Category: Leadership articles

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

Infuse the Holiday Spirit

Infuse the Holiday Spirit

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

Follow @procrnatom on Twitter for leadership tips

 

holiday postThe 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 Twittersocial media post

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

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

Thankful postBe 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!” has very little effect.  Taking an individual aside and telling him/her “I really appreciate the work that you have done today.”, 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

fault post

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

Times achanginThe 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

 

nbcrnaNurse 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

Start Tomorrow Today


Start Tomorrow Today

By Thomas Davis, CRNA

start tomorrow todayEffective leaders in healthcare, and across corporate America, are known for being very busy and efficient using effective schedules. Those who make it to the top leadership positions may appear to have everything under control as they progress through massive schedules. Although top executives have a support staff to help them maneuver through the day, their ability to navigate the workload goes beyond a skillful staff. CEOs have learned early in the game to establish a daily routine and weave it into it an agenda that the support team helps bring to life. An important component of the daily schedule is the end of day routine where the leader closes today and plans for a productive tomorrow.

Healthcare leaders work in an especially chaotic environment and by the end of the day it is tempting to pack up and leave. But if you skip out the door too quickly, you will deny yourself the opportunity to grow as a leader. The end of the day is a special time for you to reflect on the successes and challenges of the day, and to prepare for tomorrow. Leaders at any level will benefit by following these examples for routine and reflection.

• Block the last slot on your calendar for your shut down routine.
• Clean the clutter from your desk and your computer. Remove scrap paper and throw away everything that you do not absolutely need to keep. When in doubt, throw it out. Close any open files on your computer and reply ONLY to urgent email. Caution: Do not sacrifice your EOD routine by browsing through email and social media.
• Review the tasks on today’s to-do list and assess your effectiveness in bringing things to closure. Assess whether or not you were successful in completing your top priorities and determine which items to move to tomorrow’s to-do list.
• Close your eyes and visualize your biggest challenge. Relax and ask yourself WHAT questions such as, “What are other resources that I have not used?” “What if I re-prioritized my to-do list?” or “What piece of information is needed to allow the project to move forward?” Writing in the British J. of Psychology, Wieth and Zacks note that your brain is most creative when it is groggiest. Relaxing you tired brain and thinking through your upcoming challenges may give you insight that will solve tomorrow’s problem.
• Thank someone for their contribution to your personal success or the success of the team. Regularly recognizing others puts you and someone else in a positive frame of mind. In addition to showing thankfulness, sometimes offering forgiveness is important and appropriate.
• Review both your schedule for tomorrow as well as your to-do list. Make sure that your list reflects your priorities and that you have adequate resources to complete your list.
• Leave work at work and go home. On occasion you may need to finish something at home but routinely extending your work day into the evening will cause burnout and actually detract from your effectiveness.

Place value on your own after-work activities and develop the routine that works for you. To end my day with an established routine after leading a team of 110 healthcare workers, I created CROTE. Clean, Reflect, Organize Thank, Exit.

It’s All About You

It’s All About You: Keeping Resolutions

By Thomas Davis, CRNA

 

 

For many of us, starting the New Year is an opportunity to hit the reset button and change things that are not working well. When you look back this year, do you see a list of good intentions that were never accomplished? Do you know why?  Here is some solid advice for making New Year’s Resolutions that you can keep.

 

It’s All About You. Simply making a list of good intentions, does not solve a problem. To be effective, your resolutions must represent you and your resources. If you cannot reasonably achieve them, you are wasting your time and your commitment will only lead to frustration without results. When resolving to make change, consider the following:

  • Resolutions must be doable. By definition, a New Year’s resolution begins January 1. Be sure that a goal is within your grasp and that all the resources are available so you can start now.
  • The resolution must be within your control. You will not lose weight by asking others to give up cake for dessert. Likewise, resolving to help a child achieve straight A’s second semester is also a lofty goal, but you can’t control the final outcome. However, resolving to lose 5 pounds and to read 6 news books this year are goals that are totally under your control…as long as you are the one giving up the cake.
  • NYR’s must be specific and measurable. A resolution described in general terms leaves you with vague intent rather than firm commitment. “Ing” intentions like losing weight, exercising more, smoking less, or being happier are undefined with no end point. In contrast, “I commit to losing 10 pounds by exercising 30 min 3x a week,” or “I will stop smoking completely by April 1,” are both specific and can be measured. With an appropriate and measureable resolution, you will be able to answer yes/no as to whether or not the resolution was kept.

 

  • Accountability enhances success.   Accountability can provide an incentive to actually make the change that you want. You can avoid the easy anchor of status quo and create accountability by attaching a timeline to your resolution. Ensure that your resolution is doable, under your control and measurable, and give yourself a deadline. After setting a goal of losing 10 pounds, resolve that you will lose 1 pound per week for the next 10 weeks so that by a certain date you will weigh ten pounds less. Important: Put your timeline on your calendar.

 

  • Share your intent with others. Telling others about your resolution is another means of accountability that puts you in a position to reach the goal and get praised, or to fail and look foolish. It’s even more helpful if a friend with a similar resolution joins you and holds you both accountable. If you mutually establish 3 workouts per week as your resolution, arrange to exercise or walk together several times a week.

 

  • Seek support on social media. Social media is another venue for getting accountability. Publicly sharing your goal and your progress takes courage and invites a large and connected community to cheer you on. Nobody wants to fail while their 400 best friends are watching, and by revealing your resolution, you may also generate support from your true friends.

 

New Year’s Resolutions mark the passage of time and open the door to opportunity. Create your list with confidence and use positive language by stating your goals like affirmations. Begin each item with the words “I WILL” and mean it, and if you lapse, don’t abandon your resolve. Double down and get back on track. Realistic New Year’s resolutions, combined with commitment and accountability, will ensure success.

Thomas Davis is an experienced clinical anesthetist, leader, speaker and CEO of Frontline Synergy.  Enhancing leaders, Empowering teams

Who wants to be a millionaire leader?

Who wants to be a millionaire leader?

By Thomas Davis, CRNA

Keep up to date with healthcare leadership topics,

 

lifelinesAfter several decades in the workforce observing the leadership skills of former bosses as well as peers in leadership roles, I have yet to meet anyone who wants to fail as a leader. Regardless of the leadership position, from entry level to CEO, people want to be recognized for their excellence. They want to be remembered as being a great boss. They want to meet organizational expectations while engaging and empowering each team member. In their minds, they want it all.

Not all leaders make it into the elite group who are remembered as being a “best boss.” Though all start with the same desire and most will follow up with honest effort to be the best, some will be remembered fondly while others will be remembered as failures. Why do some excel while others fail?   Try taking a little game show advice to create your leadership game changer.

In 1999 Regis Philbin introduced the popular British TV game show Who Wants To Be a Millionaire? to America. Like people in leadership positions, the contestants on the show were given a series of questions to solve. Each contestant drew upon their personal knowledge base to answer progressively more difficult questions. When a contestant was unsure of the answer, they were allowed to use lifelines and ask for help. Contestants would ponder the nature of the question and choose between asking help from an expert, a friend, or by polling the audience.

As a leader, you are presented with problems on a daily basis that require your attention. Because of your background knowledge of both the organization and your team, you are usually able to quickly find solutions to problems.   However, like the contestants on the game show, now and then you are unsure and need help. Turn to your lifelines for support.

Ask an expert.   Seeking the advice of an expert is a viable option when stumped with a problem that is tied to a specific body of knowledge. Large organizations tend to have more experts on staff and advice is readily available.  If your organization is small, you may need to look outside to find a similar expert. Regardless, you want to be successful so contact an expert and ask your question. Caution: Although the expert has advanced knowledge, he does not know your workplace, your team or the context of the problem you with which you are faced. An expert may suggest applying general principles to what they think is the problem. Sometimes that’s a hit and sometimes it’s a miss, so when you seek advice from an expert, consider that they may be wrong. If your results are similar to the TV show, an expert will only get the right answer about 50% of the time.

Ask a friend. If the expert didn’t know the answer, your friend may. When people use a friend as a lifeline, they usually pick a friend who has a broad knowledge base and a lot of common sense. As your friend, they have a general idea of what you do and the challenges you face. As a leader who needs to ask a friend for advice solving a work-related problem, talking to a trusted peer or mentor will open a discussion with someone who can understand the nature of the problem. If you were on the TV show, your friend would be right about 65% of the time.

Poll the audience. In your workplace, you don’t have to poll a group of ordinary people who happened to score a ticket to the show. You have a qualified audience called a team. Gather your team into a town hall meeting and discuss the problem. You already know your own thoughts so be careful not to poison the pool of knowledge by sharing your ideas before listening to theirs. A better approach is to present the problem to the group, then close your mouth and listen. Take notes and ask follow-up questions to clarify ideas. Your team is on the front line and will be the ones implementing the solution. They have first-hand knowledge of the implications of the problem and the solution.   If you were on the TV show, your team would be right a whopping 95% of the time

Open your mind to the concept that the collective wisdom of your team holds the answers to most of your challenges. Listen carefully and agree on a plan that includes a timeline for implementation. Use your lifelines wisely and you will score points with administration and with your team for being a great problem solver and a millionaire leader.

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

Effective Listening

Beautiful Vietnamese business lady consulting client in the office

Keys to Effective Leadership: Listening

By Thomas Davis, CRNA

Nurse Managers and other frontline healthcare leaders want to be known as the boss that everybody wants to work for.   It is only natural to want to set goals that build your personal reputation and the success of your workgroup.   Being a good listener is foundational to achieving your goal and here are 2 guaranteed ways to increase your listening skills

  • Listen to understand
  • Listen to emotions

 

Listen to Understand

People want to be heard and understood.   When asked about the traits of their best boss, people will frequently say that it was a person who listened and at least tried to understand them. Conversely, when asked about their worst boss, they describe a person who was distant, isolated and out of touch with the needs of the individuals in the group.

The key to effective communication is effective listening.   Leaders often put two barriers between themselves and effective listening: the hectic pace of the workplace and the demands on time. Both factors place the leader at risk to be distracted while talking with a member of the team. Just like the raffle at church, you have to be present to win. Somebody on your team finally has the courage to open up to you with a problem and your mind is elsewhere! Whether you’re in the hallway or in the office, value the information that each member of your team offers and give them 100% focus when they talk to you.

The second and more difficult barrier to overcome is the tendency to prepare your response while the other person is talking. I call it agenda listening. You can’t fully appreciate the message the person is delivering if you are focused on your rebuttal. Serious listening is like drilling into the mother lode. By listening to learn, you will gain insight that will elevate you as a leader. Forget about your reply and listen carefully and hear everything that is said. You don’t have to agree but you will benefit from knowing their point of view.

Points:

  • Learn from listening.   Appreciate the gift you are being given.
  • Restate the other person’s position to ensure you both agree on what has been said.
  • Encourage the person to tell you more. Build on what they say with replies like, “Tell me more about…”
  • Encourage the person to clarify by asking how questions.   “How can we do that?” “How will that benefit the group?”
  • Avoid questions that put the person on the defensive.  Asking “why did you” puts them on the defensive and looking for an explanation.

 

Listen to emotions

As educated professionals, we listen with an academic ear. As team leaders, we must listen to both content (actual words) and the emotion that drives the words. We like to think that we are rational beings and that the argument founded in fact will win. Not so. We also have an emotional side and emotions frequently trump logic when interacting with troubled team members.  In a famous study, Albert Mehrabian noted that only 7% of what is communicated comes from actual words.  Tone of voice and body language make up the other 93% of communication. Maybe that is why so many email and text messages are misinterpreted.   As an effective leader, listen not only to the words but also listen to the tone and watch the body language to pick up on the emotion behind the message.

Points:

  • Allow people to feel how they feel. Telling them how they should feel ends communication.
  • Make open-ended statements about the emotions that you observe and listen to responses.
    • “I sense that you are uneasy with this proposal”
    • “You appear concerned about….”
  • Welcome and encourage team members to suggest solutions.

 

As a leader, your greater goal is to have a cohesive and effective team where each member is valued not only for the work that they do but also for the person who they are. Listening is the foundational element to build a one on one relationship with each team member.

 

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

Building Common Purpose

Building Common Purpose

By Thomas Davis, CRNA

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

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

 

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

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

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

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

Create a common purpose

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

 

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

Implement Change

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

 

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

 

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

When a Barrier Falls

When a Barrier Falls

By Thomas Davis, CRNA

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

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

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

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

Removing personal barriers

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

Removing team barriers

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

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

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

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

Leading Frontline Change

Leading Frontline Change:

Today’s leadership investment yields tomorrow’s team dividends

By Thomas Davis, CRNA

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

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

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

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

Build on a solid foundation  

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

To be an effective leader:

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

 

Do your Homework

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

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

Before you meet with your team:

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

 

Communicate

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

To keep the team informed:

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

 

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

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

Advice from Mom

By Thomas Davis, CRNA

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

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

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

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

 

Building a family

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

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

 

Building a business

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

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

 

Building a good name

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

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

 

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

 

 

The Value of Vision

By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

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

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

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

Effective Leadership

Leadership

By Thomas Davis, CRNA

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

 

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

 

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

 

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

 

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

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

 

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

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

 

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

 

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

 

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

Getting the Right Match


By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

Chief CRNAs are Team Builders


Chief CRNAs are Team Builders

By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

 

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

The strategy that will fix healthcare

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

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

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

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

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

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

Click here to read the original article

Chief CRNA: Building a Safe OR Environment

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

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

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

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

Chief CRNA: Supervision and Billing Fraud

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

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

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

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

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

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

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

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

 

Chief CRNA: Disabled Alarms Cost Lives

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

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

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

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

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

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

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

Chief CRNA: Collecting Compensation Information

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

Please provide the following information:

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

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

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