Category: Leadership articles

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

Set boundaries at work and in your life

By Thomas Davis, DNAP, MAE, CRNA     

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

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

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

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

Set boundaries at work and in your life

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

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

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

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

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

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

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

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

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

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

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

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

Workplace Wellness: Important and achievable

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

Promote physical wellness.

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

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

  Promote Mental wellness

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

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

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

Emotionally Intelligent Teambuilding



By Thomas Davis, DNAP, MAE, CRNA

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

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

Why emotional intelligence makes a difference?

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

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

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

Tips for building an emotionally intelligent team.

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

Truth in advertising.

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

Check references.

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

At the job interview.

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

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

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

Success.

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

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



Evidence-based Leadership

By Thomas Davis, DNAP, MAE, CRNA

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

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

Leadership matters.

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

Identify your needs.

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

Gather evidence.

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

Develop a hypothesis.

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

Implement the plan.

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

Gather data.

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

Share your findings.

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

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

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

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

Running circles around patient safety



By Thomas Davis, DNAP, MAE, CRNA

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

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

The magic of traffic circles

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

Safety circles in healthcare

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

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

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

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

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

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



Cognitive reframing; Reduce stress and increase productivity



By Thomas Davis, DNAP, MAE, CRNA

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

What is cognitive reframing?

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

Choose your thinking framework

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

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

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

Reframe your thinking

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

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

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

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

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

Take control

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

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



Values-based Leadership



By Thomas Davis, DNAP, MAE, CRNA

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

What is values-base leadership?

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

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

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

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

Values-based team building

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

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

Values-based daily management

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

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

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

Be a values-based leader

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

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



The Doctorate degree: Do I need it?

By Thomas Davis, DNAP, MAE, CRNA

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

Why a doctorate degree and why now?

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

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

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

Does the Doctorate degree make me a better anesthesia provider?

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

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

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

Which doctorate degree is best for me?

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

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

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

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

What is my next step?

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

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

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

Halloween Leadership Lessons

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

— Elvis Duran

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

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

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

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

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

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

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

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

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

Core Competency for Leaders

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

Bucket list leadership lessons

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

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

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

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

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

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

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

5 ways to get more from your video meeting

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

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

Three Essential B’s for Effective Teambuilding

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

~Kat Cole

Be present

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

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

Be empowering

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

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

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

~Christopher Reeve

Be resilient

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

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

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

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

Ace your video interview

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

Ace your virtual interview

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

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

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

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

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

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

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

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

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

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

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

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

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

~John Maynard Keynes

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

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

Inclusion; The key ingredient for successful diversity



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Social media is abuzz with strong opinions about diversity, social justice, and equality for all.  Facebook, twitter, and professional discussion boards such as AANA connect display hundreds of comments from passionate people who want their opinions to be heard.  Overnight, diversity has become a hot topic for discussion throughout our society.  While cultural diversity is important, it is the assurance of inclusion, both in society and in the workplace, that adds equality to the equation.

Diversity versus Inclusion; what’s the difference?

Diversity

Throughout its history, the United States has been referred to as a cultural melting pot.  We are a nation of immigrants where most people found their way to our country seeking an opportunity for a better life while others were captured, enslaved, and brought to our shores against their wishes.  Regardless of the circumstances for immigration, every individual currently in our society adds a unique perspective to the diversity of the nation. 

Without question, we are a diverse nation; however, that does not ensure that all people are respected and treated equally.  The decades of struggle by women and African Americans to obtain the right to vote highlights an instance of segments of a diverse population that were excluded from full citizenship and serves as an example of diversity without inclusion.

Inclusion

Inclusion is living one’s life with the belief that all people are important and deserving of respect.  It is overtly manifested by behavior affirming that the best and most creative ideas arise from many ideas and mandates participation by each segment of our diverse population.  Writing for Forbes.com, author Dan Schawbel stresses the importance of workplace inclusion by noting, “Inclusion is a call to action within the workforce that means actively involving every employee’s ideas, knowledge, perspectives, approaches and styles to maximize business success.” 

On the job, behavior ensuring that every member of the team can participate fully and equally in creative thinking, problem solving, and the development of innovative practice protocols are examples of inclusion.  In an inclusive environment, all voices are heard, and all opinions are thoughtfully considered.

Creating inclusion in the workplace produces positive consequences as noted by The Denver Foundation;

  • Higher job satisfaction
  • Lower job turnover
  • Higher employee morale
  • Improved problem solving
  • Increased creativity and innovation
  • Increased organizational flexibility
  • Improved quality of applicants for open positions
  • Decreased vulnerability to legal challenges

There is no downside to a culture of inclusion in the workplace.

Avoid subtle forms of exclusion

Overt exclusion involves behavior that is blatantly discriminatory and is illegal in most workplaces; However, covert forms of subtle discrimination are more difficult to identify and occur more frequently.  Author Jane O’Reilly identifies behavior such as failure to respond to a greeting from a colleague or looking at the phone while talking to a person as being dismissive and are examples of social exclusion.  Psychology today author Lynne Soraya adds to the list of workplace behavior that exclude team members and increases polarization of the workgroup.  She identifies the following as killers of inclusion:

  • Publicly reprimanding of an employee
  • Selectively not inviting all stakeholders to a meeting
  • Using sarcasm / ridicule when speaking to another employee
  • Dismissing those who do not speak up quickly as having nothing to say
  • Judging a colleague as less than committed if he/she does not participate in off duty activities
  • Committing a colleague to travel or extra work without discussing it with them
  • Punishing an associate for speaking up truthfully when something is not right
  • Cutting off and dismissing a person if they have a complaint
  • Finishing a sentence or thought for another person if they speak slowly
  • Bullying in any form

Writing for Quill.com, author Lindsay Kramer adds isolation, minimizing, and ignoring to the list of subtle behaviors that exclude people from full participation on a work team; behavior that must be taboo in the workplace.

Build an inclusive workplace culture

Human Resources has done their job and staffed your workplace with a multi-cultural, multi-gender, and multi-generational team; they have created diversity.  Now, it is up to you to add the magic ingredient of inclusion to capitalize on the ingenuity that each person adds to the group.  Here are some behaviors that will promote inclusion and transform the culture of your workplace

Examine your assumptions and become aware of hidden bias that you may have.  Ask yourself, “What if the opposite were true?”   For example, instead of assuming that James is not capable of taking on a project, consider that he is fully capable but has never been encouraged or given the opportunity to show his talent.

Seek opinions and ideas from a broad range of people.  Move beyond the comfort zone of your inner circle and ask for opinions from staff members who will most be affected by your decision.  Have a small, diverse group of workers meet to discuss issues and go around the table to ensure that each person speaks.  Listen attentively and if someone does not express an opinion the first time around the table, go back to that person and ask him/her to comment on a suggestion made by another person. 

Focus, listen, and ask questions when you are speaking to others.  Even the quietest people among the team have opinions and often they are quiet due to a history of being marginalized.  Actively listening and asking questions to expand the person’s train of thought sends a clear message that they are valued and builds a sense of inclusion.

Defuse drama and have zero tolerance for gossip or bullying in your workplace.  Drama focuses on a problem, creates a victim and is divisive to a team.   Instead, focus on finding a solution and encourage mentoring and coaching.  My previous article, 4 keys to eliminating disruptive behavior has additional tips for leaders who actively fight drama in the workplace.

Showcase the achievements of each team member and tie their individual accomplishments to the success of the team.  Demonstrate your belief that all jobs are important and praise grassroots workers for their commitment to the job and the team.  Post a Kudos Board in the break room and spotlight each team member several times per year and turn all birthdays into special days hailed by the entire team.

Promote cultural awareness by celebrating ethnic special days.  Plan festive displays in the break room for Cinco de Mayo, Kwanzaa, St. Patrick’s Day, Ramadan, and other holidays that are celebrated by individual members of the team. 

Encourage multigenerational collaboration among team members.  The Boomers on your team were born and raised in a world without cell phones or computers whereas the youngsters cannot imagine a world without them.  My previous article, Older workers strengthen the team,notes that combining the street sense of the elders with the tech savvy of Gen Y & Z is a great formula for success.  In a highly productive workplace, mentoring is two way and trans-generational with each demographic learning valuable lessons from the other. 

Build a gender-neutral environment where rewards and recognition are based on achievement.  Harvard Business Review author Tara Sophia Mohr advises against listing qualifications for a job because women don’t apply unless they meet 100% of the items whereas men apply when they meet 60% of the qualifications.  Rather, list the desired behavior and achievements expected from the new person and more women will apply.  Writing in Forbes Magazine, author Peggy Yu advocates gender neutral language in all management policies to include pay and benefits.  In addition, she notes that gender friendly bathrooms complete with pads and tampons promote an inclusive culture.

Diversity and Inclusion

Several centuries of American history have documented that diversity without inclusion marginalizes segments of the population and sets the stage for the protests that we are currently witnessing across the country.  Politicians can pontificate and pundits can tell us what we ought to do, but meaningful change will only happen at the grassroots level.  I cannot change the world, but I can change my world starting with my workplace and that mandates a culture of inclusion.  It is time to stop talking and get to work.

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



Setting the Standard

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Standards are essential

High quality patient care must be delivered in a consistent and safe manner; professional organizations set standards to define it, institutions develop policies to provide it, payors demand it and patients deserve it.  Frontline workers must deliver it.

The history of standards for patient care can be traced to the 1800s when obstetrician Ignaz Semmelweis demanded handwashing by those providing medical treatment.  Several decades later, surgeon, Ernest Codman, became a relentless champion for hospital standards and the assessment of outcomes.  Legendary nurse, Florence Nightingale, identified the link between living conditions and death rates among soldiers and became a powerful advocate for basic nutrition of soldiers and setting sanitation standards for the barracks.  In each case, a healthcare  champion pushed the medical profession to set standards – a minimal expectation below which care cannot be allowed to drift.

Throughout the 20th and into the 21st century, there is an ongoing focus on improving patient safety and outcomes through the development and enforcement of standards for care.  The topic of reliable evidence-based medical treatment has gained front page prominence and is now included in the AMA Journal of Ethics for physicians.  This, from the ethics journal:

  • Standards of quality are statements of the minimum acceptable level of performance or results and what constitutes excellent performance.
  • Medical practice guidelines are evidence-based statements to assist practitioners in their decision making.
  • Medical review criteria are statements used to assess the appropriateness of specific decision, service, and outcomes in the delivery of care.
  • Performance measures are observable and measurable criteria that indicate compliance with medical quality standards

In 1965, Congress passed legislation that created the Medicare and Medicaid programs intending to create a medical safety net for the elderly and those who were otherwise uninsured.

Authors Youssra Nariousa and Kevin Bozic. note that along with entitlements, the bill established “conditions for participation,” conditions which, in subsequent years, evolved into a mandate for the establishment of standards of care; criteria that must be met if reimbursement for service is to be obtained.  By default, the Center for Medicare and Medicaid services became a powerful force demanding the creation and enforcement of standards of care in healthcare.

Professional organizations and patient safety advocacy groups also play an important role in the establishment of standards of care for practice.  The American Medical Association and the American Nurses Association collectively set practice standards that are applied broadly to the healthcare industry.  Sub-specialties in medicine and nursing also have professional organizations that establish performance criteria for providers in their sub-specialty.   For example, anesthesia related organizations establish practice standards that affect the entire perioperative area.

Specific to the practice of anesthesia, the American Association of Nurse Anesthetists, the American Society of Anesthesiologists, and the Anesthesia Patient Safety Foundation have all established minimum criteria that must be met to ensure safe practice.  Although each organization’s differing views on supervision may affect the wording, most of the standards are essentially the same between the three anesthesia specific groups.  Current standards for the delivery of anesthesia include:

  1. The constant presence of a qualified anesthesia provider.
  2. Adequate oxygenation including continuous analysis of the fresh gas flow, pulse oximetry and clinical observation
  3. Adequate ventilation as evidenced by continuously observing the level of expired carbon dioxide during moderate sedation, deep sedation or general anesthesia.  Verification of correct placement of any artificial airway device.  The use of ventilatory monitors as indicated
  4. Physiologic monitoring of blood pressure, heart rate and respiration with documentation at least every 5 minutes.  Monitors must have audible alarms that are turned to a pitch that is easily heard by the anesthesia provider.
  5. Cardiovascular monitoring to assess the patient’s heart rate and cardiovascular status.
  6. Thermoregulation when clinically significant changes in body temperature are intended, anticipated, or suspected. 

Although specific hands-on techniques have changed due to the threat of COVID-19, standards of care remain in effect and must be met.

Look beyond the horizon

As cutting-edge technology becomes routine evidence-based practice, standards of care are updated and the baseline for minimal acceptable care is elevated.  For example, the pulse oximeter was introduced to clinical practice in the mid-1980s and by 1987 rapidly became a standard of care for the administration of general anesthesia in the US.  The sudden elevation of monitoring requirements created a scramble to obtain the necessary equipment for meeting the new criteria.

Therefore, before morphing into a standard of care for the profession, new technology and techniques that are safe and effective are often introduced as local policy and evolve over time into a new minimum requirement.  Rather than waiting for requirements to change, be a workplace champion and elevate your practice by developing local policies that exceed current minimum standards.  Once done, push to make your elevated level of care a standard for the profession.

Future standards of care

Implementing new standards of care must be done judiciously and within the capability of providers to comply with the mandate.  Once a standard is set, those who do not meet the requirement are legally liable and might not be reimbursed for their services.  Stay ahead of the curve by considering these items for inclusion in the policies that govern your workgroup.

Video laryngoscope   Fiberoptic endotracheal intubation was introduced to clinical practice in the 1960s and by the 1980s became the first line of defense for a difficult airway.  Now, the video laryngoscope has proven itself to be faster, lighter, and equally reliable to the technology of the 80s making fiberoptic intubations a rare event.

With the outbreak of the COVID-19 pandemic, anesthesia providers are seeking ways to separate themselves from the patient’s airway and many who intubate opt to use the video laryngoscope to create distance from the patient’s face.  Because the video scope has proven itself to be an exceptionally reliable first backup for a difficult airway and offers the added protection of distancing the provider from the airway, many anesthetists believe that the video laryngoscope should be a standard of care for the future.

Ultrasound for nerve blocks   Anesthesia providers toward the end of their careers can remember the days of seeking paresthesia while placing a peripheral nerve block.  Not only were results of landmark guided blocks less reliable, actual damage to the nerve was not uncommon.  Currently, ultrasound is being used to visualize the placement of local anesthesia in the space surrounding the nerve and has reduced the incidence of nerve damage associated with administering the block.  The improved patient safety and reliability of ultrasound guided nerve blocks will mandate this technique as a standard of care.

Multimodal pain therapy   The spectrum of sedation through general anesthesia does get the patient safely through the surgical procedure but it does not provide adequate analgesia for the immediate postoperative period.  Multimodal pain management uses a combination of different classes of analgesics which opens the door to comfortable, opioid-free recovery from surgery.  The effort to eliminate addiction to opioid drugs will mandate that multimodal pain become a standard of care.

Change the status quo by raising your standards

Quality healthcare is a platitude that arises from the C-suite; however, it is a way of life for the frontline workers delivering hands on service to clients.  To ensure positive outcomes, standards of care draw a line that quality patient care must not fall below; however, they do not necessarily represent the optimal treatment options available.  Healthcare providers in every specialty can raise the bar and exceed minimal requirements by constantly developing policies and procedures that exceed existing standards.  Anesthesia providers implement policies that require the use of new technology to protect the provider and improve the safety of the patient.  Surgeons implement policies that provide effective, opioid-free pain control postoperatively.  Perioperative nurses alter workflow policies to ensure the delivery of high-level care while maintaining social distancing. 

Today’s policies will become tomorrow’s standards.  Be a champion for your profession by constantly updating policies and procedures to reflect an elevated level of care and then be an advocate for establishing them as a new standard of care.    You may be on the frontline, but your initiatives will have a greater impact on healthcare than all the slogans coming from the front office.

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

Life lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

For everybody, even those who hold advanced degrees from prestigious business schools, great leadership is built upon life experiences.  Growing from lessons learned in kindergarten and subsequently validated throughout one’s personal journey, life’s lessons provide a solid foundation for decision making and for relating to others.  The release of Robert Fulgham’s book in 1986, All I really need to know I learned in Kindergarten, prompted chuckles, head nods and words of agreement from those who read the popular book.  Now, almost 35 years later, readers of his updated book continue to appreciate the life skills that they learned as a 5-year-old.  Several of the life lessons identified by Fulgham include:

  • Play fair
  • Don’t hit
  • Share everything
  • Don’t take things that aren’t yours
  • Clean up your own mess
  • Say you are sorry when you hurt somebody
  • Take a nap every afternoon

You are only a leader if others are willing to follow

Toddlers who initially learned the golden rule from parents and then learned entry level social skills in elementary school got a great start, however, the wouda, shoulda, coulda moments experienced by each of us during the course of our life solidify concepts that, when heeded, propel us into a successful future.   There is a lot to be learned from the school of hard knocks, but it is always better to learn from the misfortune of others rather than making mistakes oneself.  Here are a few of life’s lessons that you can incorporate into your behavior to enhance your leadership abilities.

You must be present to win

John Maxwell, in his book The 5 levels of leadership: proven steps to maximize your potential, describes level 2 as leadership by permission in which the team wants to follow the leader.  It is based on trust and confidence that develops over time through transparent interaction.  Being both physically and mindfully present is essential.   Having a physical presence takes commitment and requires the leader to schedule time every day to mingle with workers.  Being mindfully present necessitates centering on the other person to ensure that he/she is not only listened to but heard.  A workplace survey conducted by Bain & Company revealed that centeredness arising from a connection between workers and the boss was the number one attribute of a successful leader.

Protect your reputation

In the words of Benjamin Franklin, “It takes many good deeds to build a good reputation and only one bad one to lose it.”   Your reputation is your calling card and in the digital world it can be handed out to hundreds of people with a few clicks.  Recently during a procedure, the surgeon harshly and unfairly made false accusations and chastised the circulating nurse in front of her peers.  Before the procedure ended, every nurse in the building knew about the incident (text networks operate at laser speed) and to date, none of the nursing staff trust the surgeon.   What you say and do is seen, known, and shared by others.  Determine the reputation that you want for yourself and align your words and actions accordingly.  You will be watched and discussed; make sure people have positive things to say.

Be good to people and build good relationships

In the business community, success comes at the speed of developing confidence through honest and open relationships.   Author Jonathan Okies writes “It doesn’t cost a penny to be nice to someone” and encourages people to smile and strike up a conversation with at least one new person each day.   Vendors of all types, including those selling orthopedic devices, know that their survival is not based on the product, but rather on the relationship they develop with the surgeon.  If you are a leader, your team deserves no less.  Get to know those you work with and offer mentoring and verbal encouragement daily.  When members of your team know that you have their back, they will give you their trust.

Your attitude toward life will determine life’s attitude toward you

In the words of Samuel Goldwyn, “The harder I work, the luckier I get.”   Leaders at every level set the tone for their workgroup, set expectations, and influence productivity.  Author Liminita Savuic applies the law of attraction to life’s experiences and notes that we attract the things we focus on.  If you think that life is unfair, you will constantly be in the role of a victim whereas believing yourself to be competent and capable will attract a steady flow of opportunities.  If you want good things to happen but you are not fully confident in yourself, fake it until you make it.  Visualize someone who is successful and play the role until it becomes who you are.

Establish your health early and maintain it for life

It doesn’t matter how smart or competent you are, when your physical health is gone, your work career is over.   It is important to have a healthy body and mind as noted by 17th century English bibliographer William London, who advises “To ensure good health; eat lightly, breathe deeply, live moderately, cultivate cheerfulness and maintain an interest in life.”  

As described in my prior article, Welcome to club 85, those who neglect their health acquire co-existing diseases which require medications that suppress the immune system and, in turn, increase susceptibility to the COVID virus.  Establish healthy habits while you are young and maintain them throughout your life.  To paraphrase my mother, “it’s easier to stay healthy than to get healthy.”

Invest wisely

When asked about life lessons that have propelled his career, Warren Buffet replied, “invest wisely.” Author Drew Hendricks notes that Mr. Buffet was not talking about buying stocks, bonds, or businesses, rather, he was talking about investing in ideas and then finding the right people to convert them into a reality.  Leaders are resource managers and two valuable resources are time and energy.  Whenever you say yes, you are committing time and energy that cannot be used elsewhere.  Follow Warren’s advice and invest yourself sparingly only after considering the cost/benefit ratio.  Before making a promise, assess the ROI and take on only those projects that offer benefit to you, your team, and your organization.  Without exception it is better to give an honest no than a false yes. 

Millions of dollars are spent each year on books, videos, webinars, and courses in leadership that, when stripped of the glitter, really come down to the application of life’s lessons.  The principles of emotional intelligence are founded in the lessons learned in kindergarten and the value of collaboration and empowerment arise from the time-proven lessons we learn from our successes and failures.  We all make mistakes, that’s a given; gaining knowledge from them and applying the lessons to future situations is the difference between being a great leader versus an average manager.  As you walk the path of life, look up and appreciate every experience that is offered along the way.  Live, learn and enjoy life one day at a time.

Tom is a published author, skilled anesthetist, proven leader, and frequently requested speaker.  Click here to view current topics ready for presentation.

Celebrate the Fourth of July by Teambuilding

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Enhancing teamwork is an essential task for leaders who want to empower workers, promote their collaboration, and increase their commitment to the job.  Writing in Forbes Magazine, author Brian Scudamore notes that group activities for the team “builds trust, mitigates conflict, encourages communication and increases collaboration.”  In addition to bringing people together, teambuilding activities break the daily routine and adds pizazz to a special day.   Author Eric Schad agrees that teambuilding is essential and notes that group activities promote socializing, friendly competition, and improves team performance.  Planning and implementing events to challenge cooperative interaction requires time, energy, and resources on your part as the leader and the organization; however, the ROI is worth the effort. 

The fourth of July is a mid-summer celebration that historically draws families to parks to eat hot dogs, sip on soda and watch fireworks.   Similarly, the week leading up to Independence Day is often a festive time in many workplaces and a great opportunity to infuse a little fun and energy into your group with team building activities.   Distancing restrictions are being eased, people are returning to the workplace and insightful leaders are leveraging their position by planning activities to re-unite the workgroup.  Here are some tips for lighting a fuse that will unite and motivate your team.

Individuals play the game, but teams beat the odds. 

~Seal Team

Virtual teambuilding

Americans are creative people and have found a way to continue to function within the parameters generated by the social distancing rules.  The traditional company July Fourth picnic is likely taboo but that does not need to shut down the opportunity for group events.  The internet offers a great platform for virtual events that are fun an interesting.   Look over these activities to get started, then use your imagination to invent more.  

Games People Play

Who-is-it competition   Ask each person on the team to write something about themselves that others would not suspect.  Post several each day leading up to the 4th of July and have team members guess who it is.   A variation of the game is to name the person and post 3 “facts” of which only one is true.  Have the team consider the person and select the true statement.

Riddles   The internet is “riddled” with them and some are quite complex.  Find one, post it then challenge your team to solve the riddle together, as one.  Slack and WhatsApp are two popular platforms that are user friendly for team chats that allow the group to work together to reach the solution.

Online games   Chess, checkers, Yahtzee, and many other traditional games are online.  In addition, Parade Magazine lists 25 online games to be enjoyed while social distancing.  Set up a tournament and let team members go head to head until one champion is left standing.

Quizbreaker   This is an online app that each team member can join.  A question is posed to the group and each team member replies.  This is a favorite for remote workers who want to remain connected with one another.

Build a story   Start a story line and then challenge team members to add to the tale, one person at a time, until the last individual brings the story to a surprise ending.   A group “reply all” email or one of the chat platforms listed above will facilitate this activity.

Picture contest   Create categories and have people submit pictures.  A variation is to have each person submit a picture of something in their home and have others guess who posted the pic.

Online happy hour   With or without alcohol, gather on a zoom or skype platform to share music, stories, and a glass of whatever floats. A variation would be to have a bartender’s happy hour where each person shows the group how to mix their favorite drink.  Danger:  Active participants may not remember the last few recipes that were shared.

Getting good people is the easy part.  Getting them to play together is the hard part

 ~Casey Stengel

Workplace teambuilding

Those of us who remained on the job over the last historic months have learned very quickly how to work around others while preventing the spread of the deadly disease.   Even though masks are being worn and social distancing is enforced, most workplaces continue to have common areas where workers gather in small groups, take breaks and share stories.  On the day before the holiday break, bring in extra people to help cover the workload and offer an extended lunch break for each worker.  Allow the team to filter through the break area in small groups and have activities set up for them to enjoy. 

Hot dogs and ice cream   Hey, it is the 4th of July and some traditions must be maintained.  Give the workers a free lunch while they mingle among the activities.

Puzzles.  Start a jigsaw puzzle on a table and encourage everybody to add a piece to the puzzle as they filter through the room.

Bean bag toss.   This game comes in all sizes from tabletop to targets large enough for the park.  Assess your space and start tossing.

Guessing games.  Fill a jar with gourmet coffee beans or red, white, and blue Jelly Bellies and have each person write down their guess with the jar going to the closest guess.

Basketball hoop.  OK, you are inside but a mini hoop with a nerf basketball is an open invitation for a free throw contest.  Watch the hot shot secretary shame the high school letterman.

Foosball table.   Space permitting, set up foosball for those who want to expend a little energy on head to head competition with a colleague.

Giveaways.   Make it a day to remember by sending each person off with a gift.  A R,W,& B facemask with your company logo demonstrates your commitment to safety and advertises your company to the local community.

Outdoor activities

With July 4th falling on a Saturday and most state and city parks open again, plan a long social distance walk in the city park, a hike on the trails in a wonderfully wooded State Park or a group bike ride.  Designate a central location where a variety of activities can begin and end, then coordinate a time for everybody to return for BYO recovery treats.  Breaking into small groups and using multiple routes respects social distancing requirements while providing healthy outdoor activity.

It’s time to emerge from the COVID cave

The best and most productive workplaces know the value of teambuilding and actively seek mentally challenging and physically stimulating ways to bring the group together.  Reuniting teams after the COVID separation is essential and the fourth of July is a holiday that naturally draws people together for active relaxation.    Give your team a red, white, and blue experience to remember, and one that will unite them, augment relationships, and improve productivity.

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

Can you hear me now? Communicating in the COVID workplace

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Communicate, communicate, communicate…a message that has been drilled into all of us as a key ingredient for effective leadership, patient safety, teamwork, and the future of mankind.  Collaborative teamwork requires that the vision of the leader be understood by the team and empowered workers deserve to know exactly what is expected of them.   Partial or ineffective communication sets the stage for disaster regardless of knowledge or level of experience of those involved, as evidenced by the greatest loss of life in aviation history.

On a foggy morning in 1977 on the island of Tenerife, just off the coast of western Africa, KLM flight 4805 was awaiting clearance for takeoff as PanAm flight 1736, still on the runway, was rolling toward the nearest exit point.  Pilots in each plane and the controller in the tower were all speaking in English, a learned second language for each person.  Fog prevented visual contact from the tower to the runway so verbal talk in a non-native language via a radio was the only way to communicate the positions of the planes.  Interpreting a message from the tower as clearance for takeoff, the KLM flight went to full throttle, accelerated, and hit the PanAm plane killing 583 people.  Communication failure cost many innocent lives that day on what was otherwise a beautiful vacation island.

Communication is equally important for safety in healthcare.  The Institute of Medicine published a report in 1999 stating that up to 100,000 deaths occur annually in the United States due to medical error.   Current statistics published by the CDC and CMS indicate that death due to medical error has not been reduced in the past 20 years and root cause analysis of closed claims prompted the Anesthesia Patient Safety Foundation to list communication errors as a major risk for patient safety.  Poor communication in healthcare does not leave hundreds of people dead on a runway; however, the results are equally devastating to the family and friends of the injured person.  Just as in aviation, effective communication among healthcare providers prevents errors and saves lives.

Shrouding the body in plastic, masking the face, and shielding the head stops more than the COVID virus, it muffles sound and removes visual ques.

The threat of the COVID 19 virus mandates that healthcare providers utilize personal protective equipment (PPE) for their own security as well as the safety of friends and family that they interact with after work.  Along with the protection provided by the PPE barrier comes the unintended threat of patient harm caused by difficult communication among those wearing full PPE.  For example, recently a surgical technician in our break room commented, “I’m glad I know his routine because I didn’t understand half of what he said to me.”  My personal experience while wearing PPE is that I find myself speaking louder, standing closer and asking people to repeat themselves frequently.  The option of being like the KLM pilot and acting based on what was thought to have been said rather than seeking clarification is not acceptable in healthcare.

An internet search related to communicating while wearing PPE revealed the story of a nurse who was hard of hearing, dependent upon lip reading and was forced to retire when masks became a requirement in her workplace.  No doubt, many of our elderly patients, with or without COVID, share her inability to fully understand words spoken through a mask and face shield.  Even when word are heard and understood, masks present a barrier to developing trusting relationships with patients as evidenced by a study by Wong et al (2013) published in the BMC Family Practice journal.  The study revealed that family practice physicians who wore a mask while interviewing patients were less likely to create an empathetic, trusting relationship.  The findings reinforce the importance of removing the facemask if possible when around non-COVID patients while maintaining strict social distance rules.

Am I suggesting that we should NOT be using PPE?  Emphatically NO because PPE is crucial for provider safety; however, we must take steps to ensure that PPE is not a barrier to collaborating with colleagues or connecting with patients.  Here are some tips for effective communication while wearing protective equipment.

Communicate clearly in the COVID workplace

Use closed loop communication.   Advocating for patient safety, the CDC recommends closed loop communication while wearing PPE to ensure understanding.  With closed loop communication, the sender initiates the message, the receiver acknowledges the message by giving feedback, and the sender verifies the feedback.  For example, one person may ask another to draw up 0.5 mg of atropine.  The second person repeats, “I will draw up 0.5 mg of atropine” to which the sender says, “yes, 0.5 mg of atropine is correct.”

Use technology.  We live in a digital world and technology abounds to assist communication.  When words are muffled, mobile devices can be used for typing and sending messages to others while wearing PPE.  Always protect devices in a plastic wrap and wipe them frequently with disinfectant.  In addition to personal devices, walkie-talkie type gadgets can be worn under the PPE garment and provide a channel for clear communication.  The Vocera system is but one example of an electronic device designed to provide effective communication while wearing PPE.

Create trigger words and signs.  Pre-arrange both verbal and non-verbal ways to bring the team to a halt if something is not understood or is not correct.  Make a large sign that says “STOP” or have a red card to hold up for all to see when immediate help is needed.  Agree on a hand gesture such as the “timeout” signal given by a football referee or the “halt” sign given by a police officer to stop any procedure that you feel is unsafe.  Next, consider other supplies that are needed or events that happen frequently where a sign would be appropriate for informing colleagues.  Make sure that signs are appropriately cleaned between uses.

Use body language and facial expressions.  Writing in Health News Hub, author Ken Harrison offers advice for using the body to enhance communication while wearing PPE.  Recommendations include maintaining a relaxed posture and using hands and arms to reinforce the words that are spoken.  Stand where you can see one another’s facial expressions.  Psychology Today author Karen Krauss Whitbourne notes that the eyes tell the story when it is difficult to hear words.  Joy, fear, anxiety, and excitement are all expressed through the eyes and eyebrows add emphasis.  Use them to your advantage when your words are difficult to understand.

Gestures and nods.  Several years ago, I was told that traveling in Italy is easy because Italians talk with their hands; just ask for directions and watch their hands.   When in PPE, do as the Romans and use your hands to reinforce your words.  If you need two syringes, hold up two fingers. When a patient needs to move to a new position, use your hands to indicate what you want the patient or your assistant to do.  While talking to another person, use head nods to indicate understanding of what was said.

Flash cards and pictures.  Being sick, fearing death, and receiving treatment from people in space suits can be very frightening.  Take and print a picture of yourself, wrap it in plastic and pin it to the outside of your gown to let patients know that there is a human inside.  Create flash cards for instructions that are frequently given to patients and hold them up as you talk to the patient.  As above, use your eyes, gestures, and body language to reinforce the message you are sending.

The COVID crisis has caused healthcare workers to pause and re-define their workflow to ensure that patients receive effective treatment while solidifying the safety of providers.  The first step toward safety is to become aware that others may not understand what you say, and the second step is to immediately halt the other person and ask for clarification if you do not understand them.  With some thought and pre-planning, the barriers put in place to protect providers need not pose a threat to those in need of their care.  Rather than behaving like the pilot sitting on a foggy runway and taking action based on a garbled message, use all your resources to creatively ensure that messages are accurately sent and received.  Who knows, learning to speak loudly while using facial expressions and hand gestures might position you for a career on stage when theaters reopen.   

Tom is a published author, skilled anesthetist, proven leader, and frequently requested speaker.  Click here to view current topics ready for presentation.

4 Keys to eliminating disruptive behavior

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Disruptive behavior is a killer

Disruptive behavior kills team morale and productivity in several important ways, some more obvious than others.  When unsettling behavior is allowed to continue, tension and anxiety become the mood of the group.   Even worse, constant complaining is often contagious and can cause some co-workers to respond with, “If you think you have it bad, this is what happened to me.”  Disgruntled workmates may overtly retaliate and respond with anger and acts of sabotage.  Eventually, the team will break down and become totally dysfunctional.

Adding to the problem are the less obvious negative effects of disruptive behavior; workers risk their physical health as they lose sleep or begin unhealthy activities to cope with the workplace stress.  When animosity builds and collaboration breaks down, there is an increased risk of injury both for the workers and the clients they serve.  In addition, the organization suffers when productivity drops, clients become dissatisfied and the most talented members of the team find a new job.

Have you worked with these people?

Supertech’s story   A surgical technician, working in a busy surgery center, happens to be exceptionally good at her job.  She is also the most predictable person employed at the center, but not in a good way.  Supertech has a toxic personality and you can count on her to deflate the morale of the group daily.  At every opportunity, she dominates the conversation and dwells on one of several topics – problems in her personal life, inept co-workers, incompetent management. While her skills are respected, her mere presence creates an undercurrent of tension that is exhausting to her colleagues and damages the entire group. 

IckyU’s tale  At a nearby hospital, an experienced ICU nurse who wants what he wants when he wants it has scant tolerance for disappointment.  Because he needs people to like him, he remains pleasant with a smile on his face, uses an agreeable tone of voice, but relies on passive-aggressive behavior to give pay-back and reek workplace havoc.  Once a co-worker is on his bad side, he will intentionally withhold both information and assistance because he takes pleasure in watching others struggle and fail.  Both IckyU’s insidious sabotage and Supetech’s in your face attitude keep the pot stirred at their respective workplaces and both damage the team.

“Peace is not absence of conflict, it is the ability to handle conflict by peaceful means.” ~Ronald Reagan

Types of disruptive behavior

It is easy to address a problem that is seen and known by all.  Overt acts such as harassment, bullying and aggressive behavior are easily witnessed and documented, and the leader has tangible reasons to hold the perpetrator accountable for his/her actions.   Addressing covert acts such as those displayed by the disgruntled ICU nurse is more challenging but equally necessary.  Writing for Chron, Author Molly Thompson identifies the following as behaviors that upset the team:

  • Bullying
  • Harassment
  • Tardiness / absenteeism
  • Gossip/bad attitude
  • Insubordination
  • Know it all
  • Primadonna
  • Office romance
  • Personal issues

When left unopposed, these negative forces form a powerful vortex that sucks the life out of the team and the workplace.

            Keys to combating disruptive behavior

Problems seldom go away on their own.  Leaders have a choice between stopping a bad behavior when it first emerges or dealing with it later after it kills the spirit of the team.  Anticipate that perpetrators will use every possible excuse to rationalize their behavior so make sure your facts are correct before jumping in to call a foul and hand out a red card.  That said, do not let analysis paralysis prevent you from taking necessary action.  Try these four actions to help you confront and address issues created by the problem child on your team.

Listen  Those who lack courage or power to address issues head on will fight back via passive/aggressive behavior and sabotage.  The essential first step toward correcting the situation is active listening because the feeling of not being heard, understood, or respected leaves a person feeling unappreciated and powerless.  You do not have to agree with or pacify the person, but you must actively listen before acting.  Showing empathy and clarifying misunderstandings will often convert an enemy into an ally.  Sometimes, just feeling as if he/she is understood is enough to defuse anger and modify behavior.  

Review the purpose of your team.  When there is an overall negative vibe throughout the group, the problem will not go away until the culture changes.  Call a team meeting to discuss the need for common courtesy and collaboration in the workplace.  Ask leading questions such as, “How would we behave if we truly respected one another?”  “What behaviors do we need to either promote or eliminate in order to demonstrate collaboration and appreciation?”  Allow your team to develop lists of desired and taboo behaviors and use those lists for step 3, developing a code of conduct. Note: do not be surprised if  your team puts some of the behaviors of your bad actors on the taboo list.

Develop a code of conduct.  Build on the feedback from the team and develop a code of conduct for your workplace.  The code must outline behavior that is expected when staff members are working with each other and with your clients.  Print the code on a form with a signature block and invite team members to sign a pledge to use only positive behavior.  Once done, challenge team members to hold one another accountable for abiding by the new rules that they have helped to create.

Enforce zero tolerance.  Once the groundwork has been completed and the stage has been set for a culture change, assume that you will be challenged.   If disruptive behavior continues, have a formal one on one talk with the person, review the code of conduct, and then tell the person, “If this code is not you, this is not your job.”   As you build your team, discuss the code of conduct with each applicant to ensure that he/she knows up front the expected behavior in your workplace.  Have applicants sign a pledge to adhere to the code of conduct as a condition for joining the team.

Some leaders inherit troublesome workers like the scrub tech and the ICU nurse when they sign on to be the boss; others watch behavior deteriorate over time as one bad apple ruins the bunch.  Superteach trash talks everybody around her, insists that she is a victim and drags down anybody who will listen.  IckyU is more elusive and acts out his victim role by sabotaging the group and by being unwilling to work collaboratively.   Both behaviors are disruptive and violate a normal code of conduct for a collegial workplace.  Build upon the consensus of those on your team who want to create a positive culture and take a stand against bad behavior.  Have some courage, do the right thing, and disrupt the disruptors.  Both you and the others on your team must be allowed to do your job without the anxiety caused by unruly workers.

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

Get Results

By Thomas Davis, DNAP, CRNA

Follow @procrnatom on Twitter

Some people want it to happen, some wish it would happen, others make it happen ~Michael Jordan

My colleague, Dr Eric Shepard, MDA, had a strong desire to ensure that our staff was able to continue to function in the COVID environment with the least possible exposure to the deadly virus.  In his research he located a scuba facemask used by the Italian military and envisioned replacing the snorkel port with a filter that would remove 100% of the airborne virus.   Tirelessly, he worked on developing an adaptor that would accommodate a filter which removed the COVID virus from inhaled air.  After developing a design, he consulted a local engineer and together they produced a prototype adaptor that would fit into the mask.  He then coordinated with the manufacturer in Italy who eagerly welcomed the modification and produced samples.   Next, Eric applied for and received approval from the FDA to use the mask in the United States.  Eric’s creative idea at the beginning of March resulted in a new barrier to COVID by mid-April.  As a result, NAPA anesthesia purchased 2000 of the masks and distributed one to each healthcare provider in their system.  Without persistent effort, a valuable concept would have died on the vine. 

Similarly, Diane Miller, CRNA, had a vision for a device resembling a toy that would make inhalation induction of anesthesia more fun for children.   She, too, worked tirelessly to develop prototypes followed by testing.  Based on feedback from colleagues and the reaction of children using the experimental device, she tweaked her model to make it user-friendly for the anesthetist and fun for the child.   She spent months obtaining a patent, testing the device, and gaining FDA approval for marketing the gadget.  Diane located a person to manufacture and package the product and investigated marketing strategies.  Without the creator’s consistent and committed effort, the Pedia pediatric anesthetic device would not exist.

In contrast to those who do achieve their goals, some people work extremely hard, are fatigued at the end of the day but have little or nothing to show for the effort.  They are busy but not necessarily productive.  Here is the difference.

Busy people are always in motion working on something.  They want to be good at everything and continually multitask which ensures that no project gets their full attention.  They frequently feel rushed, so their efforts to make what they are working on a little better often leaves the project undone, awaiting one more tweak.  Busywork is ongoing and is seldom completed.

Productive people remain focused while working with a sense of purpose.  Because they have a clear concept of what they want to accomplish, they do not become distracted nor discouraged.  They tend to be less frantic than their “busy” colleagues and have a relaxed concentration and optimistic interest in the task at hand.  Because they are determined to achieve the desired outcome, they will not be deterred until the project is brought to closure.

How to Achieve Results

Numerous times throughout my career, I have heard a friend or colleague groan when a new device was introduced saying, “I thought of that years ago…I’d be rich if I had followed through on my idea.”  

Transforming yourself from wants it to happen “trier” into the makes it happen “doer” requires a clear knowledge of what you plan to achieve.   With the outcome in mind, you will need a commitment of time, effort, and resources in order to get the ball rolling.  Applying your focus to the project requires you to narrow your perspective and remove distractions.  Peter Landau, writing for the Projectmanager bog, offers several suggestions for removing distractions, including the following.

  • Develop a schedule and keep it
  • Ensure proper nutrition and sleep
  • Use physical and emotional barriers such as room dividers and relaxing music to block other activities
  • Have a clean workspace
  • Turn off your phone
  • Let others know that you are working and accept emergencies only

Once distractions have been removed, the pathway is open to move your project forward. Keep in mind that what you are doing may affect others and, if so, it is important to get their feedback early on.  

Before you start a project, step back and review your intended outcome, resources, and personal talents.  You may have the vision and the energy to push a project forward yet lack the expertise that is required to complete each individual step of the process.  Diane was able to develop a prototype of her pediatric device but needed help from others to obtain a patent, FDA approval, production of the device and marketing.  Eric was able to design the adaptor for the airway filter but needed an engineer to help produce the prototype.  Stay true to your goal, seek advice where needed and persistently push your project to the next level.  If you do not know the solution to removing an obstacle, find someone who does.  When consulting with others, ask game changing questions and always strive for excellence.  Never settle for less than best.

Keys to transforming yourself into a highly productive person include believing in yourself and taking ownership for creating the result.  Courage is needed to put achieving your vision above your fear of failure or humiliation.  When you take ownership, your desire to achieve a goal will become stronger than the roadblocks that you will encounter.  Anticipate setbacks and have the resiliency to convert deal breakers into deal makers. Don’t be a trier who works at things; be a doer who gets things done.

If you still have a few more miles to travel on your personal journey from busy to productive; use the tips in this article to grease the wheels and supercharge the engine. Implement a functional schedule with measurable tasks toward a worthwhile goal and commit to it until each task is completed and the goal is achieved. Stay optimistic, resist distractions, be relentless and convert yourself from “busy trier” to “productive doer.” 

Tom is an experienced leader, author and requested speaker. 

When it’s up to you



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on Twitter

There are many paths to leadership; some people want to be leaders and plan a career progression that positions them for the nod when it is time for a change.  Others become leaders out of necessity when effective leadership is lacking and a team is suffering.  For example, some years ago a group of 47 CRNAs serving a large hospital had a leader who was just putting in time until his scheduled retirement.  Because he didn’t want to make waves, he kept a low profile and simply put the team on autopilot. The boss was disinterested with no goals, the team lacked direction and felt abandoned, morale was low, and recruiting was difficult.  One team member stepped forward. Using a two-pronged approach, he simultaneously assumed responsibility as the lead recruiter for the group while working with colleagues to find ways to make the job more attractive for applicants.   As a result, morale improved, open positions were filled, and the responsive team member was subsequently promoted to the position of Chief CRNA. 

Leadership is important at all levels.  The CEO of an organization takes charge of public relations, interacting with other leaders, and reassuring both the workers and the public that resources are being obtained and the staff is fully prepared to meet the challenge.  The middle manager organizes logistics and brings together unit managers to ensure that staffing is adequate, training is completed, and sufficient supplies are in place.  The frontline leader establishes the mood for the group, sets goals, provides reassurance, facilitates collaboration, communicates the latest updates and protects team members from harm.  A crisis enables an effectual leader to stand out among peers but, unfortunately, while some leaders flourish, others falter. The ones who flourish will appreciate help that is offered by the team. But those who falter will need to be rescued for the sake of both the team members and the patients.  Across the leadership spectrum there is ample opportunity for motivated workers to step up and share a slice of the leadership pie.  

If leadership is lacking, it’s time for you to stand up and be a champion for your team

A workplace champion voluntarily takes an extraordinary interest in a cause, policy or project that will promote the success of the team.  Often, the champion is considered by colleagues to be a go to person on the team; a person with knowledge, expertise and a willingness to help others in need of guidance.  Champions are opinion leaders who are uniquely positioned to influence groupthink and steer the team in one direction or another.  When there is a crisis and the designated boss is unable to provide effective leadership, it is often the team champion who fills the void.  If all eyes turn to you when the chips are down, draw on these behaviors to help you to be a successful non-titled leader.

  • Maintain ties with the boss.  Your goal is to step up, help where needed, and ensure that your team safely weathers the challenge at hand.  It should not be your intention to incite mutiny and create a mini crisis embedded in the larger crisis.  As you see and do what needs to be done, keep your boss in the loop and do not challenge his/her authority.  Rather, focus on what needs to be accomplished, engage your fellow team members to help, and know that others notice and appreciate your efforts.
  • Connect with the chain of command.  If your boss is in total absentia and you are picking up the pieces, make sure that your activity is known and was approved by the next person in the chain of command.  Work often crosses department lines and supervisors must be in the loop as you initiate activities with your team.
  • Be decisive.   As the saying goes, a good plan today is better than the perfect plan tomorrow, so assess the situation and quickly come up with a viable solution. Openly communicate with your colleagues and bring them on board with the plan.
  • Be resilient.  Not everything that is tried will work out as thought out.  Rather than throwing your hands in the air in frustration, take setbacks in stride, re-focus on what you are trying to accomplish and develop a new plan.  If you are filling a leadership void, your team does not need yet a second person to go absent.
  • Be consistent and available.  A crisis, such as the one we are experiencing with COVID,upends workflow and interpersonal relationships leaving workers feeling hopeless.  You may not be able to make the virus go away, but you can bring stability to the group through consistency.  Maintain a visible presence and, where possible, establish and stick to a schedule.  Have a positive attitude and do not allow yourself to make emotional responses when glitches arise.
  • Use emotional intelligence.   People are emotional creatures and often respond and make decisions, good or bad, based on emotions.  Emotional intelligence involves becoming aware of your emotions as well as sensing the emotions of others, and then interacting in a manner that affirms the feelings of the other person.  Saying, “I sense that you are uncomfortable with this plan,” affirms the person’s emotions and opens the door for discussion.  Feeling understood has a calming effect whether you are interacting with a colleague, patient, or family member.     

There’s no end to stories of team members stepping up to the leadership plate during a time of crisis:  When the platoon leader is killed on the battlefield, a sergeant takes command; when the all-star quarterback injures a leg, the backup runs on the field and wins the game; when communication is lost with headquarters during 911, the paramedic takes charge and moves a group of patients to safety; when the ICU nurse steps up and takes charge because her boss is overwhelmed by the COVID crisis and is paralyzed with anxiety, lives are saved.  The workplace is full of heroes who have stepped in to fill the void left by a leader gone AWOL, and you can join their ranks.  Whether absence of leadership is caused by a crisis, a lack of skill, or loss of the leader’s personal motivation or any other reason, you can be the one to carry the flag if the leader flags.

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



Welcome to Club 85

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Preface to Prevention

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

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

Club 85

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

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

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

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

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

Connect the dots

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

Preparation for Prevention

Exercise

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

Nutrition

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

Hydration

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

Sleep

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

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

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

Tom is an experienced leader, author and requested speaker. 

COVID 19; A Call to Leadership

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

Leadership is essential

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

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

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

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

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

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

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

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

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

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

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

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

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

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