Category: Leadership articles

Timely and powerful articles to enhance leadership and build an empowered team.

Tax Tips for 1099 Workers

Tax tips for 1099 workers.

By Thomas Davis, DNAP, MAE, CRNA

Love it or hate it, it’s tax time and Uncle Sam is expecting you to ante up again this year.  It’s quite likely that many people reading this article have already filed their 2024 taxes, and some have received refunds.   Hopefully, the money that was set aside was sufficient to cover your tax obligation and there was enough extra to warrant some cash coming back to you…wahoo.  

For W2 workers, the employer tracks your income, withholds money from each paycheck for tax, and ensures that social security obligations are paid.   At the end of the year, the employee receives a W2 statement to go along with other tax documents and filing your tax return is simple.  W2 employees tend to file early and often receive a refund from the IRS.

Taxes for 1099 workers

The IRS refers to a 1099 worker as a freelancer, independent contractor, or self-employed worker and many CRNAs fall into this category of work.  As a 1099 worker, you are not an employee of the organization, rather you contract your services to them for an agreed upon fee.  Individual contracts specify the number of days to be worked, the location, as well as who is to provide necessary supplies and equipment.  In this scenario, the employer does not provide benefits, and it is up to the individual CRNA to obtain their own profession and medical insurance as well as contribute to their own retirement plan.   The employer does not withhold taxes or pay social security fees, so it is incumbent on each 1099 worker to pay those expenses from the compensation provided by the organization.

Because the 1099 worker is essentially a business selling services, the individual is eligible for many tax deductions that are not available to the W2 worker.  The good news is that 1099 contracting opens the door to tax deductions, the bad news is that it requires vigilance and record keeping.  Writing for Bonsai, author Michael Eckstein emphasizes the importance of consulting a tax professional who you can work with you year around to ensure that you are capturing all available tax deductions.

Commonly overlooked deductions for 1099 CRNAs

Business expenses: As a 1099 worker, you are essentially a business of one person selling anesthesia services to an organization.   Because you are a business, you are eligible for business deductions like those claimed by others who sell services to the public. 

  • Home office.  If you have a designated area in your house where you maintain your records and schedule work, you may deduct the space from your taxes.  The IRS allows $5/square foot up to 300 square feet.
  • Phone: If your phone is essential for scheduling work, a portion of your phone fee may be deductible.
  • Startup costs: If you decide to formally establish an LLC or S-Corp, the startup fees are tax deductible. Talk to your tax advisor and learn about the advantages of establishing an LLC or S-Corp.
  • Bank fees: If you are registered as an LLC or S-Corp, bank fees related to a business account are tax deductible.
  • Malpractice insurance: Commonly, the 1099 CRNA must provide their own malpractice insurance.  This is a tax-deductible business expense.
  • Health insurance: If you are working under the umbrella of LLC or S-Corp, the cost of health insurance for you and your family is tax deductible.  However, if you are not LLC or S-Corp, your insurance premium must exceed 7% of your adjusted gross income to qualify for a deduction.
  • License/CME: CRNAs working as a 1099 are eligible to deduct the expenses related to required continuing education and licensure.
  • Equipment depreciation: In some cases, independent practice CRNAs must provide their own anesthesia equipment.  If this applies to you, the value of the equipment that you own may be depreciated on an annual basis related to the life expectancy of the equipment.
  • Social security tax payment: As an independent contractor, you are required to make social security tax payments.  The fees that you pay for social security are tax deductible.
  • Retirement tax shelters: Self-employed workers are eligible to establish and fund retirement tax shelters.  The personal 401K is a frequently used platform for retirement funds, however there is a cap on the amount that you can contribute each year based on your gross income.   Your tax consultant will know how much you are allowed to contribute.
  • Car: In some cases, the mileage on your car may be deductible, however there are many requirements to qualify for the deduction.  If you are a 1099 worker commuting to the same full-time location daily, the auto deduction may not apply.  However, if you are more mobile and service many different offices on different days, the deduction may apply.  Your tax expert will advise you on your specific situation.
  • Tax consultation/preparation: The fees that you pay for tax consultation/preparation services are tax deductible.

The 1099 work arrangement is more complicated than working as a W2 employee for an organization.   Maximizing the benefits of independent contracting requires time and vigilance.  Gaining full benefit also requires the expertise of an experienced professional tax consultant.  That said, those who take control of their own finances, monitor their business on a frequent and regular basis, and keep accurate records tend to come out ahead on taxes at the end of the year.

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

Leadership; It’s more than a title

By Thomas Davis, DNAP, MAE, CRNA

Leaders: we love them, we hate them and then we become them

In the workplace and in our personal life, the concept of leader and leadership are often intertwined and misunderstood.   Let’s start this article by explaining the difference between the role of a leader and the behaviors that are associated with effective leadership.

Leader

A leader is a designated individual who has been given the responsibility to organize, guide, and manage a group of individuals.  Commonly, the leader is a person who has been handed a title and job description that outlines the expectations of the role.  Some of the common descriptions of a leader include:

  • Being the selected person in charge of a team or group.
  • Maintaining the status quo while achieving objectives outlined by the organization.
  • Delegating tasks, supervising work, and ensuring that resources are available.
  • Rigidly enforcing policies and procedures outlined by the organization.
  • Motivating team members to achieve production goals

Leadership

In contrast to being a person who carries the title of the leader, leadership is a concept or process that involves influencing and motivating a team/organization to achieve goals.  Leadership goes beyond day-to-day management and involves having a vision and the tenacity to move the organization forward while developing the individual talents of each team member.  Ideally, the person designated as the leader goes further than managing a team and exhibits leadership behavior.  Robert Smith Leadership identifies specific behaviors that are tied to effective leadership.

  • Coach and mentor.  Be a content expert and freely share your knowledge with team members.
  • Facilitator.  Ensure that the team has the required resources to accomplish the task.
  • Communicator.  Use emotional intelligence to deliver the message clearly and hone listening skills while being receptive to honest feedback.
  • Conflict resolver.  Listen attentively and use emotional intelligence to reframe the facts so that each side sees the conflict differently.
  • Innovator.  Constantly seek ways to improve the workflow.
  • Decision-maker.   Ensure that your authority is sufficient to enable you to be decisive with your responsibilities.   Align decisions with the mission, vision, and values of the organization.
  • Motivator.  Clearly define the goal, motivate the team and show resilience when setbacks occur.
  • Delegator.  Enhance professional development by delegating duties where appropriate.
  • Performance manager.  Use data-driven evidence to establish benchmarks and timelines which keep the team on track to achieve the goal.

Moving from leader to leadership

Designated leaders are often given their position as a reward for past performance and loyalty to the organization.  Often, the “go to” worker is bestowed the title as the boss with the expectation that they continue to effectively guide the workgroup and develop leadership traits.  Writing for Forbes, author Mark Murphy notes that it is difficult to transition from having a title to demonstrating leadership behavior because it requires transitioning from task-oriented work to empowering and motivating others.   He identifies the following as challenges that must be overcome when assuming a leadership role.

  • Trust others.  Designated leaders feel personally responsible for the outcome and tend to micro-manage to ensure the desired results.  Leadership is about surrounding yourself with competent people, trusting their capability, and relinquishing control.
  • Develop your leadership skills.   Communication, emotional intelligence and conflict resolution are all essential leadership skills and must be learned.
  • Delegate duties and authority.  Those in leadership set goals, provide resources, and motivate competent people to get the job done.  Leadership must ensure that workers have the authority to complete assigned tasks.   Micromanagement kills creativity must be avoided.
  • Professional development of others.  An essential component of long-term success for the organization is the continued professional development of every member of the group.  Effective leadership ensures that every employee can hone existing skills while expanding their role in the organization. In so doing, both productivity and retention are increased.

Being a designated leader with a title is all about you and how well tasks are completed.   Exhibiting leadership behavior is about the team and the success of the organization.   The most effective people in leadership positions have a vision, hire the right people, provide resources, ensure professional development, and trust team members to use their creativity to achieve the goal.  The challenge for those designated as the leader is to increase your value to the team and the organization by developing the leadership behaviors described above.

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

Break the Behavior of People Pleasing

By Thomas Davis, DNAP, MAE, CRNA

Do you have difficulty saying no when someone imposes on you? Do you feel responsible for how others feel, and do you say that you agree when you don’t?  Do you avoid conflict and accept fault when you aren’t to blame?  If so, you are not alone.  According to a 2020 survey by YouGov, 49% of US adults classify themselves as people pleasers so you are in good company.   And like most others in the PP club, you have probably discovered that deferring to the needs of others does not enhance your mental health or happiness.

Nurse Anesthesiologists and nurses in general are at increased risk of being people pleasers because of the job we do and the role that we play.  After all, nurses are nurturers, and our profession is built upon rendering care and comfort to others.    Although our intentions may be noble, extending the professional caregiver role to our personal life and sacrificing our own needs in deference to the needs of others will ultimately create stress, unhappiness, and burnout in the pleaser.    The stereotype of healthcare workers being people pleasers is reinforced by the introduction of the drama triangle by Stephen Karpman in 1961.  Psychologist Karpman studied workplace drama and noted that there are three positions on the drama triangle: persecutor, victim, and rescuer.  His work revealed that people usually enter the triangle at the same position and once the drama begins, individuals shift from position to position.   In my work with groups of nurse anesthesiologists, I have found that approximately 80% state that they enter the drama triangle as the rescuer which is totally consistent with nurturing and people pleasing.  Nurses want to make things better…they need to be needed.

Author Johanna Schram notes that people pleasing denies our personal needs and is not healthy.   She lists the following as dangers of people pleasing.

  • It sends a message that we are not good enough and changing who we are to please others reinforces a concept that we are inadequate as we are.
  • It creates a barrier to a deeper relationship.  When we focus on what they think of us, we lose the opportunity to get to know who they really are as individuals.
  • We neglect ourselves by always putting the needs of others first.
  • We suppress our emotions out of dread that expressing joy, sadness, anger or fear will make the other person uncomfortable.
  • Our actions are manipulative and dishonest.
  • We teach others how to treat us and as we accommodate, they make even more requests for our time and energy.
  • We lose track of ourselves and suppress our preferences in lieu of approval from others.

The extreme opposite of the people pleaser is the narcissist who puts personal importance and selfish needs above all else.  We have all known people who think they own the world and the rest of us are there to serve them.     The key for your own mental health and personal happiness is to carve out a niche that falls in between people pleasing and narcissist.   Setting boundaries for yourself and others is a good way to start re-defining how you interact with others.

Author Kim at the Clay behavioral health center urges people to be aware of their personal needs, be true to those desires rather than trying to fit in, and suggests that learning to say no is a great way to start the process.   Negotiation coach Chris Voss emphasizes that an honest no is better than a false yes and that sincerity reinforces personal integrity.  Offering additional advice on how to break the people pleasing habit, Psychology Today author Jennifer Gutman provides the following tips:

  • Keep the plans that you make for yourself.   Don’t knee jerk and abandon your personal agenda just because someone puts a demand on your time.  Practice saying, “thanks for asking but I have other plans.”
  • Practice being alone.  You don’t have to become a hermit, nor are you obligated to be immediately available to the whims of others.  Balance yourself by taking a break from being with others and find fulfillment in activities that you enjoy.
  • Decide by yourself.  People pleasers hedge their desires by first considering how others will react.  Have confidence, follow your instincts, decide, and stand by it.
  • Don’t offer unsolicited advice.  People pleasers are fixers and want to rescue others.   Your intentions may be honorable; however, it is much better to show empathy than to offer solutions to other people’s problems.  Don’t give a solution, rather, help them discover a solution themselves.
  • Develop a positive inner dialogue.  Everyone has a constant inner dialogue running in the background of their thoughts.  Focus on positive self-talk and reassure yourself that you are capable, competent, and your happiness is not dependent upon the approval of others.

In general, people want to be appreciated and accepted by others and some individuals think that altruistically giving of themselves is the key to success.  However, people pleasing is driven by insecurity, low self-esteem, and a commitment to avoiding conflict at all costs.   Escape the negative spiral by valuing your strengths and set both internal and external boundaries to manage rather than avoid conflict.  Follow the suggestions above and free yourself from the endless obligation of pleasing others.

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

Ban Affective Polarization in the workplace

By Thomas Davis, DNAP, MAE, CRNA

It’s been four years since our last presidential election, and now we are entering the final countdown toward election day 2024.   Despite rhetoric from both sides pledging to unite the country, the current political season finds our population more polarized than ever.  The emergence of social media as a primary means for gathering news only adds fuel to the fire.

Writing for Forbes magazine, author Tony Ewing notes that we all have thinking biases that distort our interpretation of the opinions of others.   He states that topics such as politics, religion, race, and sexual preferences push emotional buttons that often lead to heated reactions and arguments between formerly congenial colleagues.  This disruptive behavior polarizes the team and affects not only those who disagree with one another, but also others in the workplace who observe the behavior.  In the end, teamwork, productivity, and patient safety are all threatened by workplace polarization.

What about freedom of speech?

For over 250 years the United States has thrived on the free exchange of ideas with open dialogue and debate between both individuals and political parties.  Freedom of speech is so important for democracy that the first amendment to the constitution enshrined it as an American right.  The founders of our country believed that democracy could only exist within an environment of open debate of the issues.  Political disagreement was viewed as healthy all the way back to the early days of our independent nation when Thomas Jefferson introduced the two-party system.   Historically, political opponents openly debated the issues yet respected one another and remained friends at the end of the day. 

Affective polarization

Over the centuries, political debate has been taken to new levels and our society has moved from debate of the issues to affective polarization.   Wikipedia identifies affective polarization as progressing from a disagreement on the issues to an emotional dislike and distrust of those with opposing opinions.   Writing for Brookings, authors Overgaard and Woolley describe affective polarization as hostility and animosity toward those who disagree with your political viewpoint..  

The American Psychological Association studied affective polarization in the workplace and note that 1 in 4 employees report being negatively affected by political talk during the election season.  The APA study revealed that younger employees are more affected by polarization than older workers and that they report feeling stressed, isolated, and having negative views of co-workers who engage in political dialogue at work.

Ironically, behavior scientists have found that dogmatically promoting your political view causes the other person to dig in their heels and become more deeply entrenched in their position.  You are not changing their mind but rather solidifying their point of view. 

The bottom line is that affective polarization moves the interaction from “I don’t agree with you” to “I don’t like you.”  Your political opponent then becomes a “bad person” and labeling them as ignorant, out of touch, or deplorable turns dislike into hatred.  Behavior scientists find that most people have more in common than they realize, and that affective polarization needlessly drives a wedge between them.   This is not what you want in your workplace.

Preventing workplace polarization

Creating a preferred workplace is a goal for every effective leader.  Preventing political division from invading an otherwise collaborative and cohesive team takes foresight and courage.  It is easier to prevent a problem than to rebuild a team, so guardrails must be in place, especially going into the upcoming election season.   Author Roger Carbajal offers tips for controlling affective polarization in the workplace.

  • Establish a policy about political speech and signs in the workplace
  • Apply the rules consistently, without exception
  • Monitor workplace discussion
  • Periodically remind everyone of the rules

Regardless of your position on the team, be a champion for promoting collaborative teamwork and have zero tolerance for behavior that divides members of the group.   Review the mission, vision, and values of the organization and most likely you will find that affective polarization does not align with the core values that are meant to guide employee behavior.  Enforce and role model the core values of the organization.  In the end, workplace team unity is more important than the outcome of an election. 

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

Boost your value in the workplace

By Thomas Davis, DNAP, MAE, CRNA

You are at the end of another work year and it’s time for your annual performance review…what will you learn about yourself?  You spent a year delivering high-quality patient care but is that enough to be rated as a high achiever and earn a merit-based bonus?   Read on to discover the behaviors that elevate you to all-star status on your team and position you for rewards.

The indeed.com editorial board notes that the most valuable employees are dedicated individuals who use their skills and attitudes to not only improve their performance, but also to positively influence the work environment and elevate the entire team.  Clearly, establishing yourself as a highly valued employee requires more than doing your job well; it also involves your impact on achieving team and organizational goals. 

So how do you become the cream of the crop and rise to the top of your workgroup?  The editorial team at Star Staffing note that high achievers are skilled in the following areas:

  • Consistency.  Be rock solid consistent, reliable and predictable regardless of the chaos that often occurs in the workplace.  Respond with reason rather than emotion.
  • Nurture a positive attitude.  Attitudes are contagious.  Show up every day with pep in your step, a smile on your face, and anticipate that good things will happen.
  • Accept change.  The old cliché is true…the only thing that is constant is change.  Be a leader by accepting and embracing change.  Look for the potential good that will arise from the proposed change then leverage and promote the positive.
  • Grow your personal network.   Move beyond your immediate workgroup and connect with others in the organization who are outside of your department.  For example, if you work in the operating room, develop contact with people in radiology, pharmacy, and lab.
  • Hone communication skills.   Emotional intelligence is a foundational skill in the modern workplace regardless of the job that you do.  How you say it is as important as what you say…delivery is everything. 

Writing in Forbes Magazine, author Kara Dennison adds insight into increasing your value in the workplace with the following suggestions:

  • Build your personal brand.  Develop exceptional skills and expertise in a particular area to the point that you are recognized as a content expert and then become a resource outside your immediate department.  For example, anesthesia providers can become known throughout the organization as content experts for pain control, particularly non-narcotic, multi-modal techniques.
  • Never stop learning.  Equally important to constant learning is freely sharing your knowledge and skills.  Stay at the forefront of your profession and enhance your value by becoming a mentor.
  • Treat the job as if it is your business.  Gain an understanding of the cash flow within the department and actively market the services that your department delivers.  Develop and implement ways to improve workflow and cut costs.

Author Scott Mautz identifies core strengths that are shared by the most highly respected workers on the team.   Incorporating these strengths into your daily behavior will elevate your value to the team.

  • Self-confidence.  The inner belief that I am competent, capable and up to the challenge at hand.  Self-confidence arises from trust and acceptance of yourself and a sense that you have control of your life. 
  • Fortitude.  This refers to the ability to encounter difficulty or danger with courage.  In the workplace, this is demonstrated when a person stands up for what is right despite being faced with peer pressure to do otherwise.
  • Boldness.  In the workplace, boldness is a willingness to take risks and be innovative in a confident manner that shows no fear.   Boldness is demonstrated by setting high goals and then aggressively making them happen.
  • Decision-making.  Quickly consider the options and then take a stand.  Base decisions on increasing the good rather than avoiding a loss and then conclusively set a course of action.
  • Messaging.  Take control of your inner dialogue and eliminate negative thoughts, then, use your positive energy to influence and elevate others on the team.  Openly share your knowledge and skills with others in a manner that affirms their needs.  Make it obvious that you are there for the benefit of others. 

Pulling it all together

The collective wisdom of the authors mentioned in this article will position you to be a shining star and win the MVP (most valuable provider) award for your team.  Read through the behaviors listed above and pick out two to focus on immediately and then add one per month until you have mastered all of them.   It is easy to read an article like this and walk away motivated, however, your commitment to change must be more than a New Year’s resolution that lasts only a few weeks.  Rather than making the behaviors in this article what you do, make them who you are.  With commitment, over time you will be successful.

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

Dealing with Angry People

By Thomas Davis, DNAP, MAE, CRNA

A surgical technician came into the locker room at our outpatient center with out-of-control anger shouting, “They have idiots running this place and I’m not going to take it any longer.”  He changed clothes, walked out the door and never returned…road rage on steroids.

Anger in the workplace is something that we have all witnessed during our career.   At times it is a colleague who is irritated by a careless comment or glitch in the workflow and wants everyone to know about it. At other times, anger presents itself as full blown, out of control, road rage.  Either way, team members become uncomfortable, workflow suffers, and gossip is rampant in the break room.  If the event is a one-off, calm will be restored. However, when tension and anger are everyday occurrences, morale is destroyed, and patient safety suffers.  Regardless of your position on the team (leader versus worker) there are things that can be done to defuse anger not only in the workplace but also with people in other areas of your life.

Emotional intelligence.

Emotional intelligence was a buzz word 10 years ago and now has become an important skill for successful people at all levels.  In the leadership course that I teach at the Medical University of South Carolina, students learn that emotional intelligence is based on recognizing/controlling one’s own emotions and the emotions of others.   Techniques for self-awareness and self-control are relatively easy to master; the challenge is controlling the emotions of others including methods to defusing anger.

Understand Anger

The psychology and behavior science communities have done extensive research and posted publications about anger and its connection to the amygdala area of the brain.  In short, when we are stressed and something finally pushes our button, the brain responds by shifting both electrical activity and blood flow away from the thinking areas of the brain and shifts them to the emotional amygdala area triggering a flight or fight response.  We respond by saying and doing things that we would not normally say or do when the thinking brain is in control.  Therefore, the key to maintaining self-control when stressed is to be aware that you are stressed and actively keep the thinking brain in action thus preventing a takeover by the amygdala. Here are a few tips for achieving self-control and avoiding amygdala hijacks.

  • Pause.  Unless someone is shooting at you or you are about to be hit by a car while crossing the street, most stressors do not require a knee jerk response.  Intentionally take a moment to take a deep breath and calm yourself.  Then, organize your thoughts before responding.
  • Engage the thinking brain.  Rather than responding immediately when stressed, start an inner dialogue, and ask yourself several questions.  “Are things really as they appear on the surface?”  “What are my options for responding?”  “What will be the consequences of my action/response?” “What would the person I respect the most do in this situation?”  By keeping the thinking brain engaged, the shift of energy to the amygdala is prevented and you are more likely to make a response that you can live with.

Dealing with people who are angry.

Recall that emotional intelligence involves controlling your emotions and the emotions of others.  The first part is easy because you govern your thoughts and actions but how do you tame the anger in others?

Writing in the Harvard Business Review, author Leane Davey suggests when you are confronted by an angry person that initially you show support by NOT disagreeing or pushing back.  Use a calming tone of voice and listen while seeking to understand the emotion that is driving the anger.   Similarly, Psychcentral suggests that you NOT take the other person’s anger personally and that you focus on responding rather than reacting. 

Tips for defusing an angry person.

First and foremost, the other person’s anger is not about you.   You did not make the person angry; there may have been an issue that triggered them, however, it was their choice to respond with anger rather than reason…it’s not personal and it’s not about you.  Fighting back only throws kerosene on the fire and further shifts the other person’s brain activity to the amygdala.  So, how do you proceed when confronted by an angry person?

Force the other person to pause.  A pause gives time for stress hormones to dissipate and for the other person to regain composure.  For example, you are walking down the hall, and you are confronted by a colleague who uses an angry voice and is very upset about an issue.  Use a calm voice and say, “I have an urgent message that I have to send then I will give you my full attention because I want to learn more about what is going on.”  Then take out your phone and take a full minute to send yourself a text message.  Give the other person time to cool and regain composure.  Sometimes it’s best to schedule a time to meet later in the day thus allowing anger to dissipate.

Use a calm voice.  When stressed, we tend to speak with a higher voice pitch and at a faster pace.  Instill a sense of control by speaking in a low, slow voice.  People tend to mimic one another and often the other person will respond by calming their voice.

Set boundaries.  Hopefully the first two steps have started to calm the other person but if they remain irate, it’s time to set boundaries.  Famous FBI negotiator Chris Voss suggests using an “I” message where you identify the behavior, state how it affects you, and outline the consequences if it continues.  For example, “when you yell, I become defensive, and I want to withdraw.  I don’t think we can continue this discussion if you have this level of anger.”  Often, the person will calm out of fear of your walking away.

Listen to understand.  The single most important factor for defusing anger is for the other person to feel heard and understood.   Use body language to show interest in the other person, ask questions, and listen to understand rather than to rebut.  Ask questions that engage the other person’s thinking brain and be attentive to their point of view.   Use questions that start with “how” or “what”.   Questions that start with “why” or “you” put the other person on the defensive and must be avoided.  Always restate your understanding of what was said and allow the other person to correct you if you don’t have it exactly right.   Remember, you don’t have to agree with the other person, but you do have to understand them.

Guide the other person to the solution.  It’s human nature to get behind something when it is your idea.  Use guided questions, active listening, and allow the other person to discover the solution that you want.  Questions such as “what if”, “what would it look like if” or “how does this align with” forces the person to solve the problem.  If their solution is not reasonable, respond with “how am I supposed to do that?” and then remain silent until they find a workable solution.  When they come up with an appropriate solution, they are more likely to follow through and make it happen.

Use emotional intelligence to defuse anger.

The parable of the blind men and the elephant demonstrates that it is human nature to make decisions based on the piece of information at hand and rather than considering that others who have different experiences are equally correct.  Often, angry people do not have all the information and feel as if they are victims of something that they cannot control.  Consciously slowing the pace and taking an active interest in discovering the other person’s perspective will calm the anger and place you in a position where you can collaboratively find a solution.  Use the techniques described above to take control of your emotions and tame the wild beast in others.

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

The Emperor’s New Clothes; Lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

Born in Denmark in the early 1800’s, Hans Christian Anderson was a prolific writer best known for his fairy tales.  Among his famous fables, The Emperor’s New Clothes is a classic story that continues to be referenced two centuries later when the reality that we experience does not align with what we are told is “the truth”.  

In the story, two con men implement a plan to cheat a prideful emperor by manipulating his ego.  The men pretend to be weavers who have developed an amazing fabric that is invisible to those with a simple mind or unfit for their job.   Eager to have the best clothes ever made, the king was captivated by the ruse and hired the men to weave the fabric and make the clothes.  The men went to work pretending to weave fabric and make the clothing.  At intervals the emperor would send staff members to check on the progress and, knowing that only simpletons unfit for their position could not see the fabric, they reported that it was the most beautiful material ever made.  Finally, the tailors dressed the emperor in fake clothing and his staff marveled at the elegance of the new clothes.  Wanting to show off, the emperor paraded through the streets where everyone applauded and admired the beauty of the clothes…until a child called out…” but the emperor has on no clothing at all”.   Once the words were spoken, everyone, including the emperor, knew that they had been deceived and the embarrassed leader quickly returned home wearing only his underwear.

The most obvious takeaway from the story is that we must always trust what we see and experience rather than what we are told to believe by those who want to control the narrative.  Entering an election year, we will have ample opportunity to compare the reality of our lives to the narrative of the politicians and determine for ourselves whether the emperor is wearing clothes.

Leadership lessons from the story

Legendary football coach Vince Lombardi once said, “Leaders aren’t born, they are made and just like anything else, they are made through hard work.”   Becoming a respected leader takes effort and the story of the emperor’s new clothes contains a wealth of guidance for those who are leaders or aspire to leadership positions.  Here are some takeaways from the story.

Pride comes before the fall.  People aspire to leadership positions for a variety of reasons and, unfortunately, some seek power and position to boost their ego.  Authoritarian leaders use a heavy hand to maintain dominance and control over a workgroup and quickly silence those who challenge or disagree with them.  Workers learn very quickly to filter information and share only that which the leader wants to hear.  When open and honest communication is stifled, the leader is blinded from vital information.  Decision making without access to all the details ultimately results in failure.

Create the right environment.  Regardless of the leadership style, creating an environment based on open and honest communication ensures that the collective wisdom of the group is combined to formulate the best answer to a challenge.   Author Chris Voss notes that success is most likely when you enter a discussion with the mindset that you do not have all the information and that there is more to be learned.  By being receptive and rewarding feedback, both positive and negative, colleagues openly share their knowledge and trust is built within the workgroup.  When leaders value listening over telling, they are on the path to success.

Build the right team.  As an Air Force officer moving up through the ranks, I made it a point to observe my leaders and question what made the good leaders good versus what made the bad leaders bad.  Early in my career I observed that the worst leaders developed an inner circle of people who were most like themselves and shared the same view on most topics.  In contrast, the strongest leaders knew their strengths and weaknesses and built a team of individuals who could best cover the weaknesses.   Confident leaders delegate tasks and authority to those who are most skilled in that area.  The best leaders created a diverse team and actively sought out contrasting opinions.  A strong leader welcomes criticism and is willing to learn from mistakes.

Have realistic expectations.  Grandiose ideas set the leader up for failure when they cannot deliver on promises.   It takes more than imagination and good intentions to bring an idea to life.  A solid plan backed by resources, both materials and human, and a realistic timeline are all required for success.  In this story, the emperor foolishly believed that he could have whatever he imagined.

Learn from the Emperor

Whether you are a leader, worker or a citizen who desires to live in a just world, the lessons the emperor can be applied to your life.   Exposing yourself to contrasting opinions and listening to understand rather than to rebut will reveal information that is essential for decision making.   Avoid group thinking and once you have the facts, trust your instincts.   Trust what you see and experience and have the courage to say it like it is. 

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

Reverse mentoring; Unite and enlighten the workplace.

By Thomas Davis, DNAP, MAE, CRNA

Josh has been a solid frontline healthcare worker for 4 years, he is respected by colleagues and has developed a comfortable workflow.  His boss seems to be a little aloof and although Josh does his job well, he is stagnant in his work and does not sense an opportunity for professional growth or promotion.   The corporation is at risk of losing a qualified and productive worker. 

Marsha is in her 50s, Josh’s supervisor, and is the perioperative administrator in a busy 10 room suite of operating rooms.  She skillfully moves workers like pieces on a checkerboard to cover the hour by hour needs of the unit.  Many of the workers on her team are in their 20s/30s, and Marsha does not understand why they complain about their work.  She believes that younger workers lack the work ethic that she grew up with.

This workplace has a toxic disconnect between management and workers which is taking a toll on morale and productivity.

Harvard Business Review tackled the question of why people quit their job and offered these three primary reasons; 1) they don’t like the boss, 2) lack of professional development or opportunity for promotion, 3) the offer of a better gig elsewhere.  In this case, Josh did not sense a connection with the boss and experienced a void regarding professional development.  Suddenly, the pop-up recruiting messages on his phone started to catch his eye and he noted that others in his profession were not only making more money but also enjoyed jobs that included professional development.  Two months later, josh submitted his resignation and moved on.

In contrast, Marsha was so driven by production pressure and so focused on the immediate task at hand that she did not know or understand the personal challenges of younger workers, nor did she have a concern about their professional development. 

Culture change with a focus on professional development will convert this toxic environment into a preferred workplace.

Professional development is one of the three key pillars of a preferred workplace, the other two being emotional intelligence and values-based leadership.   Professional development can be achieved externally through the effort of the individual worker. However, in a preferred workplace, the leader ensures that opportunities for professional growth are offered and encouraged within the organization.  An effective mentoring/reverse mentoring program is a quick, easy, and inexpensive way to connect individuals, develop young workers, and enlighten older workers to both new technologies and the personal needs of the younger generation. 

The advantages of mentoring are well documented.  Author Nicola Cronin lists benefits to the mentee to include:

  • Increased self-confidence
  • A sense of being valued
  • Increased self-awareness
  • Improved communication skills
  • Developing a personal network
  • Becoming a good listener
  • Exposure to new and different perspectives
  • Increased emotional intelligence
  • Reduced level of anxiety
  • Increased chance for promotion
  • Increased job satisfaction.

In the scenario above, an ongoing mentoring program would have given Josh a support system and connection to a trusted person who was committed to developing Josh’s talents and helping him to advance in the organization.  Josh would have developed new skills and more importantly, he would have felt connected to the workplace and loyal to his supervisor.

Reverse mentoring is equally important.

Mentoring is most thought of as a top-down sharing of knowledge/skills from an older experienced person to a neophyte worker.  Reverse mentoring is equally important and often overlooked.  Simply stated, reverse mentoring is when a junior employee mentors someone more senior to them in the organization.  What can the apprentice possibly offer to an executive that would improve the functioning of the organization? 

The modern workplace tends to be multigenerational and multicultural.  It is not unusual for the executive suite to be filled with baby boomers while millennials shoulder the burden of the frontline work.  To further complicate things, Gen Z workers are graduating from college and enter the workplace with skills and expectations that are foreign to the Boomers in the front office.  Reverse mentoring closes the generational gap, teaches the latest technology to high level executives, and gives them a first-hand glimpse into issues that are important to young workers.  In contrast, young workers have face time with executives and gain insight into the C-Suite and plans for moving the company forward.  In the process, the junior employee feels valued and develops a sense of loyalty to the organization.

Legendary leader Jack Welch, former CEO of General Electric, was one of the first to promote reverse mentoring.  In the 1990s, the internet was a new technology, and the use of personal computers proved to be a challenge to upper-level executives.   Jack noted that new college graduates were all experts on computer use and quickly set up a reverse mentoring program connecting entry level workers with upper executives to help the elders understand and become comfortable with the new technology.  It was a win/win for GE.

Similarly, the modern healthcare workplace is a melting pot where new technology updates and replaces older techniques and, as Jack Welch noted in the 90s, the new graduate, junior employees, are the experts.  The use of ultrasound in the practice of anesthesia is but one example.  As noted by one of my colleagues, “anyone who has been out of school for over 10 years needs to be taught how to use ultrasound to assess gastric volume, new graduates know how and routinely use the technique…they are the best teachers.” 

Senior workers who openly seek mentoring from junior workers learn new skills and make personal connections which promote increased emotional intelligence.

Published in the online blog, Together, author Matthew Reeves identifies benefits for the senior workers that arise from reverse mentoring.

  • Closing the generational gap.  Each generation was raised at a different time and grew up with different life experiences.  For example, there is no way that a baby boomer can fully appreciate the life experiences of those who used computerized home schooling during the COVID crisis, nor do they fully appreciate the impact of social media on the younger generation.  Learning is about sharing new knowledge that transcends top-down teaching.  With reverse mentoring, senior employees learn new skills while junior workers gain a wealth of information based on the experiences of the senior worker.
  • Supporting diversity, equity, and inclusion.  Marian Wright Edelman said, “If you can’t see it, you can’t be it.”  The corporate world has made a commitment to increasing diversity in upper-level positions and reverse mentoring affords the opportunity for minority junior workers to have one on one time with executives.   While learning new technology skills, senior workers become aware of cultural challenges while junior workers are introduced to life in the front office.
  • Millennial retention.  Millennials (age 29-43) make up almost 40% of the workforce in the United States and recently an increasing number of them have negative feelings about their employers.  Workflow changed with COVID as did the expectations of the workers.  Reverse mentoring re-connects millennials with leadership, improves communication and aligns the company with post-covid worker and customer needs.
  • Enhancing creativity, open-mindedness, and innovation.  Connecting with and learning from a person of a different generation promotes learning about new technologies as well as becoming sensitive to their cultural needs.  Artificial intelligence is a concept to baby boomers however it is an everyday reality for new graduates.  AI and other technology are fertile ground for senior managers to learn from junior employees.
  • Empowering emerging leaders.  Young workers receive knowledge and technical skills that did not exist when the Boomers were in school, yet the youngsters are often intimidated by senior people who are high on the corporate ladder.  Reverse mentoring allows the junior employee to develop communication skills and self-confidence by mentoring senior leaders in the organization.  Once they realize the value that they bring to the job, junior workers become eager to expand and take on new and more challenging roles.

Mentoring is an essential component of a preferred workplace, and the most successful workgroups view it as a two-way process.  TED talk speaker and author Chip Conley notes the value of merging the knowledge of the young worker with the wisdom of older person when creating solutions to modern problems.  Regardless of your position in the organization, the first step in mentoring is opening your mind to the reality that others have something of value to share with you.  Seek them out, identify their strengths, and actively listen with the intent to learn as they share their knowledge with you.  You will grow professionally, and the other person will feel valued, which creates common ground for trust in one another.  Both parties in the relationship will walk away feeling empowered…a win/win situation for all.

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

Exterminate your ANTS; Conquer Automatic Negative Thinking

By Thomas Davis, DNAP, MAE, CRNA

“I wish I were a better person”, “I’m so helpless”, “I always get the worst assignments”, “I feel as if I’m an imposter”, “Work is sucking the life out of me”, “Nobody appreciates the stress that I have in my life”, “I’m so disappointed in myself”.

Is your head filled with ANTS?

Psychologists estimate that the human brain has up to 70,000 thoughts per day and those thoughts determine how we interact with those around us.  At the heart of how we collaborate and network with others is our ongoing inner dialogue of thoughts that guide our behavior.  ANTS, Automatic Negative Thoughts, are a part of the internal dialogue and when left unchecked, can undermine achieving happiness in life.

When negative thoughts pop up in moderation, they serve an important role in protecting us from potential danger in the world.  A baseline level of caution protects us from con artists and scammers who prey on gullible victims.  They also allow us to see potential consequences and help us to establish boundaries with ourselves and with others.  In moderation, a blend of negative thoughts with an otherwise optimistic attitude is a good thing.

However, all too often, negative thoughts dominate the inner dialogue and become the new baseline.  When ANTS take control of the brain, a negative spiral develops, people view themselves as inadequate, and the world around them as a threat.  Author and psychologist Jaoquin Selva notes that negative thoughts can be impactful and affect health outcomes as well as quality of life.   Yale news reports that negative thinking and depression can shrink the brain and cause a loss of synapses.  In addition, negative thoughts deplete the feel-good neurotransmitters serotonin and dopamine.  While negativity shrinks the brain, the brain’s fear and emotional center, the amygdala, becomes enlarged.   Buddha was correct when he noted, “nothing can harm you as much as your own thoughts.” 

So, what’s in your head?  What soundtrack do you have running in the background as you move through your day?  Forbes leadership author Christine Comaford notes that 90% of our thoughts are repetitive and we tend to think the same way today as we did yesterday.    Put differently, many of us have ANTS in our heads out of habit and not out of necessity.  Moving from a baseline of negative thought to a more balanced blend of optimism and caution requires erasing the old soundtrack and developing new habits, but as we all know from New Years resolutions, it takes more than good intentions to make the change.  Focused commitment is required.

Exterminate the ANTS

Restoring a healthy balance of thoughts in your brain begins with self-awareness.  What is your baseline?  Does your mind automatically see the downside to every encounter or are you upbeat and optimistic?    Here are some tips for those who want to exterminate ANTS, reduce anxiety, and increase happiness.

Removing ANTS begins with changing the news feed that you put into your head.  Being aware of negative thoughts allows you to question them and separate truth from unfounded fear.  When people wanted to pass negative news to the ancient philosopher Socrates, he would ask three questions: 1) Is it true? 2) Is it good?  3) Is it useful?  If the answer to any of the questions was no, he considered it to be gossip and would not listen.   When ANTS creep into your head, ask yourself the same questions and, like Socrates, reject thoughts that are not true.

TED talk speaker Anthony Metivier reinforces the advice from Socrates and suggests asking yourself two questions when experiencing negative thoughts; 1) Is it true. 2) How does it affect my behavior.  I would add a third question…how does my behavior affect the behavior of those around me?  Attitude is contagious and how you show up can either build up or take down the morale of the entire work group.

Viktor Frankl, author of Man’s Search for Meaning, states “in between stimulus and response is the most powerful human freedom; the power to choose. Here are some suggestions for stamping out the ANTS.

  • Increase your awareness of your baseline thoughts and question whether they are true, if they are useful, and how they influence the way you interact with those around you.
  • Find new evidence.   Rather than focusing on your shortcomings, make a list of your strengths.  Never say “I can’t”, rather say “I’ve not yet mastered that skill.”
  • Become aware of how the brain works. New neural pathways are developed through repetition so bathe your brain in positivity.
  • Be kind to yourself.  You are not obligated to focus on weakness or demeane yourself in any way.
  • Know your personal values and be true to them.  There are several online values assessment tools…select one and gain insight on the things that you value the most.
  • Define yourself based on your strengths and values.  Don’t waste time trying to be the person who someone else wants or expects you to be.  Limit your time on social media.
  • Ignore ANTS.  Use Socrates questions and throw out thoughts that do not rise to the standard of being truthful, good, and useful.
  • Meditate.  Start the day with a focus on positivity and end the day with a review of the good things that happened.
  • Be receptive to help.  If  ANTS are so deeply embedded into your brain you may need professional help.  Connect with a therapist who can give you practical advice for removing negative thoughts.

We live in a fast-paced, media driven world complete with pop-ups alerting us to every threat known to humanity.  As stress increases, so does the potential for an ANT infestation.  In the process, health and happiness falter and we are cheated out of the peace of mind that we deserve.  Removing the ANTS is a life changer.  Make a commitment to pest control and shake the ANTS out of your head.

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

Had I known then what I know now; Wisdom gained from experience

By Thomas Davis, DNAP, MAE, CRNA

Time travel is a captivating theme for Sci-fi movie enthusiasts.  Wouldn’t it be fun to go back in time 30 years knowing what you know now and be able to re-live the decades knowing in advance what the outcome will be.  If we had it to do again, we would all be successful…and very wealthy people.

While we await the development of time travel capability, there is another way to make decisions in our life that will open the door to success as if we were looking into the future.  The approach is so simplistic that many will doubt its effectiveness, however, listening to and building on the knowledge of successful people who are at the end of their careers will pave the way for people at all levels to advance themselves.  Regardless of whether you hold a leadership title, or if you want to be more effective in your daily life, learning from those who have walked the walk is a great starting point.

Published in Forbes.com, the article “15 Leadership lessons these leaders wish they had learned sooner” offers wisdom gained through the school of hard knocks.  Similarly, an article published by Christina Desmaris in Inc.com, “17 things these successful leaders wish they had known years ago” adds to the pool of wisdom meant to encourage the confidence of those developing their human interaction skills.  Reading through the articles, I must admit that I have learned some of the same lessons the hard way and only wish that I had known then what I know now.  As you read through the advice offered by experienced leaders, keep an open mind, and imagine that the advice is true.  Apply the advice to a current challenge that you are facing and visualize success in the months and years to come.  Learning from others can be a life-changing experience.

Things that leaders wish they had known earlier in their life.

  1. Leaders are there to help people grow professionally and personally.  If you are in a leadership position, know your people as individuals and focus on their professional development.  If you are a worker, let go of fear of your boss and assume that he/she truly wants you to be successful.  Develop a relationship that will enable your growth and position yourself to help others with their advancement.
  2. Successful people can adapt to any situation.  We are all more resilient than we think so open yourself to finding a creative solution and don’t throw in the towel.
  3. Self-awareness is the key to successful interaction with others.  Become self-aware and be mindful of how you affect others.  How you show up every day and your basic attitude is contagious.  Self-confidence, upright posture, optimism, and a great smile set the tone for any interaction that you engage in.
  4. The leader isn’t always the smartest person in the room.  People who are intent on alpha-dog dominance and insist that their solution is the best tend to micromanage and stifle the creative thoughts of others.  The most effective leaders surround themselves with talented people, establish the goal, provide resources, let them do their work, and are open to learn from them.
  5. The best leaders are transparent.  Transparency goes beyond basic honesty and builds a foundation for integrity.  Transparent people freely share the reason behind decisions and admit when they make mistakes.  Being transparent opens the door to revealing vulnerability which is frightening for many people.  Transparency requires courage.
  6. Confident people define themselves.   Never change who you are based on who others think that you are or want you to be.  Know yourself, your personal values, and your vision for the future and then be true to yourself and your goals.
  7. Great leaders listen to and respect frontline employees.  Diversity of thought adds strength to any group or organization and must be actively encouraged.   Solicit creative thoughts from others, actively listen with the intent of understanding, and then incorporate new ideas into problem solving.  Your team members will feel validated, and your supervisor will be amazed and the creative ideas you put forth. 
  8. There is a difference between leadership and management.  Leadership is about people and management is about things.  People have personalities and individual needs, things do not.  Use charts and spreadsheets to organize things, use emotional intelligence to connect one on one with people.
  9. Morality matters as much as competency. Ralph Waldo Emerson said, “Who you are speaks so loudly I can’t hear what you say.”  Your honesty, integrity and transparency are reflected by your behavior, and you will be judged on what you do and not how intelligent you are or what you say.
  10. Personal growth is a lifetime process.  There is no single philosophy or leadership course that will ensure success for the remainder of your career as a leader.  As the world changes, so do the leadership challenges and the approaches for solving them.  Regardless of whether you hold a leadership title, make a commitment to being open minded, observant, and learning from every experience.

The ten pearls of wisdom listed above were compiled based on feedback from experienced leaders.   I am now in my fourth decade as a healthcare provider, educator and leader and have learned many lessons along the way myself.  Looking back over my career, the most important thing that I have learned is that leadership is about the people, not the leader.   Success arises from using emotional intelligence to connect with those you supervise, those who supervise you, and the population that you serve.  True success comes when you can align the personal goals of others with the goals and vision of the organization to reach the point where, in the words of General Eisenhower, “people do what you want them to do because they want to do it.”  

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

How well do you know your patient?

By Thomas Davis, DNAP, MAE, CRNA

You know the type of surgery that your patient will receive, you have reviewed the lab work and history/physical and you have a sense about their basic health.  It’s time to meet the patient, assess the airway, explain what you will be doing and then get the case going.   You feel as if you know your patient, but do you know who they are as an individual?

The business community has learned that regardless of the product being offered or the knowledge of the salesperson, it is the consumer who makes the decision about what to purchase or pass up.  Over the past decade, the business community has become increasingly aware of the importance of understanding consumer intent.  Simply stated, consumer intent is the desired outcome that drives the person to purchase a product.  It is the foundational reason that creates the motivation to buy the item.  You may know your patient from a medical perspective, but you don’t truly know them until you understand what drives their desire to obtain medical care and their desired outcome.

How does consumer intent apply to us as healthcare workers? After all, we are in healthcare to provide a basic service and promote wellness.  Yes, we provide essential care, however patients have ownership of their medical records and are no longer geographically bound.  Our patients are free to travel either locally or to distant communities to obtain healthcare as they desire.  As a result, healthcare delivery has become competitive, and providers must be sensitive to creating a loyal customer base that generates the cash flow required to keep the doors open.  Becoming aware of customer intent builds a foundation for a trusting relationship and promotes two-way loyalty between the provider and the patient. 

On the institutional level

Healthcare organizations want to be at the forefront delivering state of the art, evidence-based care to their population base.   Introducing new lines of care and investing in technology to support emerging programs is expensive, therefore, upper-level leaders assess return on investment before moving forward.  Gathering information about consumer intent gives important insight into what services their client base want the organization to provide.  Writing in Loyalhealth, author Brian Gresh describes how healthcare organizations are using chatbots linked to artificial intelligence to assess consumer intent.  Prominently displayed on the company website is a chatbot with the Question, “How can I help you.”  Questions from patients are submitted and AI links to evidence-based information that answers the person’s question.  In the background, the organization captures the questions that are asked and gains valuable insight related to what is on the mind of the population that they serve. 

Consumer intent on a personal level

Reviewing information gathered by the company chatbot may be interesting, however, it is up to us to connect one on one with our patients and determine not only what they want, but also why they want it.  The task may sound daunting, yet by making a commitment to connect with each patient and following a simple plan, you will be amazed how easy it is to gain insight into the patient and their family.  Let’s get started.

Develop a routine.  We are creatures of habit and are less likely to forget something when it is part of our routine.  Review your order of events for doing the pre-operative assessment/teaching and create a space to learn about the patient as an individual including their expectations related to the desired outcome.  Create and ask personal preference questions at the same point during every pre-op interview. 

Develop open ended questions.  Establish one or two non-medical questions to assess who the person is as an individual.   Writing in the Harvard Business Review, Authors Awdish and Berry recommend questions that reveal individual preferences and expectations.   Rather than opening the pre-operative interview with questions about the person’s baseline health, introduce yourself and then ask, “What is important for me to know about your health, your preferences, and you as a person?”   If you listen attentively, you will gain valuable insight about baseline health as well as expectations.  A favorite question that I ask patients as we roll to the operating room is “Tell me something about you that is not on your medical record.”  Again, careful listening will give you insight into the things that matter the most to your patient.

Hone your listening skills.  The questions in the previous paragraph are only effective if you actively listen.  Enter the conversation with a curiosity to know more about the person and a commitment to using higher levels of listening to gather insight.  Writing for The Black Swan, author Derek Gaunt describes five levels of listening:

  • Listening for the gist.  In a busy, high production pressure environment, who has time to effectively listen?  When you listen for the gist, you say “ya, ya” as the other person talks and all the while your mind is elsewhere.  If you check your phone for messages while another person is talking, at best you will get the gist of the conversation and no more.  Not only is it rude, but you also cheat yourself out of an opportunity to learn about what is on another person’s mind.
  • Listening to rebut.  Unfortunately, we spend too much time at this level of listening.  The entire time the other person is talking, your mind is on your reply.  When talking to patients, we don’t always rebut them, rather, we flip the conversation away from them and toward ourselves.  The patient opens the door with a statement, and you jump right in to tell the patient about your experience.  Suddenly, the patient is silenced, the conversation is about you, and you learn nothing new about the person.
  • Listening to the logic.  At this level of listening the focus is on the other person and you have a sincere desire to learn what they are thinking.  Whether you agree or disagree doesn’t matter, the important thing is to learn their point of view.  Keep the conversation alive by restating what you hear and say, “tell me more about.” 
  • Listening to the emotion.   When you achieve this level of listening, you are experienced at listening to what a person thinks and now you desire to learn why they think that way.  Again, use open ended statements such as, “that must have made you tense, frightened, happy…”  Then listen as they describe their feelings.
  • Listening to their point of view.  It is rare that we would get to this level of listening with a patient.  At this level, you learn where the person feels they fit into the global scheme of things.   It takes time and trust to get to this level of communication where it is safe to share political, religious, or personal preferences without judgement.

Why is connecting with patients important?

We work in a competitive market where many organizations vie for the healthcare business of our patients.  Connecting one on one with each patient and giving the impression that you understand them as an individual creates a loyal client base.  However, the greater benefits include higher patient and provider satisfaction, improved patient safety, and improved outcomes.  Simply stated, we tend to take better care of patients when we feel a sense of connection and, likewise, patients are more likely to comply with medical directions when they trust and feel connected to the provider.  Actively gaining insight into our patient’s consumer intent is a win/win for patients, providers, and healthcare organizations.

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

Production pressure; Tame the wild beast

By Thomas Davis, DNAP, MAE, CRNA

In November of 1999, the Institute of Medicine shook America’s healthcare consumers when they released their report “To Err is Human.”  The report noted that up to 98,000 patients were being harmed each year by medical errors.  The healthcare community responded with an endless line of safety initiatives meant to protect the patient, however in the past 23 years, the safety numbers have not changed significantly.  What is driving those numbers and what can we do to make the operating room a safer place for our patients?

Many factors contribute to medical errors and two common causes that are high on the list are production pressure and its byproduct, normalization of deviance.  Understanding and controlling those two important contributing factors will position you to become a leader in patient safety. 

What is production pressure?

Writing in the AANA Journal, authors Evans, Wilbanks and Boust define production pressure as “the emphasis on increasing efficiency, output, or continued productivity to increase monetary gain at the expense of patient safety.”   Writing for the Agency for Healthcare Research and Quality, author Pascuale Carayon PhD reinforces the definition noting that production pressure involves both overt and covert pressures and incentives to place production, not safety, as the primary priority.  

Definitions are nice but as CRNAs we know first-hand what production pressure looks like.  Being called in early to get the extra case done before the posted schedule starts, being judged by how quickly the next patient gets into the room, staying long after fatigue has set in to do the add-on case.  These expectations are rationalized by the benefit on the bottom line of the organization through an increase in case numbers.  The unfortunate downside is that increased productivity is frequently attained by the risky practice of normalization of deviance.

What is normalization of deviance?

Normalization of deviance is the theory that minor deviations can be managed and tolerated.  Writing for the Anesthesia Patient Safety Foundation, author Richard Prielipp notes “the normalization of deviance process breaks the culture of safety and applies equally to clinical anesthesia practice.  Production pressure is frequently cited as a major driver of normalization of deviance and causes providers to work even when fatigued, create workarounds for safety systems, stretch the boundaries of hospital or departmental guidelines, and expedite patient care to the point of “cutting corners in the interest of staying on schedule.” 

Production pressure, normalization of deviance and wrong site surgery.

When reviewing literature related to normalization of deviance, the crash of the space shuttle Challenger is a prime example of what can go wrong when decision makers bend the established policy and thinking that nothing bad will happen.   In the operating room, wrong site surgery is equally devastating as the tragic explosion of the Challenger and leaves one to wonder how it could happen. 

Wrong site surgery is an event that should never happen, however, the National Institute of Health reports that wrong site surgery occurs up to 40 times per week.  This statistic exists despite the universal precautions of preoperative verification, marking of the operative site and the surgical time out.  How does this happen?  Production pressure encourages cutting corners and when nothing bad happens, more corners are cut until eventually a tragic event happens. 

Be a high reliability organization

Author Amanda Bonser notes that “high reliability” describes an organizational culture that strives to achieve error-free performance and safety in every procedure, every time, while operating in a complex, high-risk, or hazardous environment.  Providing high reliability requires an element of frontline empowerment where healthcare providers can slow the process and ensure that policies and procedures are followed as intended in every surgical case.  In high reliability environments, there is a reluctance to simplify or cut corners and exploring the root cause and understanding a failure is more important than bragging about the things that go well.  At the heart of a high reliability mentality is the refusal to be pushed to compromise any part of the surgical process.  Likewise, it is equally important not to pressure others to make compromises. 

Develop a traffic circle mentality

For decades, traffic engineers have sought to design intersections that eliminate the possibility of death or major injury.  Knowing that the highest risk scenario is a left turn on a high-speed road, engineers are installing traffic circles at high-risk intersections.  When approaching a traffic circle, drivers are forced to slow the pace, assess the danger of other cars in the circle, make eye contact and coordinate with other drivers and then safely navigate through the intersection.   Even though fender benders may occur, it is almost impossible to have a fatal crash in a traffic circle.

Developing a “traffic circle” mentality with each surgical patient requires that providers slow the pace, assess potential risks to the patient, coordinate with others and finally, successfully perform the surgical procedure.  In such a scenario, safety is more important than speed, the needs of others are recognized, and patient safety is the top priority.  Using a traffic circle mentality in the operating room with an emphasis on slowing the pace while communicating and coordinating with everyone on the team eliminates the need to cut corners and makes it almost impossible for events such as wrong site surgery to occur.

Every time you allow yourself to be pushed or you push another person on the team to value productivity over safety you are inviting a sentinel event in your operating room.  Develop a traffic circle mentality and transform your workplace into a high reliability organization. 

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

8 simple steps to create trust in the workplace

By Thomas Davis, DNAP, MAE, CRNA

Trust is a glue that holds relationships together whether they be family, social, or work related.

Brittany has been a chief CRNA for almost a year and is struggling in the position.  As a colleague, she was a rising star on the team and when the Chief CRNA retired, she was quickly moved into the position.   Brittany is a person who likes to be liked and needs to be needed, therefore she avoids conflict by saying yes to every request that is made.  Unfortunately, “yes” often turned out to be a “false yes” leaving Brittany not trusted to follow through on her word.

Like Brittany, Jason is struggling as a Chief CRNA.  He is active in the clinical area and has frequent meetings with his team to assure them that he has their back and that he will not allow them to be abused.  However, when a surgeon, makes a request, Jason quickly bends policies to accommodate, and in the process, throws a team member under the bus.  Simply put, frontline workers cannot trust Jason to support them when disagreements arises.

Brittany and Jason are both in leadership positions and both have eroded the trust of the team.  When this happens, morale is poor and team members give up and move on. 

Leadership matters and trust is the foundation that must be created before a preferred workplace can be built.

What about you…are you a trustworthy person?  Whether you are in a designated leadership position, building relationships with colleagues, or interacting with others in your personal life, trust must be present before you can be fully successful.  On an intellectual level, we know the value of trust, but life happens and along the way we are vulnerable to losing the trust of others.  Increasing your awareness of the importance of trust and becoming sensitive to behavior that will either enhance or destroy it is the first step toward establishing yourself as a trustworthy person.

The Mindtools content team describes trust as “reliance on the character, ability, strength, or truth of someone or something.”   They note that trust is enhanced when the person leads by example, communicates openly and transparently, follows through on commitments, and doesn’t blame others.

“To earn trust, money and power aren’t enough; you have to show some concern for others.  You can’t buy trust in the supermarket.” ~His Holiness the Dalai Lama

Writing in the business blog, Jostle, author Fae Wai notes that trusting relationships are developed on two levels; practical and emotional.  Practical trust is developed by consistently showing up on time, doing what you say you are going to do, and working with others to get the job done.  Over time, people learn that they can count on you.  Emotional trust is equally important, takes time to develop, and is present when others know that you are on their side.  It grows from treating others kindly, respectfully, and in a non-judgmental manner.  Emotional trust can be sacrificed in an instant with an unkind word or false accusation.

8 Tips for building a trusting relationship.

  1. Tell the truth.  Veracity gives others a reason to believe that what you say is, in fact, correct.   Untruth and half-truth are always revealed and once exposed, it is difficult to believe anything the person tells you.   Trust is gone when you walk away from a conversation thinking, “I’ll take that with a grain of salt.”  A person who is not believable is not trustworthy.
  2. An honest NO is better than a false YES.   People want to be liked and accepted by others and therefore are susceptible to saying yes to gain the favor of the other person.  The problem is that once you say yes, the other person expects your action to make it happen.  Through strength of character and knowing your limitations, it is much better to give an honest NO rather than creating expectations that will not materialize.  When you say no, the other person may not be happy, but they walk away trusting that when you do say yes, you will mean it.
  3. Follow through.   This is living proof that you did not give a false YES when a request was made.  To create the practical trust, show up with a commitment to achieve a goal or keep a promise and you will be on solid ground.
  4. Set the standard.  Honesty, transparency, follow-through, and all the things that enable us to trust another person must set the standard for how we make decisions and interact with others.  If a colleague were asked to describe you, what would they say?  When you set a high standard for yourself, the other person will likely begin by describing you as a person who can be trusted.
  5. Be vulnerable and admit mistakes.   Despite our best intentions, we all make mistakes, however, our foibles do not necessarily kill a trusting relationship.  Quickly seek out the other person, admit your mistake, and do what is possible to correct the error.  Hiding a mistake shrouds the truth and creates a barrier to trust.
  6. Never blame or accuse.  A common behavior in a toxic workplace is the blame game.  In a trusting relationship it’s not about who did something wrong but rather, what happened and how do we fix it?  When you move beyond blaming, an error becomes fertile ground for creating trust by supporting the other person, correcting the problem, and ensuring that it is not repeated.
  7. Listen to understand.   People trust you when they sense that you understand them and are truly interested in them as individuals.  All too often we listen to the gist of what is being said so that we can formulate a rebuttal.  Move beyond superficial listening and listen with intent to learn how the other person feels and what motivates them in life.
  8. Be aware of how your words and actions affect others.  The words that we choose and the tone in which they are delivered determine whether the other person walks away feeling affirmed or chastised.   Interacting with emotional intelligence opens the door to a trusting relationship. 

Some who are reading this article are starting at ground zero with a new group and don’t have to worry about prior mistakes.   Others have made mistakes and want to rebuild trust in a stressed relationship with colleagues.  In either scenario, making a commitment earn trust and using the tips in this article to guide your interaction will create the reputation that you desire.  Soon when others are asked to describe you, they will begin by saying that above all else, you can be trusted.

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

Take control of Holiday stress

By Thomas Davis, DNAP, MAE, CRNA

“It’s the most wonderful time of the year
With the kids jingle belling
And everyone telling you be of good cheer
It’s the most wonderful time of the year”

~Song by Andy Williams

The earth is completing another trip around the sun and the holiday season is rapidly approaching.   It is a time of the year when we are forced out of our daily routine and thrust into glitz and glamor of the holidays.  Regardless of your culture or religious background, business as usual is cast aside and festivities abound in our homes, workplaces, and communities.  In many ways, it’s the most wonderful time of the year, however, along with excitement comes expectations, obligations, and stress.

It’s the most stressful time of the year

Intrinsic to the holiday season are both internal and external sources of stress, however, taking time to plan and prepare will enable you to bypass many of the frazzled moments that commonly accompany festivities.  Like it or not, we are creatures of habit and being forced out of a routine is known to cause anxiety and frustration.  Holiday obligations disrupt the status quo and take time away from normal activities.  Gatherings with the family or workgroup require proper attire, hair, makeup, childcare, not to mention the hostess gift and the dessert tray.  In addition, children have holiday events at school that conflict with a busy work schedule and cause guilt if you ask for time off or guilt if you don’t. 

My podcast interview with Cathy Horvath, DNP, CRNA and Chair of the AANA Wellness committee exposed the extent to which healthcare workers are feeling stressed.  Her statistics reveal that 77% of our colleagues report frustration and exhaustion related to their work and 45-55% report feelings of stress and anxiety on a frequent basis.  Even more telling, 50% of healthcare workers report feelings of depression with 13% stating that they have had suicidal feelings.  The numbers are alarming, and the stress only increases during the holiday season.

Thinking that the workplace will provide a haven from the chaos at home may lead to disappointment when work does not provide the escape that is desired. Typically, patients have reached maximum co-pay by the end of the year and are in a rush to get procedures done before the ball drops in Times Square.   The case load is high, the vacation calendar is full, and your work hours are longer just as you have a million other things to do.  Yes, it’s a stressful time of the year.

The Mayo Clinic healthy lifestyle blog identifies the holiday season as a potential source of significant stress and advises that we become attuned to our feelings and acknowledge them.  In addition, they recommend that we remain realistic by not abandoning healthy habits and by saying “no” to set boundaries.   The Johns Hopkins wellness blog advises that we keep sight of what really counts and always respond with kindness, even when stressed.  Building on the theme of reducing stress, author Kaleigh Carter notes the importance of physical activity, meditation, and sleep during the busy holiday season.  Regardless of the source that you reference, all agree that the holiday season is stressful and that a combination of anticipation, planning, and preparation will make the stress manageable…and may even re-infuse fun into your life.

Practical tips for managing holiday stress

Ramp up your self-care.  A healthy body is the first line of defense against stress and your body’s basic requirements don’t change with the season.  Put differently, the body does not need more calories and less sleep during the holiday season.  Taking charge of the body’s basic needs requires focus, discipline, and commitment.  Self-control is empowering.

  • Nutrition.  The body’s basic need for high quality fuel does not change just because holiday parties are on the calendar.  Essential nutrients are still required, and harmful foods are still harmful.   Unless you become a mega-cardio gym rat, your calorie requirements remain the same during the holidays and extra food volume will give you extra work to do when “lose weight” appears on your New Year’s resolution list. Go heavy on fruits and vegetables while limiting foods that are high in fat and salt.
  • Exercise.  Keep moving and don’t let distractions pull you away from your exercise time. Participate in outdoor activities when the weather permits and move indoors when the snow flies.  A gym membership offers the opportunity for a social aspect to your workout.  Buy a mat and use online programs at home to assist with stretching, yoga, and meditation.
  • Sleep.  When things get hectic, it’s easy to sacrifice a few hours of sleep, however over time the lack of sleep will take its toll.  Get into a bedtime routine and allow your body to relax by quietly reading or meditating before retiring for the day.  Keep a regular schedule that ensures the proper amount of sleep.
  • Seek the sun.  Seasonal affective disorder is described in the DSM5 as depression related to a lack of exposure to the sun.  Military personnel returning from duty in Alaska will affirm the negative effects caused by the long periods of darkness during the winter months.   Similarly, OR personnel drive to and from work in the dark during the holiday season with little opportunity for sun exposure.  Be creative, walk to a different area of the building, find a sunny spot for your lunch, and you’ll get the added benefit of exercise.
  • Take a break.  Rather than slurping coffee on the run, plan a mid-day break into your schedule.  Get out of the lunchroom and leave the gossip to others.  Plan a 5-minute walking route that includes going up and down one flight of stairs and passes through a sunny location along the way.   Be creative and find a quiet location to put a mat on the floor and do some stretches at work.  Both your mind and body will thank you. 

Anticipate and prepare for external stressors

It’s always easiest to pick the low hanging fruit and taking care of oneself physically is easier than dealing with all the external expectations/obligations of the holiday season, however, by setting goals and limits you can develop a plan to minimize stress.   Here are some holiday stresses that may emerge from the festivities and knock you off track.

Social gatherings with the workgroup and/or your family.  Receiving an invitation to the annual office party or family holiday gathering gives you a sense of inclusion and the expectation of a joyful evening.   The invitation also creates an obligation to add another item to your already packed schedule.  Time, effort, and money are required to get the right attire, arrange childcare and put together a hostess gift.  Once at the party, high calorie food is abundant and alcohol flows freely, both are challenges to your commitment for self-care.  Here are a few tips.

  • Eat a small amount of healthy food before going to the party so that you are not ravenous when you arrive.  At the party, commit to sampling a few items rather than filling your plate several times with high calorie, high salt, food.  “All you can eat” does not mean eat all you can.
  • Drink alcohol slowly and commit to alternating each alcohol drink with a non-alcohol drink.
  • Make it about the people, not the food/alcohol.  You work with these people daily, but do you really know them?  Challenge yourself to learn something new about each person at the party.  As you talk to colleagues, remind yourself of something that they do particularly well or something about them that you are grateful for.

Financial obligations.  We criticize congress when they pass a budget and then spend millions of additional dollars for “off budget” items.   Often, during the holiday season we imitate our government, throw caution to the wind, and throw “off budget” money at gifts and parties.   Establish a reasonable budget for the holidays and stick to it.  Find low-cost activities such as a family hike through the woods to replace the high dollar trip to the theater complete with twenty-dollar popcorn.  Make a hostess gift such as an ornament rather than buying an expensive bottle of wine.  When you finish buying gifts for the family, be finished.  That one extra gift or stocking stuffer for each member of the family can add another $100 to the cost of the holidays.  The bottom line is that unlike the Federal Government, you must pay your bills so pull the reigns and spend wisely.

Create good cheer and positive vibes for the Holiday season

The holiday season is a time for gift giving and the best gift that you can give yourself is an organized, low stress month filled with pleasant memories.  Your internal dialogue sets the tone, and an optimistic and proactive attitude are building blocks for success.  Start and end each day by practicing gratitude and think of three things that you are grateful for.  The activity will reduce your negativity bias and help to remove the feeling of being victimized by the holidays. 

The bottom line is that in addition to being the most wonderful time of the year, the holiday season can also be the most stressful time of the year.  Be mindful of the tips put forth by Cathy Horvath in the podcast and use a combination of self-help activities, planning, and an optimistic mindset to set reasonable boundaries and ensure a memorable Holiday season.

Click here for the podcast with Cathy Horvath, DNP, CRNA

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

Create an empowering workplace

By Thomas Davis, DNAP, MAE, CRNA

The times they are a changing.  Not long ago, applicants who lined up to compete for healthcare jobs hoped to be the lucky winner of the coveted position.  Now, due to many factors including COVID burnout, healthcare organizations are competing to attract candidates to fill the void created by open positions.  More than ever, employers are seeking ways to retain current workers while creating a positive reputation that will attract additional qualified people.  In short, organizations have a new focus on implementing employee friendly activities and have discovered that professional development is a core element of a preferred workplace.  Investing in all aspects of worker growth improves morale, engagement, productivity and retention.

Writing for Insperity, author Celenia Estime identifies the following as characteristics of a great workplace:

  • A sense of belonging
  • A sense of purpose
  • Allowing employees to have fun
  • Provide an opportunity for development and advancement

Clearly, Celenia is in alignment with other writers who tout professional development as an essential component of a highly desirable workplace.

The Gallup organization has been collecting information related to staff engagement for several decades and have refined their engagement assessment tool to 12 basic questions referred to as the Gallup Q12.    Savvy employers note that many of the twelve questions are designed to generate positive responses from workers when the organization has an ongoing commitment to the professional development.  These questions from the Gallup Q12 that support the importance of a robust professional development program.

  • In the last seven days I have received recognition or praise for doing good work
  • My supervisor or someone at work seems to care about me as a person
  • There is someone at work who encourages my development
  • At work, my opinions seem to count
  • The mission or purpose of my company make me feel as if my job is important
  • In the last six months, someone at work has talked to me about my progress
  • In the last year I have opportunities to learn and grow.

The Gallup team know that affirmative responses to these questions indicates that the team is highly engaged in their work and are likely to be both productive and loyal to the employer.

At this point, you may be all in for professional development but unsure about where to start.   If your workplace does not have an ongoing staff development program, step up and look for opportunities to learn new skills and to share your knowledge with your teammates.  An active combination of teaching, coaching, and mentoring will provide opportunities for personal growth for you and your colleagues as you learn and grow together.

“You will get all you want in life if you help enough otherpeople get what they want.”

~Zig Ziglar

In a podcast interview with Richard Wilson, CRNA, the importance of teaching, coaching, and mentoring are discussed.  Although there is overlap between the three approaches, Richard discusses the subtle differences and offers insight into how to effectively apply each approach to introduce professional development to your workplace. Click on the podcast at the end of this article.

Teaching is designed to impart academic information and instruction to a group of learners.  In most cases, the material is presented in a pre-determined manner and is designed to fulfill a specific need.  Teaching is often confined to working with neophytes in the classroom however when best practice guidelines are updated, opportunities for teaching arise for experienced workers.

Coaching occurs in the actual work environment and is often an extension of the classroom.  Typically, the coach builds on classroom knowledge by using his/her experience to teach hands on skills to less experienced people on the team.  As Richard points out in the podcast, coaching moves the learner from understanding concepts to acquiring the skills necessary for completion of a task.  When a leader arranges for an experienced person to coach a new member of the team, both the coach and the new hire have opportunities for professional growth.

Mentoring is a special relationship between two people in which the senior, more experienced person helps the underling define a vision, develop a plan, and achieve a goal.  Mentoring goes beyond teaching and coaching by introducing elements of professionalism and networking to the process.  The mentoring relationship is built upon trust and often develops into a lifetime friendship between the two individuals. 

“Never doubt that a small group of thoughtful, committed people can change the world. Indeed. It is the only thing that ever has.”

– Margaret Mead, American cultural anthropologist

Professional development is the ultimate win/win for the organization, frontline leaders, and individual workers.  By actively engaging workers to participate in professional development, an important step is taken toward creating a preferred workplace that will attract and retain the best employees.   Author Trevor Antley notes the following as positive outcomes related to professional development:

  • Professional development expands your knowledge base.
  • Professional development boosts confidence and credibility
  • Professional development increases earning potential and hireability
  • Professional development can provide networking opportunities
  • Professional development keeps professionals current on industry trends
  • Professional development can open the door to future career changes

Congratulations if your workplace encourages and supports professional development because you landed a great job.  However, when the boss does not provide avenues for personal growth it is time to step up and be a leader regardless of your seniority or position in the workgroup.  Stay current with professional literature and freely share your ideas with your colleagues.  Establish both formal and informal times to share what you have learned by teaching and coaching.  Volunteer to be a coach for new hires and seek coaches for yourself when you want to learn a new skill.  Seek out a mentor who will help you move into a leadership role initially in your workgroup and later in the organization.   Look outside your organization and consider completing an advanced degree or gaining certification in a related area such as ultrasound nerve blocks or pain management.  Finally, listen to the advice provided by Richard Wilson in the podcast.

Click here to listen to the Podcast

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

Take charge of your professional development

By Thomas Davis, DNAP, MAE, CRNA

A common theme of my leadership articles is emphasis on the importance of creating a preferred workplace.  Both healthcare and business management literature reinforce the connection between employee engagement/productivity and working in a favored environment.  Among the foundational elements of a great workplace is professional development where the employer actively seeks avenues for employees to gain new professional skills.

Unfortunately, not everyone works in a preferred workplace.  If your employer does not promote expansion of you career skills, you have three choices; 1) stagnate with the status quo, 2) find a new job, or 3) step up and take charge of your own professional development.   For workers who are tied to their community and unable/unwilling to move, option 3 is the best choice.

When the employer can’t or won’t, step up and take charge

Personal development begins with awareness of its importance and a sincere desire to gain new knowledge and skills independently when it is not promoted in the workplace.  Writing in the blog rgpm, author Elizabeth Harrin offers the following tips for starting your own personal development program.

Make self-improvement a priority.  Set a goal for improving your work skills and make it specific.  “I’d like to get better at” doesn’t cut it.  State the new skill that you intend to develop or the current skill that you intend to improve and then follow with “as evidenced by” and state specific milestones along the pathway to accomplishing the goal.

Be the best at what you do.  As busy healthcare professionals, we get into a routine workflow and robotically move through the day as efficiently as possible.  Take time to reflect on what you currently do and find ways to do it better.  For some it may involve organizing the workspace and for others, it may be improving interpersonal relationships with patients or colleagues.   Regardless, be the best that you can be.

Solicit feedback.  It is human nature to revel in praise and wilt in the face of criticism, however, self-improvement comes from a “make me better” attitude where honest feedback is important.  In my practice, cataract patients are usually scheduled to return to have the second eye done.  After the first eye I always ask, “when you come back, what can we do differently to make your experience better?”   At the end of the day ask your perioperative team, “do you have any suggestions for things that I can do to help your workflow?”   Listen, learn, and don’t push back.

Get a mentor.  It may be a colleague or someone up the chain of command but there are others who are skilled at the area that you want to improve.  Tap into their expertise and form a mentoring relationship with someone who truly wants to help you gain new skills.  In addition to personal growth, you expand your network and may even develop a friendship that will continue throughout your career.

Become a trainer.   Your employer may not have a professional development program, but they often introduce new technology to the workplace.  When new equipment or computer programs are introduced, volunteer to be a super-user and be the first to master the needed skills.

Earn a degree/certification.  Opportunities abound for healthcare workers to gain certification in specific areas of practice such as ultrasound guided regional anesthesia or pain management.  In addition, advanced degrees including a doctorate degree are offered online and provide abundant opportunities for personal growth.

Taking charge of your future is empowering

Personal growth in the workplace often involves a series of low-key behaviors that boost your sense of self-worth and your value to the organization.  Put differently, you don’t have to receive advanced training in new skills to experience personal growth.   The management blog career Contessa offers additional tips for creating your own professional development plan.

Organize your life.  Remove the clutter from your workspace, create a calendar with a daily block of time for self-help initiatives, then make a list of things to accomplish each day.  End your day with a feeling of accomplishment as you review the items that you completed and checked off the list.

Create goals.  Be realistic and ensure that your goals are both attainable and things that you will commit to accomplish.  State the desired outcome and make a list of tasks that must be achieved in route to your goal.

Talk directly to management. Sometimes it’s not that they don’t want you to have professional development, rather, production pressure has kept managers too busy to focus on your needs.  An honest and open discussion will let them know that you desire growth in the job and position you to be selected to manage the next project.

Ask questions and hone listening skills.  Become aware of the issues that are of most concern to management and offer to help create a solution.  Listen and learn.

Use positive self-talk.  We constantly have an inner dialogue going and often it can take us places that drag us down.  Rather than focusing on the negatives, recall the things that you do well, congratulate yourself, and visualize ways to expand those successes in other tasks.  Develop an asset-based mentality with a focus on what can be done with the available resources.

Accept responsibility for your personal growth and development

In an ideal workplace, your boss, and your colleagues care about you as an individual and want you to have ongoing opportunities for improvement.  If you are in such a workplace, cherish it appreciate the openings that it provides.  However, if you are like many others who toil in a less than ideal workplace, free yourself from the bonds of stagnation by using the tips in this article to plan and implement your own professional development plan.   Your efforts will pay big dividends as you master new skills and inspire your colleagues to follow in your footsteps.  Who knows, you may be the catalyst to bring professional development into your workplace transform the organization from “just another job” to being a preferred workplace.

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

Be a Rising Star in your Profession

By Thomas Davis, DNAP, MAE, CRNA

Rising stars in the workplace and in the profession…we all know who they are and the contributions that they make to group.  It would be a cliché to say that those entering a profession are the future of the organization, and we all know that it is true.   To ensure that nurse anesthesiologists continue to be valued members of the healthcare community, a combination of solid workers and rising stars are essential.

Ask any Chief Anesthetist who the “go to” people are in the workgroup, and they quickly point out the all-stars.   Likewise, ask any program director to identify students most likely to move into leadership positions at the State level and they will instinctively point out the rising stars in the class.  What is a rising star and what do they look like?

Writing in the Inc.com blog, author Scott Mautz discusses the characteristics of people who are rising stars in the workplace or the profession

  • Ability to adapt (resilience) Rising stars are always moving forward and are not stopped by speedbumps along the way.  Their vision for the future is more important than a temporary setback and glitches only motivate the rising star to find a solution.
  • Zeal for improvement The status quo may be good enough for today, but rising stars have a vision for the future and have a keen eye for establishing new policies and streamlining the workflow.   They move beyond having a concept and develop a plan for implementing change.
  • Ability to influence Rising stars tend to be the “go to” person in the group and are often referred to as the influence leader.   They may or may not have a title in the group but they have a powerful influence on the mood and motivation of the group.
  • Powerful presence When a rising star enters a room, everyone knows it, usually in a positive way.  The rising star instills confidence in others and makes the group believe that challenges can be conquered.
  • Both EQ and IQ Emotional intelligence is a buzz word in the business community and organizations are using EQ evaluation when selecting new hires.  In nurse anesthesiology, many training programs are incorporating EQ assessment into the selection process for students.   The rising star tends to be intelligent, visionary and can blend IQ with EQ when working with others.
  • Solid decision-making Rising stars know what they want to accomplish, believe that it is possible and are not shy about making decisions to support the goal.

In 2016 I had the privilege of meeting a rising star in our profession.  While attending an AANA leadership summit in Chicago, I was introduced to Julie Linton, a senior SRNA interested in leadership and doing a great job networking with others at the meeting.  Three short years later while speaking at the West Virginia State association meeting, I became re-acquainted with Julie who was serving as the president of the West Virginia association.   In three short years, she progressed from new graduate to State president.  Recently, I recorded a podcast with Julie and learned about rapid journey to leadership.   Click here to listen to the podcast.

Listen to Julie Linton’s podcast about her path to leadership

Some people are born with an outgoing personality, but nobody is born with leadership skills.   Rising star status is something that can be achieved through mindful practice.  The biospace.com blog offers tips for behaviors that will make you a rising star at work or in your life.  

  • Know when to listen.  We live in an electronic world where texting is easier than talking.  Take time for conversation and view it as a chance to listen and learn.  You don’t learn anything new when you state your opinion, you only learn when you listen.
  • Give credit when credit is due.  When others have good ideas give them full credit and then build upon the foundation that they have provided.  Engage the other person as a collaborator rather than a competitor.
  • Be agile.  Those who are agile can move through awkward situations gracefully.  Be respectful of the feelings of others and seek collaboration when dealing with difficult situations.
  • Be honest.  Honesty is a value that is essential when building trust between individuals.  You will never be trusted as a go to person or viewed as a rising star if you are dishonest.
  • Come up with a new idea.  There is a solution to every challenge and the best ideas arise from many ideas.   Brainstorm with colleagues, listen and learn from others, and develop a new approach to the problem.
  • Bring solutions, not problems.  Asset-based thinking is built upon identifying the resources that you have and doing the best that you can with them.  Avoid whining about what you lack and create a solution with what you have.
  • Make yourself available.  You must be present to win.  Enter the room with a positive attitude and a presence that inspires confidence from others.   Say yes when asked to participate and follow-up quickly when asked to do a task.
  • Be a doer.   Achieving is an active sport and requires participation.  You may have great ideas, however, if you want to be a rising star you must put them into motion.  The person who sits back and says “they ought to” will never be recognized as an achiever.

My friend Julie Linton is a rising star, but she is not unique.  We are in a profession with many talented and intelligent people who can take us into the future.  Julie has mastered many of the traits listed above and will be a great role model for future rising stars.   Click here and enjoy the podcast describing Julie’s experience as a rising star.

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

Dr Angela Mund, DNP, CRNA; A leader leading leaders

By Thomas Davis, DNAP, MAE, CRNA

The leader is often a dynamic person who guides a frontline team to the completion of a task or goal.   In the traditional scenario, the boss is in a position of authority over the workers, and both know their position on the chain of command.   Breaking the traditional hierarchy of leadership, in 1992 coach Chuck Daly found himself with a unique challenge as the coach of the first US Olympic men’s basketball dream team.  Without doubt, every player on the team was a super star in his own right, now it was the job of the coach to unite the individual leaders into a cohesive team. 

In the workplace, as frontline leader climbs the chain of command, they may find themselves in a position where, like Coach Daly, they are leading a team of leaders.  Although basic leadership principles form the foundation for working with the team, modifications in leadership style are required when leading a group of leaders.

Writing in the Ivey Business journal, author Jeswald Salacuse notes that leadership is hard work and can be even more challenging when directing a group of leaders.  Jeswald notes that success arises from building a trusting relationship with everyone on the team.  Frequent, one on one interaction while keeping an open mind and using transparent communication is essential for success at all levels of leadership and especially important when leading leaders.

An online article by Ken Jacobs offers tips for leading leaders and agrees with other authors that it is important to develop a personal relationship with each member of the team and then learn the strengths that each person brings to the group.  A heavy-handed, micromanaging approach must be avoided when leading leaders, rather, the best results are obtained by ensuring that opinions of each person are both welcomed and used to strengthen the decisions of the group.   It is the role of the designated leader to set goals and then empower the others to discover creative solutions and attain the goal.   Believing in the talents of others and resisting the temptation to interfere is essential when leading groups of leaders.

Angela Mund DNP, CRNA, is president elect of the AANA will begin her year as president in August of 2022.  Despite her decades of experience as an anesthetist, educator, and leader, she will face new challenges leading a “dream team” board of directors who are each recognized leaders and independently elected to the board.   Her success as the president of the organization will require a leadership style based on trust, collaboration, and recognition of the talents that everyone brings to the group. 

I recently had the privilege of recording a podcast with Dr. Mund and discussed the challenges that she will face in the upcoming year.  In our dialogue, she noted the importance of the leader going to the front and showing way rather than directing from behind.    Intending to base her interactions with the board on an inclusive leadership style, Dr. Munds said that she always enters a meeting with the willingness to be influenced and listens carefully to the points made by others.  In her year as president elect, Angela has had the opportunity to learn the personalities of others who will serve on the board of directors and welcomes the unique perspective that each brings to the table.  She noted that encouraging individual opinions and playing to the strengths of each person will be components of her approach to working with the board of directors.

Click here and listen to Dr. Mund’s podcast

Leadership is a full-time job that is dynamic, especially when you are leading a team of leaders.   Coach Daly did not have to teach NBA all-stars how to play basketball, rather, he was tasked with bringing them together as a cohesive team.   Likewise, Dr. Mund is tasked with uniting a team of proven leaders and creating a group committed to the common good of the organization.  Using emotional intelligence, listening skills, ongoing learning, and encouraging individual creativity, Dr. Mund will position the board of directors to follow the path of the dream team and bring home the gold for AANA.

Enjoy Dr. Mund on the prosynex frontline leader podcast

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

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

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

Teaching

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

Coaching

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

Mentoring

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

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

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

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

Develop leaders on your team

By Thomas Davis, DNAP, MAE, CRNA

Leaders don’t create followers, they create leaders.

~Ralph Nader

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

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

Advantages of internal leadership development

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

Identify your future leaders

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

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

Create an opportunity for growth

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

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

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

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

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

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

10 Behaviors that generate powerful results

By Thomas Davis, DNAP, MAE, CRNA

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

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

Eliminate the negative

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

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

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

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

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

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

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

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

By Thomas Davis, DNAP, MAE, CRNA

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

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

Learning from the past

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

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

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

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

Improving provider/patient trust

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

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

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

Emotional Intelligence; The Holy Grail for Successful People

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

Emotional intelligence; Buzz word or formula for success?

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

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

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

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

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

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

Tools for improving emotional intelligence

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

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

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

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

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

If it’s important, make personal contact

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

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

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

Stay out of Jail; Avoid billing fraud

Stay out of jail; Avoid billing fraud

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

The QX trap

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

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

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

Examples of billing fraud

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

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

Protect yourself

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

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

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

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

By Thomas Davis, DNAP, MAE, CRNA

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

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

COVID-19 and provider wellness

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

Be active, Be well

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

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

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

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

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

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

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

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

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

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

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

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