Tag: AANA

Reverse mentoring; Unite and enlighten the workplace.

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

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

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

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

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

Reverse mentoring is equally important.

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

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

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

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

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

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

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

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

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

Exterminate your ANTS; Conquer Automatic Negative Thinking

By Thomas Davis, DNAP, MAE, CRNA

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

Is your head filled with ANTS?

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

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

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

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

Exterminate the ANTS

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

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

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

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

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

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

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

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

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

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

Production pressure; Tame the wild beast

By Thomas Davis, DNAP, MAE, CRNA

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

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

What is production pressure?

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

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

What is normalization of deviance?

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

Production pressure, normalization of deviance and wrong site surgery.

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

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

Be a high reliability organization

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

Develop a traffic circle mentality

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

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

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

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

Take control of Holiday stress

By Thomas Davis, DNAP, MAE, CRNA

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

~Song by Andy Williams

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

It’s the most stressful time of the year

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

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

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

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

Practical tips for managing holiday stress

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

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

Anticipate and prepare for external stressors

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

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

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

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

Create good cheer and positive vibes for the Holiday season

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

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

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

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

Create an empowering workplace

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

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

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

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

~Zig Ziglar

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

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

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

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

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

– Margaret Mead, American cultural anthropologist

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

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

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

Click here to listen to the Podcast

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

Take charge of your professional development

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

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

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

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

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

Taking charge of your future is empowering

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

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

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

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

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

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

Accept responsibility for your personal growth and development

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

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

Be a Rising Star in your Profession

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

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

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

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

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

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

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

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

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

By Thomas Davis, DNAP, MAE, CRNA

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

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

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

Teaching

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

Coaching

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

Mentoring

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

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

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

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

Set boundaries at work and in your life

By Thomas Davis, DNAP, MAE, CRNA     

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

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

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

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

Set boundaries at work and in your life

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

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

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

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

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

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

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

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

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

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

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

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

The Doctorate degree: Do I need it?

By Thomas Davis, DNAP, MAE, CRNA

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

Why a doctorate degree and why now?

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

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

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

Does the Doctorate degree make me a better anesthesia provider?

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

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

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

Which doctorate degree is best for me?

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

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

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

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

What is my next step?

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

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

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

Halloween Leadership Lessons

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

— Elvis Duran

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

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

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

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

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

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

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

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

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

Core Competency for Leaders

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

Bucket list leadership lessons

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

Encore Synposiums Online

Well known for vacation meetings at resort hotels across the country, Encore Symposiums has temporarily converted to an online format due to COVID 19 restrictions. Although participants are not able to enjoy the luxury hotel, the quality of the meetings has been preserved by knowledgible and dynamic speakers giving live presentations via the Zoom platform. Participant response has been positive as indicated by the comments below.

Nancy LaBrie and the Encore faculty look forward to returning to live meetings as soon as restrictions are lifted.

“I attended my first “webinar conference” this past week; Encore Symposium Aug 3-6, 2020. While I prefer an in-person conference, I was pleasantly surprised at how well it was done and how easy it was to participate. I think attendees were more apt to participate and dialogue in an on-line “chat” discussion vs in person at a face-to-face conference. I will strongly consider the webinar venue again. I have attended several, and often recommended Encore Symposiums to other colleagues. Nancy always has excellent speakers and a wonderful potpuri of interesting topics and when in person, the venue is unmatched. My favorite portion of the Encore’s conference is always the legal presentations. The attorney speakers are consistently phenomenal. “

From AS. ” I recently attended the Newport virtual seminar. Speakers were excellent and with wealth of knowledge.   I will definitely attend encore seminar again.  Hopefully it’s in person next time.   “

5 ways to get more from your video meeting

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

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

Three Essential B’s for Effective Teambuilding

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

~Kat Cole

Be present

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

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

Be empowering

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

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

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

~Christopher Reeve

Be resilient

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

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

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

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

Ace your video interview

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

Ace your virtual interview

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

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

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

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

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

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

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

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

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

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

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

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

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

~John Maynard Keynes

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

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

Life lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

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

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

You are only a leader if others are willing to follow

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

You must be present to win

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

Protect your reputation

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

Be good to people and build good relationships

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

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

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

Establish your health early and maintain it for life

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

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

Invest wisely

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

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

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

Get Results

By Thomas Davis, DNAP, CRNA

Follow @procrnatom on Twitter

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

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

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

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

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

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

How to Achieve Results

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

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

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

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

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

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

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

Tom is an experienced leader, author and requested speaker. 

When it’s up to you



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on Twitter

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

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

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

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

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

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

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



Welcome to Club 85

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Preface to Prevention

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

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

Club 85

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

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

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

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

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

Connect the dots

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

Preparation for Prevention

Exercise

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

Nutrition

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

Hydration

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

Sleep

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

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

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

Tom is an experienced leader, author and requested speaker. 

Get wise to the elderly

Get wise to the elderly

Follow@procrnatom on Twitter

“Age should not have its face lifted, but it should rather teach the world to admire wrinkles as the etchings of experience and the firm line of character.”  ~Ralph Perry

Statistics reported by the Population Reference Bureau revealed that in 2016 over 51 million Americans were over the age of 65, and it predicts that the number will increase by over 50% in the next 20 years reaching 78 million by the year 2036.   This precipitously increasing demographic has implications for current healthcare leaders related to how we interact with our customer base and how we prepare our teams to meet the challenges that accompany the aging population.  If there were ever a fertile ground for honing leadership abilities, this is it.  The rapidly expanding elderly population is a veritable gold mine of opportunities for leadership skill development. 

Emotional intelligence

Emotional intelligence remains a buzz word in the human resources/management community. A highly desired skill for leaders at all levels, it has an internal component that requires you to  gain insight about your personal emotional reactions and their effects on others, and an external component that requires the development of social awareness and of skills related to relationship management.  Working with aging patients opens the door for a leader to connect with and gain social awareness about the features that make this population unique.  Learning to relate to one demographic smooths the path and makes it easier to learn about other populations of patients.

Take a sincere interest, ask questions, listen

Older patients are full of amazing stories and will eagerly share if asked.   Expand your listening skills by asking questions and then listening to the stories that emerge.  Your 74-year-old patient who is next in line for cataract surgery may be the one who scored the winning touchdown in the 1970 Rose Bowl; his wife (and designated driver) might have been a flight nurse evacuating casualties from Viet Nam.  You won’t know until or unless you strike up a conversation.  When you have time to chat with boring old people, consider the following:

  • Those now in their 70’s were the students marching for civil rights in the late 60’s and were back in the streets marching for women’s rights in the early 70’s.
  • Senior citizens were born into a world with hard-wired phones and TV sets connected to an antenna on the roof and receiving only 3 channels.
  • Many Seniors remain actively attached to social activism in the form of “volunteer” at hospitals, museums, schools and civic events.
  • Seniors have traveled to your bucket list places and many have interesting hobbies.
  • Those in their 80’s were children during World War II and remember the air raid drills, food rationing, nighttime blackouts and energy conservation.  Some had relatives who did not return from battle. 

Emotional intelligence involves connecting on a personal level and getting to know the other person beyond the information published in their medical records.  Start a chat session by asking your gray-haired patient a general question about events that happened while he/she was a child and be prepared to hear wonderful, perhaps astonishing, stories.  In my daily clinical practice, I regularly discover what is currently important to them by asking, “Tell me something about yourself that is not on your medical record.”  Often, the answer is tied to their personal identity and response you get may take you by complete surprise.  

Establish best practice guidelines based on physiologic changes

Managers typically publish policies and guidelines related to best practice recommendations.  Subsequently, it is incumbent upon leaders to build a team of knowledgeable workers who want to follow the guidelines and deliver the highest quality of care to all age populations, including the elderly.  When working with your team to create best practice protocols, consider these physiologic changes that are common in the elderly.

  • Cardiac   Atherosclerosis is common in the elderly American population and arises from a lifetime of smoking, hypercholesterolemia, hypertension, type 2 diabetes and obesity.  The result is ventricular hypertrophy, with reduced ventricular compliance, contractility and cardiac reserve.  Normal doses of induction drugs take longer to circulate and may produce significant hypotension.
  • Renal   Glomerular filtration is reduced as is the ability to regulate sodium and potassium.  The kidney is less able to concentrate urine and may have difficulty removing free water from the system.   Elderly patients are less tolerant of hyper or hypovolemia. Drugs dependent upon renal clearance have a longer duration of action and smaller doses are required. 
  • Pulmonary.  Like an old rubber band, the lung loses elasticity with age.  Combined with reduced chest wall compliance, one can expect a reduction in FVC, FEV1, and VC as the person’s age increases.  Small airway collapse is common and presents problems with VQ mismatch.  The elderly patient is at a greater risk for atelectasis and impaired diffusion of gases.  Anesthetic techniques that further suppress ventilation put the elderly patient at risk.  Volatile anesthetics require more time to leave the system and should be used sparingly in reduced doses.
  • Nervous system.   Both vision and hearing diminish as the person ages and eye-related procedures are common in this demographic.  Autonomic nervous system dysfunction makes the elderly patient more susceptible to labile blood pressure and postural hypotension.  In addition, thermoregulation is impaired in the elderly patient making him/her more susceptible to hypothermia and less able to mount a physiologic response.
  • Cognitive dysfunction.   Altered mental status is a common fear among the elderly and causes concern for those awaiting anesthesia and surgery.  For many, the fear of mental decline exceeds the fear of death. Slowed drug metabolism/clearance, hypotension, hypothermia, and hypoxemia are all listed as potential causes of POCD.  More recently, neuroscientists have correlated the inflammatory response with cognitive dysfunction.  Attention to detail and strictly keeping the patient within physiologic parameters will reduce the incidence of POCD.  Opioid-free multimodal anesthesia with little or no volatile agent is the technique associated with the least amount of POCD.

Begin with a thorough pre-operative evaluation and then the development of a plan that addresses the specific needs of each patient.  In general, elderly patients do best when the anesthesia provider has a is gentle and provides a slow induction with plenty of time for drugs to circulate.  A regional nerve block with sedation is preferred over general anesthesia, but when general anesthesia is the only option, a propofol based TIVA technique that includes multimodal pain control and anti-inflammatory drugs is the least likely to cause respiratory compromise or cognitive changes.   Opioids and inhalation anesthetics should be avoided if possible, in the elderly patient.

Leadership

Embrace the rich history and learned wisdom of your simultaneously interesting and fragile older patient by tuning in to their special needs.  Conduct meetings with your team to review the physiology of the aging and mentor them to work collaboratively in developing best practice guidelines.  Listen carefully to elder patients and hone your skills at understanding, treating and enjoying the elderly population.   Lead by example and become aware of the fears and concerns, the strengths and the joys that each of your elderly patients brings to the operating room.  Some day you, too, will be older, maybe even wiser. 

Tom is an experienced leader, author and requested speaker. 

John-the-Boss and the Bag of Tricks

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

I can still vividly remember the day early in my Air Force anesthesia career when Lt. Col. John- The-Boss enthusiastically entered the workroom where our team was setting up the day’s equipment. Like a kid with a new toy, John had excitement written all over his face, wearing a grin indicated that he had something for show-and-tell.  John announced that he had discovered and purchased a tool that would increase our productivity by ensuring that every open project would quickly be brought to completion.  He had our attention and we insisted that he show us the contents of his bag.  John opened the bag and dumped ten round, 4-inch petri dishes on the worktable and then handed one to each person.  With one eyebrow raised and one lip curled, we each opened a glass container and discovered a label inside that said, TUIT.  Ignoring our chuckles and groans, John continued by going down the list of unfinished projects that had been started with good intentions and put on hold until someone got a round tuit.

 

Ideas flow freely from a creative group and projects that are started with the best of intentions often die from lack of follow through.   The implications arising from procrastination are even greater when it is the leader who fails to follow-through because not only is there a loss of productivity, the leader’s integrity is compromised.  Lack of follow through on commitments is demoralizing, destroys trust, and fragments the team.

 

“Be impeccable with your words and speak with integrity. Say only what you mean…”

 ~ Don Miguel Ruiz

 

Observing for follow through on a commitment is an overt way to measure the personal reliability of another person.  Here are two examples, one negative and one positive.

 

One of my friends has a son is in his early 20s and very talented at wood working.  He can flawlessly design and build cabinets, dressers and chairs.  He is a bright young man and has many creative ideas for developing a business that includes opening a woodworking shop, hiring help and marketing furniture throughout his region of the state.  Unfortunately, to date, he hasn’t done much about it.  He has not consistently followed up on many of his promises to customers, nor on any of his own ideas.  The business isn’t thriving and he lives hand to mouth while telling others about his dreams for dominating the furniture market.

 

 

Conversely, a second friend, and professional colleague, is always available and eager to share ideas when either of us is working on a project.  When we brain-storm, he freely shares his ideas and often says, “I’ll send that information to you.”  Without exception, he follows through within 24 hours on whatever he promises, sometimes sending a document before we even finish the call. In the past three decades, he has never failed to follow-up when he promises action.   To his credit, he quickly says no if he cannot accommodate a request. Yes or no, I have the utmost respect for his honesty and reliability.

 

Following through with commitments is a habit that will elevate your status as a leader, develop self-respect while earning respect from others, and contribute to the overall morale of your team.  Here are some tips for aligning your action with your words.

 

 

  • Define the ask. Requests come in many forms throughout the workday; an email message asking you to update a database, a request for information for the annual report, a need for you to champion a project, a personal request from a team member in need of schedule considerations.  Before giving the quick knee-jerk “yes” response, catch your breath and clarify what is being asked of you.  A database update could be a 5-minute quick click or a 3-day deep dive into archived data files.   A schedule consideration could be an easy accommodation, or it could leave a shift unstaffed and demoralize the team.   Because you intend to follow through to completion, it is essential to define what is being asked and the effect it will have on other work that will be set aside when you tackle the new commitment.
  • Make yes mean yes. As previously stated, integrity requires alignment of your words and actions, and you can only have integrity if you follow through on commitments.   After clarifying the ask, assess your resources, including your available time, and make a reasonable decision about accepting the request.   You will gain respect with an honest “no” and conversely, you will lose respect with a false “yes.”  When you say yes, be prepared to explain when and how the issue will be completed because yes without a plan really means no.
  • Commit with decisive language. Your inner dialogue has a powerful effect on your motivation to follow through. Saying “that’s a good idea” or “yes, we should do that” are not calls to action.  Using words such as can and will are more powerful and indicate a commitment on your part.  Think in terms of “we will do this and here is how we will approach it.”
  • Resolve small things immediately. My high-integrity friend with instant follow-up is the role model I use when the ask is small and easily resolved.   If the resources are at hand and the item can be resolved immediately, do it now.  If your resources are in the office or at home, make it the first thing you do when you get to the location.  From personal experience, I can affirm that I have never awakened in the night thinking about promises that were kept quickly; it’s the unkept promises that keep the stress hormones circulating and disrupt sleep.
  • Establish a timeline on your calendar. The workplace can be crazy and chaotic so it is important to write down your commitments lest you forget.  If a project extends over time, make sure that each of the milestones is on your calendar and that you achieve them.  Calendar and planner apps, readily available for mobile devices, are a good place to enter your commitments.   In addition to the target date for completion, schedule the app to send reminders at intervals to hold yourself accountable.
  • Find a mentor. A mentor is a valuable resource person who will help you develop your plan, identify resources, and keep you on track.  In addition to tapping into the expertise of a mentor, check in at intervals and update the mentor on your progress.  Share your timeline and encourage the mentor to hold you accountable for your commitment.  It’s much easier to make yes mean yes when someone is sitting on your shoulder and offering encouragement.

 

“What you do cries out so loudly that I can’t hear what you say”

 

Lt. Colonel John-The-Boss and The Bag of Tricks is a funny but true story with an elementary lesson about reliability.  And reliability is no joke.  Reliability is just as important as ability and a person of action motivated by integrity always follows through with commitments.  Consistent follow-through directly affects productivity and establishes a positive view of your personal ethics among co-workers, which in turn, opens the door to trusting relationships. High morale, elevated productivity, cohesive team, respect, trust.  Maybe we should all get a round tuit.

 

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

The Future of Healthare: 2020 and beyond

 

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Crafty clairvoyants claiming 2020 vision, can’t wait for the New Year to arrive so they can capture the spotlight and publish their predictions.   However, history reveals that although forecasts from the know-it-all pundits may have sounded logical, many predictions completely missed the mark.  For example:

 

  • In 1876 Western Union Telegraph stated that the telephone had too many flaws and zero inherent value, LOL.
  • In 1954 radio host, Eddie Bond, advised Elvis to keep his day job, predicting the soon-to-be-heartthrob would never make it as a singer. And eight years later, Decca Records opted not to offer the Beatles a recording contract, publicly predicting that guitar music was on the way out and Beatle music would never sell.
  • 50 years ago, when Neil Armstrong took the first steps on the moon, prognosticators said that within 50 years we would have a colony on the moon and that shuttles would take vacationers back and forth. I enthusiastically bought into that concept but have yet to receive my boarding pass.
  • Again in 1954The National Cancer Institute stated that even if excessive smoking played a role in lung cancer, it was only a minor role.
  • In 1988, Dr. Thomas Neff proposed that the newest medical technology – pulse oximetry – would be considered as a basic vital sign along with blood pressure, pulse and respirations. The experts of the day predicted that within 5 years pulse oximetry would eliminate hypoxic brain injury yet, today hypoxic brain injury continues to be a cause of anesthesia related death.

 

Predicting the future is not a foolish pastime; visionary leaders keep a step ahead of the competition by looking over the horizon.  That said, the future is seen through the lens of today which distorts the view of the world that is yet to exist.   Prognosticators use current trends to create a logical foundation which guides the predictions of the world’s wizards, whom I am about to join.

 

In the spirit of full disclosure, I do not possess psychic abilities, nor have I won awards for my spot-on insight into the future.  Rather, I have spent the past several years working full time providing anesthesia, reading professional literature, publishing, speaking and observing trends in healthcare delivery.   Based on emerging technology and current trends, here is what I see when I read the Crystal Ball.

 

Artificial intelligence    Simply put, artificial intelligence (AI) is the use of computer systems to perform tasks normally performed by humans such as visual perception, speech recognition and decision-making.  Computers are being trained to read X-rays better than a radiologist and to read tissue slides better than a pathologist.  The Johns Hopkins has developed and deployed the TREWS system that utilizes AI to detect early signs of sepsis in ICU patients, and other organizations are developing complex AI programs that allow the computer to take a deep dive into medical records and identify trends that predict future healthcare needs for individual patients.   Writing for builtin.com, author Sam Daley gives 32 examples of current uses of AI in healthcare.   Tom’s Crystal Ball reveals an expansion of AI to include computerized a pre-op record review for each patient followed by a prescription for the ideal anesthetic to include choice of anesthetic technique and ventilator settings.

 

Robots    Machines that can replicate certain human functions are referred to as robots.  Factory assembly lines currently use robotic arms to accomplish tasks previously done by human appendage.  The push for automation is extending beyond the factory and managers are actively identifying human functions that can be replaced by machines.   Currently, a robot called TUG is being introduced into the hospital environment.  The TUG device uses programmed maps and complex lasers to navigate its way through the hospital, delivering food and supplies where needed.  Tom’s CB believes that within 5 years, self-directed delivery carts will be commonplace in hospitals.   Indeed, large organizations with multiple buildings covering a medical campus will employ driverless vehicles to transport patients from the parking area to their designated appointment.

 

Pharmacogenetics   The use of the patient’s individual genetic profile to predict their response to drug therapy is termed pharmacogenetics.   For example, anesthesia lore includes the belief that those with red hair require higher doses of anesthesia.  Pharmacogenetics has confirmed that notion and identified the actual genetic cause for the increased anesthetic requirement in red heads.  TCB shows an expansion of pharmacogenetics that includes obtaining cells via a cheek swab on all pre-op patients.  The cells will then be given to AI to determine the patient’s genetic profile and the appropriate prescription for anesthesia will be generated; based on the person’s DNA profile, specific drugs, doses and re-dose intervals will be recommended.

 

Disease targeted anesthesia care   The protocol for early recovery following bowel surgery and the trend for opioid sparing anesthesia technique has shattered the historic one size fits all approach to anesthesia care.  Tom’s Crystal Ball reveals an expansion of anesthesia techniques designed to address patients with specific risks.  For example, anesthesia techniques to reduce recurrence of cancer and protocols to reduce the risk of post-operative cognitive dysfunction are two areas currently being developed.  Over the next few years, additional medical conditions will be targeted for the development of disease specific anesthesia protocols and AI will be used to connect the dots and ensure that every patient receives the best possible combination of drugs.

 

There you have it.  My predictions may prove to be spot-on, or they may result in a disappointing mis-read of the tea leaves.  Robots and AI may join the moon colony in the junk pile of bad predictions, or they may usher in the future generation of healthcare.  But regardless, I think we can all safely predict that Beatle Mania is here to stay.

 

Tom is an experienced leader, author and requested speaker.