, holiday plans and a number of other things.  She was so engaged with her friend that she did not acknowledge me or the person in front of me.  When I stepped up to check out, she scanned the items and pointed to the credit card machine without a breath of interruption in her ongoing conversation.  I accepted the receipt and left without ever being acknowledged as having been in line.  My only positive memory of the trip to the store was the product, not the experience.

We work in hospitals and not grocery stores and we treat patients rather than scanning items.

In another personal experience last week, at the end of a long day a case was added for a brain biopsy on a 30-year-old with a suspected tumor.  The woman was visibly frightened when I met her and though I didn’t have magic words to give her, I listened and heard her fears and concerns.  By the time we rolled back, having been heard made her much more relaxed and as I rolled her into the room, I told her about the amazing OR team who were there just for her.  As we entered the room I said, “Hi everybody, this is Karen.” Silence.  The nurse and scrub tech were reviewing instruments and did not look up.  A second OR nurse was on a computer and did not respond.  Karen got a stressed look on her face so I turned to the team and enthusiastically announced, “Let’s do this again.” We backed out the door into the hall, re entered the OR and again I said, “Hi everybody, this is Karen.”  The second entry generated a warm welcome from the team, Karen relaxed and we quickly got the patient settled and off to sleep.

Connecting with patients matters.  The current literature documents a strong link between patient satisfaction and patient outcome, and CMS is no longer willing to reimburse at the full rate when patient satisfaction is lacking.   Here is what we know.

  • When patients are satisfied with their experience, they are more likely to be compliant with instructions and to keep follow up appointments, both of which affect outcome.
  • Patients do not have the technical knowledge to know whether or not they received the best possible treatment, however, they do know how they were treated.
  • Healthcare teams committed to giving patients a positive experience have a common goal and tend to work more collaboratively.
  • As patient outcomes improve, the morale of the healthcare team also improves making the workplace more attractive to those seeking a great job.

Introducing yourself and reviewing a medical history can be like scanning items at the store – robotically, without ever going below the surface to acknowledge the patient as a unique individual.  Or, you can easily connect to the patient on a personal level by simply adding this question, “Tell me something about yourself that is not on your medical record.”  Humanizing the process opens a window into the patient’s life and the things that interest them.  When entering the OR, introduce the patient and let the team know something about them.  Others in the room will join the conversation and soon the patient will feel a connection to the entire team.

As healthcare workers, many things are beyond our personal control.   One thing that is completely within our control is the way we interact with our patients.    In 2013, 6 in 10 patients reported that they were not respected or heard.  If we surveyed your patients from last week, what would they say?  Connecting is quick, easy, fun and rewarding.  Go beyond the medical record and start treating whole patients.

My wife mailed a registered package at the US Post Office last week and came home saying, “The place was really busy, the man who waited on me took forever, but he knew all the forms needed, the kind of tape to use, the reasons behind the new security regulations and kept up a cheerful chatter with me while he worked, including his two coworkers and even two other customers who were filling out forms and waiting for service. Everyone was smiling and you’d think we had all just had a biscotti and latte with our best friend.” Now that’s a 10 out of 10!

Coming soon: Values based Leadership Webinar series.

 

Millennial Magic

By Tom Davis, CRNA, Lt. Col (ret)

Follow @procrnatom on twitter

 “The slow one now will later be fast,

 As the present now will later be past. 

 The order is rapidly fading, and the first one now will later be last,

 For the times they are a-changin’.”   Bob Dylan

                                                        

 Yes, The times, They Are A-changing

Times achanginThe gremlins are gone, the spectacular fall color has been raked and as we search for the perfect gobbler, sleigh bells are ringing overhead.  Just as sure as the seasons change, the face of the American workforce is changing.

While the baby boomers peruse their retirement bucket lists, the much-maligned millennial kids are setting up their work space. As a group, the millennial generation carries several negative stereotypes that makes hiring managers raise their eyebrows in doubt?.   Millennials are represented as entitled, spoiled, impatient, lazy and a host of other negatives that, if true, would render them unfit for employment.   Yet those born between 1977 and 1992 are rapidly entering the job market, including healthcare, and productivity is soaring.   How can that be?  There is a disconnect between the stereotype and the reality.

Consider a few of the elements that are desired in an ideal workplace regardless of the age or background of the worker.

  • Sense of belonging
  • Making a difference
  • Professional development
  • Culture of creativity/thinking environment
  • Civility/diversity/mutual respect
  • Recognition/reward

Whereas baby boomers entered an authoritarian, top down workplace and spent their careers working to create the ideal workplace, millennials have entered the workforce with the expectation that the elements their elders sought for decades are already in place.  It’s not that millennials don’t want to work. It’s simply that if you don’t have a supportive environment, they don’t want to work for you, and they are fearless about looking elsewhere.   The most effective leaders know the value of creating a highly desirable workplace, one that retains experienced workers while attracting the best and brightest of the younger generation.

In my experiences as a Nurse Anesthesia leader, I have hired many young healthcare professionals.  Without exception, they have infused knowledge, talent and energy into the workgroup and quickly transitioned to become valued members of the team.  Here are some excellent reasons to actively seek and hire young adult professionals.

  • They are highly educated. Baby boomers entered the job market with hospital based diplomas whereas millennials are required to have post graduate degrees for entry level certification.  They have mastered a body of knowledge that did not exist when their supervisors were in training.
  • They are determined. Far from being lazy, the younger set believe that they can change things for the better and aren’t afraid to try.   Computers have taught them that it is easy to delete and start over so they aren’t afraid to make mistakes.  State the goal and provide the resources, then stand back and watch young people as they develop a creative solution.
  • They are diverse. Baby boomers have survived decades of diversity training in the workplace whereas millennials don’t know anything but diversity.  To them diversity is not an issue; it is a way of life.  In addition to cultural diversity, millennials welcome diversity of thought and value the opinions of other.
  • They are skilled with technology. As healthcare continues to transition from paper to digital, the young set is best prepared to lead the way.  Baby boomers were raised with land line phones and learned to use computers as adults.  Millennials were born into a computerized world. They view stories of the pre-computer world as ancient history and they will be attracted to jobs that encourage them to use their computer based creativity.  To a millennial, an ideal workplace isn’t just tied to technology.  To a millennial, work and technology are synonymous.

 

Just as the seasons change, so does the workforce that we depend upon to provide quality healthcare to a population with ever increasing needs.  An ideal workplace has a mix of youth and seasoned workers who value one another and collaborate to blend knowledge and experience.  By capitalizing on the strengths and optimism of the millennials while striving to develop an ideal workplace regardless of the generation of the worker, leaders will find a magic formula for ongoing success.  Call it Millennial Magic!

Encore Symposiums Cape Cod 2017

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Meeting review by TD

Meeting Date: 10/9-12/2017

Meeting location: Chatham Bar Inn, Cape Cod

Meeting sponsor: Encore Symposiums

Strengths of the meeting: Great location with topics relevant to current practice and dynamic speakers to bring them to life. This particular meeting attracted a fully engaged audience of CRNAs eager to learn and participate. Overall, a great experience.

Value for the money:  Nancy puts her heart into finding the best locations and then putting together a program that causes attendees too want to attend every session.  If you are combining vacation with education, you can’t do much better than this.

Patient Experience Affects Outcome

By Thomas Davis, CRNA, MAE    Follow @procrnatom
Author, Leader Reader 1, Authentic Lessons in Leadership

experience article picPatient satisfaction, patient rights and the patient’s experience are factors that drive healthcare reimbursement across the United States. Those of us who have been healthcare providers for decades can remember the “good old days” when patients had few rights and little thought was given to patient experience. After all, we were trained professionals and knew what was best for our patients. The pendulum has now traveled to its opposite end of the arc and medical care is directed not only to curing disease but also creating a positive experience. The new model of healthcare delivery begs the question, “Does today’s patient-centered healthcare delivery system have any benefit beyond making the patient feel better about the experience?” The answer is a resounding YES. In the words of British physician Sir Sam Everington, “…it’s not about what is the matter with the patient, but what matters to the patient.”

In the present atmosphere of evidence based medicine, studies are ongoing and publications are appearing to support the concept that both safety and ultimate outcomes are tied to the patient’s overall experience which drives their satisfaction. The Agency for Healthcare Research and Quality (AHRQ) correlated patient satisfaction with outcome and made the following observations about the snowball effect that satisfaction has on outcome.
• Effective communication is essential for patients to have a positive experience.
• A good patient experience is related to a lower risk for malpractice claims.
• Patients who perceive the experience as positive are more likely to comply with treatment and achieve better results
• Efforts to improve the patient’s experience also result in a higher level of employee satisfaction and reduced staff turnover.
• The quality of the relationship between the patient and provider is a major predictor of loyalty to the provider and the treatment plan.

Articles related to improving the patient’s healthcare experience are weighted heavily toward improving communication between the physician and the patient. However, the overall experience of the patient depends on much more than the few minutes that they actually talk with the physician. In a system that is truly focused not only on quality care but also patient experience, every person in the organization is important. Patients don’t care how talented the doctors or nurses are if they must struggle to gain access to the system or sense a lack of respect. The Cleveland Clinic addressed the issue by implementing the tagline WE ARE ALL CAREGIVERS and applying it to ALL employees at all levels.

Regardless of your location or job description, when you interact with a patient, you are contributing to their experience. Along with the competence that you bring to the job, your attitude is important. When patients think back on their hospital experience, they often have a vivid memory of attitudes and the perception of being valued whereas the memory of the actual treatment received may be blurred.

Patients entering the hospital know that not all conditions and diseases have a happy outcome. A terminal condition will take its course, however, both the patient and family can feel valued and maintain their dignity based on their perception of respect and a sincere desire by the healthcare team to ease their pain. Here are some ways to create a positive experience even in the most difficult situations.
• Set the tone by showing up each day with a smile and positive attitude.
• Make eye contact and engage in conversation where appropriate.
• Always introduce yourself and let the patient and family know what you are doing before starting a treatment or giving a drug.
• Uncover the patient/family personal needs. Discover what is important to them beyond the medical care and make accommodations if possible.
• Take time to listen. Attentive listening validates the patient and their concerns.
• Resolve everything that you can immediately and on the spot. If there is something that you are qualified to address, don’t delay by seeking permission.
• Never settle for “OK.” Challenge yourself to make it perfect.

Patient-centered healthcare delivery has clear benefits beyond making the patient better. By extending the focus of patient-centered care to the family, we created the ultimate win-win scenario. Patients are more satisfied and have better outcomes. The work environment becomes more of a ‘happy place’ and staff engagement improves. Patient loyalty develops and patients walk away with the commitment that there is no other place where they would seek care.

ProSynEx   Your source for leadership coaching and team building

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West Virginia ANA 2017

Oglebay1Meeting review by TC & TD

deerMeeting Date:  3/31/2017

Meeting Location:

Oglebay Resort, Wheeling, West Virginia

Meeting sponsor:  West Virginia Association of Nurse Anesthetists

Strengths of the meeting: Great mountain location with beautiful scenery, walking trails and abundant tame deer.  Awesome speakers, great topics and lots of fun.   With a reception the first night and a theme party the second, both providing dinner, this meeting offers the complete package.

 

Value for the money:   20 CEUs on a 3 day get away weekend with breakfast, lunch and dinner provided plus a reception.  The West Virginia Association knows how to do it right!  This is definitely on my list for next year.

Alaska Association of Nurse Anesthetists

header-hotel-summerMeeting review by TD

Meeting Date:  3/24/2017

Meeting Location:

Alyeska Resort, Alaska

Meeting sponsor:  Alaska Association of Nurse Anesthetists

Strengths of the meeting: 

Kudos to the Alaska Association for putting together a great agenda in a stunning location.  Excellent weather and spring skiing at it’s best added to the enjoyment of the meeting.   The stunning Alaska scenery was exceeded only by the hospitality of the association members.

Value for the money:   This is a hidden jewel among State meetings.  If Alaska is on your bucket list, this is a must meeting for you.

Meeting Review: Encore Symposiums, Palm Springs

Palm springsMeeting review by JD and LB

Meeting Date:  2/22/2017

Meeting Location:  Palm Springs, CA

Meeting sponsor:  Encore Symposiums

Strengths of the meeting: 

JD: I thoroughly enjoyed the meeting as well as the speakers.  The topics were especially relevant to me and were presented by energetic speakers.  The location was exceptional and I enjoyed the resort atmosphere.

Thanks for another great conference.  I’ll be back next year!

LB: Encore always does a great job. The speakers are always interesting with topics that are current and relevant. Most , if not all , of this meeting’s content applied to my current position. I also gained useful tips for a family member with chronic pain.
The locations for all of Encore’s meetings are very nice. My family enjoys coming along to each place. Nancy also does a very nice job with the first night meet and greet. Families are always included and it is really nice especially after traveling all day.
An Encore rep is available at each meeting for questions or clarifications.

Value for the money:   LB: All conferences have gone up in price but the facilities are always top notch, the food delicious and the clinical info always good. The resorts are also good for the families that must hang out while the CRNA is busy. So, yes, I think it is good value for the money.

 

Connect Through Recertification

By Thomas Davis, CRNA

 

nbcrnaNurse Anesthetists practicing in the United States are required to be certified and then recertified at intervals throughout their career. The recertification process is an opportunity for leaders to connect one on one with each member of their team, ensure that the person is qualified for recertification and improve employee engagement.

Management literature is filled with articles about the advantages of employee engagement and corporations pay millions of dollars every year on programs for improving it.   Very similar to other types of employment when it comes to the advantages of engagement, healthcare organizations depend upon effective leadership within the organization to inspire and motivate employees. Among the advantages of having an engaged staff are the following:

  • Improved Safety  Engaged factory workers are up to 5X less likely to be injured on the job. In healthcare not only are the workers less likely to be injured but they are less likely to make mistakes that injure others, including patients.
  • Improved health Engaged employees are less stressed, more relaxed in their interactions with others and are less likely to miss work due to illness.
  • Improved happiness  Engaged employees look forward to coming to work and interacting with co-workers who they are more likely to view as friends.
  • Improved Performance  Engaged employees tend to be more creative, have a better attitude and work at a higher level.   Their high-end work is more likely to be reflected in a salary bonus than that of a less productive peer.
  • Improved sense of community   Engaged employees tend to have the backs of their co-workers which is reflected in increased safety for the entire unit.
  • Improved retention Engaged employees are easier to retain.   Costs of recruiting, hiring and orienting new employees can be significant and employee engagement saves time and money for the organization.

 

Although many crash courses and gimmicks exist to improve employee engagement, the one piece that is essential for success is a trusting one on one relationship between the employee and the supervisor.   Whether you are the leader or the employee, developing the relationship is foundational to being a workplace of choice.

For several decades the Gallup organization has worked with employers to survey their workforce, assess engagement and make recommendations for improvement. The current Gallup engagement survey has been refined to 12 essential questions which give an accurate estimate of employee engagement. Three of the 12 can be addressed when the proactive leader uses recertification as an opportunity to connect individually with the employee.

  • Question 6  Is there someone at work who encourages your development?
  • Question 11 In the last 6 months has someone at work talked to you about your progress?
  • Question 12  In the last year have you been given opportunities to learn and grow?

 

The recertification process is a gold mine for the proactive leader committed to building a fully engaged team. Schedule a private, face to face meeting with each member of your team and discuss the following:

  • Determine eligibility for recertification  Whether the person recertifies this year or is mid cycle, determine where they are in obtaining the required continuing education.
  • Review the professional education that the person has received over the past two years. Discuss ways in which they can share their knowledge with the group.
  • Plan professional education for the next two years.   Make note of any special interest that the person may have and discuss ways in which developing the interest will benefit the group.
  • Explore enrichment opportunities beyond the required continuing education.   Many organizations offer in-house learning opportunities that do not award continuing education credit. Discuss ways in which the individual can pursue interests and grow professionally regardless of the credit that is awarded.

 

 Elevate your leadership by connecting with your team and motivating them to grow professionally.   By encouraging team members to enhance their individual skills, you will address issues that have been identified as essential by the Gallup survey and you will improve the engagement of your team.   Savvy leaders don’t wait for a stroke of luck to elevate the status of the team. A highly effective leader connects and engages with each individual by making use of a great opportunity like recertification.

 

Watch for the release of Tom’s book, Leader Reader 1, Authentic Healthcare Leadership scheduled for release on Amazon Books March 15, 2017

Start Tomorrow Today


Start Tomorrow Today

By Thomas Davis, CRNA

start tomorrow todayEffective leaders in healthcare, and across corporate America, are known for being very busy and efficient using effective schedules. Those who make it to the top leadership positions may appear to have everything under control as they progress through massive schedules. Although top executives have a support staff to help them maneuver through the day, their ability to navigate the workload goes beyond a skillful staff. CEOs have learned early in the game to establish a daily routine and weave it into it an agenda that the support team helps bring to life. An important component of the daily schedule is the end of day routine where the leader closes today and plans for a productive tomorrow.

Healthcare leaders work in an especially chaotic environment and by the end of the day it is tempting to pack up and leave. But if you skip out the door too quickly, you will deny yourself the opportunity to grow as a leader. The end of the day is a special time for you to reflect on the successes and challenges of the day, and to prepare for tomorrow. Leaders at any level will benefit by following these examples for routine and reflection.

• Block the last slot on your calendar for your shut down routine.
• Clean the clutter from your desk and your computer. Remove scrap paper and throw away everything that you do not absolutely need to keep. When in doubt, throw it out. Close any open files on your computer and reply ONLY to urgent email. Caution: Do not sacrifice your EOD routine by browsing through email and social media.
• Review the tasks on today’s to-do list and assess your effectiveness in bringing things to closure. Assess whether or not you were successful in completing your top priorities and determine which items to move to tomorrow’s to-do list.
• Close your eyes and visualize your biggest challenge. Relax and ask yourself WHAT questions such as, “What are other resources that I have not used?” “What if I re-prioritized my to-do list?” or “What piece of information is needed to allow the project to move forward?” Writing in the British J. of Psychology, Wieth and Zacks note that your brain is most creative when it is groggiest. Relaxing you tired brain and thinking through your upcoming challenges may give you insight that will solve tomorrow’s problem.
• Thank someone for their contribution to your personal success or the success of the team. Regularly recognizing others puts you and someone else in a positive frame of mind. In addition to showing thankfulness, sometimes offering forgiveness is important and appropriate.
• Review both your schedule for tomorrow as well as your to-do list. Make sure that your list reflects your priorities and that you have adequate resources to complete your list.
• Leave work at work and go home. On occasion you may need to finish something at home but routinely extending your work day into the evening will cause burnout and actually detract from your effectiveness.

Place value on your own after-work activities and develop the routine that works for you. To end my day with an established routine after leading a team of 110 healthcare workers, I created CROTE. Clean, Reflect, Organize Thank, Exit.

Fitness Fiscal Forecast

Fitness Fiscal Forecast

By Liz Sanner Davis, Certified Personal Trainer

 

Fit to LeadYour workout program for 2017 may resemble the weather history of the Galaxy 7 cell phone – unhealthy here today and, Poof! dead tomorrow. January is already pushing against the heart-happy, founding father’s birth month and this question quickly comes to mind. How many of you healthcare leaders out there started a January fitness program with your staff or for them, and how many of you are already sleeping in or sleeping it off? Fair questions. It’s easy to set up a contest, challenge the plebes, appoint a progress reporter and offer a prize, feign support and then go on about your busy business of leading. After all, your top-dog position entitles you to a few things like covered parking, private office, dinner meetings, football tickets; doesn’t that level of privilege also mean you and your health are your business? Shouldn’t you get to skip out on your own workout if you worked 14 hours yesterday? Isn’t it okay- heck, wasn’t it expected – that you drink two gin-t’s at the First Friday Leader’s Conference Kick-off dinner and catch some z’s while your dedicated team walked four miles without you in 35 degrees the next morning?

 

Nope, not okay. In fact, a worthy leader has a deep and well-maintained level of integrity or s/he should not have been selected for leadership.

 

It’s your job to lead by example. You can fake it or put your heart into it, your choice, but it’s still your job. Especially in healthcare, you have an accepted responsibility to your co-workers to be fit and healthy, to appear energetic and ready to rock ‘n roll every single day. And if you don’t see it that way, move over Rover and let someone with equal leadership skills but superior wellness ethics take your place.

 

Most health care teams would rather have a leader with crooked teeth who plays straight than a boss with straight teeth who plays crooked. If you implemented a wellness program for your staff, review and revamp it. Be an honest, straight forward leader and join your team on the walking path to wellness. Follow up and follow through in the same manner that you approach all team goals. Your fiscal fitness forecast should read: Sunny and healthy today, sunny and here tomorrow.

 

Liz Sanner Davis is a certified personal trainer, writer and regular contributor to Frontline Synergy. She is married to Tom S Davis, author, healthcare leadership and team developer, speaker and Certified Registered Nurse Anesthetist.

It’s All About You

It’s All About You: Keeping Resolutions

By Thomas Davis, CRNA

 

 

For many of us, starting the New Year is an opportunity to hit the reset button and change things that are not working well. When you look back this year, do you see a list of good intentions that were never accomplished? Do you know why?  Here is some solid advice for making New Year’s Resolutions that you can keep.

 

It’s All About You. Simply making a list of good intentions, does not solve a problem. To be effective, your resolutions must represent you and your resources. If you cannot reasonably achieve them, you are wasting your time and your commitment will only lead to frustration without results. When resolving to make change, consider the following:

  • Resolutions must be doable. By definition, a New Year’s resolution begins January 1. Be sure that a goal is within your grasp and that all the resources are available so you can start now.
  • The resolution must be within your control. You will not lose weight by asking others to give up cake for dessert. Likewise, resolving to help a child achieve straight A’s second semester is also a lofty goal, but you can’t control the final outcome. However, resolving to lose 5 pounds and to read 6 news books this year are goals that are totally under your control…as long as you are the one giving up the cake.
  • NYR’s must be specific and measurable. A resolution described in general terms leaves you with vague intent rather than firm commitment. “Ing” intentions like losing weight, exercising more, smoking less, or being happier are undefined with no end point. In contrast, “I commit to losing 10 pounds by exercising 30 min 3x a week,” or “I will stop smoking completely by April 1,” are both specific and can be measured. With an appropriate and measureable resolution, you will be able to answer yes/no as to whether or not the resolution was kept.

 

  • Accountability enhances success.   Accountability can provide an incentive to actually make the change that you want. You can avoid the easy anchor of status quo and create accountability by attaching a timeline to your resolution. Ensure that your resolution is doable, under your control and measurable, and give yourself a deadline. After setting a goal of losing 10 pounds, resolve that you will lose 1 pound per week for the next 10 weeks so that by a certain date you will weigh ten pounds less. Important: Put your timeline on your calendar.

 

  • Share your intent with others. Telling others about your resolution is another means of accountability that puts you in a position to reach the goal and get praised, or to fail and look foolish. It’s even more helpful if a friend with a similar resolution joins you and holds you both accountable. If you mutually establish 3 workouts per week as your resolution, arrange to exercise or walk together several times a week.

 

  • Seek support on social media. Social media is another venue for getting accountability. Publicly sharing your goal and your progress takes courage and invites a large and connected community to cheer you on. Nobody wants to fail while their 400 best friends are watching, and by revealing your resolution, you may also generate support from your true friends.

 

New Year’s Resolutions mark the passage of time and open the door to opportunity. Create your list with confidence and use positive language by stating your goals like affirmations. Begin each item with the words “I WILL” and mean it, and if you lapse, don’t abandon your resolve. Double down and get back on track. Realistic New Year’s resolutions, combined with commitment and accountability, will ensure success.

Thomas Davis is an experienced clinical anesthetist, leader, speaker and CEO of Frontline Synergy.  Enhancing leaders, Empowering teams

Who wants to be a millionaire leader?

Who wants to be a millionaire leader?

By Thomas Davis, CRNA

Keep up to date with healthcare leadership topics,

 

lifelinesAfter several decades in the workforce observing the leadership skills of former bosses as well as peers in leadership roles, I have yet to meet anyone who wants to fail as a leader. Regardless of the leadership position, from entry level to CEO, people want to be recognized for their excellence. They want to be remembered as being a great boss. They want to meet organizational expectations while engaging and empowering each team member. In their minds, they want it all.

Not all leaders make it into the elite group who are remembered as being a “best boss.” Though all start with the same desire and most will follow up with honest effort to be the best, some will be remembered fondly while others will be remembered as failures. Why do some excel while others fail?   Try taking a little game show advice to create your leadership game changer.

In 1999 Regis Philbin introduced the popular British TV game show Who Wants To Be a Millionaire? to America. Like people in leadership positions, the contestants on the show were given a series of questions to solve. Each contestant drew upon their personal knowledge base to answer progressively more difficult questions. When a contestant was unsure of the answer, they were allowed to use lifelines and ask for help. Contestants would ponder the nature of the question and choose between asking help from an expert, a friend, or by polling the audience.

As a leader, you are presented with problems on a daily basis that require your attention. Because of your background knowledge of both the organization and your team, you are usually able to quickly find solutions to problems.   However, like the contestants on the game show, now and then you are unsure and need help. Turn to your lifelines for support.

Ask an expert.   Seeking the advice of an expert is a viable option when stumped with a problem that is tied to a specific body of knowledge. Large organizations tend to have more experts on staff and advice is readily available.  If your organization is small, you may need to look outside to find a similar expert. Regardless, you want to be successful so contact an expert and ask your question. Caution: Although the expert has advanced knowledge, he does not know your workplace, your team or the context of the problem you with which you are faced. An expert may suggest applying general principles to what they think is the problem. Sometimes that’s a hit and sometimes it’s a miss, so when you seek advice from an expert, consider that they may be wrong. If your results are similar to the TV show, an expert will only get the right answer about 50% of the time.

Ask a friend. If the expert didn’t know the answer, your friend may. When people use a friend as a lifeline, they usually pick a friend who has a broad knowledge base and a lot of common sense. As your friend, they have a general idea of what you do and the challenges you face. As a leader who needs to ask a friend for advice solving a work-related problem, talking to a trusted peer or mentor will open a discussion with someone who can understand the nature of the problem. If you were on the TV show, your friend would be right about 65% of the time.

Poll the audience. In your workplace, you don’t have to poll a group of ordinary people who happened to score a ticket to the show. You have a qualified audience called a team. Gather your team into a town hall meeting and discuss the problem. You already know your own thoughts so be careful not to poison the pool of knowledge by sharing your ideas before listening to theirs. A better approach is to present the problem to the group, then close your mouth and listen. Take notes and ask follow-up questions to clarify ideas. Your team is on the front line and will be the ones implementing the solution. They have first-hand knowledge of the implications of the problem and the solution.   If you were on the TV show, your team would be right a whopping 95% of the time

Open your mind to the concept that the collective wisdom of your team holds the answers to most of your challenges. Listen carefully and agree on a plan that includes a timeline for implementation. Use your lifelines wisely and you will score points with administration and with your team for being a great problem solver and a millionaire leader.

Thomas Davis is an experienced clinical anesthetist, leader, speaker and the owner of Frontline Team Development and Leadership.

Maryland Association Fall meeting 2016

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Reviewed by:  Compilation of several CRNA reviews

Meeting Date:   10/8-9/2016

Meeting location:  Baltimore MD, Baltimore Hilton Hotel, Downtown

Meeting presented by:   MANA

Meeting strengths / interesting topics & speakers:    This meeting had an exceptional lineup of speakers and many interesting topics.  Lorraine Jordan provided an excellent update and other Nationally recognized speakers added to the quality of the meeting.  On Sunday, the ultrasound topic was a valuable presentation.   Several reviewers gave positive comments on the interactive format for the safety talk.  Overall, attendees were impressed by the quality of the speakers.

Suggested improvements:   Although the Hotel provided excellent service in a very nice space, some attendees stated that they would prefer NOT to be downtown with the challenges of parking and traffic.

Overall value for the money:   Excellent value. Great content and a nice meeting space.

Effective Listening

Beautiful Vietnamese business lady consulting client in the office

Keys to Effective Leadership: Listening

By Thomas Davis, CRNA

Nurse Managers and other frontline healthcare leaders want to be known as the boss that everybody wants to work for.   It is only natural to want to set goals that build your personal reputation and the success of your workgroup.   Being a good listener is foundational to achieving your goal and here are 2 guaranteed ways to increase your listening skills

  • Listen to understand
  • Listen to emotions

 

Listen to Understand

People want to be heard and understood.   When asked about the traits of their best boss, people will frequently say that it was a person who listened and at least tried to understand them. Conversely, when asked about their worst boss, they describe a person who was distant, isolated and out of touch with the needs of the individuals in the group.

The key to effective communication is effective listening.   Leaders often put two barriers between themselves and effective listening: the hectic pace of the workplace and the demands on time. Both factors place the leader at risk to be distracted while talking with a member of the team. Just like the raffle at church, you have to be present to win. Somebody on your team finally has the courage to open up to you with a problem and your mind is elsewhere! Whether you’re in the hallway or in the office, value the information that each member of your team offers and give them 100% focus when they talk to you.

The second and more difficult barrier to overcome is the tendency to prepare your response while the other person is talking. I call it agenda listening. You can’t fully appreciate the message the person is delivering if you are focused on your rebuttal. Serious listening is like drilling into the mother lode. By listening to learn, you will gain insight that will elevate you as a leader. Forget about your reply and listen carefully and hear everything that is said. You don’t have to agree but you will benefit from knowing their point of view.

Points:

  • Learn from listening.   Appreciate the gift you are being given.
  • Restate the other person’s position to ensure you both agree on what has been said.
  • Encourage the person to tell you more. Build on what they say with replies like, “Tell me more about…”
  • Encourage the person to clarify by asking how questions.   “How can we do that?” “How will that benefit the group?”
  • Avoid questions that put the person on the defensive.  Asking “why did you” puts them on the defensive and looking for an explanation.

 

Listen to emotions

As educated professionals, we listen with an academic ear. As team leaders, we must listen to both content (actual words) and the emotion that drives the words. We like to think that we are rational beings and that the argument founded in fact will win. Not so. We also have an emotional side and emotions frequently trump logic when interacting with troubled team members.  In a famous study, Albert Mehrabian noted that only 7% of what is communicated comes from actual words.  Tone of voice and body language make up the other 93% of communication. Maybe that is why so many email and text messages are misinterpreted.   As an effective leader, listen not only to the words but also listen to the tone and watch the body language to pick up on the emotion behind the message.

Points:

  • Allow people to feel how they feel. Telling them how they should feel ends communication.
  • Make open-ended statements about the emotions that you observe and listen to responses.
    • “I sense that you are uneasy with this proposal”
    • “You appear concerned about….”
  • Welcome and encourage team members to suggest solutions.

 

As a leader, your greater goal is to have a cohesive and effective team where each member is valued not only for the work that they do but also for the person who they are. Listening is the foundational element to build a one on one relationship with each team member.

 

Thomas Davis is an experienced clinical anesthetist, leader, speaker and the owner of Frontline Team Development and Leadership.

Snack for the Long Run

Snack for the Long Run

By Liz Sanner Davis, Certified Personal Trainer

 

Apples“Sugar and Salt, preferably together,” is the tantalizing message sent and received by a huge percentage of American snacks. Fifty or sixty years ago, coming home from school at 3:30 to a “snack” meant a glass of milk, an apple or a piece of bread slathered with Skippy. Today’s children come home at 5:30 to a bag of sugar and a package of salt.

Watching parents and children and their chubby chums walk or waddle down the snack aisle of Ralph’s or Teeters is mind-numbing experience. Watch what goes into their grocery carts. Caramel nut chocolate Turtles, popcorn fortified with candy and nuts, and Sweet and Salty Chex mix, then mixed some more. The snack aisle is the path to nutrient poverty. Multiple shelves are stacked floor to top with gummy-this, and that, while tiny hands and taller teens reach out to grab colorful boxes and cellophane bags of sugar and salt. Talk about high-fiving your kindergartener!

Sweet-and-Salty snacks has become the new normal for junkies. “Hold on, now,” you exclaim. “My grandpa always sugared his sweet potatoes and salted his watermelon slices two generations ago. “True enough,” I offer as a rejoinder, “And my grandfather had sugar diabetes.”

Quick, convenient, easy to store and landfill-ready are the current snack prereqs. Child-friendly and digital means finger food. Goodness forbid that we ask our children or spouse to sit at the kitchen counter to stick a spoon in Greek yogurt or fork into juicy chunks of melon while chit-chatting about a day at school or at work. Snacks today must be quick and convenient so that everyone’s life can be lived quickly and conveniently.

Yes, participating in the twenty-first century Snack-Pack will insure that your life is indeed quick, but you and yours may not find your maladies to be convenient.

A short risk list associated with snacking on fructose and sodium includes these hazards:

  • Hypertension
  • Weight gain or obesity
  • Dehydration
  • Lack of physical satisfaction
  • Tooth decay and gum disease
  • Nutrient deficiency
  • Digestive disorders
  • Depression
  • Gastrointestinal dysfunction

 

To avoid sounding like a POTUS candidate – big on criticisms and short on solutions – here are some great snack options, low-calorie, nutrient-dense or both. You might actually have a good time preparing them and even more fun distributing them among your children, their friends or the adult who walks in the house later than you do, wearing that hungry look.

  • 10 Wheat Thin Hint of Salt crackers(or the equivalent), stacked with 1 small slice of low-salt deli turkey cut into small squares, 1 slice of avocado, divided
  • ½ apple, sliced into eight pieces with a dab of natural peanut butter on each
  • 1 whole orange, peeled, each section cut in half
  • A bowl of mixed melon cubes
  • 16 unsalted almonds and ½ piece of whole fruit
  • ½ cup of plain yogurt with six strawberries, stemmed and cut in large chunks
  • ¼ cup of blueberries, ¼ large banana, 2 tablespoons granola, ¼ cup of plain yogurt, mixed
  • Green zucchini and carrots, crinkle-sliced and dipped in plain yogurt mixed with salsa
  • Smiley face multi-grain, peanut buttered bread rounds with blueberry eyes, banana slice nose and strawberry lips!

 

It doesn’t need to break the bank to snack well without sugar and salt. And you can fill your health needs without filling the land. Mix your own healthful dip, cut a pile of veggies and a whole melon on Sunday before the busy week begins. Mid-week, ask your teen to do it again. And is there some family law against the big kids peeling their own oranges and getting some rind under their nails or helping toddlers count their crackers and carrot sticks? Snack time could be the ultimate family fiesta amore!

Helping children get to college, paying off the mortgage, achieving personal job satisfaction are essentials in the long run. Make your own fixings to get yourself and the entire family back in the business of preparing and consuming healthful low-salt low-sugar snacks. Nix the mix and the long run will be healthier, seem shorter…and taste sweeter.

Liz Sanner Davis, Personal TrainerCertified by The Cooper Institute, Dallas, TX

bdyfrm@aol.com