Leadership articles – Page 4

Evidence Based Leadership

By Thomas Davis CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

Dr. David Sackett, an epidemiologist from McMaster University in Canada, is credited as being one of the early individuals most associated with evidence-based medicine. “Evidence based medicine,” in the words of Sackett, “is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The intent of using data to guide care is to move patient care beyond traditional lore and personal experience to a level of treatment based on solid evidence authenticated by research.

Building upon the success that evidence-based medicine created in healthcare, insightful business leaders are actively seeking ways to apply evidence-based management in the business community. Writing in the Harvard Business review, authors Jeffrey Pfeffer and Robert Sutton note the importance of gathering and using information to support leadership and management decisions. Their insightful article, Evidence based management, gives examples of business leaders, like GE and Adobe, gathering information in order to revise policies/procedures founded upon documented validation.

Examples of evidence-based management in the business community include GE and Adobe making the bold move to eliminate the dreaded annual performance review. Evidence revealed that APRs focused on the past, caused anxiety and impaired rather than improved performance. With the clear intention of building a collaborative culture, those same companies now require managers to have frequent one on one talks with employees instead of the APR. The new system requires managers to discuss ways in which workers can enhance their future performance. Inherent in the process is listening to employees suggest ways to improve the workflow and efficiency.

Communication, mutual understanding, respect, and ability to work together are four essential pillars that support highly effective workgroups. Gathering and using evidence to implement those essential items builds a foundation for solid management decisions. Managing a group of frontline healthcare workers is much different from directing a division at IBM, however the same principles apply. Taking the time to accrue information will position you as a solid thinker and will earn you the respect of your team and your chain of command.

Implementation of evidence-based management within your healthcare team is a 4-step process

Ask questions. What are the policies and procedures that make the least sense to you or cause the most stress and anxiety in your team? Ask further, “Why do they exist, are they effective, and are they necessary?”
Search for evidence. Review the literature, survey or interview other leaders, develop a questionnaire for your team and gather real information from every possible source. Often, similar management issues exist in the business community as in healthcare, and data is available online to guide your leadership decisions.
Evaluate the data. Following the collection of information, set up a process to evaluate the data. A survey with interval and ratio data can be scrutinized with statistical analysis. Qualitative information collected by the interview process can be coded into themes that identify strengths and weaknesses of current policy.
Act on the evidence. Develop a plan to implement the new data and roll it out with a pilot plan. Agree up front that the pilot is a trial that will be carefully assessed and modified before permanent changes are made to existing policy. Specify a period for the pilot and assess the results to determine if goals were met. Modify the plan to address deficiencies identified in the trial period and introduce the final version of the new policy for implementation by the entire team.

For example, a healthcare team was not satisfied with the results achieved by their current one size fits all bonus system where each person received the same amount of money regardless of productivity. Using the four-step process, the system was questioned, and team members agreed that the system was not fair, nor did it reward high achievers. Literature was reviewed and other leaders were questioned in the process of gathering information about alternative applications of bonus money. With fresh information in hand, a new plan was developed with defined metrics that when achieved, moved the person to a higher bonus level. Under the new system, everybody had the opportunity to receive the highest bonus, however benchmarks were required in order to earn the reward. Some on the team were driven by the money and others were driven by the status of achieving the upper tier. Regardless of the personal motivation, the productivity of the team soared under the new system. At the end of the first year, a committee of peers reviewed the process, updated the benchmarks for achieving the highest reward and rolled out the plan for year two.

Evidence-based thinking that is currently being applied in the business community emerged from the concept of evidence-based medicine and now has come full circle as it is being applied to healthcare management. The shift to data-driven decisions breaks the burden of being tied to tradition and opens the door for you to guide your performance and the dynamics within your team in new and insightful ways. Applying evidence makes healthcare leadership healthy.

Tom is a noted author, speaker, clinical anesthetist and is a strong advocate for nurses in leadership roles

Older workers strengthen the team

By Thomas Davis, CRNA, MAE, DNAP candidate

We respect our elders. There is wisdom that comes from experience, and I am not going to stop learning from wise counsel. ~Marcia Fudge

Our baby boomers are aging, our healthcare needs are increasing, and our shortage of nurses and other healthcare providers is expanding…an unhealthy situation. Concurrently, many highly qualified healthcare providers who have reached retirement age are not quite ready to throw in the towel. Keeping experienced, qualified people on the job adds depth and diversity to the team and reduces the shortfall of workers needed to meet the expanding demand for healthcare services.

Arlene Donovan, Forbes.com contributor, confirms that seasoned workers add value to a workgroup. “They possess years of experience, have industry knowledge and are committed collaborators.” In addition, many older workers have a calming and unifying attitude based on their ability to withstand the battle-scars of past achievement. Blending the wisdom and experience of older workers with the knowledge and enthusiasm of younger workers creates a diverse workgroup uniquely positioned to meet the challenges posed by the expanding patient population.

Efforts to broaden the age range and retention in the workforce must go beyond making all capable workers welcome to remain. It must include active recruiting to bring experienced people back into the workforce. Many who have recently retired are having second thoughts and would welcome an opportunity to rejoin a team, even if part time, but feel too old to apply for a job. Reaching out to mature workers opens the door for their return to the job.

Glassdoor.com, author, Jacqui Barrett-Poindexter, highlights several characteristics of mature workers that make them valuable team members.

Problem solving With decades of experience, veteran workers have overcome challenges and deadlines, have a network of connections in place, and know the most efficient way to bring a project to completion. Along with adding insight, in stressful situations they have a calming influence that that generates confidence.
Perspective Seasoned workers know that not every project is urgent and not every deadline is firm or realistic. By drawing on experience, they are able to discern the difference and when to focus on urgent tasks prior to addressing other issues.
Knowledge Older workers may not have the same knowledge base as younger workers who recently completed advanced degrees, but, as described in the March 24, 2019 procrna.com blog, there is a big difference between knowledge and wisdom, and both are important. Where older workers lack textbook knowledge, they win the prize for perceptive common sense.
Capacity to grow/learn. It is a myth that older workers are set in their way and resist change. To the contrary, older workers have spent a lifetime implementing change and know how to do it. Today’s workers who are in their 60s and 70s were the activists of the 1960s and 1970s who spearheaded the civil rights movement and attended Woodstock. The hair may be gray, but the spirit remains.
Mentoring. Older workers want to share their stories and ensure that those who follow in their footsteps have the benefit of their experience. Older workers tend to be willing mentors who are eager to leave a legacy through the work of the next generation.

Attracting older workers to apply for a position in your organization should not be a daunting task. It is a myth that the long-serving people who join, or rejoin, your group will try to steal your leadership position or demand a higher level of pay. Experience from the business community has revealed the opposite; older workers want to share their experience, but they do not want the responsibility of being the boss nor do they expect top dollar in the pay check. Whereas younger workers are attracted to pay/benefits, school districts and flexible hours, older workers are working because they want to and are attracted by things that make them feel valued. When recruiting older workers, appeal to the following:

Competitiveness Senior workers who wish to remain in the workforce have been the innovators of change throughout their careers and even though they are no longer leaders, their competitiveness remains. Their desire to achieve will lift the performance of the team.
Wisdom The transfer of knowledge into action requires the judgment, foresight and prudence that older workers have accumulated over the span of a career. Your elders know how to get the job done.
Place in life Mature workers are at a place in life where they are neither harried by the schedules of their children nor encumbered by leadership responsibilities. Appeal to their needs by offering flexible work schedules that allow them to travel, visit their children and grandchildren or pursue the other activities that keep them in shape for continuing to work.
Flexibility Appreciate and place value on the flexibility that older workers offer the collective welfare of the team as they fill schedule positions that are difficult for younger workers who are raising young children. You’ll find that the grandparents on your team who have been there, done that, will help out where others cannot.

Baby boomers ARE aging, and their health needs ARE changing; and, they bring balance to the ever-expanding need in health care. Engage with the gray-haired and tie-dyed who still want to work and you’ll rediscover what, sooner or later, you will experience…decades of wisdom based on experience, a wonderfully collaborative spirit, and the dedicated dependability of those who truly want to help build the bridge to a healthy situation.

Tom is a clinical anesthetist, noted author and requested speaker.

Don’t let intellect ruin your career

By Thomas Davis, CRNA, MAE, DNAP candidate

My wife records travel shows – relentlessly. We watch Hawaii Life, Rudy Maxa, Samantha Brown, International Househunters, Rick Steves, oh, and did I mention Hawaii Life? “Ya just have to want it!” Recently, an online fitness trainer from Austin, house hunting in Colombia with his online public health care provider wife, is quoted by HGTV, saying, “I have no idea what it feels like to be wrong!” Some viewers might laugh, some might shrug but some of us would walk away disliking him, much like we dislike the person who’s so smart he’s become an active boss and inactive leader.

Intelligent, dynamic people who can take charge and give clear directions are often promoted to leadership roles and when intellect, charisma and the ability to connect with team members are in balance, teams thrive and all is well. In contrast, when balance is lacking, teams falter and leaders fail. In leadership, all smarts and no savvy is a dangerous combination.

According to Harvard Business Review contributor, Alice Boyes, very smart people can overplay their intelligence and sabotage their own careers along with team growth. She advises that intellect should be used to promote the entire team and must never be used in a way that devalues any member. Linking one’s self-esteem to intelligence and always needing to be right is a sure-fire way to kill effective teamwork.

Pitfalls for Smart Leaders to Avoid

I’m smarter than you and therefore wiser. Management issues contributor, Peter Vajda, says that there is a big difference between being intelligent versus being wise and refers to wisdom as the “right use of knowledge.” When I was working as a clinical instructor earlier in my career, one of my co-instructors was viewed by many as being “dumber than dirt” when it came to quoting textbooks or the latest research; however, he had a real gift for applying knowledge and getting the job done. The “smart ones” on the staff were awed by Jim’s clinical wisdom when responding to a crisis and his ability to save the day. Really smart people know that wisdom trumps intellect.

I’m smarter than you that’s why I was chosen as the leader. No question, intelligence is an attribute in managers at all levels. However, it is only a piece of the puzzle. The ability to connect with individuals and motivate a group to achieve a common goal, and the wherewithal to function as a contributing teammate, is more important than raw intellect. In another department chief experience, a middle-manager who had previously been assigned as a sub-group Lead, consistently came across as being smarter than everyone else. A bright and capable person, she was working on a doctorate and flaunted her intelligence in every conversation, trying to make certain that people walked away feeling insignificant and honored that she had talked to them. Though she eagerly pursued greater leadership opportunities, she was regularly passed over because of her superior attitude. Clearly, potential for rising in the ranks can be knocked off the track by placing your book smarts above smart interaction.

I’m smarter than you so you can put up and shut up. Authoritarian leadership is needed on a battlefield, during a natural disaster and especially in a code situation, but heavy-handed bullying, or blatant arrogance disguised as intelligence, is divisive and will kill team loyalty. For everyday management under normal circumstances, collaborative teamwork that recognizes and employs collective intelligence wins the day. At one point in my military career, I worked for a department Chair who governed by strictly worded “do this or there will be a penalty” memos. He assumed that he was appointed to the leadership position because he was the smartest person in organization and demanded compliance to his whims. Within a year, the department was in near mutiny and the leader was replaced.

I’m smarter than you so I can share what I know when I want and with whom. Allowing team members to struggle with a project by intentionally withholding information is self-defeating. As well, when a leader is privy to information before it is released publicly and shares it selectively to the chosen few, an inner circle of loyal supporters is created, dividing the privileged few from the many. Eventually, your team will become polarized and collaboration, the key to team building, goes out the window.

I’m smarter than you and I can hang out with smart people, not with you. Upward climbers are prone to becoming elitists who clamor to spend their time and attention at or above their current level of responsibility. Reportedly, a new department chair at a major teaching hospital assumed the helm of the department and quickly turned her focus to connecting with other department chairs and hanging out with organization’s top leadership. In the process, communication with the remaining 80% of the department was scant and impersonal. By limiting your contact to smart people in the know, an opportunity for both team and personal growth will be lost.

The best leaders are multidimensional and bring many skills to the job. Intelligence is important, but never forget as a leader that the nucleus of the organization is the team and intellect by itself will not produce effective teamwork. The combination of applying intelligence to create a vision, using charisma to motivate others and having the savvy to pull it all together is a formula for success. Rather than bossing like an intellect who “has no idea what it feels like to be wrong,” balance your smarts with your other leadership talents and actively travel with the team.

A noted speaker and author, invite Tom to speak to your organization.

Prevail over office politics

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

When experienced leaders are asked to list things that they like the least about their position of authority, “office politics” will be high on the list of annoyances. Similarly, when rank and file workers are asked to name several things that they dislike about their work environment, “office politics” makes their list too! Disruptive sub-agendas in the workplace cause trepidation among leaders and create conflict among workers, yet politics is accepted as a natural component of the environment.

Webster and Wikipedia both agree that office politics involves the use of power and authority to gain and keep an advantage over co-workers or business competitors. The concept is simple; those with P&A constantly use politics to expand and solidify their position. Strong, designated bosses can use authoritarian power that goes with the position to enforce compliance however, savvy leaders know that using a touch of politics will create a team that wants to follow rather than a team that must follow.

In contrast, where strong leadership is absent, quasi leaders emerge to shape the opinions of co-workers and undermine the agenda of the designated leader. Opinion leaders claim power by controlling the emotions of their peers, often by starting rumors that generate fear and anxiety. In dysfunctional workgroups that are void of effective leadership, the quasi-leaders often have more power than the person with the title. Workers who want to be loyal to the organization are stressed by the conflict of choosing between the designated leader and the opinion leader. When left unchecked, opinion leaders gain power and can ruin both morale and productivity.

“One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors” ~Plato

Politics in the workplace may arise from many different sources. Harvard Business Review contributor Michael Jarrett identifies several dynamic forces that fuel office politics, including the following.

Grassroots politics – generated by the buzz that exists just below the radar screen of the designated leader or organizational administration. Opinion leaders spin and spread enough fear to undermine just about any initiative put forth by leaders. Because gossip and rumor are the vehicles for spreading discord, there is seldom accountability for instigators.
Authority politics – linked to the official title or role of the individual. The designated leader or a person appointed to head a project may use her position to coerce others into obedience.
Policy politics – wielded by individuals who memorize the rule book and quickly report anyone whose behavior is suspect. Rather than addressing an issue with the offending person, the rule mongers quickly file a complaint with HR or any authority who will listen and act.
Status quo politics – emerging from established norms, assumptions and unspoken routines. “We have always done it that way,” rules the day and those in the cocoon of comfort generated by routine will fight any disruption to workplace habits.

Stop the shaking at your knees and lead with confidence. As the leader, you have an opportunity to view workplace politics as a dynamic source of energy that can be tapped and directed to produce impressive results. Put the harness on runaway politics and channel team energy into more productive activities by adopting and practicing the following leadership behaviors.

Learn the office culture. Be confident of your ability and agenda while discovering who the opinion leaders in your group are. Identify your sources of support and use positive politics to ensure that they are allies. Assess the status quo of your workplace and consider that many elements of the daily routine serve a positive purpose and enhance the workflow. Before implementing change, evaluate the level of support for the new policy, and be politically aware by fully informing the team of the need for change well in advance of implementation. “Knee jerk” policy implementation fuels the furnace of political rivals and ensures sabotage.

Don’t burn bridges. Divide and conquer is an established military strategy and those who would steal your political power are energized whenever you have a rift with another person. Avoid emotional responses that poison personal relationships and consider that today’s foe may be tomorrow’s ally. Don’t turn a blind eye to bad behavior, instead, address every issue in a mature manner that addresses the problem while maintaining a positive relationship with the individual.

Never allow gossip. The undercurrent of gossip that is ubiquitous in many workplaces only serves to empower opinion leaders and may be used to sabotage you. Do not participate in gossip and cut it off immediately by dispelling rumors. As a leader charged with improving the morale of a group, I gained political respect by publishing a weekly update which included the “rumor mill”. In that space I directly addressed any current rumors by transparently informing the group of the truth. In short order, rather than gossip, people came to me unswervingly to clarify rumors.

There are no unimportant people. Display charismatic politics by connecting with everyone on the team on a personal level including, and especially, the opinion leaders. Be professional and remain on alert that they will try to control you. Take responsibility for your relationships and give the loyal opinion leaders on your team additional responsibility and then recognize/reward them when they are productive.

Be strategic. What is your long-term goal for the team and what are the steps that must be taken to get there? Start with small projects and put others in a logical sequence so that you can build momentum as you go. Again, give appropriate recognition to your all of your high achievers whenever possible.

Be collaborative. The positive use of politics augments effective teamwork, unites individuals, enhances morale and eliminates power struggles that fuel office politics. Creating interdependence and a sense of shared responsibility puts you clearly in control as the leader and strips power from those who would take yours.

Think of politics as a use of power. The politics of the 60s united a nation and landed a man on the moon whereas the politics of the 70s divided a nation and mandated the retreat from Viet Nam. Workplace politics are less sensational but equally control the mood and productivity of a team. Capitalize on the collective strength of your team, take charge, and use the political capital that comes with your position to build a cohesive and productive workplace.

Tom is a clinical anesthetist, noted author and requested speaker.

Boost your credibility

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

Would you have faith in the information that you received from a person for whom you had little respect and trust? Even if you gave the person the benefit of doubt, you would be likely to view the information with skepticism and validate the report before fully it. That is because respect and trust go to the heart and soul of being believed. Whether you are starting to climb the professional ladder, or reaching down to assist others with their ascent, when you’re dealing with others, your personal credibility will either enhance or kill the results you achieve.

Business is conducted at the speed of relationships and credibility is the gatekeeper that will makes or breaks the deal. Forbes.com contributor, Victor Lipman, reinforces the notion that credibility puts spurs to the process of making a deal. For example, at one point, Warren Buffett’s company sought to make a 23 billion-dollar deal that normally would take months, or even years, for lawyers to complete. Based on the personal credibility established during previous deals between Mr. Buffett and his counterpart, both parties felt secure that the other was working honestly and in good faith. As a result, the monumental deal was completed in a few short months.

In the movie The legend of Bagger Vance, Rannulph Junuh, played by Matt Damon, is the local favorite locked head to head in competition with the two greatest golfers in the world. Having trailed for much of the match and now tied with the pros, Junnuh hits a ball into the rough. “He has a chance to win the match on the final hole but has the integrity to call a penalty on himself when his ball moves after he tries to remove a loose impediment.” (wikipedia). A young boy and eager fan implores him not obey the mandate, saying, “But nobody saw it move.” Junnuh replies, “I saw it.” Honesty and integrity provide credibility, and Rannulph Junnuh had both. Sometimes personal integrity leads to an immediate loss, but it always creates a long-term winner. You will have to watch for yourself to see who finally wins the match; however, the young golfer’s high ethical standards set a precedent that would build a foundation for honest dealing beyond the golf links.

Follow the example from Bagger Vance and build relationships like those of Mr. Buffett by focusing on behavior to boost your credibility. Incorporate the following behaviors into all your interactions and establish yourself as an honorable trusted person in all that you do.

Be honest. The call for honesty appears so often in self-help articles that it is almost a meaningless cliché; however, without honesty there can be no trust and without trust, there is no credibility. A retired used car salesman whom I’ll refer to as Pompous Patient, told me, “If a used car salesman told the truth, he would never sell a car.” Do you want to do any kind of business with a person who is a professional liar? In your leadership transactions, move beyond mostly honest and establish a goal of totally honest. Admit your mistakes and assess yourself a penalty when needed. Total honesty also involves refusing to turn a blind eye and proactively holding those around you responsible for following established standards.

Deliver results. It’s easy to volunteer and say yes when someone is needed to tackle a project; however, saying yes puts your integrity on the line. Credibility is established when the task comes to fruition in a timely manner and achieves the desired outcome. Protect your reliability by refraining from over-promising and treat all tasks, large or small, as opportunities to deliver results. When you agree to perform, keep your word and deliver.

Be transparent. Credible people have the courage to share information, both good and bad, to those who have a need to know. Trying to shield those around you from bad news is a losing proposition. When you’re the messenger of bad news, put it into context by discussing the reasons behind the decision. Eventually, people always learn the truth and if you have not been forthright, they will have good reason to doubt you in the future.

Be consistent. Human beings, including your colleagues, thrive on routine and are more relaxed and trusting when the behavior around them is predictable. By making certain that policies, procedures and rules are known by all and equitably applied, predictability is reinforced. When administering discipline is required, it must be appropriate for the offense and be meted out evenly to every offender.

Be principled. Situations change but guiding principles remain constant. What are the principles that you stand for and guide your deciaion-making? If you need your consciousness raised, go to jamesclear.com to review a list of values, select 5, and practice, practice, practice. Your credibility is enhanced when others observe that consistent, principled behavior is who you are and not just something you do.

Lead by example. Imagine yourself with impeccable credibility and then be the person you visualize. It’s easy to want or intend to be honest, trusted and credible, however intentions do not change reality. Personal credibility can only be present when people know your integrity not by what you say, but by what you do. Your behavior is being observed and will determine the reputation that you create for yourself.

Credibility is a visualized, rehearsed, observed, taught, role-modeled behavior that, lucky for leaders, can be learned. It is often said that we are who we are when no one else is watching. If you consistently set high standards for yourself no matter who’s in the audience, you will earn the reputation of a straight-shooter with whom people want to do business. You will garner respect and trust, the key components of credibility.

Tom is a noted author, speaker and team builder

Compelling messages get results

By Thomas Davis, CRNA, MAE, DNAP candidate

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“Effective communicators make great friends. They’re open to many things and are able to translate their thoughts into meaningful words and actions.” ~Patrick Cogen

E-mail is an amazing and vital byproduct of the digitalization of America. At present, it is attractive, affordable and essential for communication between leader and team. Group messages are an effective way to update and inform an entire team about policy change, workflow alterations or any other topic that affects the group. Individual messages provide an avenue for private, two-way dialogue related to a specific issue. The electronic message platform is so familiar that an important message may blend in with the volume of junk mail and go unnoticed and unopened. Therefore, it is incumbent upon the writer to create a recognizable topic for the subject line, and a compelling message inside that catches the attention of the recipient and demands to be opened.

Caution

There are two important cautions to consider before delving into the finer points of writing effective email messages. Caution #1 Do not use email to avoid personal interaction. Relationships are essential and often make the difference between success or failure of a project. Janice Nadler Ph.D. published a study revealing that people who introduced themselves with a brief phone call were four times more likely to reach agreement when negotiating via email. Email used as a time-saving means of communication is a supplement, not a substitute.

Caution #2 Don’t send emails that pose the risk of creating an unwanted paper trail. Always consider that your messages may be stored or shared so check your amygdala at the keyboard and avoid writing emotional, unkind or nasty rhetoric. Assume up front that anything you publish thoughtlessly can and will be forwarded in mere seconds to the receiver’s support network.

Preparation is key

Before you shoot out a quick message, take a moment to consider the purpose. What is the single most important concept that you want the reader to remember? Recipients tend to remember one or two main points and if you shotgun too many topics in the same message, they may remember the one that affects them the most while overlooking the others. Combine and condense subjects to support a single concept and clearly state the desired respnse of the reader at the end of the message.

Identify your target audience and tailor the language of the message to make it easy to understand. Whether you’re sending a message to a single person or to an entire workgroup, never talk up or down to your reader. If you are implementing a policy change and notifying people at different levels on the chain of command, develop a separate message for each group. For example, a workflow change will affect technicians and nurses differently than physicians and APPs. Developing a message for each group ensures that the information is presented appropriately.

Capture the reader’s attention

You can control the words you write and who initially receives it; however, you have no control over whether the receiver opens and reads the message. Hubspot writer, Olivia Allen, suggests creating a subject line that piques interest, stimulates urgency or is personalized to the reader. For example, “Vendor sponsored dinner” sparks less interest than a subject line “Dine and earn CME at the Steakhouse.” If your goal is to get people to read a draft and offer feedback, a subject line “XYZ policy draft, reply by Friday” will stimulate both curiosity and urgency.

Power Words make Power Mail

Impactful messages begin with a powerful opening and your first two sentences will either win or lose your reader’s attention. Review your goal and write several versions of the first two sentences making sure to include a few power words. Blog author John Morrow offers 595 power words that can be incorporated onto your messages to compel the message recipient to continue reading. Words like amazing, fabulous, remarkable, spectacular, exciting and tremendous might be used to describe an opportunity or an achievement. Power words like frightening, revolting, toxic, scary staggering or scary can be used to give warning or to describe challenges. Regardless, your message content must be related to and flow from the subject line.

“Fools talk because they have to say something whereas the wise talk because they have something worth hearing.” ~Paul Bowden

Once the message is opened, remember, less is better. One or two short, concise paragraphs will be read attentively, whereas, a rambling message will be visually skimmed over before joining the trash barrel. Transparency gives the sender credibility, builds trust and maintains the writer’s integrity. If you’re sending a message that will alter the status quo, briefly state the reasons and the benefits. For example, an ambulatory surgery center required workers to copy two pages from the patient record at the end of each case and submit them to the billing department. Without prior notification by the employer, the usual copier was removed and workers had to walk down the hall to a different copier. The workers did not welcome the change and gave pushback. Had the leader sent the group a message informing them of the impending change, openly revealing that removing the extra copier would save $15,000 per year in ink costs, there would have been little dissent.

When the purpose of the message is to implement change, there must be a clear description of the next step for the reader. Workers are comforted when the leader takes charge and has the foresight to state clearly and without ambiguity the exact behavior that is expected from the reader. Soft messages that only imply but do not specify action will be misread and cause confusion. After giving a powerful opening to capture attention, a transparent description of the problem, and a clear directive to the reader, summarize the message in 1-2 sentences. Unless the message is urgent, save a draft and re-read it before it whooshes out to all.

Electronic communication is not the wave of the future, it is the reality of today. Like the junk mail delivered by the postman that you transfer quickly from the mailbox to the trash can, bland email messages go to the electronic trash can with one click. Communication is an essential component of leadership and email is currently the platform of choice for sending electronic messages. Honing your skills to use current and future digital technology wisely and well, will ignite your leadership and unite your team.

Tom is a clinical anesthetist, noted author and requested speaker

Build a Bridge

The Team Is The Trestle

By Thomas Davis, CRNA, MAE, DNAP candidate

Great leaders know that even the most brilliant plans fail without the support of members of the team. Motivating workers to leap on board to work collaboratively toward a common goal is a challenging yet important part of being a leader. Don’t be daunted or intimidated by the collective roll of the eyes when you introduce the topic of teambuilding. Instead, appreciate the importance of inspiring team spirit by doing projects outside the scope of normal work. In addition to uniting team members, they will experience the reward of creative collaboration and the energy generated from the project will be carried back into the workplace.

On teambuilding.com, Samantha Mc Duffee identifies several essential benefits from teambuilding activities and puts improved communication/collaboration at the top of the list. When a group who works together daily is removed from the normal workplace and given an open-ended challenge to solve a problem, an amazing spirit of collaboration emerges. Take for example a teambuilding activity that was used with a group of nurse managers during a leadership course.

The large group of eager participants was divided into 5 groups of 5 people; each group was given 25 pieces of uncooked spaghetti, a string, a role of scotch tape and a pair of scissors; the individual groups were challenged to build the tallest tower in 15 minutes. The simple rules were to use only the materials provided and to work collaborative with a positive focus on what is possible with the available resources. During the first 5 minutes each group quickly constructed a tower and each tower collapsed; then each group spent the next 10 minutes collaborating to create a better design and re-build the tower. At the end of the allotted time, each group had a standing tower; however, two tables opted to combine resources, work as a larger group and constructed the tallest tower. Remember, they were told to work collaboratively and seek the best use of available resources and there was no rule about working across group lines.

Brian Scudamore, founder and CEO of O2E brands, took another avenue toward teambuilding by treating his team to a country music concert at a local dance hall. They enjoyed sharing the evening together with music, adult beverages and learning the two-step and taking advantage of the relaxed venue outside the workplace to appreciate each other as individuals. Brian encouraged the team to continue the networking within the workplace and to share personal interests with one another. From interaction developed during the two-step, a book club emerged. You might not be permitted to treat your workgroup to a night out; however, you may be able to arrange a group discount at the ballpark or reserve a park pavilion for a barbecue.

Community service is important to the image of a company and opens another opportunity for teambuilding. By serving the community outside the scope of normal business, a bond is created between the organization and the people it serves. Employees’ hidden talents are revealed and, as well, the community receives support for projects and events important to the local area. Here are two examples of teambuilding projects that solidified ties between the organization and the community.

Example 1 While on faculty at the University of Kansas Medical Center, I participated in the annual KU community service day. Over 100 energetic volunteers from the hospital assembled in a cold parking lot at 7am on a Saturday morning and were greeted with hot coffee and pastries. We were told ahead of time to wear work clothes and bring a few basic tools. The Medical Center had identified a two-block area within the city with run down homes that were inhabited by elderly indigent people and pre-arranged permission for us to do basic repairs on their homes. We went to the neighborhood, divided into teams and went to work. Some raked, some cleaned gardens and others did inside repairs. We re-attached cupboard doors, fixed locks, patched cracks and even fixed some plumbing leaks. At the end of the day the residents of the area were all smiles as were the UKMC volunteers. I spent my day working with one person from radiology and another from the lab and from that day forward had a point of contact in each area.

Example 2 A group of nurse anesthetists, at The Johns Hopkins was actively seeking a teambuilding activity that would serve the community and arranged to do a craft night at the local Ronald McDonald house. After scheduling the activity, the team set a goal of providing the most amazing “craft night” ever for the children and families staying at the facility. Planning sessions were held where creative ideas were shared and then supplies were assembled. On the big night, children cautiously entered the craft room and quickly became energetic as they engaged in the numerous projects provided. Parents and siblings jumped into the fun and none were ready to quit at the end of the evening. As with the experience at KU Med, when the evening was over it was difficult to tell whether the residents of the Ronald McDonald house or the volunteers were the happiest.

Workgroups across the country routinely participate in community service teambuilding activities. Use the comments box below to share your project with other readers.

Successful teambuilding is evidenced by the momentum that is brought back into the workplace following the event. Whether joining in a social interaction event or a community volunteer enterprise, those who work collaboratively outside the workplace are more likely to work well together on projects serving the organization. Encouraging people to enjoy one another’s company and appreciate creative ideas carries innovative vitality forward and becomes contagious. A collaborative environment is the bridge to elevated productivity in a preferred workplace. A collaborative team is the trestle linking the organization to the community. Teambuilding activities strengthen both.

Tom is a clinical anesthetist, noted author and requested speaker.

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

Are you capable, competent, committed to the job and yet feel like your daily routine has you mired in a muddy rut? You are not alone. One thing that business, industry and healthcare have in common is that each has a cadre of talented people who feel imprisoned by the status quo and are ready to break the bonds of mediocracy. Take control of your destiny, shake things up, and gain the recognition/promotion that you deserve.

Both those who are in leadership roles as well as those who are frontline workers must act to position themselves for advancement in the organization. Cameron Chapman, staff writer at skillcraft, says that it is foolish to wait to be “discovered” at your workplace when there are things that you can do to revitalize your career and increase your value to the organization. Chapman suggests that you start with self-evaluation and do an honest review of your capabilities compared to your actual work performance. Begin to resuscitate your career by taking action to close the gap between your current performance and the maximum potential that you are capable of putting into the job. Here are some simple ways to advance yourself in the pecking order of most valued employees:

Be more assertive. Confident extroverts infuse energy into a group and are catalysts for productivity, whereas introverts blend in with the environment and go unnoticed. Take the initiative to up your energy level and set a positive tone for your team. Even those who are not natural extroverts can be more outgoing by giving every colleague a friendly greeting and engaging in conversation. Be brave, set ambitious, attainable goals and have high expectations for yourself and colleagues. Positivity is contagious and as you increase your performance, your team will follow suit.

Learn new skills. Instead of arriving every day with a flat attitude and stagnant skill set, enhance to advance. Visualize the job that you desire, the skills required for that position, and then find a mentor or take the classes necessary to expand your capabilities. Taking a course in accounting, personnel management or team development will enhance your existing position as a leader. Mastering the use of new equipment or learning to perform new clinical techniques will advance you as a healthcare provider.

Ask for responsibility. Meet with your supervisor and ask about the most pressing needs in your workgroup or the organization. Better yet, identify an existing situation where your team could improve safety or efficiency and offer to head a project to strengthen the team in that area. For example, the patient handoff between the operating room and recovery room did not include all the basic information required for continuity of care. Alice, a nurse anesthetist talked to the supervisor and proposed a project to team with a recovery nurse and revise the handoff procedure. Completion of the project improved patient safety and having a defined format made the process more efficient.

Align yourself with the company culture. What does your company stand for, why do they exist, and how does your behavior enhance or detract from the greater goal? Read the mission, vision and values of the company and then assess/modify your behavior to ensure that your action supports the purpose of the organization. Behavior that is observable by others and supports company values will ensure that you are noticed when people are being considered for promotion.

Increase your networking. Progress, to include revitalizing your career, happens based on relationships at all levels. Solidify your relationship with others on the team and then expand your horizon by getting to know the people outside your immediate workgroup. Never miss an opportunity to extend your hand to meet new people regardless of their title or role in the organization. As you take on projects, it will become increasingly helpful to know others who can support or mentor your activity.

Eliminate deal breakers for decision makers. Attitude and physical attributes are components of the perception that you create for others to consider when they are selecting the next person for promotion. Characteristics that are unwritten, not discussed but affect the final decision include personal hygiene and habits such as a wimpy handshake or a boring communication style. Clean up your act, literally, interact with confidence and put yourself at the head of the line for the next promotion.

We are each known by our reputations, good or bad. Breaking the bonds of the status quo, increasing your status in the organization, and positioning yourself for advancement are all tied to the reputation that you build for yourself. Everything you say and creates a memory and it’s your job to make sure it is a positive picture. Master new skills, align behavior with company values, and connect with decision-makers to ensure that your name is the first one that comes to mind when your boss is asked to name his/her top performer.

Tom is a clinical anesthetist, noted author and requested speaker.

7 Tips for giving Negative Feedback

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

“She did what?” I said to the distraught person on the phone as he reported unacceptable behavior that just spewed from a self-assured subordinate whom I supervise. I took a deep breath and organized my thoughts knowing that the conduct of the arrogant offender required immediate attention and possibly disciplinary action. We were working in a major medical center with a significant population of international patients. My irate employee had just been in the face of a non-English speaking patient, shouted ethnic insults, and told the person to learn English or seek care elsewhere…totally unacceptable behavior.

In contrast, the infraction of another employee took the form of passive omission. Employee two was frequently 5-10 minutes late for work in the morning, took 30 minutes to get in sync and consistently extended lunch a few minutes beyond the allotted 30-minute break. Both situations, one an egregious act of commission and the other a passive act of omission, required honest feedback.

Leadership is multi-dimensional and can be simultaneously rewarding and stressful. When goals are met, and hard-working people exceed expectations, the leader is positioned to hand out recognition and reward to the high achievers. The unfortunate reality is that not all behavior meets standards and not all goals re met. Rather than being stressed, view lapses in employee behavior as an opportunity for you to grow as a leader and for the employee to learn valuable lessons about accountability.

Lisa Bodell, founder and CEO of FutureThink, writes in Forbes.com that more than 90% of employees would prefer their manager to address mistakes immediately rather than letting weak performance slide until presented in the annual performance review. This conclusion is affirmed and expanded upon by Social psychologist, Heidi Grant, who further contends the value of immediate feedback and notes that workers who are on the learning curve want praise and positive feedback, whereas experienced employees who want to improve skills desire a more critical review of their performance.

The trend for ongoing feedback has prompted companies such as The Gap and Adobe to do away with annual performance reviews altogether and to replace them with mandates for leaders at all levels to provide real-time, ongoing feedback to employees. The performance yard blogger, John Courtney, touts the benefits of providing negative feedback and recommends using a positive approach that is intended to change the behavior of the individual while preserving the integrity of the individual and the organization.

Negative feedback that is purposeful and thoughtful, ensures undesirable behavior is addressed and that offenders know the expected change in behavior. By following the techniques used by business leaders when you deliver negative feedback to those you supervise, the task of holding team members accountable does not need to be a daunting or stressful experience.

Avoid emotional responses. Both crisis-causing blow-ups and chronic poor performance can trigger an emotional response from the leader. Whether the behavior of a team member is outrageous or simply disappointing, take a deep breath and collect your thoughts before responding. Like Coach John Wooden role-modeled in his leadership, (ProSynEx blog, Feb 3, 2019) engage your thinking brain and imagine scenarios that caused the event along with several approaches that will bring resolution. Avoid a knee-jerk emotional response that will only pour kerosene on the fire to ensure the best outcome.

Gather the facts. The truth is seldom what appears on the surface. Attempting to address an issue before the facts are known, may force you to walk your decision back later. Expect only part of the truth from the person involved and verify what you are told as you get the rest of the story from other perspectives. A second benefit of fact-finding is that it creates time for your emotions to settle and enables you to find a better solution than your initial knee-jerk response.

Focus on the job. Don’t take or make the situation personal. Focus on your goals for the team and avoid making an attack on the individual. Placing an individual on the defensive will obstruct the work that you are trying to accomplish and render him unreceptive to feedback. Unless the event warrants an employee’s immediate dismissal, approach each situation with the intent of addressing and changing unacceptable behavior.

Be specific. An overt act of aggression is obvious, however chronic poor performance can be insidious and more difficult to describe. State your observation honestly and succinctly by giving examples so the individual clearly understands the issue.

Use questions. The best results are obtained when the person has an ah-ha moment so she can identify ways to correct the problem herself. Ask the person to explain how her behavior affects the team morale, outcome of the project, or how it affects the goals established by the team or the organization. State your desired outcome and challenge the person to identify alternative behavior that would better support the goal. An open dialogue with guided questions will lead to insight about action that will be more productive and achieve better results.

Develop a prevention plan. Feedback without a plan is just a discussion. Build on your intervention by creating a written plan to outline the expected new behavior as well as a timeline for implementing the change. A serious infraction may require an apology or formal discipline followed by ongoing monitoring, while other issues, like weak performance, may require mentoring and a renewed commitment to improve performance.

Follow-up. Establish a timeline and check in frequently with updated honest feedback. Give positive feedback when it is earned and reinforce boundaries if performance starts to slip.

The opportunity to provide negative feedback is a gift for all: Leader, employee and organization. Discussing deficient behavior and is intended to convert a negative into a positive and is most effective when viewed as an opportunity for both the leader and the worker. On the highest performing teams, people not only know what is expected of them, but also receive feedback frequently in an ongoing manner. Assume that most employees have a desire to meet your expectations and want to do the right thing; they desire your reaction to their performance, both positive and negative. Providing timely and constructive feedback enhances your stature as a leader, opens lines of communication and builds the morale of the team.

Tom is a clinical anesthetist, noted author and requested speaker.

The Legendary Leadership of John Wooden

Wooden Wisdom:

3 lessons from a coaching legend

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

When asked to name the greatest college basketball coach of all time, many would argue that John Wooden has earned the honor. While coaching the Bruins at UCLA (1948-1975), the team made it to the final four 12 times, winning the event an astounding ten times. Even more impressive, he coached the Bruins to four undefeated seasons.

Without a doubt, John was able to recruit and coach talented players, but there was plenty of talent on competing teams. It was The Wizard’s character and leadership that congealed his players into a unified team with a single purpose, setting his program apart from the competition. Knowing that pushing good people to work harder would not deliver the desired results, the coach focused on developing individual talents and taught teamwork that capitalized on those innate abilities.

The legendary John Wooden had 3 rules for his team and they were enforced with integrity every day and in every situation. The same rules that propelled UCLA to basketball fame apply equally in today’s workplace and following them will propel your team to a winning season.

The Wizard’s Wizdom

Rule 1: Never curse. Cursing is an emotional response that results from feeling angry or threatened or when danger is perceived. Wooden allowed only socially acceptable language within his team and taught the players to control their emotions in order to keep “the thinking brain” engaged in the game. Research conducted by George & Dane (2018) affirms that anger undermines good decision-making and must be avoided in the workplace. UCLA’s coach was ahead of the times when he focused on keeping the thinking brain in control. Likewise, applying rules of civility and respect in the workplace eliminates knee-jerk emotional responses and promotes proactive, creative thinking.

Rule 2: Never criticize a team mate. The coach’s ban on criticizing a team mate built an attitude of interdependent collaboration. Nadidah Coveney, of the Forbes coaching council, agrees that collaborative relationships provide a spearhead to success. Tolerating criticism encourages people to see one another as competitors rather than collaborators and, subsequently, to vie for dominance on the team. The superb UCLA teams were expected to see themselves as a single unit in which criticizing a team mate equated with criticizing one’s self. John focused to create teams on which individuals worked to strengthen one another, elevating the entire team. Trust within the Bruins was earned by collaboration, honesty and actively helping one another. Applied in every workplace, a ban on criticizing team mates includes barring gossip and other acts of sabotage that undermine the morale or productivity of the team.

Rule 3: Never be late. Coach Wooden viewed promptness as outward sign of respect for one another. He insisted that practices start on time and, in turn, showed his respect for the group by ensuring that practice ended on time. He believed that sticking with the schedule was evidence of honesty and integrity, both key elements of a trusting environment. Corporate recruiter Chitra Reddy affirms this wisdom by noting that mutual respect enhances collaboration and overall productivity. Team solidarity is created through acts of integrity where members follow through and deliver as promised.

Many work groups are staffed with talented individuals who are competent and capable of doing the assigned job and yet, as with college basketball teams, individual talent may not be enough to win the trophy. Rather than winning with raw talent, the most successful teams win through collaborative team work. Following John Wooden’s three rules of controlling emotions, working collectively, and building trust through respect will enable a slam dunk for success. Now get out there and crash the boards!

Tom is a noted author, speaker and avid advocate

for healthcare leaders.

Scout out a promotion

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

Promotions play an essential role in the success of an employee and his organization. Workers who are recognized and rewarded for their job performance and work ethic tend to develop loyalty to the organization and work even harder to prove that they merit promotion. As a result, organizations benefit because morale and creativity will be high and employee turnover will be low; both of which are improved when deserving people receive earned promotions.

Employers collectively spend millions of dollars on research and consultants intended to improve the morale and production of the company workforce. Behavior and neuro sciences help the employer’s managers build superior teams by collaborating with psychologists to gain insight into the profile of the perfect worker. Author Emily Smykal (2016) identifies work ethic, positive attitude, dependability, and effective, team-oriented communication as skills possessed by the perfect team member. In a companion article, Smykal describes behavior geared to get high achievers promoted as collaboration, reliability, honesty, ownership, effort, creativity and hard work.

Save your research money and go back to your roots to find the secret of earning a promotion. In his book, All I really need to know I learned in Kindergarten, author, Robert Fulghum, lists 15 lessons learned in kindergarten that enable you to live a balanced and successful life both at home and at work. Tips such as, “clean up your mess,” and “don’t hit anyone,” are on the list of desired behaviors.

Based on my experience as a Chief nurse anesthetist, I am convinced that we make earning a promotion much more difficult than it needs to be. My 7-year old grandson learned socialization skills in kindergarten and is now a proud cub scout who is all in trying to learn and follow the scout law. In reviewing the 12 points of his new code for life, I am struck that his code of conduct describes my ideal employee and the person whom I would select for promotion. Tailoring your work behavior to follow the 12-point scout law will make you an ideal employee and first in line for a promotion.

The Scout Law

Be Trustworthy Trust is a foundational building block of a highly effective workplace and it requires that everyone on the team can be trusted. Show your trustworthiness by arriving on time, completing your assigned tasks and showing sincerity in saying what you mean and following through. Create an environment of trust by being scrupulously honest.

Be Loyal Show loyalty to your colleagues by sticking with them through good and bad times. Show loyalty to your superior and the company by doing your job well and taking pride in your work.

Be Helpful Those who are helpful freely give assistance to colleagues who are having difficulty with an assignment. Helpers assist and coach others without crossing the line and playing rescuer.

Be Friendly Being friendly and upbeat is something that we all understand and can be as simple as putting on a smile and a positive disposition. Take a sincere interest in colleagues as an act of friendship. Keep confidences. Friends don’t gossip.

Be Courteous Show respect for others by listening attentively when they speak and keep people informed when plans change. Never embarrass a co-worker and always respect their personal needs.

Be Kind Opportunities for acts of kindness exist with every interaction that you have with another person. Give sincere compliments, thank others promptly as appropriate and do small things for the team. As unremarkable as it may seem, making a new pot of coffee may be appreciated as an act of kindness.

Be Obedient Policies and procedures exist in the workplace for a reason and they set the boundaries for expected behavior. Follow the rules and guidelines, and never intentionally put your supervisor in a position where she/he must defend you or explain your behavior.

Be Cheerful Happy, pleasant workers elevate the mood of an entire team. A smile and a friendly greeting is contagious and prompts others to reply in kind. An upbeat attitude is energizing for both you and those around you.

Be Thrifty Overhead expenses exist with any job and the thrifty employee ensures that the department and the organization get value for the money. Eliminate wasting both time and resources by giving a full day’s effort every day. Never take-home supplies from the workplace.

Be Brave Demonstrating bravery in the workplace is not a matter of placing yourself in the path of physical harm. Rather, brave workers have the courage of their convictions, they are forthright and will not compromise personal values. Bravely stand up for what you know is right and never compromise your integrity.

Be Clean Cleanliness is all encompassing and includes your body, mind and workplace. Maintain your personal hygiene and the orderliness of your workspace. Think or verbalize clean thoughts regarding colleagues, clients, your employer and the bad referee call during Sunday’s big game.

Be Reverent A pervasive, deep feeling of respect arising from trust and loyalty unites a group of individuals into a cohesive team. View your job as a special place and feel privileged to work with colleagues who are also following the scout law.

Behavior scientists and business gurus have saturated the blogs with tips for those seeking promotion at work; however, none have offered advice that will position you better than following the scout law. At your next performance review, when you’re asked why you deserve a promotion, go through the 12 points of the scout law and give examples your behavior supporting each element. Consciously living the law will make it who you are and engrain it into your personality. Start as a cub, live the law, and fly like an eagle.

Tom is a respected leader, speaker and clinical anesthetist. Contact tom@procrna.com for a list of topics and availability to speak at your next meeting.

CRNA week 2019

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

The AANA national headquarters in Park Ridge, Illinois is the nerve center of the organization and a hub for activity designed to enhance the practice of every CRNA and to bring credit to the profession. The team of full time professionals at the home office work diligently to provide a broad spectrum of services for the members.

January 20-26, 2019 marks national nurse anesthesia week (CRNA week), a time to raise the flag in reflection and an opportunity for nurse anesthetists to celebrate and promote their profession. In addition to giving recognition to CRNAs for the valuable service that they provide in the medical community, this special week also spotlights the importance of the professional organization in providing a foundation to support its members.

American Association of Nurse Anesthetists (AANA) is the professional organization representing over 50,000 CRNAs and SRNAs (students) the US. This active, Chicago-based organization plays a vital part in uniting members, creating positive energy, establishing practice standards and ensuring the right of each qualified CRNA to work to the full extent of his/her capability.

Since it’s founding in 1931, the AANA has fulfilled a vital service to the members through its focus on uniting CRNAs, keeping them informed, and providing opportunities for each individual to experience a lifetime of personal growth.

Professional development. The professional practice division of the AANA is a repository of valuable information related to every aspect of the clinical practice of anesthesia. The division publishes a professional practice manual and has sample policy/procedure suggestions for many of the common areas of practice. In addition, the division sponsors workshops to address specific practice skills such as the use of ultrasound in the placement of nerve blocks. Ewa Greenier, director of professional practice, welcomes queries from members and provides answers to common questions related to the practice of anesthesia.
Publications. An AANA journal is published and available both by mail and online to active members of the organization. The magazine contains a wealth of evidence-based research including a journal course that provides continuing education credit. The AANA Newsbulletin, is the printed platform for the AANA President and Board of Directors to update all of the members with timely information.
Annual Congress. Yielding still another opportunity for professional growth, the annual AANA congress provides the stage to personally hear from and talk with leaders in every area of practice, learning from the best. Networking opportunities abound at the national meeting and post meeting follow-up extends the relationship throughout the year.

Professional support. The professional organization supports not only the clinical practice of the members, but the business aspect of practice through insurance and legal advice. The AANA sponsors workshops designed to inform members about the business of anesthesia.
Research. An important aspect of being in a homogeneous consortium is the expectation that it will add to the body of knowledge related to their field of expertise. The AANA Foundation plays a crucial role by sponsoring independent research related to the practice of anesthesia. Foundation dollars have sponsored large-scale professional research to document the safety and cost effectiveness of CRNA practice and has also funded studies done by students.
Mentoring. Opportunities abound for experienced members to share their knowledge with neophytes via the AANA. Adopting students at the Annual congress, sponsoring students at State meetings and connecting online are all opportunities for connecting and developing mentoring relationships. Online webinars open the door for members at all levels of experience to learn from content experts related to every aspect of practice.
Jobs. Professional organizations are in a unique position to unite applicants with potential employers. Job boards abound on State association web sites and meetings are fertile ground for those seeking employment to connect with the next boss.

Here’s what CRNAs are doing to celebrate CRNA week

The public relations department at the AANA and state CRNA associations work full time to promote the practice of nurse anesthesia and showcase the important talents that members provide to the patient population that they serve. The PR department offers promotional material for CRNA week and offer suggestions to help local workgroups and state organizations promote themselves. Below is a sample of projects designed to honor CRNAs during their special week.

Radio interview. CRNAs from Mississippi and Alabama have been interviewed by local radio stations. The on-air discussions highlighted the education and skills of CRNAs as well as the vital role that they play, especially in rural communities.

Video promotion. The Michigan association of Nurse Anesthetists and the US Military are two organizations that have released videos to promote the profession year around. Click on the names and view the videos.

Official proclamations by the Governor. State associations from Illinois, Louisiana, Michigan and Mississippi have all received official proclamations signed by the Governors of their respective states. By the time CRNA week arrives, the list will be much larger.

Legislator visit to the OR. Members of the Texas association of Nurse Anesthetists arranged for local legislators to visit them at Northwest Hospital in Amarillo, TX. and learn about the important role CRNA play in rural healthcare.

Community service projects. CRNAs tend to be generous with a desire to make their local communities a better place. Community service projects ranging from local food kitchens and the Ronald McDonald house to high school career day, and wounded warier events are some of the activities done by CRNAs that build positive relationships with the community and give recognition to the profession.

Team building “extraclinical” activities. During CRNA week, workgroups around the country gather for team building activities as well as happy hours, lounge celebrations, attendance at local entertainment events or participation in group walks.

These examples only scratch the surface of the projects done by nurse anesthetists to promote CRNA week. Share your CRNA week activities with colleagues by using the comments box at the end of this article to describe your project.

CRNA week is a time for recognition of the valuable work done by nurse anesthetists. In addition to receiving recognition for their work, it is also a time for CRNAs to reflect and appreciate the value of their professional community. CRNA week puts nurse anesthetists in the spotlight and gives them a platform for connecting with their medical institution and their community. The symbiotic relationship of each individual nurse anesthetist with the patient population and the professional organization is in focus annually during the third week of January – CRNA week.

Tom is a clinical anesthetist, author and speaker committed to promoting nurse anesthetists as leaders in the healthcare industry.

Plan for success

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter for leadership motivation.

“Without continual growth and progress, words such as improvement, achievement and success would have no meaning.”

~Benjamin Franklin

Keeping the workplace relevant involves updating goals, re-defining the workflow to provide better service to clients and staying ahead of competitors. Establishing new team goals that leverage new technology while reflecting social change, positions the organization to remain relevant in the foreseeable future. A positive spinoff of new team goals is the energy and enthusiasm that is injected into the team as the status quo is shaken when the group challenged with a new task. The time and effort spent assessing current priorities, anticipating future trends and establishing new goals will revitalize the team and paint them as the face of leadership in the organization.

Start with a comprehensive assessment. Review the team goals that were established a year ago and note which were achieved, discarded or ongoing. Goals that have been achieved deserve a high five and can be crossed off the list. Items that slipped off the radar screen and were not achieved deserve to be re-assessed. If they are no longer relevant, cross them off the list, however, if it’s a should do that lost momentum, move it back to the active list and create a plan to ensure completion. Ongoing goals merit a progress report and tweaking of the plan to ensure that the goal is achieved.

Develop a written list. Following your assessments, develop new goals for the upcoming year and put them in writing. A written list will organize your thoughts and give you something concrete to publish for others to review. Include all pertinent goals that remain from the prior year along with the modifications needed for successful achievement of the objective. Next, anticipate the new priorities needed to align your team with the greater goal of the organization and add them to your forecast. Following completion, prioritize and notate the items on your written list.

Clarify your goals. Teams suffer when a leader’s vision for the future is vague; people are most productive when they know exactly what is being requested of them, the resources that are available and the timeline for completion. Goals should be written in language that is specific, measurable and attainable and each should include a timeline with milestones to mark the team’s progress. Once the list has been presented to the team, each person should know exactly what is expected and their role in the plan.

A bonus for establishing and clarifying goals is the opportunity for mentoring. During the progression of self-reflection, the review of old goals and establishing new ones, invite one or two of the up-and-comers on your team to participate in the activity. Mentees benefit from being included in the discussion and learning the process of uniting a team with the greater goals of the organization. In addition, you will benefit from the insight provided by subordinates who view the workplace from the grassroots level.

After the goals have been established and clarified, organize a team meeting to present the new agenda positively, proactively and energetically. As described in Leader Reader 1, Authentic Lessons in Leadership, your leadership attitude during the roll-out sets the tone for the group and your enthusiasm creates an expectation for success. At the meeting, establish the importance for change, outline an overview of the plan, establish a timeline and identify key people to take charge of specific projects. A congenial team meeting that has been well-planned creates an atmosphere of shared responsibility wherein each person wants to contribute to the team’s success.

“Always plan ahead. It wasn’t raining when Noah built the ark.”

~ Richard Cushing, Catholic priest

Staying ahead of the times in the workplace can be challenging so take advantage of the changes that occur naturally with the passage of time. View social change as an invitation to renew and re-focus the priorities of your team. Like cleaning the closet and discarding old items to make room for the new, make an honest assessment of workplace priorities and remove the goals that have been completed or that no longer apply. Then boldly, confidently, and proudly introduce your team to the new priorities for the year. Your efforts will be rewarded as your team takes the lead and works with renewed energy to ensure that your clients and patients receive superlative service.

“Every minute you spend in planning saves 10 minutes in execution; this gives you a 1,000 percent return on energy!”

~Brian Tracy, author and motivational speaker

Tom is a noted author, speaker and team building coach.

Leader Reader 1, Authentic lessons in leadership is a practical guide that is loaded with tips for enhancing your leadership skills.

Redefine normal

By Liz Sanner Davis, certified personal trainer

A friend and I exchanged this text talk on January 1. “After the fireworks…back to normal – normal food, normal exercise, normal normalcy.” “Ha! Define ‘normal.’”

We laughed, of course, because, after all, what really is “normal food and exercise?”

Following all our joyful noise and fa-la-lollies, we agreed that perhaps we should redefine it.

Based on one’s intended lifestyle, normal simply isn’t the same for everyone. It can’t be. Your co-workers, John and Jill, have three children to consider, Emily and her spouse have hefty commutes, Cheryl has live-in elderly parents and Damont is the only unencumbered single male. But they have one thing in common. They work outside the home in the healthcare profession. Their normal is defined around their jobs.

Make nutrient-dense food and regular exercise ‘who you are’

and not just ‘something you do.’

Results from research on the positive impact of exercise completed by multiple healthcare, business and fitness professionals are very convincing. Harvard Business Review concluded several years ago that “incorporating regular exercise into your routine” improved concentration and prolonged mental stamina while lowering stress. A current impact-of-fitness study by Leeds Metropolitan University in England suggests that the level of focus and efficiency in the fit worker creates the extra time needed for going to the gym in the first place. Becker Hospital review names numerous hospitals in its list of 100 great places to work in healthcare based on their onsite fitness facilities. In addition, hospital studies regarding the effect of unfit, unhealthy employees on the bottom line of their organization’s budget, support the concept that providing for employee fitness pays significant dividends for both employee and employer. From the employee’s perspective, the professional reasons to get fit are many.

You will be sick or injured less often if you take care of yourself by exercising and eating a plant-based nutrient-dense diet. Although there is secondary gain when you are ill, there are personal risks for developing chronic conditions, risks to your coworkers who don’t want to get sick and further risks for patients who are already sick. People who take good care of their total wellness are able to work, they feel like working and their personal performance has greater potential for being optimal.

Your physical strength and endurance are greatly enhanced by being trim and fit. In a fast-paced clinic where every second counts, the fit employee can bend, lift, carry, push and pull quickly and efficiently without causing patient or personal injury in the process. Some applications for anesthesia jobs specifically state the requirement for an applicant to be able to safely lift and carry patients and equipment. If you have a sedentary healthcare job in which you rarely need to bend from the waist, more’s the pity, because without staying trim and fit, soon you won’t be able to.

Personal Appearance is more convincing and comforting to patients and coworkers when you look and feel rested, energetic and fit. And don’t believe for a moment that in this world of social change and cultural acceptance, one’s appearance gets a pass. It doesn’t. Who can take you seriously if you’re a healthcare worker who is unhealthy by choice? It isn’t incumbent on the patient to suspend disbelief in the care rendered by an obese nurse or physician whose presentation reflects a preference for unhealthy self-care. The patient needs the reassurance provided by a dedicated healthcare worker who has a healthy BMI to accompany their competence. Both play a role in your profession.

Working, and working with you, will be pleasant. Scrooge wasn’t just cheap, he was ornery, and ornery is neither inspiring nor fun. A great job in a name-brand hospital that can boast glass breaking research and a to-die-for benefit package will not, all by itself, make you pleasant to be around. It is true that a stellar work situation offers a lot to make you smile, but cap that off with the deep body glow you radiate after working out and eating a fresh peach before arriving at work, and everyone around you will want to be there, around you. Regular exercise and a diet that fuels your disposition bumps up stellar to superior.

You’re the face of the organization. The status and stature of the organization within the greater community and beyond is confirmed by stats provided by patient satisfaction based on both the medical outcome and overall experience. While carefully avoiding any mention of the staff’s physical attributes or deficits, the plethora of patient-satisfaction surveys always include questions regarding friendliness of staff, willingness of provider to listen, advice from the provider for staying healthy, amount of time spent with the patient and overall care. Those answers are affected by the healthcare team’s individual and collective level of wellness, general disposition, physical ability to do the job with ease and by being fully engaged and consistently on the job; all of those positive behaviors and interactions are a direct result of the food, fitness and overall healthy habits that you practice. As well, though your benefits likely include sick days in one form or other, you’re not entitled to abuse yourself and, thereby, cost the organization. The corporate budget suffers when employees are absent, chronically ill or if dissatisfied patients choose to get their care elsewhere. Your definition of normal food and normal exercise is rooted in your respect for yourself and for your organization.

What you have to do and the way you have to do it is incredibly simple. Whether you are willing to do it is another matter. ~ ~Peter Drucker

Some suggestions for how to get that deep-body glow at work

Drink water during or between cases – 8-10 measured glasses a day and spread them out if you possibly can. Your body will adjust quickly to the new volume because exercise strengthens all muscles including those that control bladder urgency. Coffee, however, doesn’t function like water and isn’t included in the count.
Stretch during breaks. There are a dozen different ways and times to stretch at work; bend slowly to touch toes once between each patient; stand against the wall and shrug or do one or several arm circles overhead and meditate simultaneously; do a few simple squats, bent-knee leg lifts, side to side neck rotations; do slow isometric rows by squeezing scapulae only. Get even more active on longer breaks by jogging down one set of exit stairs and lunging back to the top. During lunch several sets can be done on stairs or down a quiet hallway. Bonus tip: Stretching can and should be done at the back of an airplane during a long flight.
Use proper fitness techniques for bending lifting and carrying. Picture Sponge Bob with a four-cornered flexible core. Support your movements using your entire trunk including squeezing abs, spine-in-line posture, retracted scaps/broad chest, and flexible pelvis. Bending over by using the lower neck and locked knees is potentially an unplanned day off work and corporate budget buster.
Bring nutrient-dense lunch and snacks to work and pack them from your own food stock. Low-fat, low-sugar, low-salt, low-carb, high fiber, vitamin and protein rich foods are qualifiers; tacos, fat-filled wraps, cheesey burgers and everything-but-the-refrigerator cookies are not. Repeat this mantra often: Food is fuel, sugar is cruel.
Cardio for at least 20 minutes to warm up for the work day. This is important. Cardiovascular exercise strengthens your heart and breaks through the mental cobwebs to fire you up physically for the day. Everyone has 24 hours to budget so trade out 30 minutes of yours in the evening with 30 in the morning; slog down 1 cup of water and hop on the bike, the treadmill, a Peloton spin bike like the one advertised by the young, gorgeously toned couple on TV, or get outside in a safe neighborhood and knock off 20 min of fast-paced, sweaty heart-throbbing cardio before work. Don’t forget to stretch two minutes afterward. You can still go to the gym for weights or kick-boxing class after work with Damont!

The same voice that says, “Give Up,” can also be retrained to say, “Keep going.”

~ Lisa Bargstadt, personal trainer

We all like to get things done quick-as-a-bunny, yesterday. Your patient wants his broken femur to heal in time to ski in February while you may want to fit into that little black dress in time for a wedding next week. And though fitness trainers may willingly sell you an expensive package of promises and an optimistic healthcare worker may give an injured skier some reason for hope, getting fit and staying that way will take time – your time in real time. That’s just the truth. In the meantime, if you’re consistent and dedicated, you can jumpstart the process to becoming a trim, fit healthy worker who elevates and validates the healthcare profession by redefining your normal.

Make it a no go

By Thomas Davis, CRNA, MAE, DNAP candidate

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The end of the year is a time to reflect on the good, the bad and the ugly. For some, reflection on recent work experience produces the conclusion; “I gotta get a better job.” They may be people who struggle in toxic environments in which the work they do is valued but, despite their contribution, they are not appreciated, recognized or rewarded for their efforts. Those stranded in an onerous workplace may benefit from a new job and can truly justify leaving. More frequently, however, people are motivated to seek a new position because they’re in a professional rut and no longer feel challenged or empowered by their ho-hum job. In a nutshell, they are bored.

According to Alison Doyle, author for The Balance Careers, studies indicate that 51% of workers in America are planning to leave their current job and 47% of American workers who feel that they are in a good job would leave if an ideal job were available. Millennials tend to not see themselves working at one job for the duration of their careers with 44% expecting to change jobs in the next 2 years.

Why People Leave

Business journalist, author, and CNBC business consultant, Suzie Welch, affirms the current unrest in the workforce and offers three reasons to explain why people seek new jobs.

They are no longer fully engaged in their work. People spend the early days of a job mastering the skills needed to be successful. Over time, work becomes routine leaving the person feeling like a spoke on the wheel.
They have been at the same company too long. As years turn to decades, people settle into niches and robotically do their assigned task. Not only is their spot on the pecking order assured, they are may have become embedded into the position with little opportunity to move either up or down the chain of command.
They are no longer challenged in their role. “You get good at what you do” remains true today and the risk of having acquired competent comfort is the onset of boredom. When a job no longer offers the stimulation of professional development, it loses importance beyond money earned, money paid.

Why People Stay

Are you ready to throw in the towel? Not so fast! Before you start a job search, consider some factors that make the current job a little more attractive.

Geographic ties The longer a person is in a community, the more engrained the person and their family become. Friendships have been formed, and trusted resources have been located. Leaving a community may require selling a home, packing and moving with the blind faith that the new community will be as good as the new job.
Interests of partner/spouse/family Those in a two-income family must consider both incomes before pulling up stakes and moving. Children have friends and school activities that would be disrupted by relocating. If your partner own/runs a business, moving may not be an option at all.
Current pay/benefits are good Among the many reasons a person works, paying the bills is always on the list. If the pay/benefits of the current job are good, it may be unwise at this point in your affairs to trade security for the stimulation of a new workplace.
Fear of the job hunt process Searching for a job, interviewing, credentialing and onboarding are stressful and time-consuming. In addition, applying for a position opens you to unwanted scrutiny or potential rejection.
Prospect of changing the current workplace culture A great reason to stay in the existing job is the realization that your dissatisfaction with the present position can be alleviated by taking the lead in shaking things up and infusing energy into the present job.

The grass isn’t always greener on the other side of the fence so before you sell the farm, step back and look at your job objectively. If the status quo is truly toxic or oppressive, and you’re able to move on, move on. However, if the root cause of your unrest is plain old stuck-in-the-rut, you’re almost always better served by running toward the problem rather than running away from it.

When You Stay

For those who are committed to staying in the current job and want to feel fulfilled with a sense of purpose and enjoyment, try these ideas.

Develop a friendship. A friend at work gives you a trusted ear for sharing personal thoughts and someone whose company you enjoy. Having someone in the workplace who you look forward to seeing each day increases loyalty to the organization and increases the likelihood that you will remain in the same job.
Just say no to negative talk. Negative talk and gossip are draining. Refuse to say anything unfavorable about your job, a colleague or the organization. When lounge talk deteriorates, change the subject or simply leave.
Leave it at work. Taking disagreeable thoughts home to share with a partner continues your discontent into your personal time. Going home and assuming the role of a victim garners sympathy and reinforces your dissatisfaction with the job. The emotions tied to victimhood will diminish your ability to make an intelligent decision about the potential benefits tied to the current job.
Take a break. Some people seek to make a job better by working longer and harder. Doing too much for too long puts you at risk for burnout and even minor irritants at work become major issues. Take a break, relax and return refreshed.
Acknowledge your own value. The importance that is tied to your good work may not get the recognition that it deserves. End each day by reflecting on your positive contributions and your importance to the team.
Be proactive. Don’t expect the world to be placed at your feet; go after it. When you have ideas for improving workflow or making the workplace a better place, take the initiative to make it happen. Even little things can make you feel empowered and create a big difference for you and your colleagues.

In just a few days the new year will arrive, and you can quit the old job. Start the new year with a new job by re-defining your position at your current workplace. All that is required is renewed self-confidence and a shift in focus from, “I gotta get a better job,” to, “I can and will make this a better job.” Don’t allow yourself to become a victim who enjoys wallowing in the mud of negative thought. Instead, accept responsibility for making your job more satisfying by approaching the challenge with proactive, optimistic enthusiasm. Expand your friendships, leverage group dynamics and consistently reflect on the positive. When you think it’s time to go, reconsider and make it a no-go.

“Grass is greener at other people’s feet because they watered it. You need not to let your environment control you; you have what it takes to make it look beautiful!”
~Israelmore Ayivor,

Tom is a respected anesthesia clinician, author, speaker and leadership coach. Forward this article to friends and help expand the network of healthcare leaders.

Better habits through science

By Thomas Davis, CRNA, MAE, DNAP candidate

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Men’s natures are alike; it is their habits that separate them.

~ Confucius

Resolutions are intentions related to the changes that we desire in our personal lives and are often based on notions and emotions. Being “a better person” is a nebulous term that means different things to different people. Habits, by contrast, are observable behaviors that define us as individuals. The transition to each new year encourages people to make resolutions; however, the reality is that good intentions come up empty when theoretical concepts about the person you want to be do not change the behavior of the person you are. Resolutions seldom work because they are simply ideas, and ideas do not change behavior. It is actual behavior in the form of habits that define us as individuals.

The key to personal change is in transforming the abstract concept of a better you into observable, habitual behavior that will define you in the future.

The fields of neuro science and behavior science merge when addressing the issue of changing behavior. Scientists affirm that when behavior is repeated, neural pathways (grooves) develop in the brain, and when new behavior is repeated frequently, it becomes a habit. Christine Comaford, a behavior scientist who specializes in coaching CEOs to be more effective, states in Forbes.com, “First it’s key to know that neurons that fire together, wire together. This means to learn something new, to set a new habit in place, repetition is required. When you practice something deeply, intentionally, and with some element of struggle, a neural pathway is formed. Neurons are now firing together in a new sequence, and thus are wiring together as a collective.” This statement is great news for those who are willing to learn by repetition because the behavioral patterns we repeat most frequently are etched into our neural pathways. Neuro science presented in Psychology Today affirms that through repetition, it’s possible to form and maintain new habits.

Applying the wisdom of the neuroscience community allows you to convert the abstract concept of a New Year’s resolution into observable new behavioral habit. Show your commitment to changing your behavior by signing a personal contract to follow three rules for 30 days.

Bring the desired change to mind and repeat the new behavior at least 5 times per day, every day, without exception. You may not be able to go to the gym 5 times per day but you can bring fitness to mind and take time to stretch. The change you desire must be etched in your brain at least 5 times per day.
Prioritize the repeated behavior, especially if it’s difficult or inconvenient. Let nothing deter your effort.
Repeat the new behavior with intensity, constantly visualizing yourself as successfully practicing the desired behavior.

Rather than seeking a total overhaul of yourself, select one behavior and use a 30-Day Challenge to make meaningful change. Every time you duplicate the new behavior, the neural pathway becomes stronger and over time the new behavior will become your default action. When the new behavior becomes a habit, do a self-assessment, then select a second behavior that you want to change and start another 30-DC.

To get started, below is a list of categories and possible resolutions that are crying out to be included in a 30-day challenge. Select one, follow the rules above, faithfully complete the challenge, realize the results and celebrate success. If none of these bullets hits the mark, come up with your own idea and pull the trigger. The goal is to implement the 30-day plan, alter neural pathways and build a new habit.

Personal health
- Exercise 20-60 minutes per day.
- Commit to a healthy, plant-based diet.
- Restrict/eliminate one negative food such as sugar, caffeine or alcohol.
Professional development
- Learn a skill that will enhance your work performance.
- Learn key words in a language spoken by your international clients.
- Write in a journal daily.
- Select a topic and read one pertinent blog article per day.
Time management
- Limit social media to 30 minutes in the morning and 30 minutes in the evening and SET A TIMER.
- Make a daily list of realistic “must do” items and don’t stop doing until they’re done.
- Set a personal boundary, ie turn off electronics at a specific time in the evening and go to bed at a time that ensures a minimum of 7 hours of sleep.
Workspace at work and at home
- Organize and keep everything in its place.
- De-clutter and do not leave the workspace until clutter is cleared
- Set aside one item per day to donate and do it.
- Give away or trash one item daily.
Social interactions
- Speak to at least one stranger daily.
- Once a week, extend an invitation to an acquaintance to meet for coffee with the intent of learning new things about the person
- Send a thank you email or text to at least one person per day.
- Give a sincere compliment to at least one person per day.
Financial
- Stop eating out.
- Log all money that is spent during the month…no exceptions.

We are counting down the days until we count down the final seconds as the ball drops. Rather than experiencing another year with good intentions in January that end up as February failures, try a using a new method for building new habits. Combine the wisdom of the neuro and behavior science communities with your personal tenacity to commit, and follow through and enjoy lasting results that improve your leadership and last a lifetime. Using your new neural grooves, get into a groove that will set the stage for a successful 2019. Happy New Year!

“You can do anything you decide to do. The most difficult thing is the decision to act; the rest is merely tenacity.”

~Amelia Earhart

Tom is a noted author, frequently requested speaker, and leadership consultant

There’s no harm in charm

By Thomas Davis, CRNA, MAE, DNAP candidate

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What do Winston Churchill, Nelson Mandela, and John Kennedy have in common? They are all recorded in the history books as being charismatic leaders. To some, the stereotype of a magnetic personality carries the negative connotation of an all-show predator who is constantly on the look-out for a sucker who will fall prey to a con scheme. However, a closer look at charisma reveals a more positive view of the importance of an alluring personality in dynamic leadership. Some of the most memorable people in history and in our personal lives are those who use personal appeal constructively, and when you think back over the span of your career, it is likely that your favorite boss was a person with appeal beyond the actual job.

Engaging leaders use powerful communication skills to connect verbally, non-verbally and emotionally with all whom they encounter. Larger than life leaders are able to articulate a compelling vision and are masters at motivating individuals to embrace their cause by inspiring people to give effort that transcends what is required. In the words of Robert House, professor at the Wharton School, “Charismatic leaders cause followers to become highly committed to the leader’s mission, to make significant personal sacrifices, and to perform above and beyond the call of duty.” Charisma can be learned and all it takes is the desire and the commitment to add dynamic magnetism to your list of positive traits.

Writing a guest article in recruitloop.com, author Hannah Lewis, UK-based educationist, recommends infusing charismatic energy by keeping the workplace light while displaying self-confidence and making every person you encounter feel as if they have your full attention. Maintaining personal integrity while role modeling behavior consistent with your vision adds to your credibility and creates a desire in others to be loyal supporters of your vision and plan.

Captivating charm is not an inborn leadership trait, but rather a skill that is learned. Writing in Business Insider, Author Vivian Giang affirms that anybody can learn to be more charismatic and offers advice for improving personal appeal.

Focus on others. Make everyone you interact with feel as if they are the most important person in the room. Eye contact, listening and follow-up questions all give a sense of importance to the person talking to you.
Be present. Give every interaction your full attention even if only for a short period of time. Checking mobile devices or having side bar conversations are taboo.
Relax and smile. Think of something pleasant…your body will respond and change your facial appearance.
Don’t be physically dominant. Put yourself at a similar height. Stand as if you are sitting and don’t tower over others when you stand.
Give a warm greeting. Use a friendly facial expression and a firm but not overwhelming hand shake.
Value the other person. Listen, pause and ask questions. Always seek a deeper level of understanding.
Leverage your physical position. Sit next to or 90 degrees from the other person…never across. Sitting across puts a physical barrier between people and increases the likelihood of disagreement/argument.
Avoid name dropping or gossip. Don’t compare yourself to others or talk about people who are not present.
Demonstrate moral integrity. Show inner strength through the way you conduct your business. Yes means yes, no means no, and commitments are honored when brought to completion.
Be confident both verbally and non-verbally. Don’t be distracted with self-doubt. Use positive language and confident posture.
Seek personal growth. Put yourself into uncomfortable situations so that you can practice your skills.

In today’s workplace a charismatic leader at any level of the chain of command is bound to elevate the team and add to the organization. Winston Churchill proved that you don’t have to be physically attractive to be magnetic; all that is required is the ability to connect, communicate, motivate and inspire every individual you encounter. Great Britain might not have survived WWII, Apartheid might never have ended, and Russian nuclear missils might be in Cuba if not for the charismatic leadership of Churchill, Mandella and Kennedy. These three dynamic and captivating people used their ability to connect, inspire and motivate others to change the course of history. You can do the same in your workplace by infusing genuine, dynamic charm into your leadership style.

Tom is a respected author, speaker, leadership coach and clinical anesthetist

Patient satisfaction is transforming healthcare

By Thomas Davis, CRNA, MAE, DNAP candidate

One hundred years ago, American culture was in a time of rapid change with an influx of new technology changing the way people lived their lives. Being phased out, the horse and buggy, kerosene lamps and outdoor privy were quickly replaced by autos, electric lights and flush toilets. In the hundred years that followed, the shift in healthcare delivery has affected our lives to the same extent as the technology changes of a century ago. In the 1960s, healthcare was physician-centric with little concern for the needs or desires of the patient. It was a time in which “the doctor knows best” governed healthcare and patients were lucky that the doctor agreed to provide treatment. Moving forward another fifty years to the 21^st century we find a system in which patients manage their own health records and have mobility to seek care wherever they desire. Role reversal has put the patient in the driver’s seat leaving doctors and healthcare organizations to compete for the patient’s business. In today’s medical marketplace, patients select doctors and hospitals based on both the quality of care delivered and their memory of how they were treated. Healthcare providers who survive are those who are sensitive to patient satisfaction while providing state of the art treatment.

Patient satisfaction is the person’s perception of their overall experience with you and your organization. A patient’s perception is his/her reality so the impression that you make is the memory that they will share with others, sometimes for years after receiving treatment. Toma Kulbytė, content marketing specialist at SuperOffice, says “If they like you and continue to like you, they are going to do business with you and recommend you ….” Does satisfaction count in a patient’s assessment? According to Kulbytė, a positive customer experience creates a 42% increase in loyalty (likelihood for repeat business) and a 33% increase in satisfaction scores.

Loyalty is earned

Regardless of whether the need is for a car, computer or colonoscopy, today’s consumer demands a quality product at a fair price, delivered by people who understand their specific need and treat them with respect and dignity. To build a loyal base of satisfied customers, three factors are foundational: People, product and presentation.

People

It can be argued that the most important person in a healthcare facility is the first person a patient encounters at the point of entry desk. The congeniality with which a person is greeted, and the expertise shown by the attendant when entering the patient into the system create a lasting impression. Ciotti, blog author and marketing strategist, confirms the importance of customer service skills and recommends that those delivering health care, master this list.

Patience	Attentiveness	Clear communication skills
Clinical competence	Positive attitude/language	Acting skills
Calming presence	Ability to sense patient’s mood	Tenacity
Persuasion skills	Empathy	Willingness to learn

Patients moving through the healthcare system encounter many people along the way and feel reassured by being introduced to the next person by name and their role in the treatment process. With the patient’s wellbeing as your top priority, always use a positive language and an undistracted, welcoming attitude when providing care

“Nobody cares how much you know until they know how much you care.”

~Theodore Roosevelt

Product

People expect those delivering a service are competent, capable and committed to excellence. It doesn’t matter if you’re delivering a double cheese pizza, or an anesthetic, in order to earn your customer’s satisfaction, you must be skilled at your job and create expectations that are realistic. In the healthcare arena, connect with your patients pre-operatively, clearly describe what can and can not be done, and then deliver on the service as described. The bottom line is that your patients want you to be good at what you do, and they expect to receive the product and experience the outcome that they have been promised.

Presentation

Healthcare delivery is a competitive business and people are free to seek treatment wherever they desire. Marketing analysis by Keona Health reveals that 77% of patients use online reviews to find and select a physician. The physician compare area of the CMS web site makes rating healthcare providers quick and easy. Likewise, when a physician uses more than one hospital, patients rely on online reviews when requesting their hospital of choice. Once a provider has been selected, patients use mobile devices to schedule appointments and judge the organization by the degree of user-friendliness of their web site. When online sites are difficult to navigate, patients move on to another provider with a more user-friendly online presence.

Indiana University Orthopedic surgeon, James Rickett, links patient satisfaction to outcome by documenting that reduced hospital stay, reduced readmission rates, and overall better quality of care all correlate to high patient satisfaction scores. Dr. Rickett’s observation underscores the importance of delivering healthcare services in a manner that ensures patient satisfaction. The physician driven hierarchy for patient treatment that existed several decades ago no longer applies in our web-based, patient-centric world. The healthcare marketplace is becoming more and more competitive and patient satisfaction may be the key factor separating those who lead the industry from those who are forced to close the doors and turn off the lights. Patient satisfaction does matter.

Thomas is a respected author, speaker and clinical anesthetist.

Robert Greenleaf; The first serving leader

By Thomas Davis, CRNA, MAE, DNAP candidate

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“Where there is not community; trust, respect, and ethical behavior are difficult for the young to learn and for the old to maintain.”
― Robert K. Greenleaf,

Health care delivery in the United States and around the world is in a state of transition as traditional physician-driven hierarchies are being replaced with collaborative teamwork. At the root of this drive is a hope for improving employee engagement, productivity and loyalty to the organization. More than at any point in history, empowering leadership at all levels is being viewed as the key to building powerful teams and the serving leadership style is being promoted as the panacea for workplace woes.

Robert Greenleaf was born in Terre Haute, IN, in 1904, the son of a machinist and community steward. Robert attended Rose Polytechtic and Carlton College earning a degree in engineering. He took a position with AT&T where he worked as a loyal employee for 38 years and became known for his theories about empowering leadership. During that time, Robert headed a division for management training and created the first center for corporate assessment in America. One of the first to promote women and blacks into non-menial positions within the AT&T organization, Greenleaf became well known as a pioneer in leadership by seeking ways to utilize each person to his/her fullest capability.

Following retirement from AT&T at age 60, Robert worked as a consultant to businesses that had an interest in leadership development and taught them to implement his core belief that effective leadership is a partnership wherein “the organization exists as much for the person as the person exists for the organization.” In 1970, Greenleaf published his essay, The Servant Leader which coined the term and introduced the notion that the best leaders are servants first. The style of leadership that he espoused proved to be effective and requests for his leadership coaching grew into creation of the Greenleaf Center for Servant Leadership. The center states as its mission: “to advance the awareness, understanding and practice of servant leadership by individuals and organizations.” Long after the death of Robert Greenleaf, the center remains a strong advocate for servant leadership and continues to offer training through the Greenleaf academy.

Writing in EmergingRNLeader, nurse and author Rose Sherman identifies the leadership style described in The Servant Leader as an essential component of a highly effective healthcare workplace. Crediting the work of Robert Greenleaf, the following were described by Sherman as essential characteristics of the Greenleaf serving leadership style.

Listening
Empathy
Healing
Awareness
Persuasion
Conceptualization
Foresight
Stewardship
Commitment to professional development of staff
Building community

Click here for an explanation of the 10 principles listed above.

Robert Greenleaf had an unshakable belief that through collaboration and the creation of a work environment that empowers people to work at their highest capability, people will be happy, engaged and highly productive. History records that Robert was never driven by a quest for fame or fortune, but by a belief that the potential within each person that could be released, can be released, through servant leadership. Etched in his grave stone are the following words, “Potentially a good plumber; Ruined by sophisticated education.”

In the decades following the publication of his famous essay, Robert’s principles of servant leadership have become the foundation for many versions of leadership development in America and worldwide. Books, videos, and workshops may put a new spin on Greenleaf’s original work; however, when all is said and done, the beliefs of Robert Greenleaf are still alive and evident in leadership development worldwide.

“A better society, one that is more just and more loving, one that provides greater creative opportunity for its people.”

~Robert Greenleaf

Tom is a noted author and popular speaker at State Association meetings.

Make it Safe; Essential Resources for Patient Safety

Thomas Davis, CRNA, MAE, DNAP candidate

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In 1999 the Institute of Medicine rocked the healthcare world with the scathing report that every year up to 98,000 people in the United States die due to medical errors. Despite nearly 20 years of safety initiatives being introduced in hospitals nationwide, medical errors continue to be the third leading cause of death in the United States; a situation that can best be corrected by healthcare providers on the frontline of patient care.

It is easy to get the consensus of doctors, nurses and support staff to commit to patient safety; however, changing the workplace culture and making patient safety a priority can be a daunting task. Fortunately, organizations have emerged to assist frontline workers who are committed to making healthcare safe and reliable for the patients they serve.

If you are committed to ensuring patient safety, you are not alone. Here are resources to help you achieve the goal of eliminating ALL preventable medical errors.

Anesthesia patient safety foundation (APSF) The APSF was founded in 1985 with the defined goal of improving patient safety related to anesthesia. The board of directors is a group representing a wide variety of stakeholders including anesthesiologists, nurse anesthetists, nurses, manufacturers of equipment and drugs, regulators, risk managers, attorneys, insurers, and engineers. The APSF newsletter is published in 5 languages and provides a wealth of information related to patient safety that supports the organization’s mission: “The APSF’s mission is to improve the quality of care for patients during anesthesia and surgery by encouraging and conducting patient safety research and education as well as related programs and campaigns.” The AANA is an active partner with the APSF in promoting patient safety.

Patient safety movement The patient safety movement has a stated goal of zero preventable medical errors by the year 2020. The organization approaches patient safety by identifying risks to patients, challenging technology to assist by creating solutions, ensuring that providers follow established policy, and directly providing education to patients and their families regarding risks. The patient safety movement bypasses the medical establishment by directly providing information to patients and their families to alert them to the risks of hospitalization. The organization now offers the patient aider app that alerts family members regarding risks to their loved ones and provides questions to ask those who are providing care.

AHRQ (Agency for Healthcare Research and Quality) The AHRQ has the organizational mission; “…to produce evidence to make healthcare safer, higher quality, more accessible, equitable and affordable, and to work with HHS and other partners to make sure that evidence is understood and used.” The AHRQ website has a section titled “evidence now” that outlines evidence-based information designed to help healthcare providers with clinical decision making. The AHRQ site is a valuable resource for those who constantly update their practice based on the available best practice statistics.

Armstrong institute for patient safety and quality (The Johns Hopkins) The Armstrong institute for patient safety is housed at The Johns Hopkins Hospital and is committed to making healthcare safe for every patient, everywhere. The organization is dedicated to their mission: We partner with patients, their loved ones and all interested parties to end preventable harm, to continuously improve patient outcomes and experience, and to eliminate waste in health care. To ensure that providers at the grassroots level have the tools necessary for safe practice, the Armstrong institute provides patient safety courses for healthcare workers. Individuals can earn CME by attending courses in Baltimore or their employer can arrange for the Armstrong institute to travel to their location and present safety workshops.

Institute for Healthcare Improvement (IHI) The IHI has a global interest in improving the overall health of the world population through initiatives aimed at public health as well as education of healthcare providers in developing countries. In the US, the IHI focuses on system improvement, whereas in developing areas of the world, issues such as vaccination and water purification are priorities. As self-described on their web site, “We are an institute without walls, and together, we work as a cohesive unit with, common knowledge, common systems and unconditional teamwork. In all we do, we adhere to the principle of “all teach, all learn.”

AANA The AANA has a commitment to patient safety and their web site has numerous articles intended to improve patient safety. Topics such as opioids, radiation and OR distractions are just a few of those available on the AANA web site. The Professional practice division has published evidence-based practice resources to aid clinical decision making.

AORN CRNAs are not the only people in the OR who are committed to patient safety. The AORN “is committed to promoting patient safety by advancing the profession through scholarly inquiry to identify, verify, and expand the body of perioperative nursing knowledge.” The organization has published a patient safety position statement to guide the activity of nursing staff in the OR.

Center for Medicare/Medicaid services (CMS) CMS is a major payor for healthcare services in the US and has a vested interest in patient safety. The organization establishes standards and updates them annually to create criteria that must be followed in order to receive reimbursement for services. CMS seeks to improve patient safety by making healthcare providers accountable for the quality of care that is provided.

The Joint Commission (TJC) The Joint Commission accredits healthcare organizations throughout the United States and certifies that they meet or exceed established standards, including standards for patient safety. TJC has released the National Patient Safety Goals for 2019. Currently, safety priorities are patient identification, syringe labeling and blood administration. Areas of emphasis are updated to reflect perceived threats to patient safety.

Center for patient safety Established in 2005, the Center for patient safety is an independent, non-profit organization dedicated to promoting safe and quality healthcare. The organization is a resource for healthcare providers and offers information via blog, safety alerts and legal updates.

Centers for Disease Control and Prevention (CDC) The CDC is a government agency with the mission “to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.” The CDC national healthcare safety network tracks medical errors, issues statistical reports and issues alerts related to patient safety.

Patient safety company The patient safety company is an important bridge between safety initiatives and digital technology. The company offers software to support safety initiatives including incident management, patient satisfaction, workplace culture assessment, information security and peer support. They will also develop custom software for unique safety projects.

Patient safety is everybody’s business and making a commitment to ensuring a safe environment for your patient is easy on an intellectual level. Reviewing the resources listed above provides information and support for your effort; however, knowledge is useless until it is put into action. Making the transition from good intention to good practice requires a plan. The Kotter model for implementing change is a useful way to initiate a safety initiative in the healthcare environment. My previous blog, Kotter, for a change (Oct. 21, 2018), describes the model and how it can be used to make patient safety a priority in your workplace.

This article introduces the vast resources available to those who are committed to improving patient safety and provides a model for implementing change. It is up to each individual reader to convert patient safety from a theoretical “we ought to” to the reality of a workplace where safety is job one.

“Safety is not an intellectual exercise to keep us in work. It is a matter of life and death. It is the sum of our contributions to safety management that determines whether the people we work with live or die” ~Sir Brian Appleton

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

The Voice against Lateral Violence

By Thomas Davis, CRNA, MAE

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In the nursing community, Lateral Violence (LV) is the term adopted for “bullying.” Consequently, an angel of mercilessness who might otherwise be labeled a bully is officially said to be “inflicting lateral violence.” In medsurg nursing, authors Becher and Visovsky describe lateral violence as “hostile, aggressive and harmful behavior by a nurse or group of nurses toward a coworker or group of nurses via attitudes, actions, words and/or behaviors.” Lateral violence often goes beyond things that are done to another person to include things that are not done or that go unseen.

“Never be mean to someone who can hurt you by doing nothing.”

~Matt Hearnden

Recently, an anonymous post by a nurse anesthetist student on the Facebook CRNAs and SRNAs user group page described the meanness directed at him in his clinical training site because of his status as a learner. The student started the post by humanizing himself as an attentive student committed to mastering the skills and the knowledge to become a CRNA. Then he described his personal history – background, family, hobbies. His post went on to inform readers that his clinical training included accusations of being “lazy, stupid, inept, and disrespectful…” and other demeaning allegations. Clearly, he was on the receiving end of outrageous behavior at a clinical training site in which lateral violence is a toxic staple in the culture. Given the opportunity, the student would likely change training sites tomorrow and not look back, and you can be certain that he will never seek employment there.

In-your-face yelling or a punch in the nose are obvious examples of hostile and aggressive behavior; however, the daily manifestations of LV in the workplace are often subtler and less obvious. Here are some examples of behavior that qualify as LV and, over time, will have a toxic effect on your team.

Overt LV	Covert LV
Name-calling	Sabotage
Intimidation	Unfair work assignments
Blaming	Withholding information
Fault-finding	Withholding credit or praise
Threatening	Exclusion from group activities
Ethnic slurs

There is a cost associated with allowing lateral violence to exist in your workplace. As noted by nurse educators Becher and Visovsky, all levels of persecution damage the self-esteem of workers, reducing productivity and ultimately having a negative impact on the entire profession. The reputation that “nurses eat their young,” didn’t arise from nowhere; LV is a problem that has been associated with the nursing profession right along with other professions for decades. It’s time to stop LV and turn the corner.

Avoidance of conflict fuels the flames of lateral violence in workplaces where bullying is tolerated. Rather than confronting an aggressor and drawing a red line, it is easier to turn a blind eye and hope that you are not his next victim. Writing in the CPI blog, Emily Eilers, author and editor for the Crisis Prevention Institute recommends team training that focuses on changing the workplace culture and establishing zero tolerance for bullying. For training to be effective, the team must openly discuss the problem and develop a code of conduct that defines acceptable behavior. Affirming Eilers emphasis on team training, nurse educator Ericka Sanner-Stiehr, PhD, recommends a 3-step approach to eliminating lateral violence: 1) Add lateral violence awareness to the curriculum of teaching programs; 2) establish and enforce a code of conduct; and, 3) role model the respectful, courteous behavior expected of the team. Your strong leadership combined with commitment to change will position you to transform your workplace culture.

Stopping lateral violence starts with you.

Make it a priority. Whether you are the official leader with the title or the opinion leader to whom others listen, draw the line and vow to end lateral violence in your workplace. Show your commitment to culture change by establishing a policy of zero tolerance for LV and confront each offender immediately. During the interview and hiring process, include a discussion of acceptable behavior.

Discuss bullying at team meetings. An elephant in the room won’t go away until it is acknowledged, and conflict avoidance is akin to feeding the elephant. Dedicate a team meeting to discuss the negative effects of lateral violence and have the team identify areas for improvement. A one-time discussion will not have a lasting effect. Address the topic repeatedly at subsequent meetings and elicit every person’s commitment to changing attitudes and behavior toward one another.

Develop and enforce a code of conduct. Once the team understands the dimensions of lateral violence and has committed to change, use a subsequent meeting to develop a Code of Conduct. Reinforce zero tolerance as your policy for addressing covert or overt behavior that violates the Code.

Simulate triggering scenarios. Help your team find better options for situations that commonly trigger lateral violence. Take time at a team meeting to role play interactions that have generated negative behavior in the past. After completing each scenario, challenge the team to come up with professional and productive ways to more appropriately address the same or similar situation if it arises in the future.

The CRNA candidate who posted on Facebook knew first-hand the devastating effects associated with being a victim. He perceived himself to be powerless, at the mercy of the sharks swimming around him in the waters – not an optimal training ground. If you allow intimidation, oppression, bullragging or any form of persecution in your workplace, you will have team members like the student, living each workday in constant fear of the next attack, and ready to jump ship at the first opportunity. Be the voice that stops lateral violence. Lead the other voices. Then direct the choir.

“knowing what’s right doesn’t mean much unless you do what’s right.”

~Theodore Roosevelt

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

Team strength through diversity

By Thomas Davis, CRNA, MAE

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“Diversity: the art of thinking independently together.”

~ Malcolm Forbes

The combination of digital technology and the availability of dependable travel has linked people in distant areas of the globe and opened the door to blending cultures through unusual partnerships. With the click of a mouse, executives in the United States can have a video conference with just about anyone, anywhere in the world. People who were previously separated by geographical boundaries can now interact freely with one another thus creating the opportunity for diversity of thought within their organization.

In addition to connectedness created by technology, immigrants fleeing terrorism or seeking opportunities for employment are flooding across borders both in Europe and America, changing the ethnic makeup of the population, and contributing to diversity in host countries. Clearly, demographics are changing in many areas of the world and organizations on the cutting edge of their industry welcome and capitalize on opportunities that accompany diversity. Cultural diversity in the workplace is promoted when employers actively seek to hire employees from every religious and ethnic background and then capitalize on the variety of experiences that they bring to the workplace. Building a diverse team strengthens the organization and here is why.

A member of the Q6 customer service team in Perth, Australia, R. Heryati documents the following advantages that arise from a diverse workgroup:

Increased productivity
Improved creativity
Increased profits
Improved employee engagement
Reduced employee turnover
Improved company reputation

Writing for Entrapraneur.com, author Kim Abreu adds to the list of advantages to having diversity on a team by noting that diversity correlates with improving innovation and recruiting. From blogs to books, authors evaluating the relationship between diversity and productivity affirm the importance of having a diverse team when seeking creative answers to workplace challenges.

Two types of diversity are commonly found in the modern healthcare workplace; cultural and interprofessional.

Cultural diversity refers to a person’s family heritage. Do people at your workplace have different skin color, facial features and hair color? Do they speak a second language? What religious holidays do they celebrate? The greater the variation between individual workers, the more diverse the workplace.

Interprofessional diversity arises from the mix of professions that must work collaboratively to render evidenced-based care to the patient. Doctors, nurses, technicians and support staff are only a few of the professions that combine their efforts in a busy hospital environment. Each sub-group has a different purpose, has received different specialty training and brings a different perspective to the table when discussing issues and developing plans. In an ideal situation, every sub-group will have equal say and be given equal respect when interprofessional teams are formed to address issues or create policies. The term abrasive collaboration is used to describe diverse professional groups working collaboratively to find a mutual solution while, at the same time, ensuring that their individual professional needs are met.

4 ways to promote diversity in your workplace

Educate yourself. Connect one on one with people on your team and learn about their family’s country of origin and family traditions that carry over to today. If members of your team have different religious beliefs, learn about their traditions. Adjust your work schedule to enable team members to attend important religious or cultural activities.

Solicit different perspectives. In personal conversations and at team meetings openly encourage each person to voice their point of view. Seeking a variety of opinions is especially effective with reference to interprofessional groups. To be effective, the hierarchical “doctor knows best” attitude must be replaced by a commitment to collaboration where each person has an equal say.

Develop diversity activities. Include dates on the team calendar that recognize the culture or religion of your team members. Encourage people to share their traditions with the group and schedule ethnic food days to celebrate the various cultures represented on your team. When team members celebrate one another’s heritage, they respect for the contributions that each person makes to the team and become more receptive to their ideas.

Be the leader. You are the leader and set the tone for the workplace. If you are dismissive of diverse thoughts, your team will follow your example. Conversely, if you welcome and openly solicit diversity, your team will follow your lead. Openly welcome both cultural and interprofessional diversity in your workplace.

The best ideas arise from many ideas combining ideas from people with different cultural and professional background strengthens the team. First, assemble the right group and then be inclusive of their ideas when making decisions. Doing so will position you and your team for success.

“When we listen and celebrate what is both common and different, we become a wiser, more inclusive, and better organization.” ~Pat Wadors, Head of HR at LinkedIn

“If you hire only those people you understand, the company will never get people better than you are. Always remember that you often find outstanding people among those you don’t particularly like.”

~Soichiro Honda, founder of Honda

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

Legend in Leadership: John C. Maxwell

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

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“Leadership is not about titles, positions or flowcharts.

It is about one life influencing another.”

~John C. Maxwell

John C. Maxwell has bestowed a lasting gift to those in leadership positions throughout the world by his commitment to developing leaders at all levels of the chain of command. Born in 1946, John Maxwell is the son of a minister who followed his father’s call to the cloth, earning a bachelor’s degree at Ohio Christian University and a master’s degree from Azusa Pacific University. While working as a pastor, he found that his greatest gift to society lay in leading others to discover their true talents.

John and his brother Larry are the co-founders of EQUIP, a non-profit organization that is founded on the premise “We believe that every person is born with the potential to influence others.” The organization is based on Christian values and has taught over 5 million people in 126 countries techniques to motivate and empower one another. Maxwell’s style of leadership coaching is based connectedness and the development of interpersonal relationships which create a synergy and makes everyone a better person.

John’s success with his approach to leadership coaching has grown into a multi-million-dollar organization that offers books, articles, seminars, and keynote speaking to audiences worldwide. With sales topping $18 million for copies of his 12 books and having written countless articles, John Maxwell has established himself as a legend in leadership development.

Reviewing the lifelong work of John Maxwell reveals that his highly successful approach to leadership is built upon five essential elements – Vision, Values, Relationships, Attitude and Communication.

Vision “Great leaders always seem to embody two seemingly disparate qualities. They are both highly visionary and highly practical.” ~Maxwell. Effective leaders can visualize what their workplace would look like if collaborative teamwork opened the door to peak performance. Leading a team starts with being able to see the end point and relentlessly working to get there.

Values “The respect that leadership must have requires that one’s ethics be without question. A leader not only stays above the line between right and wrong, he stays well clear of the ‘gray areas.'” ~Maxwell. Values provide an essential navigation tool for guiding a team. Aligning personal and organizational values will establish the standard for behavior that is acceptable in the workplace and forms a basis for decision-making.

Relationships “The bottom line in leadership isn’t how far we advance ourselves but how far we advance others.” ~Maxwell. Productivity moves at the speed of relationships and in John’s own words, “interaction fuels action.” Maxwell describes 5 levels of leadership and at level 2 the leader connects one on one with each team member. Those who make the effort to connect with others open the door to two-way relationships that produce unexpected rewards. “The rewards leaders give are counterbalanced by the results that their people give in return.” ~Maxwell

Attitude “The leader’s Attitude is like a thermostat for the place she works. If her attitude is good, the atmosphere is pleasant, and the environment is easy to work in. But if her attitude is bad, the temperature is insufferable.” ~Maxwell. Attitude is contagious and how you show up each day is quickly perceived and copied by members of your team. Per John Maxwell, “people hear your words, but they feel your attitude.” Be a leader and set the tone for your workgroup. Leverage your position and exude the attitude that will elevate your team.

Communication “If you really want to be an uncommon leader, you’re going to have to find a way to get much of your vision seen, implemented, and added to by others.” ~Maxwell. The key to communication is delivering information in an open and transparent manner and then listening to feedback that it generates. In his book, Everyone communicates, few connect, Maxwell reinforces the importance of listening to understand the other person as a way of broadening diversity of thought. “As a leader, you will never get ahead until your people are behind you.” ~Maxwell

Now in his 70’s, Maxwell’s lifelong commitment to leadership development has earned him the status of being a legend in leadership. His books, seminars and leadership coaching has directly touched the lives of millions of leaders and indirectly touched the lives of those they supervise. In the words of John Maxwell, “leaders stretch with challenges, followers struggle with challenges and losers shrink from challenges.” Follow Maxwell’s five essential elements for effective leadership and become a legend in your own workplace.

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

The Listening Leader

The Listening Leader

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

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Leaders who listen are positioned to build productive teams. According to the Harvard Business Review analysis of employee engagement and productivity, employees are 31 percent more productive with 37 percent higher sales on average when they are happy or satisfied. Building a happy, satisfied team of employees is multi-faceted and based on the worker’s perception of being valued and respected. At the core of feeling valued and respected is the perception of being heard by leadership, that “my opinion matters.” Ergo, effective leaders listen.

Writing in Inc.com magazine, author Samuel Edwards offers 6 tips for enhancing employee satisfaction. At the top of the list is listening. Edwards emphasizes the importance of listening when he says, “By listening to your employees, you show that you respect their opinions and truly value them as part of the organization.” The same can be said of the importance of listening to your clients as evidenced by the 2013 report issued by CMS that indicated 6 in 10 patients stated that they were not listened to or respected. Satisfaction is enhanced by Value and Respect. Sound familiar?

In a recent Prosynex on-line webinar for CRNA leaders, we discussed listening as a powerful tool for leaders who are intent upon building a productive team and preferred workplace. We had a stimulating dialogue regarding the levels of listening, after which, we reviewed techniques for improving listening skills. Below is a summary of our discussion of the three articles covered in the webinar.

Team members seek the attention of the leader and want to share personal or professional thoughts with the expectation that they will be heard; but, if the leader’s mind is elsewhere, both people walk away empty. In our first article from the Black Swan group, Derek Gaunt notes that there are 5 levels of listening:

Level 1 Listening for the gist The listener’s mind is elsewhere while the person is talking. The listener may nod and say, “ya, ya” as the person talks but very little is absorbed. If the listener is texting or checking email while talking, the speaker is tuned out.

Level 2 Listening to rebut The listener is actively preparing a reply as the person is talking. The listener is more intent on defending his/her point of view than learning about the issues motivating the talker. The listener learns nothing new and the talker walks away feeling invalidated.

Level 3 Listening to logic The listener is aware of both the words that are being spoken as well as the logic driving them. Without the need to be defensive or rebut the talker, the listener is able to learn new information and gain insight into the speaker’s point of view.

Level 4 Listening to emotion The listener is aware that many issues emerging to the surface are triggered by emotion. Moving beyond the logic of the points being made allows the listener to observe body language and voice inflection that may reveal any underlying emotions, such as fear or anxiety, at the core of the concern.

Level 5 Listening for the greater world view The listener walks away with an awareness of the foundational values that the speaker. During the conversation, the speaker may leave clues about whether he/she is liberal, conservative, religious, financially responsible and many other basic personality traits.

Our consensus during this part of the Prosynex discussion was that “most leaders tend to listen at levels 1 and 2.” But, by semi-consciously tuning out, or consciously rebutting a speaker, the leader shows disrespect and misses a valuable opportunity to connect with team members. Avoid assuming a defensive posture and move to the preferable next step of listening by attentively tuning in to the logic behind the other person’s words. Effective listening is respectful and empowering for both parties.

We pursued this pithy discussion by reviewing 6 tips for becoming a more effective leader as suggested by author, Glen Llopis, in Forbes magazine.

Show that you care. Have a physical presence with your team and take an active interest in their concerns. When people talk to you, give them your full attention and never allow yourself to be distracted with mobile devices while listening.
Engage yourself. While you are interacting with your team, ask members for their opinions. Many people wait until they are asked before sharing.
Be empathetic. Problems affect people on a personal level and an emotional one. Commonly, issues are either triggered by emotions or the issue triggers an emotion. Either way, learning to sense the subtle non-verbal signs that accompany a person’s words will increase understanding and reinforce the perception of being heard.
Don’t judge others. One of the quickest ways to cut off dialogue is to tell the other person that he/she is wrong and why. If you don’t have all the facts, pre-judging ensures that you won’t get them. Listen attentively even if you think the other person is wrong.
Be expansively mindful. Put the other person’s words into the context of their environment, personal background and emotional state. Imagine how you would look at a problem from the other person’s point of view.
Don’t interrupt others. Just like being judgmental, interrupting will shut the other person down. You know what you know, and nothing new is learned by interrupting and stating your point of view. Resist the urge to be the expert leader and be the expert listener and learner instead.

The giants in leadership agree: Employee happiness and sense of self-worth affects their commitment to the job and ultimately, productivity. It is no accident that effective listening will enhance scores in 6 of the 12 identified on the Gallup Q12 employee engagement survey. Effective listening is at the core of effective leadership. Show each member of your team that he/she is valued; be a listening leader.

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

Kotter, for a change

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

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“Change is the only constant in life.”

– Herculitis, Greek philosopher (535 BC – 475 BC)

We know that change in the workplace is unavoidable and that it can sometimes be painful, making people cling tightly to the secure comfort of status quo. Savvy leaders know that modifying and implementing new policies or guidelines is inevitable and to make the changes less difficult, they find ways to rally the team.

Writing in the Forbes.com blog, author, Larry Alton, agrees with the Greek philosopher and recommends addressing change head on. Culture evolves based on relationships. Therefore, to achieve a successful rollout of a new policy or plan, it is essential to build an energized team of individuals who can accept variation and take the lead during implementation.

John Kotter, professor emeritus at the Harvard Business School studied both the necessity for and the resistance to change. In his book, Leading Change (1996), the Kotter 8-step model for managing change is presented as a thinking framework to smooth the process of making modifications in the workplace. Repeatedly and successfully used in business, industry and healthcare, the Kotter model can be applied to just about anything that requires transformation. Here is an example of how we used this dynamic, interactive model to improve the workflow at our ambulatory surgery center.

One of the myths that our ASC embraced is the belief that every female patient who is not post-menopausal must have a pregnancy test before receiving anesthesia. Being a fast-paced GI center with rapid patient turnover, any delay caused by waiting for a urine specimen slowed the work flow and ultimately caused subsequent patients to experience delays. Many of our patents have zero likelihood of being pregnant and the drugs we use pose no risk to the pregnant patient, therefore, many on our staff felt strongly that it was time to change the policy. A grassroots movement was emerged and we were well on the way to fulfilling the requirements of the first step on the Kotter model:

Create urgency Often when things don’t seem to be quiet right, the initial response is “somebody ought to change that” and the sentiment quickly progresses to “we gotta fix it.” At our ASC, Doctors, CRNAs and nursing staff all complained about delaying cases while awaiting a pregnancy test. The concerns of the staff were reinforced by negative feedback from patients when they were solicited to evaluate their experience at our center. Specifically, evaluations from patients expressed dissatisfaction with the ASC due to the required pregnancy test. ASC staff and managers sensed urgency to change the policy and we collectively agreed that we WILL address the issue head-on and take corrective action.
Form a powerful coalition There is strength in numbers. When building a coalition to support a proposed change, it is important that all stakeholders are on board with the new plan. Building a coalition involves gaining consensus among your peers who share your view point as well as from collateral professionals who look at the same problem from a different perspective. Our coalition of stakeholders included doctors, nurses and support staff; all of whom were included in the development of the new policy to modify our current practice. Patients were the ultimate stakeholders and, although we took their feedback seriously, we did not include them in revising the policy.
Create a vision Having identified the problem, we clearly knew what we didn’t want: Unnecessary testing that slowed the workflow without adding value to the process. We turned our attention to what we did want: A policy that maintained patient safety, facilitated workflow and elevated patient satisfaction. After a “best practice” review of the literature to ensure that we were on solid ground, our efforts were rewarded when the new plan was developed to support our goal.
Communicate the vision Before implementation, the new plan was shared with every worker at the ASC through email and informal discussions. The sense of urgency already in place from step 1 smoothed the process of sharing the plan with the entire group. The ASC team quickly embraced the vision that would improve workflow and patient satisfaction.
Remove obstacles There were very few obstacles for our proposed change. Knowing that involving stakeholders would increase buy-in, we reduced potential resistance by making sure that everybody was kept informed. In addition, we made sure that everybody knew that our new policy was in line with safe practice.
Create short-term wins This was a change to a local policy and it did not have a big impact on the organization, so the sense of achievement was confined to our workgroup. We gave recognition to those who were instrumental to developing the plan; however, the nature of the project did not warrant a major celebration.
Build on the change The Institute for Healthcare Improvement (IHI) recommends the plan, do, study, Act (PDSA) model for improving a plan. The PDSA model involves implementing a pilot plan, evaluating the results, modifying the plan and re-implementing a better version which, hopefully, will produce even better results. Our plan improved the overall workflow by eliminating mandated pregnancy testing and had the collateral effect of improving patient satisfaction. Success with this project motivated us to look at other workflow issues and seek ways to make further improvements.
Anchor the change in corporate culture “That’s the way we’ve always done it,” does not mean that it’s still the best way, nor does it mean that we must to continue a non-productive practice. Our new corporate culture includes the knowledge that grassroots initiatives are received in a positive light and that change can be initiated by any person in the organization.

Eliminating the need for every female to receive a pregnancy test before undergoing anesthesia is only one example of the use of the Kotter model for introducing and managing change. What is the greatest need for revision in your organization? Take time to pre-plan and practice the Kotter model when change is required. Apply it chronologically, one step at a time. It will be self-defeating to build a coalition before creating the sense of urgency or trying to implement a vision without first developing a plan. Embrace transformation and proactively use Kotter’s model to reach your desired outcome.

Heraclitus observed that change is inevitable, but he did not say that change is a bad thing. The great philosopher also said, “You could not step twice into the same rivers; for other waters are ever flowing onto you.” Today, one thing that has not changed over time is that the only constant is change.

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.