Leadership articles – Page 6

The Magic of Feedback

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

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Feedback is the process of taking output and returning it to the source so that adjustments can be made to improve the quality of future output. On the job, receiving and giving feedback are key components for improving performance and building a preferred workplace with fully engaged employees who are committed to excellence. Writing in Cognology, author John Windust notes that the majority of workers would like more performance feedback than they currently receive, yet there is a reluctance of supervisors to candidly discuss performance with workers. Providing constructive feedback is giving a gift to your team; A gift that transforms personal relationships and elevates team performance.

The transition to continuous, informal feedback has turned the traditional annual performance review into a dinosaur at many businesses that focus on the future. The standard APR happens only once a year and looks back on where the person once was. In contrast, frequent feedback identifies where the person currently is and looks ahead identifying opportunities for improvement. Organizations such as Dell, Microsoft, IBM, Lear, and General Electric have retired the APR in favor of frequent discussions between individual worker and supervisor. With recurrent discussions, workers have a clear picture of:

What they are supposed to achieve
Whether or not they are reaching goals
Things that are done well and things that need improvement
The impact that they have on others and the overall achievement of the team

Both leaders and workers gain respect from their colleagues when they solicit and give honest feedback regarding work performance. Welcoming comments and criticism from colleagues and having a, “Make me better,” attitude displays self-confidence and encourages others to openly share observations and offer suggestions for improvement. Over time, a culture of benevolent feedback will elevate the performance of the entire team.

Advantages of frequent feedback

Opportunity is always there. Fully engaged supervisors have boots on the ground and interact with team members daily. Each interaction is an opportunity to share observations, both successes and areas for improvement in real time. Ongoing feedback does not require an appointment on the supervisor’s schedule nor does it require formal documentation.
Frequent check-in cultivates a relationship. Ongoing interaction, in which comments are offered with sincerity and kindness, demonstrates transparency and the desire to help the other person improve. It opens the door for the person on the receiving end of the remarks to reciprocate making the feedback a two-way process. Over time, honesty and transparency will lead to a solid trusting relationship.
Disclosure is motivating. Sharing your observations in a manner that is intended to enhance the skills and performance of another person is energizing. When information is shared effectively, the other person sees a current weakness as a temporary condition and she will be stoked to correct the problem. Informing a person that he is just a little behind another more skilled individual will motivate him to close the gap and strive to be the best.
New skills are learned. Often, when a person is not achieving at their full potential it is not due to a lack of effort but to a lack of specific skills. Frequent non-confrontational discussion of a person’s performance will reveal areas where a little training could make a significant difference in outcome. Draw on your network of resources to facilitate mentoring to fulfill the knowledge or skill deficit of the worker. By taking an active interest in the person’s professional development, you are sending a message that he is important to the team.

Maintain a consistent presence within the team and have the courage to candidly criticize areas of weakness while openly showcasing success. Keep on your toes by reversing roles and inviting your team to make you better through the same feedback process. The trust that emerges from a two-way relationship based on transparency and sharing of information will be the cement that bonds a group of colleagues into a highly motivated and productive team.

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

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

Five Essential Questions

Five Essential Questions

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

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Preferred workplaces are built by insightful leaders who actively work to create a community of colleagues who treat one another with mutual respect and work together collaboratively. Hiring and recruiting new team members offers an excellent opportunity for you to build your dream team, and identifying well-matched applicants is an important first step. These Essential Five interview questions will put you on the right track.

When you prepared for this interview, what did you learn about our organization? This question opens the door for insight about how the applicant organizes time, thoughts and the value that he or she places on preparation.

Positive response: The applicant will show evidence that he/she has been to the employer’s web site and has seen the mission, vision and values of the organization. They will also be able to comment on something specific about the group that they are hoping to join.

Negative response: The applicant will flatter the institution speaking in vague terms about its wonderful reputation but saying nothing specific about its mission and values.

Describe your ideal employer/ job. This moves the ball beyond working for a pay check, plants the thought that not all employers are the same and opens the door to considering whether this job is a good fit for both the applicant and the employer.

Positive response: The applicant will describe a job that offers professional growth, builds a network of colleagues and presents an opportunity to join a team doing important work.

Negative response: The person will focus on pay and benefits with a work schedule built around personal needs.

What is your greatest achievement outside of work? People are who they are on and off the job. There is no right or wrong answer to this question, but it is a significant opportunity to gain insight into the applicant’s basic personality and the way they approach life in general.

Positive response: The applicant will talk about other specific team experiences noting his contributions and some of the improvements that were made he helped to achieve. He may potentially reveal the positive effects that participation had on his own self-esteem.

Negative response: The applicant will list his organizations and the titles he held or earned, tainting his good works by creating a feeling of, “Look what I did!” Applicants whose greatest achievements outside of work are wrapped around self-promotion will bring that same attitude to your team.

If you join our team and you have a successful first year, what would it look like? This question encourages the applicant to visualize being a member of your team. Not only does it create buy-in regarding team membership, it plants the seed that you expect the person to be successful.

Positive response: The person will describe learning new skills, feeling valued, working as a member of a collaborative team and making a difference in the overall outcome of the group.

Negative response: The person will make empty statements about settling into a work routine, providing quality patient care and being able to balance work with personal pleasure.

Do you have any questions? This is a very important question that loops back to question one and provides further indications about preparation for the interview.

Positive response: An applicant who is seeking to join a collaborative team that does meaningful work will ask about work ethics, relationships, team goals and opportunities for growth and excellence.

Negative response: The applicant who wants a strictly transactional, quid pro quo job will ask about pay and benefits and ways to leverage time off to meet personal needs. Or, he may not ask any questions at all.

Looking back on my experience as a hiring manager at two large healthcare institutions, I recall one of the most informative applicant interviews of my career. Following a useful discussion about the applicant’s preparation for the interview, his preferred workplace, his activities outside work and his view of a successful first year, the interviewee was asked the essential fifth, “Do you have any questions?” “Yes,” he replied. The candidate opened a folder and pulled out a sheet of 64 type-written questions that he and his wife had prepared. Our committee addressed each question one by one and by the end of the interview, he knew the minute details of the job he was seeking, and we gained valuable insight regarding his personal interests and expectations. We hired him, and he was exceptional.

The interview of applicants is a necessary step in the process of building a team to establish your institution as a workplace of choice. Using the Essential Five gives you a window through which you can gather both broad and specific information about the qualities of each applicant. A thorough interview will help you hire the perfect fit for your work community, and the one you serve.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

Now available on Amazon books

Busy or Productive?

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

Follow @procrnatom on twitter

“Establish your professional reputation based on what you’ve accomplished.”

This high-tech 21^st century requires that we move faster and process information more rapidly than during any other historic period. The price of stock at Plated, Uber or Amazon attests to the speed read race pace at which we move. Lets’ agree that we’re all hard working; however, at the end of the day, what do we have to show for it? All or many of us may grimly discover that we’ve spent the day as busy as a pile of fire ants and as productive as a heap of sawdust. Busy may appear beautiful, but Productive is Queen Bee for a day.

Are you busy or productive?

Busy people …

Say they have a mission
Appear to focus on action
Say yes a lot
Are easily distracted

Productive people…

Have a written mission and a defined goal
Develop a plan and put it into action
Say yes as much as possible and always follow through
Limit the distractions and commit to achieving results.

Here’s how to make the shift from busy to productive.

Written mission, defined goal First, commit to it. After agreeing to a proposal, identify and clarify the intended outcome. For either a long or short-term goal, focus on the published department mission while defining the outcome of the project. No matter what leadership style you opt to use, if you know where you’re headed, and if you keep an eye on the ball, at the end of the day you should have brought all your small tasks to closure and made the projected progress on your long-range projects.

Plan, action Whether you’re organizing a one-hour meeting or restructuring an entire department, all tasks require a strategic plan with a timeline. Use markers to indicate progress, and then follow your plan. Build clock blocks with specific times for different activities and allow some empty time periods for inserting priority projects. Don’t forget to create time for a needed stretch break, taking a quick jog up the back staircase, eating a healthful power lunch. Start the day by doing a last-minute “block check.” End the day by reviewing the results.

Say yes, follow through It’s easy to say yes. In fact, very often it’s easier. “Yes!” means that you have the time and the resources to complete the task or project, or that you can and will get them. To begin an assignment, declutter. Start with a clean desk and an empty waste can. Clear your schedule and the schedules of those you wish to utilize. Be certain that you, or you and the team, are up to the task and if you say yes, mean it. To be fair and honest, if you cannot say yes and follow through, just say no, “…but thank you for asking!”

Limit distractions, get results In other words, focus. Having the personnel, the tangible resources, scheduled daily clock blocks, and a decluttered mind and work area sets stage for focusing on high production. Now, do one more thing. Put your phone away. Take care of your texts and emails prior to starting the first clock block then turn it off. Turn off the ring-tone. Turn off the alerts. Turn away all the would-be hijackers and tune in to your timeline. Position yourself to see planned results.

Earn and establish your professional reputation based on what you’ve accomplish, not on how busy you managed to be. To avoid being a top that stays upright by spinning in one place or a whirling dervish that dashes and darts through the day creating more problems than resolutions, design a focused work environment with a plan for action on every project. Thoughtfully use your integrity and talent to follow through so you can finish the day with planned results and a sigh of satisfaction.

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

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

Buy Leader Reader 1, Authentic Lessons in leadership on Amazon books.

Be a Master Teacher

Be a Master Teacher

By Thomas Davis, CRNA, MAE, Lt. Col, Ret

Follow @procrnatom on twitter

Central to developing a preferred working culture is hiring the right people and then instilling them with your goals and values. Having a Master Teacher on your team to impart skills and establish expectations will ensure that your new hire becomes a valued member in your workplace.

I provide anesthesia in an outpatient center in which workers are happy and their competence is highly regarded. At the heart of our success as a team is the talent of our benevolent authoritarian and Master Teacher, Lali.

As an authoritarian teacher, she takes confident control and demands that each learner acquire detailed knowledge of the job. As a benevolent mentor, she bases her approach on goodwill, kindness and a genuine desire to help others. In our organization, Lali is the person who successfully combines benevolence with strict attention to detail and offers an orientation wherein each new person is taught to follow policy and procedure without deviation; and she does so in a gentle, supportive manner that affirms the self-esteem of the learner.

During the orientation process, Lali exemplifies the basic characteristics appropriate for a Master Teacher in the outpatient setting. She connects and relates to each new hire as a first priority; she is an excellent communicator; she has a thorough understanding of the expectations of the job and the goals of the organization; and, she makes the successful orientation of each new person an expectation and a reality. New people are not released to independent duty until they receive Lali’s stamp of approval.

Select a Master Teacher who…

…knows the job. It is essential for your master teacher to know the specific components of the job as well as being current on all policies and procedures that must be followed. The person you select as your master teacher must be able to set the standard for new hires to follow in their interactions with one another. Utilizing a qualified master teacher has the additional benefit of affirming both the teacher’s knowledge and her ability to connect to her peers.

… knows the team’s and organization’s values. During the orientation process, the master teacher isn’t just showing the new person how to accomplish the tasks related to the job; she or he is establishing a code of conduct for team interaction within the preferred workplace by role modeling the behavior. When orienting a new person, the MT gets one chance to do it right the first time. At the completion of orientation, the newly trained person must know how to do the job as well as how to interact.

… is a benevolent authoritarian. Successfully integrating a new member into your group involves their ability to do the job to exact specs and do it in such a way that it supports the mission, vision and values of the organization. To be in a workplace of choice, the person being orientated must perceive that he or she is competent, capable and valued. Using the benevolent authoritarian approach ticks off two big boxes. It creates a learning partnership in which the mentor gives the learner the security of knowing that failure is not an option, and it teaches work skills in an exact manner that affirms the new person as an important member of the team.

Having a benevolent authoritarian mentor on your team will pay huge dividends long into the future. Not only will your new team members become quickly fully functional, each will have formed lasting relationships and have a secure support system in place. To develop a preferred working culture and strengthen your entire organization, cultivate a benevolent authoritarian Master Teacher.

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

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

Buy now on Amazon Books

Hidden Jewels

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

Follow @procrnatom on Twitter

“I start with the premise that the function of leadership is to produce more leaders, not more followers.”

~Ralph Nader

Wouldn’t it be great if every person you hired already possessed 100% of the skills that are needed to be successful on your team? Perfect candidates do exist; however, searching for those hidden jewels is costly both in terms of time and money. A better option is to look within the existing team and develop their many concealed talents. Here are some reasons to make professional development a priority in your workplace.

Increased Performance. Your work environment is constantly changing as are the demands of the job. Delivering state of the art service requires ongoing education to keep up with advances in technology as well as the knowledge base. Just as your lawn mower blade needs sharpening every spring, peak performance of your staff is dependent upon constantly sharpening professional skills.
Increased engagement. In a preferred workplace there is someone who cares about your professional development. Ensuring that every person on your team has a plan to grow professionally infuses energy and loyalty while increasing engagement of the individual.
Increased retention. You can’t afford NOT to value professional development because it is linked to employee retention. Staff turnover carries an excessive cost both in money and morale. When expenses related to recruiting, hiring, credentialing and onboarding are considered, it may cost 1-2 times the annual salary to replace a licensed healthcare provider. In addition, team morale sags when a respected person departs, and the team is tasked with picking up the extra workload.

Discussing professional development with your employee at the annual performance review builds the expectation of opportunities for personal growth. Without follow-through, the discussion becomes a forum for hypotheticals and promises, and the disappointment that follows erodes morale. Professional development must be more than empty words at a once-a-year discussion; it must become a way of life that yields results for your team. Here are some ideas for infusing individual growth into your team members.

Professional meetings National and State meetings of professional groups are an excellent way to learn about innovative technology and to get updates on current research and best practice protocols. In addition, the gathering of professional peers creates a rich environment for networking. As the schedule permits, encourage your team members to attend.
Online meetings and courses Computer-based learning is an inexpensive alternative to attending meetings in person. Live, interactive webinars allow you to meet online with a group of peers, receive instruction and then have a live two-way discussion with the group. In contrast, pre-recorded webinars are accessible 24/7 but lack the opportunity for interaction. Many Universities offer coursed online that will lead to an advanced degree. For those geographically tied or too busy to travel, computer learning is a viable option. Be proactive and ensure that your team members can opt to use continuing education money to take advantage of online courses.
Mentoring Teaming up with an experienced person who has expertise in a specific area of interest is a practical way to expand skills. Whether your team member desires to update technical skills, practice public speaking, or improve professional writing, there is a qualified person in your organization who will help. Use your network of colleagues to find the right mentor for your team member.
Change jobs for a day A fun and straightforward way to add tools to a workbench is to spend a day working in a different area within the organization. Affirm your team members by helping them expand their professional network by facilitating a job swap for a day.
Professional social hour Set up a social hour for others who share your professional credentials and include people from other organizations. An informal gathering provides the opportunity to exchange information and increase your contacts. Continue by hosting other social events at intervals throughout the year.
Create an individual plan Don’t wait for your boss or your organization to put your future on a platter and serve it to you. Develop your own plan to increase your knowledge, skills and connectedness with others in your profession.

Increasing the skills and knowledge base of your team members is an expenditure of time and money, and a venture into professional development that will yield a high ROI. Professional development is economical and teaching new skills to existing team members pays for itself by providing an increase in productivity and savings from reduced staff turnover. Your organization includes many people with talents yet to be uncovered and cultivated. Among them is a hidden jewel who already exists on your team, ready and willing to be discovered.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

Connection

Make the connection

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

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In 2013, the Centers for Medicare and Medicaid services released a scathing report stating that 6 in 10 patients felt that they were not respected or heard by their healthcare providers. Even though most patients reported having received competent medical care, the majority felt a disconnect between themselves and the healthcare system. Similarly, one characteristic of an undesirable workplace is that workers sense that their opinions do not count and feel separate from the chain of command. Whether you are a patient or a worker, feeling part of the whole is essential for a successful relationship. Here are some principles for connecting with others that can be useful in both your personal and professional life.

Ask questions. There is something exceptional about every person you meet, and you will seldom discover their hidden interests unless you ask questions. As healthcare providers, we are trained to ask about symptoms that will guide the treatment we offer; however, we are less skilled at discovering the individuality of the person presenting with the problem. By asking patients about both symptoms and concerns, we open the door to connecting with their personal life and the implications of how their disease will affect relationships in the family and at work. Showing equal interest in the person and the medical condition is the first step to forming a meaningful relationship that will validate your patient as a unique individual.

Be a great listener. Asking questions is meaningless unless you unless you are focused to hear the answer. When listening, hear the words and try to understand the emotional meaning. A patient may describe an ache or pain while the real concern is that he may not be able to continue in a job or recreational activity. After actively listening, restate the perceived anxiety by saying, “I sense that you are concerned about…” When people feel that you understand on an emotional level, a common bond forms that validates the person as an individual and gives them a sense that you care.

Develop a Starbucks mentality. In old movies based in small town America, a local enters the store and the storekeeper knows the person by name as well as the details of his family. The customer feels welcome to be there and the attendant has a “customer is right” mentality with a desire to satisfy the customer. At Bux they welcome you as you enter the door by saying, “Welcome to Starbucks, what can I get started for you?” At Sams they refer to customers as “guests.” It’s part of customer service training at Bux and Sam’s to connect immediately through a warm welcome. Though healthcare is far from being a country store, interacting with a friendly, down-home attitude creates a personal link with patient and employee alike.

Discover areas of commonality. Finding and discussing common interests with another person is a wonderful way to establish unity. As you ask questions and concentrate on answers, you will discover similarities with the other person. Acknowledging shared values and areas of interest exposes you as a real person beyond your position as a healthcare provider. Be careful NOT to one-up the person by making your experience more important than theirs.

Acknowledge anxiety. Patients seek healthcare either to address a specific concern or to maintain their current health. Both scenarios carry anxiety; those with a problem fear the implications and those who are currently healthy fear the discovery of an unknown health problem. Assume that all patients are anxious and listen with empathy. Let the person know you are willing and ready to discuss both their medical condition and their concern about the consequences.

Be a friend. In a professional relationship, you do not need to become a BFF but it is important that the person views you as being genuinely friendly with an honest interest in their wellbeing. Establish a specialized relationship by encouraging the individual to tell you something that interests them on a personal level. A favorite question that I often ask is, “Tell me something about yourself that is not on your medical record.” Suddenly, the person fees as if he is more than someone in need of medical treatment, he is a real human being with a life of his own. Make it a goal to know the patient well enough to introduce her to a co-worker without reference to the medical condition. “This is Mary and when she is not with us, she cares for her grandchildren and loves to tend her garden.” By asking my favorite question I learned that my 63-year-old female patient was a pool shark. Another former patient was top 10 in table tennis in the State of New York. Each person, whether patient or colleague is unique and interesting.

Regardless of your position in healthcare or elsewhere, connecting with clients and colleagues is the key to success. Unlike finding a cure for cancer – a monumental task requiring years of research and a huge investment of resources – the perception of patients not being respected, as identified by CMS, can be cured today by healthcare providers who are focused on connecting with everyone they encounter. In fact, connection IS the cure.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

Great Leaders Inspire Loyalty

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

A really great boss is respectful, complimentary and kind, making each individual feel valued for what he or she brings to the team.

Loyalty to the company starts with loyalty to the boss. The elements of a preferred workplace include “an environment where employees look forward to spending their time and energy in exchange for the rewards that come with the job.” If you build the preferred environment by incorporating the following Behaviors of a Great Boss into your leadership style, you will inspire and connect with your team. They will respond by collaborating as colleagues and developing an enhanced sense of loyalty to you and the organization.

A great boss exudes personal character. The best leader bases decisions and interactions on honesty, integrity and fairness. The leader sets the example for conducting business within the team and trust develops as team members imitate the values they see in their leader. In a preferred workplace, strength of character creates a sense that colleagues cover each other’s back.
A great boss takes pleasure in helping others. Effective leadership starts with a one on one connection with each team member and a sincere desire to support the professional development of the individual. Rather than criticizing shortcomings, a great boss will find creative ways to leverage strengths while improving the person’s weaknesses. In a preferred workplace, everyone correctly senses that the boss cares about them and their needs.
A great boss gives recognition to team members for their ideas. Instead of hijacking the process and stealing credit for a job well done, a great boss will give full credit to the creative individual and take satisfaction from the team victory. Trust is enhanced when team members collaborate with the boss rather than competing for recognition.
A great boss clearly defines goals and expectations. As noted in Meeting Expectations, posted on ProSynEx.com, 3/19/2018, in a preferred workplace each individual knows the expectations of the job as well as the rewards that accompany completion of a job. In the most inspired environments, the leader outlines the goal, provides resources and then lets the creativity of the team kick in to complete the project.
A great boss aligns team activity with company values. Inspired teams must have a reason to exist and using the corporate core values to achieve the mission and vision gives the team a sense of purpose. When in alignment, team members sense a greater purpose for their work beyond the task at hand.
A great boss freely gives positive feedback. “Someone at work cares about my progress,” is tied to employee engagement and satisfaction within the workplace. Creative leaders not only seek original solutions to problems, they find unique ways to recognize and reward individuals for their work. From handwritten notes to public recognition, rewards are personal, simple and effective feedback.
A great boss is comfortable hiring smart and talented people. Instead of needing to be the expert, effective leaders hire people who are smarter than they are or people who complement their own skills and expertise, and then work together as thinking partners to leverage the talent of the expert to elevate the entire team. Leaders who “hire down” in an attempt to protect their egos stifle the professional growth of the team.
A great boss encourages open and two-way communication. Workers who can openly share and receive information from a boss without fear of repercussion develop a sense of safety that allows them to take creative risks when addressing challenges. In addition, relaxed discussion opens the door for a leader to know team members as individuals and creates a bond that often leads to two-way loyalty.
A great boss is optimistic. A leader’s confidence that “our team can solve a problem” is contagious and inspires workers to step up knowing that they have the full support of the leader. Focus on the desired outcome, the resources that are available, and the people who are available to assist your team. Running toward success is much more effective than running away from failure.
A great boss has a sense of humor. Lighten up and laugh. Listen to the stories that your team members tell and look for the humor in everyday occurrences. Within limits, find ways to make the workplace fun by sharing appropriate jokes, planting silly surprises for team members to discover or planning outings that include families and friends. Be creative and enjoy one another and make each other smile.

It’s human nature to be attracted to a vibrant workplace and it’s human experience that makes you want to stay. Be a leader who practices great-boss behaviors to energize engagement and galvanize job loyalty. Everyone wants to work in an exceptional environment on an award-winning team inspired by a great leader. Great bosses lead to loyalty.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

Meeting Expectations

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

Follow @procrnatom on twitter

“Every system is perfectly designed to get the results it gets.”

~W. Edward Deming

The face of the American workplace is changing as baby boomers exchange steel toed boots for sandals and millennials lace their shoes to enter the race. Whether seeking a lifetime of work on the assembly line or in a windowless OR, younger workers are seeking employment in an environment where they feel valued, are fully engaged, and where they can showcase their talent. Far from being lazy, they want to give full effort and prefer to do it where they are equally challenged and stimulated, a requisite that benefits both the employee and the organization. Writing in Chron, author Judy Brunot notes that fully engaged workers are 20% more productive and 90% more likely to stay with the organization.

Preferred workplaces are created to attract and keep the most talented workers. An insightful leader knows the benefit of having motivated workers and takes well-planned steps toward the goal of building a workplace of choice. Nationally known for their ability to assess employee engagement, the Gallup organization has identified knowing what is expected at work as a key element in a preferred workplace. Having, knowing and enforcing expectations sets boundaries that provide structure to employees while creating stability for the organization.

Leadership matters and those in leadership positions who are committed to build a preferred workplace must take advantage of every opportunity to set and communicate desired outcomes with their team. Here are three situations where the stage is set for you to describe your goals and clarify the requirements of the job.

Recruiting/hiring Those in the construction industry know the raw material that you use must be appropriate for structure the that is being built. Building your preferred workplace is like building an office building; you need a blueprint, the right material and the right people to put it together. Recruiting/hiring is your chance to get the right material for your team. In your recruiting ad, use the job description to define the workplace that you are building and state it as an obligation that the applicant will support your effort. At the interview, discuss your goals for the team as well as the organization’s mission, vision and values. Ask the applicant to describe his/her ideal workplace to determine if the applicant is a fit for your workplace of the future.

Onboarding/orientation Design a plan for bringing a new person into your organization that includes clear communication of the requirements for inclusion on your team. View yourself as a teaching partner and use a benevolent authoritarian style to plainly establish the work that is to be accomplished and the way team members are expected to work together to achieve goals. Newly hired people are open and receptive to instructions and strict mentoring during orientation will produce lasting results. You get one chance to get it right the first time and it is your job to ensure that the new person clearly knows your expectations by the time orientation is completed.

Ongoing team interaction. Existing members of your team need and deserve to know the what and the why if the standards for the team have changed. Workers who have been on the team for many years, or even decades, are working in an environment that didn’t exist when they were hired. As the workplace and the nature of the job evolves, so do desired outcomes. Use your team meetings to review mission, vision, values and goals and stimulate your team to discuss the action needed to achieve them. Active involvement and open discussion allows team members to establish behavior norms which positions people to hold one another accountable.

There are many components of a preferred workplace and skilled leaders are the master craftsmen capable of putting them together. Establish and communicate expectations, hire the right raw material, and challenge existing team members to help in the building process. Team engagement and productivity will ascend and exceed expectations.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

Let go and Empower your team

Let go and Empower your Team

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

Follow@procrnatom on Twitter

Micromanaging is a manifestation of the Authoritarian style of leadership in which the manager closely observes the details and controls the work of subordinates to an unnecessary extent. It is an aggressive form of management that places workers in a fishbowl where every action is watched, and any infraction of the leader’s vision is quickly corrected. Those who work for a micromanager seldom feel as if their opinions count and are in constant fear of repercussions for having expressed original thoughts or attempting new ways of accomplishing tasks.

Micromanagers were not necessarily born to be bullies; instead, according to an article by Andy Molinsky, the practice of usurping the power of others arises from the leader’s own personal fear and insecurity. High achieving workers are commonly selected as leaders, but once in place, they may realize that they lack background and training as a leader. Insecurity soon arises because despite being successful as a worker, they are fearful of not meeting the leadership expectations of the team or the organization. To reduce the chance of failure, a fearful, but highly competitive manager becomes an authoritarian who takes rigid control of every aspect of the job, insisting on giving approval before any action is taken.

The cost of Micromanaging

Micromanagers take pride in setting a high standard by producing perfect results. Perfection comes with a cost to both the team and the organization and eventually the drain on team morale and company resources may cost you your job. Here are some of the costs associated with micromanaging.

Workers may become fearful. When every independent thought provokes the ire of the controlling leader, workers tend to do only as told. Rather than putting their energy into creating the best experience for the clients, workers focus on NOT making mistakes and follow rules without exception. Over time, the insecurity of the leader spreads to the team and everybody walks on egg shells.

Creativity and innovation are lost. The insecure micromanaging leader who takes control of projects and insists on absolute compliance to his/her demands quickly puts an end to independent thoughts that may arise from team members.

Staff turnover is high. When subdued by a micromanager, creative workers feel stifled and look elsewhere for more fulfilling work and those who remain acquire an attitude of robotic compliance to the manager’s demands. Resources of the organization are drained as the cost of employee replacement grows and morale plunges.

Are you a micromanager?

Most leaders want to do a good job, and few would describe themselves as micromanagers. If the question were put to your team, how would they describe you? Self-awareness is the first step to overcoming your controlling tendencies and here are some signs that you may be a micromanager.

You are rarely satisfied with the work of others.
You rarely delegate and when you do, you tend to take the work back.
You must be involved with every aspect of a project.
Projects run behind schedule because you are bogged down in the details.
You expect to be copied on every email message.
Subordinates hesitate to act or refuse to move ahead without your approval.
You need to know what everybody is doing and where everyone is at all times.
You feel as if the only way to get it done right is to do it yourself.
Your team has unexplained high turnover.

Breaking the Micromanaging habit

If some of the signs above describe your leadership style, you and your team may have some tough times ahead. At some point, your team will either surrender and become low-producing zombies, or they will revolt and stage a mutiny. Either way, you will fail as a leader. Here are some tips for letting go of MICROMAGEMENT and laying the foundation for EMPOWERMENT.

Assess your own insecurity. Because the foundational emotion that drives micromanagers is insecurity, your management behavior will not change in a meaningful way until you address your own doubts. In most cases, you have more support than you realize, and people really do want you to succeed. View yourself as being a competent rather than competitive leader, leverage your resources and confidently lead your team by empowering each team member.

Let go of perfection. Perfection is in the eye of the beholder and those you assign to complete a task may visualize the final product differently than you. If the result meets the criteria established up front and benefits the organization, congratulate the team and celebrate their success. The sense of validation and accomplishment that team members feel when projects come to completion are more important than the project perfectly matching your vision.

Resist checking-in. Rather than demanding constant updates, arrange to check in at milestones or pre-arranged time intervals. Agree on goals in advance of the project, provide necessary resources then allow workers time and space to solve problems.

Require cc on only certain types of email. Take time to review the messages in which you have been included. Determine the type of information that you really need and that which is extraneous. Reduce your involvement further by requesting that your team NOT include you in every email exchange.

Designate a point person. Give total control of a project to a top performer and stand back. If releasing control makes you uneasy, start with a project that is easily within the capability of the point person. Based on your history as a micromanager, the person may be skeptical and you must give him/her a reason to believe that this is not a gimmick and, in fact, it is their project to complete.

Don’t get bogged down with the small stuff. As the leader your most important duties are defining goals, providing resources and motivating team members to accomplish tasks. Don’t get mired in the nitty gritty. If the project is staying on the timeline and progressing toward the goal as anticipated, keep your fingers out of the pot.

Micromanaging seldom works and is often associated with toxic work environments in which both morale and productivity suffer. Instead of tightening the screws on your team, empower them. Support your organization, improve relationships, build trust and elevate your position as a leader by loosening your grip on the reins and allowing your team to demonstrate its worth.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

Receive in Kind

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

Follow @procrnatom on twitter

“No kind action ever stops with itself. One kind action leads to another…A single act of kindness throws out roots in all directions, and the roots spring up and make new trees.”

~ Amelia Earhart

Kindness can change the entire culture of your workplace. The essential elements of a preferred workplace, including civility, mutual respect, and collaboration, are interwoven with the thread of kindness. The same level of thoughtfulness in the delivery of care to patients increases patient satisfaction. Kindness is contagious in the interactions of cohesive workgroups and can be the difference between staff retention and resignation. Take your team to the next level by doing catching acts of kindness that will quickly spread throughout your workplace and increase the effectiveness of your group.

Acts of Kindness. I recently worked in a busy suite of operating rooms where anesthesia providers pushed patients on carts or hospital beds from the pre-op area to the OR and then again from the OR to the recovery area. Many carts had defective steering devices and hospital beds were always heavy. Staff would make room for the struggling patient pusher to pass, then stand back and watch. Two newly hired people who noticed the difficulty of transporting patients, started helping direct carts around corners and through doors and within two weeks several others joined the practice. Within two months, with the simple act of assisting instead of watching, the culture of the entire work area changed. Not only did people continue to help one another transport patients, they started aiding in other areas as well.

Several Jewish CRNA friends in the mid-Atlantic region always volunteer for call on Christmas and Easter to enable their Christian colleagues the opportunity to be with family.

A nurse manager in the Midwest always greets patients and their families in the hallway and provides directions when needed. Despite being confined to a wheelchair secondary to an auto accident, she holds the door for people of all ages and gender, not just seniors…and does it with a smile.

My CRNA friend Sal and his wife Carol travel to Honduras to work as anesthesia provider and nurse one week every year. Augustine is a CRNA and friend who solicits other CRNAs to join him on mission trips.

James, a Chief CRNA in the Midwest, takes his office manager and one staff CRNA to lunch quarterly to reward each for their work, and to build a bond between the office staff and the frontline providers.

Michelle arrives early each morning, sets up her room and then goes room to room asking her colleagues if they need help.

Another chief CRNA, who began this practice long before the advent of Facebook, emails a personal Happy Birthday well-wish to each of his staff, and copies the group.

Kindness is contagious. An article in the highly respected APA peer reviewed journal, Emotion, describes a study done in a workplace where employees were placed in 1 of 3 groups. Those in the first group were assigned to perform designated acts of kindness for specific people in group 2. The third group acted as the control group for the study, neither offering nor receiving acts of kindness. The study revealed that those on the receiving end in group 2 were more likely to react by offering kindness to others. In the spirit of pay it forward, the thoughtfulness of a few spread rapidly and changed the culture of the work environment.

Kindness elevates patient satisfaction. Kindness affects the overall experience of our patients and their families as reported by www.winnipegfreepress.com with feedback from a Canadian patient by the name of Z. Soloman. Ms. Soloman’s experience is exactly the one all healthcare wish to provide. “Kudos to Victoria General Hospital for recruiting and retaining staff who treat patients with (such) respect and kindness. I rate my stay as 10 out of 10.” Ms. Soloman’s experience elevated her satisfaction and raised the hospital’s scores.

Give gladly and receive in kind! You can be a catalyst in changing your healthcare workplace to a culture defined by kindness just by being more attentive to the needs of others. Pay it forward by offering assistance when appropriate, or challenge yourself to perform several unsolicited kindnesses daily and watch the culture change. It starts with you.

“The greatest work that kindness does to others is that it makes them kind themselves.” ~ Amelia Earhart

Special thanks to my wife and editor, Liz Sanner Davis for contributing to this article.

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

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

Ear of Empathy

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

Follow @procrnatom on Twitter

Empathy depends not only on one’s ability to identify someone else’s emotions but also on one’s capacity to put oneself in the other person’s place and to experience an appropriate emotional response.

~Charles G. Morris

From day one, Nursing School students are taught the importance of empathy when helping patients and their families through stressful, and sometimes life ending, events. There are countless stories describing the dedicated work of Florence Nightingale and Mother Teresa who alleviated so much suffering for those in need. Neophyte nurses are encouraged to connect with, understand and share the emotional experiences of their patients in order to foster a sense of trust. Full of good intentions and a sincere desire to become pillars of support, new students are thrown into the hectic and demanding world of patient care where completing a task is frequently more important than providing emotional support, thus losing an opportunity for empathy. Lost opportunities for empathy due to the high demands of healthcare and affects relationships in other areas of business and industry as well.

In the modern workplace, leaders with deep understanding are as important in developing effective teams as compassionate nurses are in supporting troubled patients. Writing in the DDIWorld blog, Author Stephanie Neal identifies empathy as a top 10 topic for effective leadership. A companion article states, “Overwhelmingly, empathy tops the list as the most crucial driver of overall performance.” Clearly, grassroots understanding is a valuable skill that is essential for high performing teams and deserves the attention of anyone committed to developing a team in which performance is high, and workers are valued.

What Empathy is

The Oxford Living Dictionary defines empathy as “The ability to understand and share the feelings of another.” This unique capacity to understand goes beyond listening and requires using your past experiences to comprehend what the other person is feeling and to respond in a manner that shows you care.

Whether you work in a busy healthcare setting or in some other business environment, every person you encounter brings a separate set of experiences, emotions and concerns to the workplace. You may not be able to solve another person’s problem, but when they perceive that you understand and care about their wellbeing, they are better able to relax, lower their defenses and have a more productive day.

What empathy is not

Empathy is not sympathy. When being sympathetic, one person shows pity or sorrow for the misfortune that another has experienced. The person offering sympathy may have a sincere desire to comfort the other person; however, with sympathy the focus is on the misfortune rather than sharing the emotion that your colleague or friend is feeling.

For example, several months ago while teaching leadership skills to a group of managers, I moderated a practice session in which one person was assigned to ‘listen empathetically’ to a person who described a problem that she was experiencing with her team. Person A described the problem and the negative effect it had on her team. Person B replied, “I know exactly how you feel, this is what happened to me,” and went on to tell of his woes. To which person A replied, “Yes, but you didn’t have … going on.” The discussion quickly digressed into a competition where each unknowingly sought to be the victim who had suffered more. Because Person B focused on his own external events while ignoring Person A’s internal needs, both people quickly became combative and alienated.

Connect using empathy

Powerful leaders recognize the negative effect of emotional baggage which burdens a worker and blocks his ability to function at the highest level. Connecting in an empathetic manner offloads some of the inner stress and lets the worker know that someone cares about their concerns. Here are some tips for using empathy to deal with a stressful situation. Each tip builds on the previous one and when applied consistently, will have lasting results.

Have a physical presence. Interacting with members of your team on a personal level requires that everybody knows you and that you know them. Policies, procedures and planning are all important; however, they are not an excuse to stay in your office. Having daily, friendly conversation with team members builds a foundation of trust that will serve as a platform for finding solutions to personal problems. Developing trust with the team member means they feel comfortable sharing with you, knowing you will listen, understand and maybe shore them up when needed. Plan several daily walk-arounds in your workplace to become acquainted with every person and remain connected to the team.
Recognize stress in others. Knowing each team member individually places you in a position to sense when something is wrong and that if you perceive a person doesn’t seem to be him/herself, you are probably right. A solid inter-connection tells you that an issue is hiding below the surface. Trust your senses and don’t ignore the change that you have detected.
Listen to understand. If you intuit a problem, find a private place and have a conversation that encourages the distressed person to talk about their problems/concerns. While listening to the words, try to expose the emotions that are driving the person’s concern. Between the lines you may hear them shouting, “I am afraid, I feel inadequate, I feel threatened, I feel invalidated,” or some others spoken response.
Label and name the emotion. Once you have listened to the details of the person’s concern and sensed the underlying emotion, put a name on it. Call it what it is, perhaps fear, insecurity, disrespect, frustration, anxiety, anger.
State the emotion. Stating the emotion that you detect sends the message that you understand what the other person feels. Re-state the basic details of what the person said and if your understanding of the problem is confirmed, continue by naming the underlying emotion that you observe. Here are some examples:
- “I sense that you do not feel respected.”
- “I sense that you feel alone on this project.”
- “I sense that you are concerned about your patient’s safety.”
- “I sense that you are fear harming your patient.”
- “I sense that setting boundaries makes you uncomfortable.”

Connect the dots

You have listened to gain depth of understanding and you have restated the issue and agreed on a label for the emotion that the individual is experiencing. Now you can thoughtfully suggest some solutions to ease the individual’s distress.

Responsiveness is a crucial leadership skill that improves employee engagement and productivity. You may be a natural or you may have to learn to be a truly concerned listener, one who understands emotions and cares about people on a personal level. As a leader you can engage with an empathetic ear to build relationships, improve morale and increase productivity – a triple win for you, your team and your organization.

When you show deep empathy toward others, their defensive energy goes down, and positive energy replaces it. That’s when you can get more creative in solving problems.

~Stephen Covey

Special thanks to my wife and editor, Liz Sanner Davis.

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

Mark your calendar and Join Tom and a group of leaders for the next values-based leadership webinar in July 2018. Click here for information.

Keep Your Drive Alive

Keep Your Drive Alive

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

Follow @procrnatom on Twitter

Whether you’re doing a google search for effective leadership, reading a leadership book or attending a motivational presentation, you will learn that both leadership and teamwork take effort. Successful leaders are driven from within, exuding optimism and high energy like the little engine that could. However, the process of being energetic while motivating others can be draining and can wear down the inner spirit of the leader. Here are some thoughts on maintaining your self-motivation and a few simple tips for stoking your inner engine.

Know your internal motivators

The specific motivators that flip your “on” button and get you going vary from person to person; however, the following are known to be intrinsic motivators for high achievement in both your professional and personal lives.

The feeling of self-satisfaction Leaving your job at the end of the day and knowing that your work was high-quality gives you a sense of accomplishment that makes you want to come back tomorrow for another dynamic day. The upbeat feeling can be carried home to continue as you make a difference in the lives of those who are significant to you.
The pursuit of knowledge According to the Gallup engagement survey, opportunity for improving your knowledge and your skills is a motivator and contributes to making one workplace better than another. Don’t wait for your employer to offer a professional development plan, rather, take it upon yourself to identify an area of interest, develop a personal plan and learn new skills.
The challenge of solving a problem The release of inner creativity provides powerful incentive for self-motivation. Being dared to streamline a process or solve a problem is energizing and makes you want to take on larger challenges.
The feeling of self-worth Knowing that you make a difference, or the difference, to a patient, co-worker, or organization is a strong self-stimulant. It creates connectivity and inspires the desire to return tomorrow for another opportunity to serve others.

Seek external rewards

Along with intrinsic motivators, extrinsic factors bolster optimism and fuel you with the energy to continue your commitment to the job.

Tangible rewards Working at an elevated level of achievement may uplift self-worth however is does not pay the bills. Tangible rewards in the form of pay and benefits are strong motivators for showing up and doing a respectable job. Extra rewards in the form of a prize or bonus motivate good workers to give even more effort to the job.
Public recognition/praise In addition to winning a prize, being held up as an example of excellence in a public forum is a strong motivator. Whether in a team meeting or on the company billboard, being cited as a positive example is motivating.
Promotion Being selected to move up in the organization and take on additional responsibility creates an inner desire to give more and show that you deserve the trust that has been placed in you.

Simple Tangible Tips

Built on known internal and external stimuli, these tangible tips will motivate you to feed the fires within, without burning out.

Release feel-good hormones. Writing in The upward spiral, neuroscientists and authors Alex Korb and Daniel Siegel document that gratitude and optimism make you feel good because they cause the release of dopamine and serotonin in the brain. Both hormones elevate your mood and create a sense of well-being which ties into a more positive attitude. Set aside 10 minutes for daily reflection, preferably at the same time every day. For some it will be at the beginning of the day and for others it will be at bedtime. In the first 5 minutes, recall people and things for which you are grateful. In the second 5 minutes, think of upcoming events or opportunities that create a sense of optimism within you. Those two activities will stimulate the release of dopamine and serotonin which, according to Korb and Siegel, will make you feel and sleep better.
Complete a task. Building success on success is motivating and creates the feeling that you can handle even bigger tasks. If you don’t know where to start, pick something simple that can be done easily. Something as modest as committing to take out the trash is a tangible activity and may even motivate you to do something else when you return.
Make a healthy choice every day. Recognize your self-worth by doing something healthy for your mind or body every day. Making a plan and enjoying an activity that promotes nutrition, sleep, exercise or meditation today restores the energy level needed to have a productive day tomorrow.
Close the day with positive thoughts. End your day by identifying something that you are looking forward to tomorrow and give yourself a reason to get out of bed bright-eyed and bushy-tailed. If you combine optimistic thoughts with gratitude and thanks, you will experience the bonus benefit of the release of your brain’s happy hormones as you drift off to sleep.

You may be a team leader, or you may be a productive team member, regardless, it can be difficult to maintain your inner motivation constantly. Pace yourself in your work and become aware of the intrinsic and extrinsic activities that encourage your intent to remain highly productive. Use the tangible tips in this article to pour fuel on your inner fire and, like the little engine that could, never stop until you reach your goal.

Special thanks to my wife and editor, Liz Sanner Davis.

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

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

One Week in January

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

Follow @procrnatom on Twitter

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

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

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

Special thanks to Liz Sanner Davis for editing and collaboration.

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

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

Get Fit for Duty

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

Follow @procrnatom on Twitter

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

Get motivated

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

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

Change your behavior

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

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

Use technology

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

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

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

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

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

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

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

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

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

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

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

Special thanks to Liz Sanner Davis for editing and collaboration.

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

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

Stop It!

Stop It!

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

Follow @procrnatom on Twitter

Al Franken to resign… New York times

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

Matt Lauer…axed New York Post

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

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

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

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

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

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

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

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

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

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

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

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

Special thanks to Liz Sanner Davis for editing and collaboration.

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

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

Step It Up

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

Follow @procrnatom on Twitter

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

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

From: The Winter Sea by Susanna Kearsley

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

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

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

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

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

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

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

Resolution Reality

Resolution Reality

(The art creating change)

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

Follow @procrnatom on Twitter

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

Work from the positive

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

Work from your personal values

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

Focus on today’s behavior

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

Putting it all together

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

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

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

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

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

Infuse the Holiday Spirit

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

Follow @procrnatom on Twitter for leadership tips

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

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

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

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

Make it fun and festive

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

In the break room

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

At your team meeting

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

One on one

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

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

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

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

The Social Media Connection

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

Follow @procrnatom on Twitter

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

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

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

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

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

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

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

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

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

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

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

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

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

“The book that goes beyond theory

and creates great leaders.”

Now available on Amazon Books

Don’t Be Distracted

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

Follow @procrnatom on Twitter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Be Thankful, It’s Healthy

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

Follow @procrnatom on Twitter

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

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

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

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

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

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

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

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

Be thankful, it’s healthy.

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

The OR Blame Game

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

Follow @procrnatom on Twitter

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

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

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

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

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

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

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

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

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

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

The Satisfaction Connection

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

Follow @procrnatom on Twitter

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

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

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

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

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

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

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

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

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

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

Coming soon: Values based Leadership Webinar series.

Millennial Magic

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

Follow @procrnatom on twitter

“The slow one now will later be fast,

As the present now will later be past.

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

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

Yes, The times, They Are A-changing

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

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

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

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

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

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

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

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

Connect Through Recertification

By Thomas Davis, CRNA

Follow @procrnatom

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

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

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

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

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

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

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

Determine eligibility for recertification Whether the person recertifies this year or is mid cycle, determine where they are in obtaining the required continuing education.

Review the professional education that the person has received over the past two years. Discuss ways in which they can share their knowledge with the group.

Plan professional education for the next two years. Make note of any special interest that the person may have and discuss ways in which developing the interest will benefit the group.

Explore enrichment opportunities beyond the required continuing education. Many organizations offer in-house learning opportunities that do not award continuing education credit. Discuss ways in which the individual can pursue interests and grow professionally regardless of the credit that is awarded.

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

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