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Building Common Purpose

Building Common Purpose

By Thomas Davis, CRNA

This is the third in a series of blog articles applying political quotes to frontline leadership. Previous articles have applied the words of Hillary Clinton and Mike Pence to frontline healthcare management. There is no intention of supporting or disparaging any candidate or party but rather learning from their words of wisdom. We will have to wait and see whether or not politicians and parties can turn words into action.

“You are the director of your own movie; if you aren’t enjoying what you are doing, change it.” “Stand up for principles and offer a real alternative.”   Gary Johnson

 

team buildingSame stuff, different day. Is that your experience as a frontline leader and manager?   Going back a few years, the basic murder mystery was the backbone of evening television.   A crime was committed, several suspects were identified, surprise evidence emerged, and the bad guy was caught.   The format was predictable, however in 1971 “Columbo” reversed it. A crime was committed with the perp identified up front. Viewers were kept on the edges of their seats while alibis melted away until justice prevailed.

To enable your group to achieve excellence and to keep the job interesting, rewrite your daily script. Engaging your team to edit the script creates a common purpose and becomes the cement that binds the team

Develop a common purpose.   If you think you have problems building consensus and motivating a team, consider the challenge faced by Coach Mike Krzyzewski when he agreed to coach the Olympic men’s basketball team. Taking a group of millionaire all-stars and asking them to give up their summer vacations in order to play even more basketball was not an easy task. To be successful, the team needed a common purpose.   Coach K took the team to Arlington Cemetery and the tomb of the Unknown Soldier and talked about people giving their lives for their country. He then took the team to the area of the cemetery where recent casualties are buried and they viewed gravestones of people younger than they. He arranged workouts at the military academies where young people were preparing to give all for their country if necessary. When all was done, the team was no longer playing summer basketball; they were playing for the honor of their country and all those who have given their lives to defend it. They had a common purpose.

As a frontline healthcare leader, you most likely will not be able to take your workgroup on a field trip to a National monument. Therefore, you must find common purpose within the environment where you live and work.

Create a common purpose

  • Focus on patient safety and satisfaction when rewriting the way you conduct your business.
  • Openly discuss concerns and explore remedies
  • Actively listen to each member of the team as they offer fresh ideas
  • Have a former patient or family member talk to your team and tell their story

 

Change the Script. As a leader, the team looks to you for guidance and wants you to motivate and provide direction. Be bold and confident when interacting with your team.   Meet regularly and link the new script to each member personally.   Tie common purpose to a sense of urgency and role model the new behavior that is expected of the group

Implement Change

  • Display competence and confidence when sharing expectations
  • Clearly outline expectations as you role model the desired behavior
  • Actively listen to and address concerns of team members. Ask what it would take for them to be fully on board.
  • Establish benchmarks to document progress toward achieving the larger goal
  • Recognize and reward desired behavior.

 

Some tasks have to be repetitive, but no one enjoys watching the same movie day after day. As a frontline leader, you will improve the workplace for both patients and workers by making a new script that infuses energy and improves outcome.

 

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

When a Barrier Falls

When a Barrier Falls

By Thomas Davis, CRNA

This is the second in a series of blog articles applying political quotes to frontline leadership. There is no intention of supporting or disparaging any candidate or party but rather learning from their words of wisdom. We will have to wait and see whether or not politicians and parties can turn words into action.

“Whenever a barrier falls in America, it clears the way for everyone.” Hillary Clinton

BarrierOn the heels of two political conventions, one-line catch phrases are as abundant as bugs on the windshield after a drive in the country. Instead of using the quotes to defend or denigrate a candidate, good leaders listen and apply the principles from the quotes to their workplace and the team they serve. For managers, identifying and removing barriers is often the difference between success and failure.

Back in the day, as the population moved from the East coast to populate the vast continent, it was important to have more than the vision of “go west.” Forward scouts were the trailblazers who led the way. They not only charted the course but also removed obstacles so that the wagon train could move forward. Likewise, the successful frontline leader is the person who not only knows the direction but also is able to move barriers.

Removing personal barriers

Recognizing and removing barriers is an ongoing activity for most frontline healthcare managers. Obstacles arise not only in response to implementation of change but also to maintaining the status quo. Though we frequently claim that someone or something is in the way, the first barrier often lies within. In leadership, lack of self- confidence or lack of knowledge are internal rocks in the road that must first be addressed before tackling external boulders. To prepare yourself:
• Study and thoroughly understand the present state. Know the greater goal of the organization and the history of policies that govern your daily activities.
• Have a clear vision of what you want to achieve and why it is important.
• Develop a network of trusted colleagues both within your workgroup and your organization whose support is reliable and trusted. Talk with them, ask questions and “listen to understand.”
• Move forward with confidence knowing that others share your desire for success.

Removing team barriers

As an all-star frontline worker it was all about you. You were recognized for excellence and your work was held as an example for others to follow. Now, as a leader, you are no longer judged by your personal work but rather by the results achieved by the team. The engaged and collaborative work of your team will ensure success. The good news is that your team wants to do a good job. Giving them the right tools is essential.

• Information: Communication with the team is essential. They must understand and share a clear vision of the desired outcome and have confidence that your leadership will support their efforts.
• Involvement: Make sure that every member of your team has responsibility and feels that each is, and all are, an important part of the overall success. Make this about the team and not about you.
• Goals: Identify benchmarks that are readily measured and visible to all. When the larger task is divided into smaller steps, each having a benchmark, the team will be eager to achieve the next goal.
• Reward: Celebrate success as each step is achieved. Small steps can be rewarded with recognition for a job well done. When the greater goal is achieved, a large celebration is in order.

All political candidates, regardless of party, speak in platitudes that describe an ideal world. They all make promises that cannot be kept. As frontline leaders and managers, you are in a unique position to take the principles put forth by the candidates and apply them directly to the workplace where they can and will make a difference. Be a trailblazer, leading the way with confidence and integrity, and turn the barriers into little bumps in the road.

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

Leading Frontline Change

Leading Frontline Change:

Today’s leadership investment yields tomorrow’s team dividends

By Thomas Davis, CRNA

Effectiveness as a leader is not based on popularity but rather on the ability to manage change

FLA“The only constant is change.”    Modifications to best practice protocols are initiated internally and are meant to improve both workflow and patient outcome. Other initiatives have an external source and are mandated by new regulations or alterations in reimbursement.   Frontline managers and team leaders set the tone for how the work group will respond and the attitude projected by the leader will ultimately contribute to the success or failure of the initiative.   Frontline Leaders are critical to success whenever the status quo is altered.

As recently as 5 years ago, in order to accommodate the need for Nurse Anesthetists and ICU nurses to work 12-hour shifts, several hospitals offered workers 3 X 12 hours per week to count and be paid as a 40 hour work week. The response was positive and the hospitals had a plethora of applicants working the popular shift.   Over time, changes in healthcare reimbursement took place and the 36-paid-as-40 model was no longer viable. Hospitals were forced to implement new schedules that required 40 hours of work for 40 hours of pay. For example, two individual hospitals in the same community implemented the change to the 40-hour work week with very different results.   Although the change was not popular at either hospital, one system made the change smoothly with the team focused on all of the other positive benefits offered by the employer. As a result, there were no resignations. At the second hospital, 18 members of the department abruptly quit their jobs. The difference was Frontline Leadership.

Status quo does offer a level of comfort, however, change is often an opportunity for the frontline healthcare leader to experience personal growth as well as growth and development of the team. The leader’s personal response to the change will set the tone for the entire workgroup. By using asset based thinking (ABT), creativity and good communication, your workgroup can lead the way in the implementation of change.   Remember, change does not necessarily threaten your personal vision. With creativity, change can actually move your vision forward. In the example of implementing the 40- hour work week, the successful leader held true to the vision of making the hospital an employer of choice.   The reason behind the change was thoroughly explained to the workgroup and the implications were revealed.   The group learned that the change would bring financial stability to the organization and add security to their jobs. The group actively participated in creating a new schedule that was acceptable to all. When the change was made, even though they preferred the 36-hour work week, the change went smoothly.   Conversely, at the other hospital the change was implemented as a mandate from above. The attitude was, “if you don’t like it, find another job”…and many did.

Build on a solid foundation  

Change is commonly perceived as threatening when the frontline worker sees no personal benefit.   Strong leaders have an opportunity to thrive during times of change as opposed to weak leaders who wilt and eventually perish. Leaders who are successful at embracing and implementing change are people who have a long history of being connected with the workgroup. A leader may safely assume that at some point policies and procedures will be altered. Establishing yourself as a trusted and confident person who cares about each team member on a personal level will give you credibility with the team when they feel threatened by the need to modify the status quo.

To be an effective leader:

  • Role model excellence in every phase of the job. Take your turn on the front line of patient care along with the members of your workgroup and earn respect for your skills.
  • Develop a one on one relationship with each member of your team. Know something personal about each person and have a sincere desire to promote their professional development.
  • Have a vision for the group and communicate it regularly. Every member of your team must know and support your vision.   Encourage open discussion to clarify your vision.
  • Be upbeat and confidently demonstrate ABT.  Anticipate success.

 

Do your Homework

With change comes anxiety and when people are uncertain, rumors emerge.   You will be amazed at what a friend of a friend heard someone say in the elevator.   Once gossip takes on a life of its own, it will taint how we perceive people and problems. Writing in Science, Eric Anderson states, “Gossip does not impact only how a face is evaluated – it affects whether a face is seen in the first place.” Once the gossip starts, time is of the essence to get it stopped. A leader must quickly understand the proposed change and the reasoning behind it, connecting the new policy to the greater goal of the organization, and then communicating it honestly and openly.

Before you talk with your team about the upcoming change, become the expert on the topic. Read the new policy and have a one-on-one conversation with your superiors and other stakeholders. Succinctly share your concerns privately in a proactive and asset-based manner.   Always speak and listen with good intent and with a commitment to understand.

Before you meet with your team:

  • Clarify the specifics of the future state and the advantages that will emerge with the new policy.
  • Identify and utilize key stakeholders and sources of support.
  • Identify obstacles and explore ways to remove them.
  • Involve key people in the workgroup to help with the rollout of the new plan.
  • Develop a timeline and abide by it.   Delaying will only give more time for rumors and gossip to spread.

 

Communicate

Sincere, two way communication is essential for implementing and managing change.   Set a positive and confident tone when discussing the future. If members of your team perceive that you are uncertain and lack confidence, they will not openly support you. Your ambivalence will be compounded by the negative effects of rumors and gossip causing morale to drop along with the effectiveness of your leadership. Now is the time for you to display self-assurance and maintain control. Being recognized and respected as a leader is status that is earned over time. From day one a leader must earn the trust of the team. Once you have done your homework related to the change and you know the details of both why and how the change will be implemented, you are ready for one of the most important roles of a leader – keeping the team informed.

To keep the team informed:

  • Schedule a town hall meeting where the change can be openly discussed.
  • Be open and honest and share all that you have been asked to share. If you have been asked not to share something, don’t pretend that you don’t know. Simply state that you cannot yet share that detail.
  • Let people know that gossip is not acceptable(will not be tolerated?). Honestly answer all questions in order to prevent and dispel rumors.
  • Listen to each member of the team with the intent to understand. Acknowledge individual concerns.
  • Use ABT to focus on positive aspects of the change.
  • Where possible, connect the proposed change to your personal vision and the greater goal of the organization.
  • Challenge the team to actively participate with implementing the change.

 

As the leader of a team of frontline healthcare workers, you want everything to run smoothly on a daily basis with great workflow, safe patient outcome and a happy staff.   Although change can be challenging to the team, it can also be an opportunity for the talented Frontline Leader to shine.   Make a commitment to establish a solid foundation with your team and to connect with each individual. The groundwork that you lay today will pay huge dividends when it’s time to implement the inevitable change.

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

Advice from Mom

By Thomas Davis, CRNA

This is the first of a series of blog articles applying political quotes to frontline leadership. There is no intention of supporting or disparaging any candidate or party but rather learning from their words of inspiration. Only time will tell whether or not action follows the words.

“I watched my mother build everything that mattered: A family, a business and a good name.” Mike Pence.

PenceMichael Richard Pence is the current Governor of Indiana and was named last week to be the Republican candidate for Vice-President of the United States.   Born June 7, 1959 in Columbus, Indiana, Mike is a lawyer who previously served in the US House of Representatives. As stated in the quote above, Mike learned values from his mother and has incorporated them into the way he conducts himself and his business.

Putting party ties aside, there are management lessons to be learned from political leaders…and their mothers.   Frontline leaders and managers in healthcare share a common quest for improving patient care, workflow efficiency and staff engagement.   Let’s look at the things that mattered most to Mike’s mother and apply them to our work as frontline leaders.

 

Building a family

As a leader, building a team of fully engaged and collaborative workers is foundational to success.   New frontline healthcare managers inherit a workgroup and must use their leadership skills to create a vision and convert independent workers into an effective team.   With skilled leadership and a common purpose, over time your team will become your extended family.   Teambuilding requires time, effort and basic leadership skills.

  • Start building your “family” by selecting and hiring the right people.   Be selective and ensure that the new hire shares your values before you bring them into your team.
  • Have a vision for your team and openly share it.   Meet with your team to clarify your goals and discuss your expectations of how your team will achieve results.
  • Communication is essential and must be two way. As a leader, listening can be more important than talking. By listening you will learn new details from frontline workers and you will reinforce to them that their thoughts are valued.
  • Empowerment of the team to resolve every issue at the lowest possible level increases efficiency and builds a sense of being valued.   Delegating and then supporting the decisions of others builds their desire to be more productive.
  • Trust is the glue that holds the work family together. Integrity is the key to building trust.

 

Building a business

Healthcare reform, combined with new Federal Regulations, have changed the reimbursement that hospitals receive for services provided to the patient.   As a frontline leader, you represent not only your work group but also the larger institution. Decisions must address not only what we do but how we do it.

  • Constantly review staffing and workflow to ensure that patient care is delivered in both a safe and efficient manner. Challenge your team to offer suggestions for improving efficiency.
  • Know the mission, vision and core values of the institution. Ensure that your management decisions are in alignment with the greater goal of the organization.
  • Build your interaction with your team based on trust, mutual understanding and an appreciation for the talents that each person brings to the group.

 

Building a good name

“Patient safety and satisfaction” are buzz words used by payers and repeated by upper level management at many Hospitals.   Patients come to the hospital expecting that high quality care will be delivered in a safe manner AND that they will have a great experience. As noted by author Fred Lee, “Patients judge their experience by how they are treated as a person, not by the way they were treated for their disease.” To build the reputation of the organization, frontline workers must connect one on one with each patient and truly care about their experience and outcome.

  • Empathy and understanding are two of nature’s greatest healing powers. Introduce yourself to patients and their families and make sure they know your role.
  • Listen with good intent and a sincere desire to help.
  • Ask your patients to tell you something about themselves that is not on their medical record. Your interest in them as a person will build a foundation of trust.
  • Successful outcome and satisfaction arise from a daily sharing of common values with your patient.

 

Just as in life, building a business, a family and a good name are foundational in the healthcare industry. Our leaders must be principled, our building blocks sound, and should serve the patient and society. Our construction site must be safe and secure and the edifice we build should be a living reflection of our values – values that would make Mom proud.

 

 

Visualizing Fitness

The See and the Saw

By Liz Davis, Certified Personal Trainer

Liz vision articleSit on a park bench, plant your feet firmly, close your eyes and visualize this:

You are energetic and tall, your core is solid,

your muscles taut, your breathing is even and relaxed,

you welcome the world with courage and confidence.

Now get up and walk toward what you see.

In his June 10 posting on ProCRNA.com, Tom Davis, CRNA, USAF Lt. Col (ret) and former Chief of the Division of Nurse Anesthesia at The Johns Hopkins Hospital, gives bullet-proof advice on developing and maintaining a Vision in Leadership. Your road map to physical fitness is encased in your personal view of how to achieve and maintain good health. Your physical well-being requires a personal vision.

When I work with wellness clients, we sit down for an interview in which we become acquainted with each other’s overall view of what wellness means. It doesn’t surprise me anymore to hear a potential client naively say, “I just want to lose ten pounds,” or “I’m getting ready for knee surgery and my doc says I have to get my quads in better shape first.” By the time our consultation is over, the potential client is a whole lot better informed about attempting to solve a health problem using a single stroke of the pen rather that creating a wellness vision, developing a plan for success and implementing it. When the consultee leaves the office he will either be sold or not buyin’.

Your surgeon truly does want you to develop better quads to enable a speedier return to normal after replacing your knee. But what she says and what you hear are not necessarily the same. She says, “Strengthen your quads,” and you may hear, “Go to a gym and do leg extensions.” Your internist says, “Lose 10 pounds to lower your cholesterol, and you may hear, “I will be healthy if I lose ten pounds.” Leg extensions will help strengthen your quads before knee surgery, and losing ten pounds will definitely lower your cholesterol, but neither insures a speedy recovery from surgery or a lifetime of quality HDL/LDL. A well-rounded plan will work wonders for achieving a wellness goal. A vision will work wonders for being able to live each day as part of the plan.

Consult a qualified fitness expert.

This is a must. Even if you have experience with exercise, getting another opinion, even an opinion to debate, is an important step in identifying your true needs. Pay for training with a qualified fitness expert OR go online and compare programs until you find one that wastes few dollars and makes common sense. Be absolutely certain to plan a well-rounded program that includes cardio, stretching, strength-training, Yoga and Pilates plus SAFE crunches.

Schedule your exercise time in cement.

Commit a definite time to exercise seven days a week and make it who you are, not just something you do. Those who say that exercising three to five days per week is sufficient are not wrong, they just aren’t addressing your state of mind. Three to five days is like belonging to a social club. But making a daily commitment to exercise who you are is like using the bathroom when you first get up each day. Your well-being will miss it when you miss it.

 

Establish a nutrition plan

You can do this by visiting a certified nutritionist or licensed dietician. You can take a class offered by your local health care provider. Or, you can go online again and find a common sense approach using a quality web site like Livestrong.com or Caloriecount.com. Stick to your food plan as if you were a politician in constant campaign mode.

 

Change your definition of the words “comfort, “hunger,” and satisfied.

There is no comfort in being overweight and overfat; there is little chance in the civilized world that you will ever experience actual hunger; and satisfaction is a noun. Daily structured exercise and a light, nutritious diet need to become your modus operandi for consistent wellness.

 

Weigh every Monday morning at the same time, au natural.

Weigh in the buff or wear precisely the same clothing items each and every time. Keep records of your wellness on a weight chart. Use a wellness journal to make daily and/or weekly entries of your progress, your state of physical being and your state of mind.

 

Assess and alter the plan.

Part of having a vision is “arriving” and enjoying the results. My older daughter’s high school cross country coach always spent the final practice before a meet having the runners sit in a dark room and visualize the entire running route, the hills, the rough paths, the potential pitfalls and especially, the final stretch. You will know in short order if your own exercise plan needs the adjustment, or if you do.

 

Your vision for wellness is very much like attending your grandparents’ 50th wedding anniversary without using google. The address is Wellness World, Fit City is the destination, the vision. The route you take is the implementation of your plan to arrive safely and on time. Celebration is what you do when you get there. Develop your vision and a healthful, efficient plan for implementation. Then get off the bench and on the road. Drive safely and soon you will see what you saw.

NWAS Arlington VA

Reviewed by:  MD,  West Virginia

Meeting Date:   06/23-26/2016washington-dc-fireworks

Meeting location:  Arlington Virginia, Westin Arlington Gateway Hotel

Meeting presented by:   NWAS

Meeting strengths / interesting topics & speakers:    This meeting lived up to the high standard set by NWAS.   The variety of speakers (both CRNA and MD) as well as the broad spectrum of topics held my interest for the entire 4 days.    This meeting offered more credits than most meetings and was done around noon every day.

I found both the hotel and the DC area to be friendly.  I had my family with me and there was no shortage of things to see and do.  My teen aged kids especially enjoyed the Smithsonian museums.   Getting around town was easy.  If we return to DC we will rent bikes  and enjoy the bike path to Mt Vernon along the river.

All in all, it was a good meeting and a great location.

Suggested improvements:   None

Overall value for the money:   Excellent value. Great location.

The Value of Vision

By Thomas Davis, CRNA

“You’ve got to be very careful if you don’t know where you are going because you might not get there” – Yogi Berra

moon picOn May 25th, 1961 John F. Kennedy had a vision and shared it with the American public. “By the end of the decade we will send a man to the moon and safely return him to earth.” The race to space was launched. NASA quickly became one of the most important Government Agencies, spurring math and science to dominate higher education.   Clearly, Kennedy had inspired the nation and when Neil Armstrong took the first step on the Moon in 1969 the vision was fulfilled. Creating, sharing and gaining commitment to a vision produced amazing results.

Creating a vision is the first step toward success and is all too often overlooked by emerging leaders. In his book The7 habits of highly effective people, author Stephen Covey recommends that we start with the end in mind.  As a leader, having and sharing a greater goal is essential for producing collaborative teamwork and achieving the desired goal.   Writing in the Harvard Business Review, Kouzes and Posner state that when workers are asked to describe the characteristics of a great boss, creating and sharing a vision are rated as very important. Across the board, leadership trainers and coaches agree on the importance of a vision when attempting to develop a highly effective team.   Having a vision and implementing it is the difference between leading and managing.

What is a vision statement? A vision statement is a short sentence or tagline that defines where you want to go and describes your future state. Sharing the vision and encouraging collaboration helps to define how you will get there.  The vision statement should be easy to remember and it should align with the needs and goals of your workgroup as well as the mission of the larger organization. Individuals in a workgroup may disagree on technical issues, however, everyone should be in agreement with the greater vision. The vision statement must be well known to the group, be achievable, and function as a point of reference when administrative decisions are made. Always ask, “Does this decision/policy support our vision?”

Corporations often condense their vision into a catchphrase easily remembered by both their workforce and the public.

  • “Where imagination meets nature” – Seaworld
  • “To provide access to the world’s information in one click” – Google
  • “People working together as a lean, global enterprise for automotive leadership” – Ford

When both employees and customers know the vision, there is common ground for aligning expectations not only about what is to be done but also how business is to be conducted.

Vision statements are equally important in healthcare to provide focus to all members of the organization, both professional and support staff.   In my tenure at Baylor Scott & White Medical Center in Texas, any employee could be asked the vision of the organization – To be the most trusted and valued name in Healthcare in America – and it rolled off their lips.   Every employee knew and embraced the vision.  The Cleveland Clinic boasts that they have no employees, only caregivers. The tagline well known to every Cleveland Clinic employee is, “We are all caregivers.” Coincidentally, after adopting the tagline, employee engagement scores have improved throughout the organization.

Status quo is a powerful force. Vision and courage are needed to make meaningful changes. A new healthcare manager, James, was hired to be the Chief Nurse Anesthetist in a department known for low morale and recruiting problems. Clearly an opportunity for improvement existed and focus was needed to transform a dysfunctional workgroup into a collaborative team. As a new leader, James shared his vision “to be the Nurse Anesthesia employer of choice in America” and went to work communicating the vision with the group. In a subsequent meeting, each member of the group was asked to describe what would be required to achieve the vision. Discussion identified things that could be changed immediately and things that would need to change over time.   The group walked away enthused and engaged with a commitment to become an employer of choice. Over the following year, results were amazing and now the group has more applicants than openings and employee satisfaction scores have improved.   The success achieved by a group of Nurse Anesthetists with a shared vision is typical of what can happen in any group with a common focus.

All too often we laugh at comments like the Yogi Berra quote above and then continue to go through our daily tasks without a unifying vision or goal.   Just as GE is a place where “we bring good things to life,” a leader, must have a vision and then engage the group to bring life to the stated vision.

Watch for the follow-up article for tips on how to write and implement a vision.

Thomas Davis is an experienced clinical anesthetist, leader, author, speaker and teambuilding coach.

Effective Leadership

Leadership

By Thomas Davis, CRNA

For centuries, leaders in both the Military and civilian world have attempted to identify and define the perfect leadership style. As far back as 500BC Lao-Tzu wrote in the Tao Te Ching, “The highest type of ruler is one of whose existence the people are barely aware….when the task is accomplished and things have been completed, all the people say we ourselves have achieved it.” On a grassroots level, people are empowered, engaged and have the self-satisfaction of a job well done.

 

Leaders in both business and healthcare are modifying their management style to encourage employee engagement.   As noted by Edward Hess in the Washington Post, “leaders of the most successful companies do not have a top down style of management”.   Collaborative management to encourage employee engagement is the key to success regardless of the type of business to include healthcare.  In reviewing leadership literature a common thread is advocating leadership through shared responsibility.   Collaborative Leadership is a sharing of power which recognizes the contributions of each individual and helps them develop and perform at their highest level.

 

Over the past 3 decades, I have observed many styles of leadership described with many different names. Without exception, the most efficient organizations with the highest employee engagement and morale were those in which the leaders followed the principles of Serving Leadership and shared governance.   Use the principles below to establish yourself as an effective manager of an engaged workgroup.

 

There are no unimportant jobs or people in an organization that embraces shared governance.   As a manager, develop a one on one relationship with each individual. When people are respected and their views heard, they become empowered and will seek excellence.   Both managers and front line workers recognize that mistakes will be made. By treating a mistake as a learning opportunity, lessons will be learned, and the organization will become stronger because each individual is allowed to take risk.   The key to success is to keep the team focused on the common goal.   One of the powerful actions described by Covey is “Begin with the end in mind” where the mission and vision of the organization are known and shared by all. High functioning workgroups are founded in trust, collaboration and holding one another accountable.   By affirming the common goal and using mistakes as teaching moments, effective leadership can pave the way to success.

 

Work is accomplished through relationships and trust is the glue that holds relationships together. Trust begins with you.   Begin your journey toward becoming an effective manager by looking within. What is your capacity to trust? What would happen if you approached every interaction from a baseline of trusting that you and the other person share common goals and seek common outcomes? Because you may disagree on a step in the process does not mean that your greater goals are different.   In the book Trust and Betrayal in the workplace, the Reina and Reina suggest the following for developing trust in relationships:

  • Share information
  • Tell the truth
  • Admit mistakes
  • Keep confidentiality
  • Give and receive feedback
  • Speak with good purpose
  • Take issues/concerns directly to the person involved 

 

Effective communication is essential in healthcare for patient safety, efficient workflow and employee morale.     Empowering Leadership upends the traditional top down leadership pyramid and makes each team member an equal participant in patient outcome.   The best decisions are made when opinions are solicited from a broad base of individuals who have a common interest in a positive outcome.   As a trained professional and leader, your insight and opinions are needed when decisions are being made however not all opinions are openly welcomed and received.   Grenny suggests the following when confronted with a difficult conversation:

  • Share your facts. Let the other person know what is behind your opinion.
  • Tell your story. Explain how you see things and why they are seen as they are.
  • Ask the other’s path. Openly solicit the other person explain why they see things as they do and listen to learn. Do not argue or confront as the other person explains their position.
  • Talk tentatively.   Ask “what if” or “what would it look like” questions to suggest your remedy and then listen as the other person responds.
  • Encourage testing. Come to a mutual agreement on a next step with the agreement that it will be reviewed and can be tweaked.
  • Being an effective manager does not require an MBA or that you were born into a family of corporate executives.   Put the micromanaging aside and trust in the abilities of your team.   By developing relationships, building on strengths, and communicating effectively, you too can be “the highest type of ruler” where your team achieves amazing results without your heavy hand.

 

Build on individual strengths to raise the collective performance of the group.   Each member of your team brings different strengths to the workplace. The person with the most creative ideas is not always skilled at putting the plan into action.   Teaming with others who can organize and execute the plan enables the creative genius of each individual to come to life. No individual can effectively do it all.

 

  1. Hess, Edward, April 28,2013. https://www.washingtonpost.com/business/capitalbusiness/servant-leadership-a-path-to-high-performance/2013/04/26/435e58b2-a7b8-11e2-8302-3c7e0ea97057_story.html
  2. Dennis Reina and Michelle Reina, Trust and Betrayal in the Workplace.
  3. https://hms.harvard.edu/news/safer-patient-handoffs
  4. Grenny, Patterson and McMillan, Crucial conversations: tools for talking when stakes are high

 

Thomas Davis is an experienced leader, author, speaker and teambuilding coach.

Flight Path to Patient Safety

By Thomas Davis, CRNA

Flight Path to Patient Safety

747With reimbursement and therefore job security tied to patient safety, it is incumbent on healthcare workers to become actively involved with the process of making healthcare safe for our patients.   Since the publication of “To Err is Human” in 1999, much attention has been given to patient safety, however, statistics still show that your luggage is safer in the airline system than your grandmother is in your local hospital. What can we learn from the Airline industry?

The 1970s were a particularly tragic time for commercial aviation.  In 1977 the collision of two 747 airliners on the runway in Tenerife killing 583 people followed by the famous airline crash in Portland in 1978, both due to poor communication, triggered a change in the way that the airlines conduct their business.   Mandatory training and implementation of Crew Resource Management changed the way flight crew employees interact with one another and ushered the way to a 5 year period with zero adverse incidents.   How did they do it?

Crew Resource Management is a set of training procedures for use in environments where human error can potentially have devastating effects. The focus of CRM is on interpersonal communication, leadership and decision making.   Our patients deserve the same focus on healthcare safety that they would receive as passengers on an airline. Here are some recommendations for taking CRM from the cockpit to the hospital.

All humans are fallible and susceptible to error…period. The greatest disservice that we can do to our patients is to believe that because we have special knowledge or skills, we are infallible and cannot make mistakes.   The airline crashes of the 1970s confirmed that the senior pilot did not have all the answers. Not only can we make mistakes but others around us can do the same.   It is only when we acknowledge our fallibility, and engage with our team in vigilance, that patient safety can be ensured. Regardless of your position on the team, know that you can make a mistake, and also know that you can fend off the consequences of mistakes that others are about to make.

All potential problems must be openly communicated in a positive manner that supports our coworkers.  In an environment focused on patient safety, sharing your concern with other team members should be welcomed and encouraged.   In addition, you must welcome and solicit the concerns and observations of others.   As healthcare professionals, we tend to get defensive when a co-worker points out a lapse in our delivery of a treatment.   With a focus on collaboration, we set the stage for patient safety as we reply, “Thank you,” rather than feeling threatened. Your reply sets a tone for other team members to welcome feedback.

All team members must be respected and heard.   Your knowledge and skills are respected. Your eyes and ears are open and your judgment is solid. Even so, remember that magicians make a living based on creating false perceptions.     What you see and believe may not be true. The TV program “Who wants to be a Millionaire” offers the contestants lifelines when they do not know the answer.   When statistics are reviewed “poll the audience” has the highest percentage of correct answers whereas “ask an expert” lags far behind in accuracy.   When the goal is patient safety, the collective wisdom of the group is more likely to be correct than the opinion of the expert.   Openly solicit and welcome the opinions of others regardless of their position on the team. Often, we can learn as much from people with lower status as we can from the recognized team leaders.

Problems must be anticipated and contingency plans must be in place. In his book Why Hospitals should fly: The Ultimate Flight Plan to Patient Safety and Quality, author John Nance recommends that healthcare workers view every patient as having a 50:50 chance of being harmed.   With a team committed to anticipating, detecting and preventing harm, the patient is best protected.   The team time out prior to a procedure is an opportunity for each member of the team to identify potential risk and offer a plan to prevent harm.   All too often the time out is not given the respect that it deserves and potential risk is not adequately discussed among the team members. As a patient advocate, use the time out as an opportunity to focus the team on patient safety.

Reduce distractions at critical times. Regulating the airline industry, the FAA requires the observation of “sterile cockpit” during the critical times surrounding takeoff and landing.   During this time, pilots must refrain from non-essential activities and conversation so that they can focus on the critical task at hand.   Stories of lapses in communication among distracted healthcare workers abound.   Distraction by idle conversation or use of social media during high risk times of patient care increases the risk of patient harm.   In the hospital setting it is not unusual for side bar conversations to take place while checklists are being read or timeouts are being done. As patient advocates, we must all share responsibility for the focus of the team to be on the patient at all times.

Value every member of the team.   On a recent flight, our boarding was delayed by an hour awaiting the arrival of a crew of flight attendants. Once we were on board, the pilot made an announcement. He apologized for the hour delay and said that we would be delayed a few more minutes…collective groan. He went on to say that the flight crew would be greater than 8 hours without food by the time we arrived at our destination.   He announced that he had ordered dinner for the flight crew and that we would be under way once the food arrived…collective cheer from the passengers. By looking out for the crew, the pilots believed that the passengers would be better served.   The lesson here is obvious. All too often we focus on our own needs and are not sensitive to the needs of others on our team.

As healthcare workers, our best opportunity for ensuring safety for our patients is to follow the example set by the airline industry and focus on communication and collaboration.   Hospitals across the nation hire experts to provide training on patient safety and yet the statistics often do not improve. When training is an academic exercise, nothing changes. It is only by applying the knowledge that improvement is made.   Use the lessons borrowed from the airline industry to ensure that your patients are safer your luggage.

Thomas Davis, CRNA is an experienced Chief CRNA, author, speaker and teambuilding coach.

Employee Wellness is No Joke

Employee Wellness is No Joke
liz fitness

By Liz Sanner Davis.  Liz is a Certified personal trainer and frequent author for procrna.com

 

It’s one of the biggest jokes in the lay community. Q. Where can you find the sickest people? A. In a hospital!   You probably don’t think that’s funny because every day you look at people with broken arms or legs, or repeat patients who have brutally aggressive melanomas or who live with the consequences of diabetes. Their pain is not amusing. But the joke, the cynically funny part, is that the joke is really referring to the hospital employees, your physician or physician’s assistant, the chief surgeon or anesthetist, the head of HR or the department secretary, YOU. The overweight and out of shape hospital employee appears as a huge disappointment to patients who are sick and seek your help.

Two-hundred-plus years ago, extra body fat was considered to be a sign of wealth. Abbigail Adams, after all, was short and fat. In spite of her years of physical labor on the farm and having to endure significant revolutionary war shortages, Abby still “enjoyed” a majority of her years ingesting quantities of comfort food. She and others of wealth and repute often made huge contributions to society whilst making ample time, following the years of economic travails of the war, for sitting, eating and being served often, if not well.

Is that you? Are you, in spite of 40-50 hours per week on your feet, in spite of regular paychecks and good benefits, in spite of wellness issues smacking you with direct hits daily, are you fat and flabby with chronic pain that plagues you all the way to the peanut butter cups and chocolate bars in the break room? Well, then, the joke’s on you, ‘though the patient isn’t laughing.

Don’t get me wrong. Being laughed at is ok on occasion, but laughing with is a whole lot more fun, and being the laughingstock? Not fun at all. In a new society that likes to outsource responsibility for their health to the healthcare industry, what part of your health problem is theirs, and what part of the problem is yours to fix or to prevent?

One can follow the history of workplace wellness in a timeline that begins with centuries-old Asian cultures, where employers dictated the wellness rules to employees. Throughout central Europe taxpayers supported and still support mandatory month-long employee holidays, thermal baths included. In the 1800’s, westward across the pond the wealthy elite offered workplace exercise activities to other wealthy elite. George Pullman, of rail fame, was one of the first to provide for general employee onsite wellness. (http://www.marketwatch.com/story/companies-meddling-in-employee-health-since-1880-2013-04-11)

The1970’s until the present have brought gradual changes to wellness in America. We have tried to approach wellness the same way we approach politics – by keeping The Nutrition Party and the Exercise Party separate. But over the last 45+ years, we have learned that exercise coupled with nutrition equals wellness. Along the way during those 45 years, the cost of living, the cost of healthcare and, therefore, the cost of taxes has risen exponentially. Fewer people carry the large economic burden and as medical know-how improves and the need for healthcare increases, the health of over-worked, over-stressed and over-tired employees has created a greater need than ever for wellness in the workplace. Employers are stepping up.

 

  • Broward, in Ft. Lauderdale, Fla, advertises, “We are a hospital-based fitness center with professionals certified by the American College of Sports Medicine and the National Strength and Conditioning Association. Our staff includes nutritionists and personal trainers who are educated in exercise physiology and nutrition, helping you create a healthier body, inside and out.”
  • Employees at The Johns Hopkins, Baltimore, MD provide a wealth of options presented on a monthly calendar that guides employees to the right location whether to enjoy a walking program or a smoking cessation appointment. Incentives are offered to encourage participation and commitment, and who doesn’t love praise and free stuff?
  • Grant Health and Fitness Center in Columbus, Ohio promotes “…health enhancement and disease prevention.” It is associated with a vast network of area hospitals and all locations have employee-friendly hours, a no-excuses kind of offer to help you maintain your status as an employee rather than as a patient.
  • The Cooper Institute, Dallas, TX has associated itself with healthcare entities for decades and offers certification for employees to return to the workplace and develop wellness/fitness programs. The Cooper’s credible certification program attracts healthcare, corporate and government clients worldwide. 

 

Providing employee wellness programs like these benefits the employer as well as the participant. Company insurance rates go down based on number of participants and proven results. Employee absenteeism is significantly reduced. People who work out together, work better together. They’re happier and, usually, just nicer to be around. And the quality of work provided by the healthy employee improves the entire company culture. Good health should reduce healthcare costs and reduced health care costs should lower our taxes!

But, be ready to pay if you want to play. Everyone wants something for free. If one thing has a fee and the other is free, we all know we will try very hard to make the freebie work, even if it really doesn’t. And if something costs nothing, the likelihood that we will follow through with the acquisition diminishes along with the return.

If wellness and fitness programs are not available at your place of work, get on it. the gym manager to your department chair. Head to Dallas to get certified at the Cooper Institute. After a rigorous week or two of classes and examinations, you could be qualified to blaze some trails to a clinic back home in Mississippi or Wyoming.

If wellness and fitness programs are available at your place of work, get to it. Join a program or help design a new one. Arrange to work with a qualified trainer. Get a work-out buddy and give and get the support that a partner provides, even and especially if you get to make a new friend doing it. For quality results, be certain to follow an integrated program that includes nutrition along with fitness. Be prepared and willing to pay the fee if it isn’t free.

So, what card will you be at work – the joke or the joker? Peanut butter and banana sandwiches may be how many of us got through college, but not through life. Take advantage of the whole-meal-deal offered by the employer at your place of work, and remember: The changes you make, the integrated health that you display to the patient, increases their trust and respect in the entire healthcare industry. Together, the patient’s trust and your good health will leave a permanent impression on history.

 

More:

http://www.corporatewellnessmagazine.com/worksite-wellness/the-evolution-of/http://www.bethesdaweb.com/employee-wellness-programshttp://www.beckershospitalreview.com/hospital-management-administration/18-most-popular-wellness-programs-for-hospital-employees.html

http://www.fiercehealthcare.com/story/what-hospitals-are-doing-employee-wellness/2012-03-15

http://www.amnhealthcare.com/the-roi-of-hospital-employee-wellness-programs/

http://www.cooperinstitute.org/pub/class_list.cfm?course_id=303

Making the Case for Fitness

hospital fitness

Making the Case for Fitness

By Liz Sanner Davis, Certified Personal Trainer

Being fit for your job as a professional CRNA means you have fulfilled all of the requirements. You are educated, you are licensed and you are poised, CV on file and and needle in hand, to enter the operating theatre. But, wait just a minute! Are you really fit for the job?

In the exercise wellness industry it’s accepted that a “soft body” isn’t much of a marketing tool. In fact, in most aspects of wellness careers it is anticipated that job applicants will practice what they preach. But to become a quality CRNA or anesthesiologist, physical fitness isn’t required. Read your contract. Being able to do lunges isn’t there. Read the job posting, your BMI doesn’t merit even an honorable mention. There is no hands-on exam with weight-bearing exercises and cardiovascular endurance. You are allowed to be hypertensive, sleep-deprived, diabetic due to obesity, undernourished, even outright anorexic using scrubs and mask as the cover-up. If your education and your skills satisfy the needs of your Chief CRNA and his/her chief, if your personality blends with the system, if the clinic is in need of your skills and the state gives you a “go”, you’re hired. Being fit and getting fit can end up at opposite ends of the table.

In fairness, the greater acuity of the case and the more talent you bring to the table, the less important it is to have muscular curves in all the right places. Equally, a remote hospital serving a rural area is seriously more interested in your warm body than your sculpted one. But at the end of a 16-hour heart-transplant, or 10 years of them, your ability to focus, to react, to apply your years of education and experience, and to simply endure are all dependent upon your own physical condition. Umpteen years ago, some smart person over 50 said this: When you have your health, you have everything.

FYI: You will not be discriminated against for being too fat or too underfed in the modern American job market. You cannot be marginalized just because a needle is the heaviest thing you can lift. Note, however, that just because free speech about your human condition is ethically discouraged, that doesn’t mean the patient isn’t silently worried because of it. What is your long-term contribution to this or any industry if you don’t take your own health seriously? Where is your integrity in intentionally being less fit for the job than you can be?

BTW: The patient who looks at your puffy preo-op face and watery eyes may want to

post a facebook remark about patient satisfaction that reads, “I’d give it a 3. My anesthetist looked so unhealthy I was afraid he would expire before I did.”

Beki Preston, MD, JD, adamantly states that “above and beyond all other issues surrounding a surgical procedure the bottom line is always patient safety.” Well, that’s hardly a newsflash, is it? Everything you do is supposed to be directed toward the safest possible outcome for your patient. I brazenly make the claim that everything you do inside and outside of the OR affects the safe outcome of your patient. Your health affects his.

Get some shut-eye. Yours is an industry that has sleep written all over it. If your patient took the opportunity to ask you some pre-op questions on S-day, he might ask, “How much sleep did you get last night?” Getting through 45+ hours a week is not, as one popular anesthesia blogger and mystery novel author suggests,“just five minutes at the beginning and at the end of a gall bladder removal.” Case management, whether you work with or without supervision or whether the case is big or bread-and-butter, requires your full attention from pre-op to wake-up. You’d better be wearing your toe shoes and stay awake every minute that your patient isn’t.

Thirty brisk minutes of cardio starts your engines. Before your morning shower, just gitter done. Cardio will open your eyes and keep them open during the critically careful intubation of a beautiful baby, or the delivery of one. It will elevate your mood and your level of energy. Being bright-eyed and bushy-tailed enables you to look into the trusting eyes of your patient with authenticity, empowering you both. Yoga and stretching exercises will build your core, improve your balance and give you peace during difficult cases. Lifting weights and using bands will strengthen your muscles, bones and brain. Instead of complaining at the cooler about your cranky knees or the crink in your lower back, you can be aiming your complaints at the Ravens or the Rams.

 Eat some measured quality calories. Your patient has a right to expect you to be fit and fed. Rolling your heavy backside out of bed and showing up for work with sleep in the corners of your eyes and frosting between your fingers, isn’t a poster for CRNA of the Year. A doughnut and cup of black coffee may get you through one hand of a two-fisted surgery, but a bowl of oatmeal with yogurt and an orange will last much longer without infusing fat chased by a post-sugar low. Turkey slices on a half multi-grain bagel topped with avocado alongside fresh fruit serve up lunchtime satisfaction and sustenance. When a team member offers you relief, go get some real relief. You don’t want to fill out on negative calories and return to Room #22 empty. Fill your vehicle with high-grade fuel to improve your mileage.

Your medical mantra should read: I am fit for duty. It’s unfair to the patient when you drag into work and try to manage your first few cases by rote. And it’s unfair to the care team if you call in sick on a Friday or Monday simply because you don’t take care of your total SELF. Additionally, it’s totally unfair to the industry to have killer expectations of you but fail to encourage and provide for your physical well-being.

We live in a country that regulates everything but your heartbeat. That, my fitness friend, is YOUR job. To be the best that you can be for the patient and for the team, do the best you can for your personal self. Get fit for the label you wear to avoid the tear. Earn the respect that you expect, the healthy income you are paid, and the important position you have established in the health and wellness industry. Get fit and be fit at the table.

Liz Sanner Davis,

bdyfrm@aol.com

 

Coming in April, “The Gym Rat”, a dissection of fitness programs provided to providers.

Getting the Right Match


By Thomas Davis, CRNA

“What counts in making a happy marriage is not so much how compatible you are but how you deal with incompatibility.”  ― Leo Tolstoy

Neil Clark Warren is a name that you may not know, however, when you see his face and hear his voice you will say, “Oh yeah, that guy.” Mr. Warren is a clinical psychologist, Christian Theologian, seminary professor and CEO of eHarmony.com. Most likely you know him fromeharmony over a decade of TV commercials.   As a marriage counselor, Neil worked with couples who, despite their love for one another, had compatibility issues.   The eHarmony.com web site was designed to assess the basic character and values of each person and then match them with a partner based on compatibility. The success of this online dating plan has been impressive.   Compatibility is foundational to every good relationship, including work relationships.

Compatibility is just as important in the workplace as it is to your personal life.   Being in the wrong job is like being married to the wrong person…lots of work and not much fun. All too often production pressure influences a manager to hire a person primarily to get them on the job and working quickly.   After months or years of frustration, the manager realizes that the employee is not compatible with his leadership style or the institution’s values. Both are unhappy and neither is as productive as each could be.

As healthcare managers, Chief CRNAs have a vested interest in ensuring that employees are fully engaged in their work.   Engaged employees provide consistent, high levels of productivity. They are your problem solvers and proactively identify ways to streamline workflow and improve patient satisfaction. They embrace the vision and values of the organization and are on board with your management style.

In contrast, disengaged employees are actively or passively against just about everything. They believe that they are right and everybody else is wrong and would rather hold on tightly to the problem than fix it. Most people reading this article can name both engaged and disengaged co-workers.   As a manager, you seek to increase the number of workers carrying the load and to reduce the number of those who put a drag on the system. Your goal is to have a fully engaged workgroup, and employee engagement starts with the hiring process.

As my mother used to say, “It’s easier to avoid getting into a bad relationship than it is to get out of one.”   As a manager building a team, the Chief CRNA must assess compatibility of every applicant and stay out of bad relationships. Always remember, there are highly qualified, fully capable applicants who have the work experience that you seek but still may be a terrible fit on your team. Compatibility is as important as capability when assembling your team.   Building compatibility into your team begins with the application/interview process.

Competence and capability are foundational for any employee to become a valued member of your staff. Competence is evident by the applicant’s having the education and skills required in the job description, however, capability relates to the willingness to work and the quest for professional growth. When interviewed, an engaged applicant will ask about your expectations and will also ask about taking on more responsibility.   The person will want to know how you define and reward excellence.   When you follow up with calls to references, ask about work ethic and ask for examples of when the applicant went above and beyond the basic requirements of the job.   If all the person does is show up, earn a pay check and go home, don’t expect to see an attitude change after becoming your employee.

An applicant’s Commitment to the mission, vision and values of the larger organization aligns them with others in the workgroup and provides a stable platform for future interaction. When you interview, ask the applicant why they want to work with your group. Are they committed to the group values and are they committed to a long term work relationship or are they passing through until a better option arises? Before the interview ends, get a verbal commitment that the applicant supports the values of the group. Regardless of their competence, if the applicant cannot commit to the values of the group, the person is not a good fit.

Compassion and caring about the welfare of patients and co-workers are signs of emotional health.   Having a sense of happiness and a good sense of humor will elevate the mood of the entire group and make your hospital a preferred workplace. Build your team with people who appear happy, who support one another and have a desire to connect socially.   The interview is your opportunity for a conversation with the applicant that is relaxed and easy.   If the interview is stressful or there is not a free flow of thoughts, the applicant is not a good fit.

Compensation to include both pay and benefits is important to the institution and to the applicant. The offer should be competitive with the local market and the applicant should be satisfied with the offer. Employees who feel that your offer is too low will feel under-appreciated and may quickly become under productive. Not only do they become a drag on your system, they drag others down with them and create discord on your team. Don’t apologize for your offer. If the applicant does not gladly accept it, they will not fit in and will jump ship at the first opportunity.

Communicate with people who know the applicant and their work ethic. The applicant will provide a list of people who can be relied upon to give a glowing testimony.   When you interview, ask the applicant for names and contact information for current employers/supervisors. Follow up with a phone call to validate the things told to you during the interview.

Just as Neil Clark Warren uses eHarmony to assess values and characteristics of people to increase the likelihood of compatibility, the Chief CRNA must have a working knowledge of the values of the institution, conduct a focused interview, and follow-up to assure that the applicant is a good match. A happy, healthy and engaged workgroup is founded on a compatible partnership.

Remember, it is easier to teach technical skills to the right person than it is to change the basic personality of a highly skilled but wrong person. For eHarmony in your workgroup, do your diligence and make a good match.

 

 

Tom is an experienced leader, educator, author and speaker with a passion for team building.      Contact tom@procrna.com

Chief CRNAs are Team Builders


Chief CRNAs are Team Builders

By Thomas Davis, CRNA

“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”  ― Margaret Mead

As CRNAs we live and work in a rapidly changing healthcare environment.   The mandate to provide more care for more people at a lower cost combined with increased Federal regulations has introduced both stress and uncertainty into the healthcare industry. New challenges have emerged in the healthcare workplace.     Value based reimbursement, systems team-buildingintegration, and regulatory changes are but a few of the issues that are stressing the status quo.   Now more than ever, having a staff of fully engaged, cost effective workers is essential to the survival of the organization.

CRNA leadership on the local level is more important now than at any time in history as hospitals adjust to the new reality of regulation and reimbursement.   With safety and outcome metrics being publicly reported and reimbursement being tied to patient safety and satisfaction, it is essential to have the right people providing patient care.   As highly skilled, cost effective front line providers of anesthesia, CRNAs are regarded as leaders in the operating room.   We are in a unique position to make a difference on a daily basis not only with patient outcomes but also with the overall success of the institution.

Chief CRNAs across the country play an important role at the intersection of the operating room and the larger institution.      CRNA leaders are challenged with putting together a team that will provide a positive experience for the patient within the financial limitations of the Hospital.   Selecting the right people and having them fully engaged is an ongoing challenge for managers. As Chief CRNAs, we must look beyond the fact that a person has a license and wants to work. We must carefully select the right people who will be fully engaged in their work and raise the bar on patient safety and satisfaction.   The following are tips for selecting the right people to join your team:

Set a greater goal for your group.   Have a meeting with your current CRNA group and discuss the mission, vision, and core values of the larger organization.   Share your personal vision and values with your group and then listen carefully as you discuss your vision with them.   Take the initiative to develop a written vision statement for your CRNA group with a list of core values.   The vision and values that you share must become the foundation when interviewing applicants for a new position.   Develop interview questions to determine the applicant’s alignment with your vision and values.   The person may be an accomplished anesthetist however if they do not align with your vision and values they are not a good match for your group.

Describe your leadership style and how it aligns with organizational leadership.   Literature from business management states that the traditional top down “captain of the ship” leadership style blocks creativity and engagement.   In healthcare as in the private sector, shared governance “serving leader” style of management promotes creativity and engagement.   Take the initiative to learn about serving leadership and develop a one on one relationship with each member of your group. A sincere desire to promote the career of each person will lead to CRNA engagement which translates into improved patient safety and satisfaction. An applicant who views you as a serving leader and a person who will promote his/her individual career will be eager to share your vision and will give 100% on the job.

Discuss all of the positives and negatives related to the job.   It is unfair to both you and the new employee for surprises to emerge after they start working.   The applicant should walk away from the interview with a clear knowledge of your expectations. If there are less desirable assignments or shifts, the applicant should know before they agree to join your group.

Communication is essential.   In this era of instant messaging and 24/7 access to texting, email and internet, it is possible to avoid basic one on one communication.   As a manager, you need open and honest, face to face, two way dialogue with each employee. If you have problems communicating with the applicant at interview, you will also have problems later.   Patient satisfaction is founded on connecting with healthcare providers. Your new employee must have the communication skills needed to connect with each and every patient.   In addition, conflict is inherent within any healthcare team.   It is equally important that your new hire have the skills to have constructive conversations with difficult physicians.   At interview, ask the applicant about times when they have connected with patients as well as times that they have disagreed with physicians.   If they can not have positive interactions in difficult situations, they may not be a match for your group.

Not every skilled CRNA is a good match for your team.   When you have a clear vision of your goals, have an empowering leadership style, and clearly communicate your expectations, you will be able to determine the right candidate for your position.   At the end of the interview, the applicant will know your expectations and will be able to commit to your vision before accepting the position. When both the manager and the new hire agree on the greater goal up front, the road to success has been paved.

 

Let me help you excel as a Chief CRNA.  Consultation service available related to team building and serving leadership.    Contact tom@procrna.com

The Importance of Patient Handoffs

handoff2At a time when patient safety is being linked to reimbursement, handoff of care from one provider/team to another has been identified as a time of vulnerability for the patient.   The Joint Commission has stated that communication failure during this critical time may be the cause of up to 30% of sentinel events in the peri-operative period.   To promote safety, The Joint Commission has identified patient handover as a top 5 initiative.   Closed claims studies have identified a link between handover of care and negative outcomes based on the incomplete transfer of information.

A prospective study by Hudson et al published in the J Cardiothorac Vasc Anesth.  (J Cardiothorac Vasc Anesth. 2015 Feb;29(1):11-6. doi: 10.1053/j.jvca.2014.05.018. Epub  2014 Nov 24.) explored the link between patient handover and outcome looking specifically at patients receiving cardiac surgery.  They documented that errors/omissions in transferring patient information from one team to the next resulted in harm to the patient.  In their study, the authors found that when was transferred from one team to another during cardiac surgery there was a 43% greater risk of in-hospital mortality and a 27% greater risk of morbidity.

Regardless of the type of case, transfer of information from one team to another both in the operating room and in the PACU is essential for patient safety.  Intraoperative team changes should be kept to a minimum and anesthesia providers must resist production pressure and give a full and complete report when leaving patients in PACU or ICU.

Click here to review an abstract of the article.

The strategy that will fix healthcare

bundled paymentAs healthcare workers, CRNAs have an interest in the future of healthcare.  In an era where the healthcare industry is tasked with producing better patient outcomes at a lower cost, it is becoming more apparent that the status quo is not working.   In the October 2013 issue of the Harvard Business Review, Authors Michael Porter and Thomas Lee discuss changes that are intended to address the challenges of faced by our current healthcare system.   Below is a brief review of the major points.  Click here to review the original article.

Both healthcare consumers and payers are not happy with our current model for healthcare delivery.  They agree  that it is now time for a new strategy that maximizes value for patients.  The authors foresee the future of healthcare being organized around the patients’ medical condition rather than Physician medical specialties.   The future of healthcare will move away from supply driven healthcare based on what physicians do and move to a consumer driven system based on what patients need.  This change in has been termed the “value agenda”.    With this agenda, the overreaching goal for medical providers as well as all stakeholders must be improving value for the patients.  To do this, the healthcare system must either improve outcomes without increasing cost or it must lower cost without compromising outcomes.

This excellent article continues with a description of areas that need to be addressed in the move from the current state to the future state of healthcare.   The Authors identify 6 essential components:

  • Organize into integrated practice units:  This changes the way healthcare workers are organized to deliver care.   In this model, care teams are organized around the needs of the patient.  Dedicated teams of clinical and non-clinical workers come together to provide everything that is needed to treat a specific medical condition.  In this model, the patient could go to one location and receive medical care, therapy and other support by an integrated team who work together to ensure optimal outcome for the patient.
  • Measure outcomes and cost for every patient: Current quality metrics do not measure quality but rather processes.   In the future state, patient outcome and the cost to achieve it will measure the value received.  Rather than assessing how many treatments were given, providers will be measured by whether or not optimal results were achieved.   In this model, all providers must work together with the common goal of improving outcomes.   Physicians, nurses, therapists, and others must all work as a unified team focused on the patient.
  • Move to bundled payment for care cycles:  Fee for service rewards the volume of care delivered but not the outcome achieved.   Bundled payment encourages teamwork and high value care.   Wallmart recently introduced a program which identified centers of excellence for specific medical conditions.   A single bundled payment is made for all the care necessary and the provider team must work together to deliver an excellent outcome within parameter of the bundled payment.   In this system, teamwork and focus on patient outcome are essential.
  • Integrate care delivery systems:  As the healthcare system moves to bundled payments, care for specific conditions will be concentrated into fewer locations with healthcare teams who specialize in that condition.   Integrating healthcare delivery offers the patient a “one stop shopping” experience at a place known for excellence.  Having highly skilled professionals working as a team with a high volume of patients with a specific condition encourages excellence.  Patients may need to travel farther but will receive the best possible care.
  • Expand the geographic reach:  Once a team of healthcare providers has achieved a level of excellence treating a certain medical condition, the system must leverage their expertise by increasing the volume of patients they treat.  Rather than duplicating efforts at every clinic in the system, referring patients to a high excellence/high volume location will both improve outcome and reduce cost.
  • Build an enabling information technology platform:
    A supporting information technology system is required to support all of the elements described above.   The current model of silos of healthcare delivery has allowed technology to develop within each silo.   Moving to the future state of integrated care, one data platform that can be accessed by all members of the team is essential.

The healthcare system is changing.  Those who cling to the past will become dinosaurs.  Patient safety and satisfaction combined with improved value (improved outcomes) will be the hallmark of the future of healthcare delivery.   How will this play out for CRNAs?   Rather than your value being totally at the head of the OR table, expect to become part of a collaborative team focused on patient outcome.   As centers of excellence emerge, the variety of cases you do may become narrower as your team is called upon to do a higher volume of patients with similar conditions.   Expect to play a larger role in the overall peri-operative experience of the patient to include postoperative care.

In the era of healthcare reform and changing expectations of patients and payers, the only thing that is certain is that changes will be made.

Click here to read the original article

Meeting Review: Med City Anesthesia Seminars

medcitySDMeeting review by RF

Meeting Date:  4/14/2013

Meeting Location:  San Diego

Meeting sponsor:  Med City Anesthesia Seminars

Strengths of the meeting:  I just attended Med City’s first anesthesia conference in beautiful San Diego. What a great time in such a wonderful destination. The all CRNA speakers were dynamic, interesting, humorous and held interesting discussions thru use of innovative technology. One of my favorite lectures was on social media and professionalism. How applicable to our personal and professional lives! There was a networking reception, along with some fun door prize drawings. I also enjoyed having the audience be all SRNAs and CRNAs. The Hard Rock Hotel was luxurious, with an abundance of offerings within a short walk or drives time. Med City Seminars definitely put on an awesome conference. So excited for future offerings!! The owners are very accommodating and extremely pleasant to work with. Looking forward to joining you in Seatle!!

Meeting Review: NAFA, Hilton Head Island, SC

Reviewed by:  PC,  Texas

Meeting Date:   05/29/2013

Meeting location:  Hilton Head Island, SC

Meeting presented by:   NAFA

Meeting strengths / interesting topics & speakers:    This meeting had relevant and dynamic speakers. None of these speakers spoke down to us or seemed more interested in hearing their own own presentation versus actually imparting usable information. Additionally, several speakers used video simulation to illustrate case concepts. The regional lecture included live demo with video simulcast along side of the sonography. It was an excellent teaching and demonstration adjunct. Even mundane topics that, on paper, seemed like basic review (ECG recognition and management), were made interesting by the delivery and case demonstrations (video VS simulation with input from real cases).

Suggested improvements:   Add another day, I really enjoyed it.

Overall value for the money:   Excellent value. Great location.

Chief CRNA: Building a Safe OR Environment

The model for Healthcare delivery in the United States has evolved from a paternalistic, volume based approach through an era of shared responsibility and now into a consumer driven value based model.  To remain competitive in today’s healthcare market, hospitals and providers must strive for patient safety and satisfaction in the delivery of patient care.  Creating and maintaining a safe environment is foundational to patient safety.

Writing in the Healinghealth.com blog, Susan Mazer writes about the importance of a clean and safe hospital environment.  She notes “The patient environment of care plays a vital role in the discipline of patient safety for every hospital. Demonstrating that the hospital is a safe place for patients and for those that work there should be of the utmost importance for all health care personnel.”  She goes on to list 5 steps for improving patient safety by improving the environment.  Below, are the 5 points from the original article modified to the anesthesia environment.

  1. Remove Equipment from Public areas:   As anesthetists, we are well aware of equipment that is stored in the hallways .  Not only does this extra equipment block the walkways, but it also increases the risk of tripping and makes cleaning more difficult.   Work with others in the OR suite to return excess equipment to the proper place and keep the halls free from clutter
  2. Minimize clutter within the operating room:  Extra monitors, pumps, warmers etc stored behind the anesthesia machine or cart limits your ability to move within the room and increases the risk for tripping.  Excess equipment also reduces your ability to clean between cases and increases the infection risk.  As above, return all excess equipment to the proper place before starting your case.
  3. Organize your cart and machine work space:  Everything needs to be seen and immediately available before starting the case.  Organize your work space the same way for every case so you know where to look for any drug or piece of equipment.  Have a place for drugs, airway equipment and paperwork so that each is readily available.
  4. Inspect your  workspace and monitors for cleanliness:  Don’t rely on housekeeping to get it right.  Look for residual blood or body fluids on your equipment and re-clean them if necessary.  Patients expect and deserve a clean environment that protects them from infection
  5. Minimize auditory clutter:  OK, music is great but it’s not the main event in the operating room.  Patient centered care requires the provider to be able to hear monitors, alarms and be able to communicate with the surgeon.   Keep the noise low and develop a “sterile cockpit” attitude during induction and emergence.

Developing and maintaining a safe environment involves more than the anesthetist.  The entire operating room crew must be on board and work together to ensure a clean, clutter free environment that promotes patient safety.

Clinical Topic: Obstructive Sleep Apnea and Outpatient Surgery

The evolving changes in the delivery of Healthcare in general and anesthsia in particular has created an emphasis on patient safety.  With the push for more cost effective delivery of healthcare, more procedures are being done on an outpatient basis on sicker patients.  Combining the new economics with the obesity epidemic in America has created the scenario where an increasing number of patients with Obstructive Sleep Apnea are presenting for outpatient surgery.  As anesthetists, we are tasked with providing safe care and answering the question of who is or is not a candidate for outpatient surgery.

In 2006 the ASA published guidelines for the perioperative management of patients with OSA.  Although the guidelines were good at the time, the Society for Ambulatory Anesthesia felt that the ASA guidelines were due for review and updating, did a comprehenhive review, and published their findings.

An article by Joshi et al published in Anesth Analg 2012 (Society for Ambulatory Anesthesia Consensus Statement on Preoperative Selection of Adult Patients with Obstructive Sleep Apnea Scheduled for Ambulatory Surgery) reviewed the ASA guidelines.   They went on to note that the Society for Ambulatory Anesthesia task force on practice guidelines developed a consensus statement for the selection of patients with OSA scheduled for ambulatory surgery.  Some key points include:

  • Patients with a known diagnosis of OSA and optimized comorbid medical conditions can be considered for ambulatory surgery, if they are able to use a continuous positive airway pressure device in the postoperative period.
  • Patients with a presumed diagnosis of OSA, based on screening tools such as the STOP–Bang questionnaire, and with optimized comorbid conditions, can be considered for ambulatory surgery, if postoperative pain can be managed predominantly with nonopioid analgesic techniques.
  • On the other hand, OSA patients with nonoptimized comorbid medical conditions may not be good candidates for ambulatory surgery.

Click here for an abstract of the Joshi article.

As anesthetists, how do we assess patients and how do we determine who is at risk?  The Society for Ambulatory Anesthesia recommends the use of the STOP-Bang assessment tool.  The questionnaire asks 8 basic questions and gives the anesthtist valuable information about the OSA risk during the preoperative evaluation.

Click here for the STOP-Bang tool in a PDF format which can be downloaded and printed.

Combining a good physical evaluation with the STOP-Bang assessment will help identify those at risk and enable the anesthetist to make an informed decision regarding who should or should not receive outpatient care.

Chief CRNA: Supervision and Billing Fraud

CRNAs work in many practice settings.  Those working in an office, clinic or small hospital often work as independent providers and work in collaboration with their surgeon.   CRNAs working in larger hospitals often work in an anesthesia team model and charges are made based on “supervision” by an anesthesiologist who is “immediately available”.   The definition of immediately available remains a topic of debate.

Writing in the blog The Anesthesia Insider, Tony Mira addresses the topics of immediately available and billing fraud.  He notes that there has never been a numerical definition for distance or amount of time allowable for an anesthesiologist to respond to a call to the room and states that the HHS Inspector General has visited hospitals, put on scrub clothes and observed the participation and availability of the anesthesiologist during a case.

Addressing this issue, last year the ASA House of Delegates approved this definition of “immediately available”

A medically directing anesthesiologist is immediately available if s/he is in physical proximity that allows the anesthesiologist to return to re-establish direct contact with the patient to meet medical needs and address any urgent or emergent clinical problems. These responsibilities may also be met through coordination among anesthesiologists of the same group or department.

Differences in the design and size of various facilities and demands of the particular surgical procedures make it impossible to define a specific time or distance for physical proximity.

In addition to observing the level of participation and availability of the anesthesiologist, the IG also does record audits looking for the following:

  • Errors in billing medically directed (modifier QK) cases as personally performed (modifier AA);
  • Missing documentation of any post-anesthesia care; and
  • Missing physician initials on the anesthesia records.

The clear implication for the CRNA at the head of the table is that if the anesthesiologist is billing for supervising the case they must be present and must also participate.  In addition, the participation must be documented.  Failure of the Anesthesiologist to be present and participate constitutes billing fraud.

 

Chief CRNA: Disabled Alarms Cost Lives

Do you ever get tired of listening to monitor alarms?   Many anesthesia providers who are confident in their vigilance and their ability to “know when something is wrong” mute the alarms when they feel that they are needlessly alarming.  Unfortunately, patients are injured or killed every years in anesthesia related mishaps which could have been prevented had the alarms been fully functional.

According to Ana McKee, MD from the Joint Commission “Alarm fatigue and management of alarms are important safety issues that we must confront”.  Between January 2009 and June 2012, the commission received 98 voluntary reports of alarm-related events, 80 of which resulted in patient deaths and 13 in serious injuries.  (The Dangers of Alarm Fatigue)

An article published in Outpatient Surgery describes one such case in which a 17 year old female was given Fentanyl in the recovery room in a bay where the monitor had been silenced.  The narcotic caused a respiratory arrest which went unnoticed due to the curtain pulled around the bed.  The patient suffered severe brain damage and died a few weeks later.  The settlement in the case was 6 million dollars and the CRNA was named in the suit along with the PACU staff because the anesthetist had left the patient with a monitor that had been muted.   Click here to read about the case.

The Joint Commission has named alarm fatigue as one of the top healthcare technology hazards and makes the following recommendations:

  • standard operating procedures for alarm management and response
  • an inventory of devices that sound alarms
  • guidelines for alarm settings and situations when alarm signals are not clinically necessary
  • regular training on alarm management and inspection of alarm-equipped devices
  • discussions to determine how to reduce nuisance alarms

Click here to read more from The Joint Commission regarding alarm fatigue

Monitor alarms are an important tool in the quest for patient safety and should not be disabled or muted.

Meeting Review: Pennsylvania ANA State Meeting

Meeting Date:   05/03/2013

Meeting location:  Hershey PA

Meeting presented by:   PANA

Meeting strengths / interesting topics & speakers:

This meeting was an exceptional offering and probably one of the best State meetings in the country. The meeting was held at the Hershey Hotel in Hershey PA. (the sweetest city in America). The hotel was historic located on a hillside and having great gardens. The Pennsylvania Assn of Nurse Anesthetist selected top notch CRNA speakers and also had concurrent sessions with ACLS, PALS and an Ultrasound workshop. Offering 20 CEUs during a weekend State meeting exceeds expectations.

Suggested improvements:

None. You guys have it together

Overall value for the money:

Exceptional value. This was as good or better than most of the commercial meetings. If the word gets out, this could rival the AANA National meeting as the premier meeting of the year.

Chief CRNA: Collecting Compensation Information

A Chief CRNA is seeking help from others across the country.  Specifically, the Chief is gathering information related to how CRNAs are compensated when taking call.  Please use the reply area on this web site or contact the Chief CRNA directly at the email address listed below.

Please provide the following information:

Are CRNAs at your institution exempt or non-exempt employees?

Do your CRNAs take beeper call from home and, if so, how are they compensated for this call?

Please use the reply area at the bottom of this posting or contact the Chief CRNA Directly at marty.henley@camc.org

Meeting Review: AANA Mid Year Assembly

Meeting reviewed by HP, CRNA, Texas

Meeting Date:  04/14/2013

Meeting location:  Arlington, VA / Washington, D.C.

Meeting presented by:  AANA

 

Meeting strengths / interesting topics & speakers:

Every year in April, AANA have their annual Mid-Year Assembly (MYA) in Washington D.C. I’ve had the privilege of attending MYA last year as a student and made a promise to myself and our profession that I will continue to be there every year! Experiencing the Capitol visits first-hand and seeing those in action to protect our profession — I believe whole-heartedly this is the most important AANA meeting! So what did we do??? For the “first-timers” at the nation’s Capitol, Sunday – Tuesday are full of featured speakers on prepping you on how to speak to legislators, what to expect at the Capitol, issues our profession is facing, and many more. Also, you break out to your region and speak specifically on your issues within the region. Capitol visits are scheduled on Tuesday and Wednesday. In the great state of Texas, we have 38 legislators. Out of the 38, we had 29 appointments (ladies, make sure you bring an extra pair of comfy shoes because there is a lot of walking in those stylish high heels otherwise!). The appointments were coordinated via our FDP – Jessica Appel. Most of the time you meet with the Congressman(woman) health liaison aid for about 15 minutes. You talk to them about the current issues pertaining to our profession — nondiscrimination language, SRNA education funds, etc. AANA have prepared folders to leave with them so they can review the individual topics discussed. Feel free to contact me at hpham827@hotmail.com for more information!

Overall value for the money:

Pros: 1. protecting our profession; 2. networking; 3. Cherry Blossom Festival; 4. Literally endless monuments and museums to go to; 5. Great place to bring your family

Cons: Very easy to get lost – I would suggest you hooking-up with someone who has been there before to “learn” the subway system.

New Product: Handwashing Bracelet Improves Handwashing Compliance

According to the CDC, nearly 2 million people get infections while in US hospitals annually and around 100,000 of those people die.  Hand washing is one of the most important and easy ways of reducing the transfer of pathogens from person to person.

An Article by By Ruth LeTexier, RN, BSN, PHN (Preventing Infection Through Handwashing) makes the following points:

  • In the healthcare setting, handwashing is often cited as the primary weapon in the infection control arsenal. The purpose of handwashing in the healthcare setting is microbial reduction in an effort to decrease the risk of nosocomial infections.
  • The CDC has identified handwashing as the single most important means of preventing the spread of infection.5 The premise of the handwashing CDC guideline is infection control. The CDC recommendations for handwashing are as follows:

Handwashing Indications
In the absence of a true emergency, personnel should always wash their hands:

1) Before performing invasive procedures (Category I).

2) Before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns (Category I).

3) Before and after touching wounds, whether surgical, traumatic, or associated with an invasive device (Category I).

4) After situations during which microbial contamination of hands is likely to occur, especially those involving contact with mucous membranes, blood or body fluids, and secretions or excretions (Category I).

5) After touching inanimate sources that are likely to be contaminated with virulent or epidemiologically important microorganisms; these sources include urine-measuring devices or secretion collecting apparatuses (Category I).

6) After taking care of an infected patient or one who is likely to be colonized with microorganisms of special clinical or epidemiologic significance, for example multiple-resistant bacteria (Category I).

7) Between contacts with different patients in high-risk units (Category I).

An article by Cory Schultz (A new wristband measures hand washing compliance by healthcare providers) describes a new product which improves handwashing compliance:

  • The creators of IntelligentM have designed a bracelet/wristband that vibrates when the wearer has scrubbed their hands for a sufficient length of time.
  • An accelerometer can detect how long an employee spends washing their hands; the wristband buzzes once if the procedure is done correctly and three times if it’s not.

Click here to read about the new handwashing bracelet and how it can improve compliance with CMS and CDC standards.