Tag: CRNA leadership

Generative AI in academics: Can Artificial Intelligence write a better paper?

By Thomas Davis, DNAP, MAE, CRNA

Over the past few years, artificial intelligence has been touted as a technology that will have more influence on our society than personal computers or the cell phone.  The future is here, and AI is already influencing the information that we are being fed on our devices.  Search for any topic on google and the page will begin with an AI overview of the subject.  AI reviews and summarizes vast volumes of information and students at all levels have learned that AI can generate an academic paper on any subject instantly.  

The threat of AI generated plagiarism from high school through doctorate level education is real and has prompted most academic institutions to develop and enforce policies outlawing the use of AI for student generated material.   As an adjunct instructor at the Medical University of South Carolina, I can attest that each course syllabus contains a warning to students that plagiarism by using AI generated material is grounds for dismissal from the university.   Many professors are using programs such as AI detector by Grammarly , Turnitin plagiarism scan, and originality.ai to detect fraudulent work.  APA.org, the guru of writing style, notes that plagiarism software may not be able to fully detect AI generated work because it is original and not a reproduction of other work.  Of interest, APA.org also describes the proper way to reference AI generated work that is used in a paper.

In the doctorate level nurse anesthesiology course that I teach at MUSC, the students were divided into four groups and each given a separate topic to research.  The assignment was to submit their topic to AI and request a 3-page paper with a minimum of 5 references.  The students were then asked to do a critical analysis of the paper written by AI.  Specifically, the students were asked to assess:

  • How completely did AI cover the topic
  • What was missing from the AI generated paper.
  • What did AI include in the paper that surprised you.
  • What did AI include in the paper that you doubted to be true.
  • What was covered incompletely and caused you to seek more information.
  • What is your overall impression of AI generated material

Each group of students presented their assessment of AI generated material and provided the following feedback to classmates regarding their experience.

  • Overall, AI got the gist of the prompt and generated the 3-page paper as requested.
  • Each of the 4 groups reported that AI did not fully answer the question and the students were motivated to seek additional information to supplement the AI generated paper.
  • Students reported that papers generated by different platforms generated completely different papers even when the same prompt was used for both.
  • Students sensed the AI learns to know the person making the prompt and styles the paper differently for different people.   Two students giving the same prompt to the same platform got similar by different papers.
  • All four student groups were disappointed with the references listed by AI.

A review of the literature revealed that the students were spot on with their assessment of AI.  Artificial intelligence can be helpful in formulating academic work; however, it may be incomplete or inaccurate.   The following are limitations of AI when generating academic material.

  • Reliance on unvalidated data.  AI reviews a vast volume of material on the subject, however there may be bias in the data reviewed.  AI has the potential to amplify the bias and report it as fact.
  • Lack of critical thinking.  AI generates new material based on a review of hard data but lacks critical thinking and the ability to place information into the context of the assignment.  Nuances of a profession are unknown to AI.
  • Hallucination.  AI can generate facts and citations that are plausible but non-existent.  Using AI requires fact checking before work can be believed.
  • Fabricated references.  AI is known to create bogus references in the proper format that appear to be authentic. 

Overall, AI can be used to guide students when assigned to write a paper for an upper-level course.  Artificial intelligence can provide an overview and be used as a starting point when students organize thoughts in preparation for creating original work.  However, work submitted by students must be unique and not a copy/paste of AI generated material.  The following is advice for students who use AI when generating original work.

  • Do not rely on AI material without verification for accuracy.  This is especially true for references generated by AI
  • Use AI as a tool to assist in organizing thoughts.  The student must do research, critical thinking, and place material in the proper context for the course.  Nuances of the profession are generated by the student and are unknown to AI.
  • Be transparent and disclose the use of AI as a background for preparing the paper.  APA.org has guidelines for referencing the use of AI.
  • Follow the artificial intelligence guidelines of the University. 
  • Be aware of the bias that exists in the data used by AI to generate material.

When given an assignment to write an academic paper, AI can help to organize thoughts however, the work that is submitted must be original work that is validated by your personal review of the literature.  Use AI cautiously knowing that “facts” generated by AI may or may not be true.

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

Future Challenges for CRNAs

Future Challenges for CRNAs

By Thomas Davis, DNAP, MAE, CRNA

After over 4 decades of working as a CRNA, I have reached “senior” status, and I am amazed at the challenges that we have collectively faced and conquered over the span of my career.   Back in the day, I was trained on the Ohio 2000 machine using pentothal for induction, Sux for intubation and Pavulon as the primary relaxant.   We’ve come a long way.   As practice changed, so did the politics of anesthesia and the healthcare industry in general.  Without exception, CRNAs stepped up and to face challenges and leave our profession in a better position.

The adage that the only constant is change is just as true now as when the words were first said.  So, what will change look like for the future of Nurse Anesthesiology practice?

I have the privilege of teaching a healthcare leadership course to SRNAs at the Medical University of South Carolina.   At the completion of the course, students were asked to speculate on the greatest challenges that our profession would face in the upcoming years.  Below is a compilation of the responses from the students.

Full scope of practice.  The top challenge for the profession as perceived by the students is to attain full scope of practice for all CRNAs in every state.  CRNAs are highly skilled anesthesia providers who are proficient in every aspect of providing anesthesia care, including ultrasound guided nerve blocks, and should be allowed to use the skills that they have attained.   Ongoing work must be completed in every state to remove the requirement for physician supervision thus enabling CRNAs to independently care for patients.

Promoting our profession.   MUSC students perceive promoting the profession as a critical activity to ensure the confidence of patients, surgeons, and other health professionals.  Three avenues for promoting the profession emerged from student feedback.   First, we live in a world that is dominated by social media, podcasts, and headline news.  The students foresee individual CRNAs taking advantage of technology to promote their practice and their profession.   In addition, the students identify leadership development as a means to promote the profession.  Finally, the students believe that the best grassroots way to promote the profession is to connect with each individual patient, let them know that we are nurse anesthesiologists, and give them exceptional patient care.

Creating a positive workplace culture.   The fast-paced, production-oriented workplace can lead to burnout and disgruntled workers in short order.  The students recognize the worth of creating a positive workplace where diversity and inclusion are a way of life rather than an annual learning module and where everyone is valued.  Sensitivity to second victim situations and support for colleagues who experience difficult cases was also identified as an important component of a positive workplace culture.

Nurse versus physician anesthesiology politics.  Despite the common goals and practice techniques shared by the AANA and the ASA, political turf battles continue with physicians constantly seeking to control and limit CRNA practice.   The students foresee that this will continue and that it is incumbent on each individual to work with state and national organizations to stand united for the practice rights of CRNAs.

Use of Technology.  Technology drives the way that we live our lives and with the exponential growth of artificial intelligence, the influence of technology will become even greater.  Students foresee AI influencing every aspect of anesthesia practice, including needle placement for ultrasound guided nerve blocks.   The potential for pharmacogenetic profiles to influence drug selection and dosage is on the near horizon and will influence our practice.  A personal concern that I have is that as AI guides our practice, it narrows the gap between CRNAs and AAs. 

The challenges above were identified by SRNAs in training who have yet to become certified and work on the front line.  What are the thoughts of those who work daily providing anesthesia services to patients across the country?   Do you agree with the student and what would you add to their list.  Finally, what will you do about it?   Will you become involved with your state and national organizations to help face the challenges and address the issues?

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

Workplace Wellness: Fit for work and fit for life

By Thomas Davis, DNAP, MAE, CRNA

This article is written in mid-April when the cold winter winds are being calmed by temperate spring temperatures and the snow is being chased away by the warm rain that will awaken the trees and flowers.  As the days get longer, people who vowed to “improve health” as a new year’s resolution are doubling down in preparation for summer activities.  There is no better time for a leader, regardless of the profession, to introduce wellness to the balance of work-life that is essential when creating a preferred workplace. 

Wellness is a win/win

Promoting employee wellness brings benefits for both the individual and the organization.  Writing in the Harvard Business review, authors Berry, Mirabito, and Baun give several examples to support the benefits of employee wellness to the overall organization.   Noted in their article, “A study by Towers Watson and the National Business Group on Health shows that organizations with highly effective wellness programs report significantly lower voluntary attrition than do those whose programs have low effectiveness (9% vs. 15%).  According to Vicki Banks, Biltmore’s director of benefits and compensation, “Employees who participate in our wellness programs do not leave.”  In addition to improved retention, other studies document the increase in productivity tied to employee wellness.

It starts with you

Personal wellness starts with you and requires commitment to both physical and mental health.   Initially, wellness will be something that you do however, over time, repeated behavior becomes a habit, and wellness becomes who you are. 

The University of Kansas has made a commitment to promoting wellness and work-life balance in the workplace.  Organizational wellness at KU follows a three-prong approach.

  • Physical wellness: The University encourages physical activity and provides employer sponsored gym memberships.  In addition, healthy nutrition is promoted by supplying healthy options in vending machines.  Workspace is re-designed to accommodate ergonomic flow that does not strain the body or eyes.
  • Mental: Leaders are trained to be sensitive to the needs of employees and use emotional intelligence to recognize stress and impending burnout.  Schedules and workflow are adjusted to support the capabilities of the employee.
  • Culture: The University expects leaders to set a positive example and participate in wellness initiatives.  In addition, incentives are provided for employees who participate.

Get yourself going

Alter your daily routine and incorporate physical activity three times per day.   Get up a few minutes early and do a brief warmup with a 5-minute walk in your house followed by light stretching.  If you have stairs in your home, you have a built-in stair master…a few trips up and down will get your heart pumping.  Stairs can also be used for stair push-ups.  Weather permitting, take 15 minutes to walk around the block before work.

Take your wellness commitment to the workplace and plan a brief activity during your lunch break.  A brisk walk through the hallways followed by light stretching will rejuvenate your body for the afternoon work ahead.  Throw in a few flights of stairs to boost the workload on your heart and legs.   Take your own healthy food for lunch and avoid high carbohydrate, fatty foods.

Writing for verywellfit.com, author Ann Pizer describes workplace exercises that can be done at the desk.  CRNAs are very creative and, no doubt, could adapt them to the OR workplace which include.

  • Neck rolls
  • Cat-cow stretch
  • Seated forward bend
  • Seated eagle
  • Seated spine twist
  • Wrist stretch
  • Standing pigeon

After work, continue to be active by taking an outdoor walk or bike ride.  A stop at the gym for cardio revitalize the mind after work and keep the body moving.  At bedtime, plan a 15-minute cool down to include a few yoga stretches and meditation.

Get your workplace going

Build a culture of wellness in your workgroup by planning team activities that encourage your colleagues to get up and go.  Having a workout buddy creates accountability and often leads to a personal friendship.  Encouraging the entire group to participate in planned activities not only promotes wellness but also provides an avenue for teambuilding.   In including the colleague and their family members opens opportunities for family day activities.  Here are some suggestions for memorable gatherings that promote wellness.  

  • Walk
  • Jog
  • Hike
  • Bike
  • Tennis
  • Pickleball
  • Swim
  • Log your step competition

Family days are fun and will

 bring colleagues together outside the workplace.  Plan a day at the park or beach.  Find a central location that is convenient for several activities so that some could walk a paved path while others are hiking in the woods or riding bikes.  Meet back in a central location for a snack/cookout and other group activities such as volleyball or cornhole.

Workplace wellness has been proven to increase morale and employee retention while reducing the number of days missed due to illness and injury.  Individuals enjoy better health with a more robust lifestyle and organizations benefit from increased productivity and reduced cost of turnover.  It is a true win/win for all.   Be proactive and push for wellness in your workgroup.

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

Tax Tips for 1099 Workers

Tax tips for 1099 workers.

By Thomas Davis, DNAP, MAE, CRNA

Love it or hate it, it’s tax time and Uncle Sam is expecting you to ante up again this year.  It’s quite likely that many people reading this article have already filed their 2024 taxes, and some have received refunds.   Hopefully, the money that was set aside was sufficient to cover your tax obligation and there was enough extra to warrant some cash coming back to you…wahoo.  

For W2 workers, the employer tracks your income, withholds money from each paycheck for tax, and ensures that social security obligations are paid.   At the end of the year, the employee receives a W2 statement to go along with other tax documents and filing your tax return is simple.  W2 employees tend to file early and often receive a refund from the IRS.

Taxes for 1099 workers

The IRS refers to a 1099 worker as a freelancer, independent contractor, or self-employed worker and many CRNAs fall into this category of work.  As a 1099 worker, you are not an employee of the organization, rather you contract your services to them for an agreed upon fee.  Individual contracts specify the number of days to be worked, the location, as well as who is to provide necessary supplies and equipment.  In this scenario, the employer does not provide benefits, and it is up to the individual CRNA to obtain their own profession and medical insurance as well as contribute to their own retirement plan.   The employer does not withhold taxes or pay social security fees, so it is incumbent on each 1099 worker to pay those expenses from the compensation provided by the organization.

Because the 1099 worker is essentially a business selling services, the individual is eligible for many tax deductions that are not available to the W2 worker.  The good news is that 1099 contracting opens the door to tax deductions, the bad news is that it requires vigilance and record keeping.  Writing for Bonsai, author Michael Eckstein emphasizes the importance of consulting a tax professional who you can work with you year around to ensure that you are capturing all available tax deductions.

Commonly overlooked deductions for 1099 CRNAs

Business expenses: As a 1099 worker, you are essentially a business of one person selling anesthesia services to an organization.   Because you are a business, you are eligible for business deductions like those claimed by others who sell services to the public. 

  • Home office.  If you have a designated area in your house where you maintain your records and schedule work, you may deduct the space from your taxes.  The IRS allows $5/square foot up to 300 square feet.
  • Phone: If your phone is essential for scheduling work, a portion of your phone fee may be deductible.
  • Startup costs: If you decide to formally establish an LLC or S-Corp, the startup fees are tax deductible. Talk to your tax advisor and learn about the advantages of establishing an LLC or S-Corp.
  • Bank fees: If you are registered as an LLC or S-Corp, bank fees related to a business account are tax deductible.
  • Malpractice insurance: Commonly, the 1099 CRNA must provide their own malpractice insurance.  This is a tax-deductible business expense.
  • Health insurance: If you are working under the umbrella of LLC or S-Corp, the cost of health insurance for you and your family is tax deductible.  However, if you are not LLC or S-Corp, your insurance premium must exceed 7% of your adjusted gross income to qualify for a deduction.
  • License/CME: CRNAs working as a 1099 are eligible to deduct the expenses related to required continuing education and licensure.
  • Equipment depreciation: In some cases, independent practice CRNAs must provide their own anesthesia equipment.  If this applies to you, the value of the equipment that you own may be depreciated on an annual basis related to the life expectancy of the equipment.
  • Social security tax payment: As an independent contractor, you are required to make social security tax payments.  The fees that you pay for social security are tax deductible.
  • Retirement tax shelters: Self-employed workers are eligible to establish and fund retirement tax shelters.  The personal 401K is a frequently used platform for retirement funds, however there is a cap on the amount that you can contribute each year based on your gross income.   Your tax consultant will know how much you are allowed to contribute.
  • Car: In some cases, the mileage on your car may be deductible, however there are many requirements to qualify for the deduction.  If you are a 1099 worker commuting to the same full-time location daily, the auto deduction may not apply.  However, if you are more mobile and service many different offices on different days, the deduction may apply.  Your tax expert will advise you on your specific situation.
  • Tax consultation/preparation: The fees that you pay for tax consultation/preparation services are tax deductible.

The 1099 work arrangement is more complicated than working as a W2 employee for an organization.   Maximizing the benefits of independent contracting requires time and vigilance.  Gaining full benefit also requires the expertise of an experienced professional tax consultant.  That said, those who take control of their own finances, monitor their business on a frequent and regular basis, and keep accurate records tend to come out ahead on taxes at the end of the year.

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

The Emperor’s New Clothes; Lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

Born in Denmark in the early 1800’s, Hans Christian Anderson was a prolific writer best known for his fairy tales.  Among his famous fables, The Emperor’s New Clothes is a classic story that continues to be referenced two centuries later when the reality that we experience does not align with what we are told is “the truth”.  

In the story, two con men implement a plan to cheat a prideful emperor by manipulating his ego.  The men pretend to be weavers who have developed an amazing fabric that is invisible to those with a simple mind or unfit for their job.   Eager to have the best clothes ever made, the king was captivated by the ruse and hired the men to weave the fabric and make the clothes.  The men went to work pretending to weave fabric and make the clothing.  At intervals the emperor would send staff members to check on the progress and, knowing that only simpletons unfit for their position could not see the fabric, they reported that it was the most beautiful material ever made.  Finally, the tailors dressed the emperor in fake clothing and his staff marveled at the elegance of the new clothes.  Wanting to show off, the emperor paraded through the streets where everyone applauded and admired the beauty of the clothes…until a child called out…” but the emperor has on no clothing at all”.   Once the words were spoken, everyone, including the emperor, knew that they had been deceived and the embarrassed leader quickly returned home wearing only his underwear.

The most obvious takeaway from the story is that we must always trust what we see and experience rather than what we are told to believe by those who want to control the narrative.  Entering an election year, we will have ample opportunity to compare the reality of our lives to the narrative of the politicians and determine for ourselves whether the emperor is wearing clothes.

Leadership lessons from the story

Legendary football coach Vince Lombardi once said, “Leaders aren’t born, they are made and just like anything else, they are made through hard work.”   Becoming a respected leader takes effort and the story of the emperor’s new clothes contains a wealth of guidance for those who are leaders or aspire to leadership positions.  Here are some takeaways from the story.

Pride comes before the fall.  People aspire to leadership positions for a variety of reasons and, unfortunately, some seek power and position to boost their ego.  Authoritarian leaders use a heavy hand to maintain dominance and control over a workgroup and quickly silence those who challenge or disagree with them.  Workers learn very quickly to filter information and share only that which the leader wants to hear.  When open and honest communication is stifled, the leader is blinded from vital information.  Decision making without access to all the details ultimately results in failure.

Create the right environment.  Regardless of the leadership style, creating an environment based on open and honest communication ensures that the collective wisdom of the group is combined to formulate the best answer to a challenge.   Author Chris Voss notes that success is most likely when you enter a discussion with the mindset that you do not have all the information and that there is more to be learned.  By being receptive and rewarding feedback, both positive and negative, colleagues openly share their knowledge and trust is built within the workgroup.  When leaders value listening over telling, they are on the path to success.

Build the right team.  As an Air Force officer moving up through the ranks, I made it a point to observe my leaders and question what made the good leaders good versus what made the bad leaders bad.  Early in my career I observed that the worst leaders developed an inner circle of people who were most like themselves and shared the same view on most topics.  In contrast, the strongest leaders knew their strengths and weaknesses and built a team of individuals who could best cover the weaknesses.   Confident leaders delegate tasks and authority to those who are most skilled in that area.  The best leaders created a diverse team and actively sought out contrasting opinions.  A strong leader welcomes criticism and is willing to learn from mistakes.

Have realistic expectations.  Grandiose ideas set the leader up for failure when they cannot deliver on promises.   It takes more than imagination and good intentions to bring an idea to life.  A solid plan backed by resources, both materials and human, and a realistic timeline are all required for success.  In this story, the emperor foolishly believed that he could have whatever he imagined.

Learn from the Emperor

Whether you are a leader, worker or a citizen who desires to live in a just world, the lessons the emperor can be applied to your life.   Exposing yourself to contrasting opinions and listening to understand rather than to rebut will reveal information that is essential for decision making.   Avoid group thinking and once you have the facts, trust your instincts.   Trust what you see and experience and have the courage to say it like it is. 

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

How well do you know your patient?

By Thomas Davis, DNAP, MAE, CRNA

You know the type of surgery that your patient will receive, you have reviewed the lab work and history/physical and you have a sense about their basic health.  It’s time to meet the patient, assess the airway, explain what you will be doing and then get the case going.   You feel as if you know your patient, but do you know who they are as an individual?

The business community has learned that regardless of the product being offered or the knowledge of the salesperson, it is the consumer who makes the decision about what to purchase or pass up.  Over the past decade, the business community has become increasingly aware of the importance of understanding consumer intent.  Simply stated, consumer intent is the desired outcome that drives the person to purchase a product.  It is the foundational reason that creates the motivation to buy the item.  You may know your patient from a medical perspective, but you don’t truly know them until you understand what drives their desire to obtain medical care and their desired outcome.

How does consumer intent apply to us as healthcare workers? After all, we are in healthcare to provide a basic service and promote wellness.  Yes, we provide essential care, however patients have ownership of their medical records and are no longer geographically bound.  Our patients are free to travel either locally or to distant communities to obtain healthcare as they desire.  As a result, healthcare delivery has become competitive, and providers must be sensitive to creating a loyal customer base that generates the cash flow required to keep the doors open.  Becoming aware of customer intent builds a foundation for a trusting relationship and promotes two-way loyalty between the provider and the patient. 

On the institutional level

Healthcare organizations want to be at the forefront delivering state of the art, evidence-based care to their population base.   Introducing new lines of care and investing in technology to support emerging programs is expensive, therefore, upper-level leaders assess return on investment before moving forward.  Gathering information about consumer intent gives important insight into what services their client base want the organization to provide.  Writing in Loyalhealth, author Brian Gresh describes how healthcare organizations are using chatbots linked to artificial intelligence to assess consumer intent.  Prominently displayed on the company website is a chatbot with the Question, “How can I help you.”  Questions from patients are submitted and AI links to evidence-based information that answers the person’s question.  In the background, the organization captures the questions that are asked and gains valuable insight related to what is on the mind of the population that they serve. 

Consumer intent on a personal level

Reviewing information gathered by the company chatbot may be interesting, however, it is up to us to connect one on one with our patients and determine not only what they want, but also why they want it.  The task may sound daunting, yet by making a commitment to connect with each patient and following a simple plan, you will be amazed how easy it is to gain insight into the patient and their family.  Let’s get started.

Develop a routine.  We are creatures of habit and are less likely to forget something when it is part of our routine.  Review your order of events for doing the pre-operative assessment/teaching and create a space to learn about the patient as an individual including their expectations related to the desired outcome.  Create and ask personal preference questions at the same point during every pre-op interview. 

Develop open ended questions.  Establish one or two non-medical questions to assess who the person is as an individual.   Writing in the Harvard Business Review, Authors Awdish and Berry recommend questions that reveal individual preferences and expectations.   Rather than opening the pre-operative interview with questions about the person’s baseline health, introduce yourself and then ask, “What is important for me to know about your health, your preferences, and you as a person?”   If you listen attentively, you will gain valuable insight about baseline health as well as expectations.  A favorite question that I ask patients as we roll to the operating room is “Tell me something about you that is not on your medical record.”  Again, careful listening will give you insight into the things that matter the most to your patient.

Hone your listening skills.  The questions in the previous paragraph are only effective if you actively listen.  Enter the conversation with a curiosity to know more about the person and a commitment to using higher levels of listening to gather insight.  Writing for The Black Swan, author Derek Gaunt describes five levels of listening:

  • Listening for the gist.  In a busy, high production pressure environment, who has time to effectively listen?  When you listen for the gist, you say “ya, ya” as the other person talks and all the while your mind is elsewhere.  If you check your phone for messages while another person is talking, at best you will get the gist of the conversation and no more.  Not only is it rude, but you also cheat yourself out of an opportunity to learn about what is on another person’s mind.
  • Listening to rebut.  Unfortunately, we spend too much time at this level of listening.  The entire time the other person is talking, your mind is on your reply.  When talking to patients, we don’t always rebut them, rather, we flip the conversation away from them and toward ourselves.  The patient opens the door with a statement, and you jump right in to tell the patient about your experience.  Suddenly, the patient is silenced, the conversation is about you, and you learn nothing new about the person.
  • Listening to the logic.  At this level of listening the focus is on the other person and you have a sincere desire to learn what they are thinking.  Whether you agree or disagree doesn’t matter, the important thing is to learn their point of view.  Keep the conversation alive by restating what you hear and say, “tell me more about.” 
  • Listening to the emotion.   When you achieve this level of listening, you are experienced at listening to what a person thinks and now you desire to learn why they think that way.  Again, use open ended statements such as, “that must have made you tense, frightened, happy…”  Then listen as they describe their feelings.
  • Listening to their point of view.  It is rare that we would get to this level of listening with a patient.  At this level, you learn where the person feels they fit into the global scheme of things.   It takes time and trust to get to this level of communication where it is safe to share political, religious, or personal preferences without judgement.

Why is connecting with patients important?

We work in a competitive market where many organizations vie for the healthcare business of our patients.  Connecting one on one with each patient and giving the impression that you understand them as an individual creates a loyal client base.  However, the greater benefits include higher patient and provider satisfaction, improved patient safety, and improved outcomes.  Simply stated, we tend to take better care of patients when we feel a sense of connection and, likewise, patients are more likely to comply with medical directions when they trust and feel connected to the provider.  Actively gaining insight into our patient’s consumer intent is a win/win for patients, providers, and healthcare organizations.

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.

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.

4 Keys to eliminating disruptive behavior

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Disruptive behavior is a killer

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

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

Have you worked with these people?

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

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

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

Types of disruptive behavior

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

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

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

            Keys to combating disruptive behavior

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

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

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

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

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

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

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

2019 Best Airline ranking; Lessons for ambulatory surgery centers

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

Four decades ago, I was a neophyte embarking on the challenge of learning to safely administer anesthesia, earn certification, and become a productive member of the profession.   I recall being told several times that delivering anesthesia is like flying a plane; chaotic and high risk at takeoff and landing with hours of boredom in between.

 

Throughout the span of my career, other analogies have compared aviation to anesthesia.  For example, as the patient safety movement gained momentum, John Nance’s book, Why hospitals should fly: The ultimate flight plan to patient safety, took the principles that vastly improved airline safety and applied them to healthcare.  The book made a strong case for collaborative teamwork in the operating room to match that required of the flight crew in the cockpit.

 

An article by Scott McCartney published in the Wall Street Journal on January 15, 2020 ranked US airlines from the perspective of customer satisfaction.  At the top of the list was Delta Airlines with a spectacular on-time record, few flight cancellations, low incidence of bumping customers and efficient baggage handling.   Following closely were Alaska and Southwest with American Airlines at the bottom of the list of 9 companies vying for riders.

 

As an airline passenger, the article caught my eye and reading it triggered me to consider parallels between aviation and healthcare in terms of customer satisfaction.   Re-reading the article, I noted the criteria used to separate the wheat from the chaff.  Below are the standards that were used to rank the air carriers and thoughts on how they would manifest if applied to the healthcare setting.

  • On time arrivals. When buying a ticket, passengers are given a specific time for the anticipated arrival at the destination.  Likewise, when patients are scheduled for surgery, they are given a specific time to arrive the day of surgery as well as a time for the procedure to begin.  Like travelers, patients have arranged to be dropped off and picked up based on the timeline that they were given to them prior to surgery.  For the patient to have an on-time arrival, equipment, personnel and documentation must all be in place prior to the patient’s arrival.  Once the patient has arrived, every effort must be made to keep the person informed and move him/her through the system as flawlessly as possible. Those receiving care in outpatient surgery centers must be ready to depart at the predicted time.
  • Cancelled flights. Airline flights are not cancelled on a whim, but rather only when the system breaks down and it is not safe to proceed.  Broken planes are grounded, and crew rest mandates are strictly enforced.  In healthcare, cancelled surgery is the outward manifestation of a defective system.  Broken equipment, inadequate pre-op workup, and failure to follow NPO guidelines are common causes for cancellation of surgery.  On rare occasions, a conflict in the surgeon’s schedule may lead to cancellation.  Regardless, proactively improving communication with both suppliers and patients will reduce the incidence of cancelled cases.  Equipment requirements must be anticipated, and patients must be informed regarding pre-op expectations.
  • Extreme delays. Being left to sit for hours (or days) in the waiting area of the airport can be as bad or worse than having a flight cancel.  Weather, maintenance or crew rest may delay a flight; however, in healthcare unrealistic scheduling is a common culprit for delays.  Overbooking creates unrealistic expectations and ensures that patients will experience delays.   Procedures must be scheduled based on historical time averages rather than best case scenarios.
  • Mishandled baggage. I remember many years ago when a disgruntled friend had a bad experience with Delta Airlines and said, “Delta stands for don’t expect luggage to arrive.”  They have come a long way and are now at the top of the industry when it comes to baggage handling.   In healthcare, patient belongings are as important as the airline traveler’s bags.  When you lose a pair of glasses or hearing aid and the patient will tell the story for the next 10 years.  In addition, the patient’s driver or family can be considered baggage that deserves to be handled respectfully.  Provide a comfortable waiting area and offer frequent updates to show your regard for their tie to the patient.
  • Bumping.  There is nothing worse than buying the ticket, arriving on time at the airport, surviving the security check and then being told that your seat was given to another person.  The plane takes off, but you are not on it.   In healthcare, emergencies arise and sometimes the surgeon is not available to do the case.  All effort should be made to keep commitments and make reasonable accommodation where needed.  Scheduled cases should not be cancelled at the last minute to accommodate short notice vacation.  A case cancelled because of lack of equipment represents a total breakdown in the system.
  • Complaints.  In both the airline and healthcare industries complaints come with the territory.  Having a smoothly functioning system and engaged, customer-oriented employees will reduce but not eliminate complaints.  The question is not whether complaints will be lodged but rather how you react to them.   Client centered organizations will welcome complaints as a source of insight that will lead to improved service in the future.  Lesser organizations will simply track numbers and learn nothing about their failures in delivering the promised service.

 

Earning a top rating for customer service requires employees at all levels to be fully engaged in their work and be committed to creating a positive experience for the client.   Although cause and effect have not been claimed, Scott McCartney noted that while being rated 2019, American Airlines was in contract negotiation with maintenance and baggage workers.  It was implied that employees were not fully engaged in their job and that worker sabotage was tied to the low satisfaction scores.

 

Customer satisfaction is driven by the front line, not by the front office.   The Board of Directors can build a solid corporate structure, but the passenger/patient remembers the attitude of those they encounter during the journey and whether promises were kept.  Delta’s number one ranking was no fluke and employees at all levels worked diligently to provide the promised service and deliver it with a positive friendly demeanor.   When the rankings were announced, Delta executives were pleased; however, rather than taking personal credit, the Board of Directors showed appreciation for their workers and posted the following: “There’s no higher honor for Delta when our employees are recognized for the work that they do to take care of our customers.”    Clearly, passengers can expect a smooth ride on Delta Airlines.

 

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. 

What the patient wants

By Thomas Davis, DNAP, MAE, CRNA

Recently we were discussing patient satisfaction at the desk in the pre-op area.  One of the physicians noted that patients assume they will receive top-notch medical care, so the care itself is not notable.  What the patient does remember, he suggested, is their impression of the facility, the workflow process and whether they were respected as individuals. 

My colleague’s comments triggered personal memories of a recent encounter with the healthcare system.  Last year I accompanied my wife to a medical appointment.  The waiting room was filled with heavily worn furniture, magazines were scattered on empty chairs and there was a generally unkempt appearance.  We were moved to an exam room that appeared to need more than a good cleaning.  When the physician arrived, she did a quick assessment and ended the appointment by dictating a plan that did not work for us.  As you can imagine, all the way home we talked about the importance of patient satisfaction.  Having had a negative experience, my wife did not follow-up with their organization nor solicit contact with the physician again.

Because “overall experience of the patient” has become a meaningful component of quality care that is demanded by those who pay the healthcare bill, simple conformance with regulations and standards is no longer enough.  Elevating patient satisfaction, while simultaneously dealing with shrinking healthcare budgets, requires payors to insist that medical providers deliver state of the art treatments that will be remembered positively.

The Center for Medicare and Medicaid Services (CMS) has reinforced this idea by implementing the Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAPS) which ties reimbursement to patient satisfaction.  Simply put, full reimbursement for healthcare services is being tied to the overall patient experience and his/her level of satisfaction with both the individual healthcare provider and the organization offering the care. 

Improve patient satisfaction scores

Moving from the obsolete mindset of “doctor knows best” to the new paradigm of “shared decision-making,” in which doctors and patients work as a collaborative team, requires that healthcare providers learn what patients really want and then commit to meeting their expectations.   Learning about the preferences of the patient requires observing, questioning and listening during every patient encounter.  Discovered through discussions with patients and a review of literature related to client satisfaction, here are a few ways to improve your patient’s overall experience.

  • Patients want to feel respected.  The red-carpet treatment is not necessary but common courtesy is essential. Timetables that are designed to run behind schedule do not respect or value the commitment made by the patient who arranged child care, hasn’t eaten since midnight, has provided the requisite driver and arrived on time. When patients follow the rules and do as told, they expect to receive care as promised.   Likewise, a one size fits all approach to prescribing patient care does not respect the individual needs of each client.
  • Patients want information conveyed in a manner that they can understand.  We work in an environment that has its own language and acronyms.  Terms that are common to us are foreign to many of our patients.  I recently overheard a patient interview.  Nurse: Do you have A-fib?  Patient:  What’s that?  Nurse:  Do you have GERD?  Patient:  What’s that?   Nurse:  Do you take ACE inhibitors?  Patient:  What are those?  Always communicate on the level of the listener and ask follow-on questions to ensure that the person fully understands you.
  • Patients want open communication with every provider.   Hospitalized patients see their doctor once or twice a day and then spend the other 23 hours with nurses and assistants.   Patients expect and need honest, transparent answers from the nursing staff.  The cop-out reply, “Ask your doctor,” is a sure-fire way to kill trust between the patient and the nursing staff and is a trigger for dissatisfaction.
  • Patients want the staff to be collaborative with one another.  Disagreements between staff in a location where patients can observe and overhear must be taboo in the workplace.  Discord between staff members creates anxiety in the patient population and kills satisfaction scores.  When conflicts arise, make sure that they are discussed privately and behind closed doors.
  • Patients want to be included in the decision-making.  The best-practice treatment plan is one that is described rather than prescribed.  The patient must know what is recommended and why; only then are the patient and provider positioned to agree on a plan to provide the recommended treatment in a manner that affirms the patient and his/her family.
  • Patients want a response to concerns and complaints.   Receiving healthcare can spark anxiety in an otherwise intelligent and relaxed individual.  A glitch that’s the size of a pebble to the worker can be viewed as a boulder to the patient.  When a patient expresses concern, listen attentively, immediately fix what you can and follow-up on items that require additional resources.  Leaving the patient with the impression that he/she was not heard will elevate anxiety and increase dissatisfaction.

Assessing patient satisfaction

Your organization sends a survey to every patient and your workgroup consistently scores above the benchmark of 90%.  Does that mean everything is OK? 

Conducting an ongoing survey is an accepted way to gather information and is required in order to obtain full reimbursement under the H-CAPS system.  Surveys are necessary; however, those who truly seek to improve the patient’s experience constantly dig deeper in search of concerns that may not be exposed by the survey.  Rather than boasting about achieving 90% or 92% on the satisfaction survey, focus additional attention on the 8% who were not satisfied.  Seek common themes that generally fuel dissatisfaction such as lack of privacy or excessive wait times and then solicit patients to suggest ways to address the issues. 

The best way to learn about the weaknesses in your system is through the eyes of those who use it.

After working for a year as an anesthesia provider at a busy GI center, it was my turn to be on the receiving end of a colonoscopy.   Wanting to have the same experience as any other patient, I kept things low-key, and it turned out to be an eye-opener.  After following completing a bowel prep and arriving on time, I sat in the waiting room a full hour past my scheduled time.  The room had nice furniture and a TV; however, the room temperature was so cold that I entered the pre-op area shivering.  Despite receiving top-notch care, I felt as if I was on an assembly line and that neither my time nor comfort mattered.   Based on my feedback, the temperature in the waiting area was adjusted.  However, the manager was not brave enough to tackle the sticky issue of intentional overbooking.  In the end, overbooking was not addressed and excessive waiting times continued to be the top complaint expressed by patients at that center. 

The key to improving the overall experience for the patient and family is to engage them in a non-threatening discussion.   Asking pointed questions puts people on the defensive and seldom generates useful information.   Instead, first engage in a friendly conversation and then ask open- ended questions about their experience.   Rather than asking, “What do we need to do in order to improve?” ask, “If your friends were coming for this procedure, what advice would you give them?”   Instead of, “Where did we fail?” ask, “What was your greatest surprise while in our care?”  Finally, ask the patient, “In retrospect, what do you wish that you (or we) had done differently?”   Ice the cake by asking the patient to identify one or two people on the staff who made a positive impact on their experience, and to follow-up by describing the behaviors that made the worker outstanding.

Patient satisfaction IS notable; and it’s not difficult to achieve.  Design a system that values the patient’s time, one that recognizes the patient’s anxiety, that openly communicates information, that develops a collaborative treatment plan and solicits suggestions for improvement; then your satisfaction scores will take care of themselves.

Encore Symposium: Sedona 2019

post card 1

Meeting Date: November 4-7, 2019

Meeting location:  Hilton resort, Bell mountain, Sedona, AZ

Meeting sponsor: Encore Symposiums

Strengths of the meeting: 

Person #1  Very informative and I really liked the speakers.  Encore staff was very pleasant and helpful.  I would really recommend Encore for future CME.  Sedona was the perfect site; I really liked the outdoor activity and the perfect weather.

Person #2  Great location with lots of activities and perfect weather.  The speakers were top notch and presented a variety of topics.  The information from this meeting will help my case management and has also given me ideas for improving teamwork in our anesthesia group.

Person #3 regarding the CPC review:  I did the CPC Review and the Sedona Red Rock & Grand Canyon Program November 2-7. Sedona is an absolutely beautiful location for a fall conference. While I was there the weather was perfect….blue skies, upper 70’s. The Hilton Resort Sedona at Bell Rock is a beautiful and well kept resort. The Hilton staff were very helpful and accommodating. The meeting rooms were comfortable and spacious. Encore Symposiums provided a delicious breakfast with many choices each morning. The night before the seminars started there was a stargazing welcome reception. It was wonderful to have time to socialize with other CRNAs and their spouses. Nancy and her staff at Encore provide a professional and well run Symposium!!! The the topics were applicable and informative. The speakers were very knowledgable, friendly, approachable, interactive and presented their topics clearly. The CPC review was a well thought out review. Yes, I knew the majority of the information presented, but it never hurts to review the anesthesia information with the CPC examination happening in the next few years. I am looking forward to my next Encore Symposium Program!


Suggestions for improvement: 

Person #1  none

Person #2  I don’t have any suggestions for the meeting itself because it was excellent.  At a place like sedona I suggest offering a group hike or bike ride in the afternoon for those who are interested.

Value for the money:  

Person #1  excellent

Person #2  excellent

Artificial Intelligence; Be a Transformer

AI vs leader post

By Thomas Davis, DNAP, MAE, CRNA 

 

Follow @procrnatom on twitter

 

The exponential growth of AI (artificial intelligence) has proven that computer-driven software and robotic hardware are the future for business and industry, including healthcare.  Factoid:   People cost a lot of money and a growing number of jobs can be done better by computers or robots than by expensive humans.  Replacing us with AI is a no-brainer.   Writing in ddiworld.com, author Menggiao Liu, Ph.D. notes that by the end of 2020 five million jobs will be replaced by technology and that by 2055, fifty percent of workplace activities will be automated.  From trading online to driving driverless cars, to robotic assembly lines, the need for human decision-making and skilled labor is vanishing like a wave at high tide washing up on the beach.

 

Our healthcare industry has always considered itself immune from the threat of job loss due to technology; however, that will rapidly change over the next decade in a number of ways.  Much of it is already evident in the places you work. As scheduling becomes automated, fewer office staff will be needed to coordinate patient visits.  Electronic records that feed into the billing department will continue to reduce the need for medical coders.  AI analysis of patient records will detect changes in the patient’s condition early in the hospital stay and recommend treatment long before the person becomes seriously ill.  With AI driven protocols, the length of hospital stay will be shortened as will the need for nurses to staff the diminished patient load.  As AI proves its ability to read tissue slides and X-rays faster and more accurately than pathologists and radiologists can, fewer physicians in those specialties will be needed.  Even the field of anesthesia will be affected by technology as AI uses pharmacogenetics to prescribe and administer the perfect anesthetic based on the patient’s specific gene composition.

 

The transition from a human to a digital workforce raises the question,

“What happens to the leaders?”

 

Those who have an eye to the future believe that leadership will always be essential.   Traditional leaders focus on getting the team to do tasks that AI and robots will do in the future.    Leaders of the future will focus on connecting one on one with workers and forming an important bridge between those who directly serve the clients and upper level administration.   Moving into the technology-based future, traditional leadership will transform into a new style that welcomes and capitalizes on technology while maintaining a focus on the so-called “soft skills” that the computer lacks.

 

Technology, including AI, is here to stay and institutions are investing millions of dollars to position themselves ahead of the competition.  Employers expect their leaders at all levels embrace and utilize the new technology to the fullest extent of their capability.  Moving forward, it is essential to leverage the things that AI can do better than human workers.

 

What AI does best

Gather data   AI isn’t limited by the time and hassles of a manual literature or data search.  It can connect to every article ever written on a subject and collect large volumes of information in a short period of time.   Likewise, AI can filter information and gather data on a specific patient population or disease entity and sort data as directed.

Analyze data   In 2017, scientists at Mount Sinai trained AI computers by feeding 700,000 patient records into the system and then allowing the program to analyze and make conclusions.  They found that AI was very good at predicting disease including psychiatric disorders, in their patient population.   Similarly, the TREWS system at The Johns Hopkins uses AI in their ICU units to detect the earliest signs of sepsis, triggering treatment before the disease becomes life threatening.

Interpret results   Lab, X-ray and pathology findings have traditionally been reported as facts and reported as real numbers or descriptions. AI looks at slides and images, describes what is seen and then makes a diagnosis.  In addition, AI can look at trends and predict future diseases.

Recommend a course of action   Building upon interpreting results, AI takes the next step and recommends the treatment of choice based on best practice guidelines.

Implement a course of action   Depending upon the nature of the disease, AI can put recommendations into action by making follow-up appointments or scheduling future treatments with the proper specialists.

 

What Humans do best

Never fear.  R2D2 isn’t replacing you with its clever technical achievements, but you will have to compete to stay in the game.   Those who wish to emerge as the top leaders will need to focus on the human aspects of the job.  Leaders must demonstrate the instinct for what clients want from the organization and what workers need in order to ensure their continued engagement and loyalty.  Your job security will depend upon your skills in the following areas.

Emotional intelligence   As noted on Forbes.com by author Falon Fatemi, emotional intelligence starts with the ability to understand and control our own emotions followed by the ability to recognize, understand and influence the emotions of others.

Adaptability   Computers are programmed, whereas, people can sense their environment and the reactions of those around them.  As we are bombarded with fresh information, leaders must be able to capitalize on opportunities and learn from mistakes.  Being willing and able to change course based on new data will be a valuable strength.

Vision   As new technologies are developed in a parallel fashion, lasting leaders will be able to assess many different platforms and establish a vision that combines several modalities; and they will do so in a manner that best meets the expectations of the client base.  Mission statements will be revised to address needs as seen through the eyes of the consumer.

Professional development    A database can store information related to continuing education, but it takes one on one interaction with a worker to learn what is important to him/her and develop a plan for personal growth.  People mentor people and AI will have difficulty functioning as a counselor or a coach.

Humility AI is what it is; highly intelligent but programmed, sterile and lacking emotion.   Admitting errors and admitting that others may know more than you do about a specific issue introduces a human emotion that computers can’t match in the high-tech workplace.

Feedback    Computers spit out numbers and report discrepancies but lack the ability to determine the cause for non-compliance or help an individual chart a course to correct a problem.  When it’s time for the boss to have a difficult conversation with an employee, human interaction is essential.

 

The workplace of the future will be rich with technology and have instant access to large volumes of information.  Algorithms will quickly assess data and either suggest or implement an appropriate action.  Many of the hands-on tasks that were historically done by workers, such as scheduling appointments, billing for services, or ordering supplies will be automatically done by computers.  As the nature of the work shifts, so will the role of the leader.  Rather than competing with AI, a Transformer will focus on the elements of leadership that that a bot cannot; understanding, motivating and connecting with clients and workers.

 

Tom is an experienced leader, author and requested speaker. 

Contact Tom for an appearance at your next meeting.

Visionary innovation

visionary intelligence post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Visionary leaders are hot commodity.  How can you go wrong with a leader who can see into the future and position an organization to stay one step ahead of the competition?

In 1995, Jeff Bezos saw the potential of the internet marketplace and visualized a virtual bookstore that would be open 24/7 and could deliver reading material either in print or online with the click of a mouse.  Naming the company after the famous South American river, Amazon books was established and rolled out from the founder’s garage in Seattle.  The Bezos vision expanded via the kindle reader eventually developing into the shopping market that we know today as amazon.com.

The creator of Amazon was not lucky nor was he unique.  There are other leaders in business and industry, including healthcare, who share the traits of a forward-thinking individual.  In working to build a better future for the clients they serve and for themselves, the more successful leaders are able to strike a balance between creative thought and observable action.  They listen keenly to clients and co-workers and use emotional intelligence to learn what people really want.  They establish a desired end point, formulate a plan, and work relentlessly until the goal is achieved.  They favor innovation, accept responsibility, and regard a setback as a learning experience.  “…glad we don’t have to do that again.”  In some cases, new technology must be created to address a need but at other times the leader with an eye to the future finds new applications for existing technology.  Bezos did not invent the internet or the bookstore; however, he did foresee that readers would flock to the convenience of online access to any book in print with immediate delivery to a mobile device.

 

CRNA inventor

Diane Miller is a pediatric CRNA and inventor whose life was changed by her inner drive to develop a playful way to initiate general anesthesia for pediatric patients.  Motivated by an experience inducing anesthesia on Zeke, a 4-year old “frequent flyer” with PTSD from previous anesthetic inductions, Diane felt compelled to develop a lighthearted induction technique.  Rejecting the decades-old tradition of “cyclo-brutane” used on fighting children, Diane developed the Pedia device for induction of anesthesia.  Widely accepted by young children, it resembles a balloon with a whistle and makes induction of anesthesia entertaining for the pediatric population.  Pedia has been awarded a patent and has been cleared by the FDA.  The Pedia device is a game changer for pediatric induction of anesthesia and I predict it will quickly become the standard for our industry.

Diane’s story and device are featured on the pedia web site

 

Point of care ultrasound

Ultrasound imaging can identify the gender of an unborn child, determine the size and shape of a tumor or locate nerves prior to placing regional anesthesia.  However, the device comes in size extra-large and it frequently isn’t available where the patient is located.  These handicaps opened the door for Dr. Jonathan Rothberg to introduce an ultrasound system that did not require transport of a cumbersome machine to the patient’s bedside.   Rothberg selected a team with whom he shared his vision and together they worked tirelessly to create the butterfly point of care ultrasound device.  The device uses a standard sized ultrasound probe with quartz crystals and, uniquely, connects to a smart phone, pad or other mobile device to display the image.  The probe can be carried in a holder on the individual’s belt and literally anyone with a modern phone can keep a personal ultrasound system at their fingertips round the clock.

You don’t have to be an inventor to foresee uses for existing technology as evidenced by anesthesia leaders who have quickly adopted the butterfly system to enable immediate ultrasound images of their patients.  In addition to the obvious use of facilitating nerve blocks, the system is being used to assess gastric volume, vascular access, ventricular movement, pulmonary fluids, bladder retention or other conditions where an image could alter the anesthetic plan.  Those boarding the butterfly bandwagon appreciate the flexibility that comes with having immediate access to ultrasound images and forecast improved patient outcomes due to information gained by this creative device.

More information can be found on the butterfly web site.

 

Some think of visionaries as having a crystal ball while others picture the mad scientist busy inventing things in the workshop.  Although there may be a touch of truth to each stereotype, the truth is that most visionaries are ordinary people visualizing extraordinary things in order to solve both ordinary and extraordinary problems.  Their mantra is, “We can do better!” and their work ethic is indefatigable.  Sometimes, a new product will emerge, and other times new uses will be found for existing technology.  Jeff Bezos developed an online marketing system that has changed the world economy; Diane Miller developed a playful way to induce pediatric anesthesia, and Dr. Jonathan Rothberg put real time ultrasound imaging into the hands of every healthcare worker.  Now it’s your turn.  Use your visionary skills to discover resourceful ways for making the new technology a standard of care in the workplace.   Identify a need, imagine the best possible outcome, develop steps to get there, communicate your plan and work relentlessly until your goal has been achieved.  When the new standard has been set, you will join the ranks of visionary leaders.

Tom is a noted author, speaker, leadership developer and dedicated clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Goal for the Gold

boys in the boat post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

The Boys in the Boat by Daniel James Brown (pub. 2013) is a true story of nine, rugged college age boys who united as a formidable rowing team during The Great Depression and became destined for glory.  From earning a spot on the team, to winning the collegiate championship to bringing home the gold from the 1936 Olympic games, this non-fiction best seller, released in June, 2013, continues to keep readers on the edge through the final stroke.  Simultaneously, heart-rending and poignant, heart-pumping and uplifting, this book is packed with valuable lessons for leaders and life, and proves that striking gold is more than a stroke of luck. Put “The Boys In The Boat” on your must-read leadership list and look for the following lessons as you enjoy the journey to Berlin.

 

Select the right people

(STORY) Refusing to succumb to the distraction of The Great Depression, University of Washington Coach Ulbrickson, maintained his ‘vision with a plan’ for winning a national rowing championship, a plan that started with selecting the right people.  From the pool of able-bodied young men who hoped that rowing would provide a scholarship to help pay for their educations, the coach carefully selected a crew that had physical size, cardiovascular stamina and mental grit.  Throughout the trial period, the coach had a keen eye out for those with a focus on teamwork.

(LESSON) Likewise, in the modern workplace, selecting the right team is the first step toward success. Along with having the proper credentials, each new hire must have a solid, proven work ethic with a focus on teamwork.  To go beyond learning about the person’s clinical skills, talk personally to the applicant’s references; ask questions that validate a work history of collaborative teamwork.  During the interview, clearly share your vision with the applicant so you can determine whether he/she is in alignment with your goals.  It’s always preferable to fill the empty seat on the boat with someone who rows in sync.

 

Establish a goal

(STORY)  Coach Ulbrickson was not shy about sharing his determination to form the right team, substituting or eliminating rowers, then training them to work as one to win the national championship.  Everything he did in his personal and professional life supported this goal and drove his thoughts and activities 24/7. He had neither time nor patience for distractions. 

(LESSON) The best leaders and most productive teams have a committed goal.  Sometimes it’s specific to the workgroup and other times it’s an organizational goal. For example, a healthcare team was having trouble hiring and retaining qualified people until the leader set a team goal ‘to be the employer of choice for nurses in that region.’  She gathered her team and they defined what a preferred workplace would look like; then the team committed to building such a place.  The culture changed, within 18 months there were more applicants than openings, and the leader’s vision was fulfilled.   Having, sharing and working for a goal can turn your team around as it gives them something to look forward to achieving.  Taking a line from the song happy talk, “If you don’t have a dream, how ya gonna make your dream come true?”

 

 

Train incrementally with a purpose

 (STORY)  The varsity crew members were not selected so they could sit in a gondola with a girlfriend; they were each placed on a coveted seat labeled “perform or lose your position.”  The coach established a purpose for every workout and made certain the proper equipment was available.  In return, each person was expected to be all-in every day working in common.  As they trained together, the team became inter-dependent and trusted that each man in the boat was giving 100% every day.

(LESSON) The best leaders are coaches who set high expectations, provide the resources and insist on trained teamwork.  They educate the team to align with the stated mission, vision and values and instill a confidence in the group that they can use collectively to handle day-to-day adversity. Those who lead and those who work in preferred workplaces have coveted jobs that come with expectations that must be met on a daily basis.  Purposeful training provides the team and team leader with two-way protection.

 

Embrace adversity

(STORY)  Neither the coach nor the aspiring oarsmen could have predicted the depression of the 1930s, nor its depth and duration.  Neither could the team foresee the unfair treatment that it would receive from the home team Germans after earning a spot in the 1936 Olympic championship race.  Hitler’s control of the Berlin Olympics enabled race organizers to place the American boys in the least favorable lane, created issues and events totally beyond UW’s control and could have justified abandoning the vision altogether; however, this remarkable team took adversity in stride, did everything they could with what they had, and discovered that overcoming layers of obstacles made them even stronger.

(LESSON) The modern workplace is a hectic place and the fight for resources today can feel as challenging as finding a hot meal in the 1930s. But, those who stay focused will survive the hard times and come out stronger, more determined to achieve success.  While always ensuring that goals are known and people are trained to do their jobs, great leaders empower the team to create viable solutions for overcoming obstacles.  Each problem you solve together positions your team to handle the next challenge.

 

Build and leverage trust

(STORY)  In the book, the coach built trust through physical conditioning of the oarsmen and teaching strategy to the coxswain or navigator.  The team started each race with a general plan delivered by the coach, but it was up to the navigator to read the field and make appropriate adjustments.  The coach trusted the judgement of the coxswain as did the muscle movers powering the oars.

(LESSON) The same philosophy applies in the workplace when the leader develops trusted relationships with the team, then steps back and allows the team to read the field, apply principles and make independent decisions.  Avoiding micromanaging and encouraging creative thinking shows that you trust your team.  A sure-fire way to ensure that your team performs at a high level when you’re away is to give them the latitude to make decisions while you’re there.

 

And there you have it.  A captivating real-life story about a group of determined young athletes who conquered adversity, earned victory, and left lessons in their wake that remain meaningful over eighty years later.  High quality work teams share the principles that brought victory to the University of Washington varsity rowing team in 1936.  Today, either through intent or serendipity, leaders are selective in the talent they recruit, the goals they set and the latitude they give to those whom they trust. And teammates are looking for preferred workplaces managed by talented leadership. Get on the varsity team then grab an oar and hop on board with a goal for the gold.

 

 

Tom is a noted author, requested speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Non-disruptive by design

Disruption post

Thomas Davis, CRNA, MAE, DNAP candidate

follow@procrnatom on twitter

Disruptive behavior cuts a wide swath in the workplace and, left unchecked, it will kill the morale and productivity of a team.  Conduct that is viewed to be disruptive runs a spectrum from minor sarcastic comments to full-blown toxicity of a colleague whose ability to put a negative spin on just about anything is worthy of an Oscar.  A working definition of disruptive behavior is:  Any ongoing personal conduct that disturbs the work environment.  Lainie Peterson, contributing author to Chron, notes that “disruptive behavior kills group morale, drops team productivity, increases workplace stress, increases employee turnover and creates a negative reputation for the employer.”  The effects of disruptive behavior are potentially pervasive, and leaders have a vested interest in drawing a red line.

“An ounce of prevention is worth a pound of cure.”

~Ben Franklin

 

 “Stay Out of Trouble…”

My mother liked to address my youthful indiscretions by saying, “It’s easier to stay out of trouble than to get out of trouble.”  In the workplace, those words of wisdom support the proactive approach of developing a system that attracts and hires workers who value collaboration and congeniality, rather than one that tolerates malignant behavior.

Recruiting.  You are not seeking a warm body to fill a position with your group, you want the right person.  Make sure that your job description touts collaborative teamwork that adheres to the mission, vision and values of the organization.  Use the JD to let applicants know not only what you want them to do, but also how you want them to do it. Making supportive teamwork a job requirement, puts you on solid ground should the need arise to address poor conduct of an employee in the future.

Hiring   Determining the right person for a job must include an interview format that includes a two-way dialogue about job expectations.  An interview technique that I have found to be particularly revealing is to provide the applicant with a list of the organization’s core values and discuss them during the interview.  Conclude the interview by saying, “if these values are not who you are, this is not your job.”  By discussing teamwork and values at interview, you further establish a solid foundation for addressing disruptive behavior should it arise.

Feedback   Schedule a one on one discussion with each new hire at the end of each of the first six months of their employment.  Each month, review the values that were discussed at interview and ask the person to relate their daily work to the organization’s values.  If negative feedback about the person’s behavior has been put forward by co-workers, give the employee a wide berth to answer to the accusations followed by a frank two-way discussion to clarify expectations.  After reinforcing your anticipation of supportive teamwork, ask for a re-commitment to the shared values of the group.

Teamwork.  Those who are already on the team deserve the same opportunity to discuss team values that you had with the job applicant.  Dedicate a team meeting to conversation about the core values of the organization and open the floor for your team members to identify behavior that would support the values.  Decisively tell the team, just as you did the applicant, “if these values do not represent who you are, this is not the right job for you.”

 “Get Out of Trouble.”

If hire-prevention hasn’t kept a bad actor from slipping into the ranks and general morale is suffering, it’s time to roll out the fire-hose.

Look for the cause.  Before you pull out the big guns and start firing, look for the cause of the disruptive behavior.  The person may be suffering unusual stress from satisfying the needs of a sick child or an infirmed elderly parent, or the worker may be experiencing critical financial woes causing internal stress that has been allowed to affect their external behavior.  Counsel your team member and look for options such as flexible work scheduling, or a leave of absence, to enable the person’s resolution of issues.

Give direct feedback.  Workers who disrupt the workplace by lack of personal restraint must be given a clear description of the problems they have created. Again, meet privately with the offender and provide an accurate review of the complaints lodged against the individual and precisely identify the consequences created for the team as a result the bad behavior.  If you are concerned for your personal safety or anticipate passive aggressive spin on your words, have a second person in attendance at the meeting.  Caution: Try not to create an environment in which the accused feels as if the boss is “ganging up.”

 

Be specific.  Giving negative feedback can be uncomfortable and it may be tempting to talk in generalities. …don’t.   In order to ensure that behavior changes, you need to be specific and define your expectations.  Be your confident self as you state, “When you do…, it has this effect…”  If you’re dealing with and angry bird, point out the far-reaching effects on those other than their target. Those who witness the encounter, either patients or colleagues, become collateral damage of the disruptive behavior.

Set boundaries.  After establishing the behavior that is to be eliminated, move on to discussing the desired behavior.  Review the mission, vision and values of the organization and make it clear as to how the behavior did not support the core values.  Challenge the person to describe how they might have handled a situation differently had they kept the core values in mind.  Make it clear that the worker’s behavior moving forward must align with core values and that deviation will mandate dismissal from the team. End the session by setting dates for two follow-up sessions.

 

Follow-up.  If behavior has changed, use the first follow-up session to extend kudos and encouragement. Give feedback from the team to promote a feeling of inclusion. If progress has been made but more work is required, congratulate the improvement and have the person identify additional measures that will continue the momentum.  If no progress has been made, move forward with termination.

A disruptive team member can create a very uncomfortable environment for both leader and co-worker.  Emotions run high in the healthcare workplace inherently and the work environment certainly doesn’t need the friction created by bad behavior within the team.  Rather than avoiding confrontation, see bad behavior as an opportunity to implement decisive leadership. In the process you will eliminate the disturbing personal conduct and earn respect.  Your failure to act with authority will allow the obstructive behavior to weave itself into the fabric of the team, creating a negative culture that will eventually require outside intervention.

Hire congenial, collaborative people and don’t hesitate to deal with disruptive employees you inherited.   Design a system that has zero tolerance for disruptive behavior, and you can stay out of trouble before you get in trouble.  Both my mother and Ben were right.

Tom is a noted author, enthusiastic speaker, committed leadership developer and superb clinical anesthetist.   Contact tom@prosynex.com to book a speaking engagement.

Build a Bridge

teambuilding post

The Team Is The Trestle

By Thomas Davis, CRNA, MAE, DNAP candidate

 

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

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

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

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

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

 

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

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

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

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

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

 

Pharm to Table: Direct Marketing Works

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

Follow @procrnatom on Twitter

 

“Tell your doctor to order Clearfast two hours before your surgery,” implored the radio messenger.  The audience listened raptly to claims that this potent preop drink, “… speeds recovery and promotes a better outcome for consumers…” than their less fortunate peers who suffer from the traditional 8-hour fast enforced by many anesthesia providers.   The narrator continued by telling listeners that downing the drink 2 hours before surgery would be calming, provide a feeling of being hydrated and nourished, reduce postoperative infection and promote a comfortable recovery.   I was shocked to hear a manufacturer bypass the collective wisdom of anesthesia providers and speak directly with future patients and encourage them to buy a product that would enhance recovery after surgery.  After all, isn’t it our job to do preop teaching?

 

As evidenced by the number of medications being marketed via TV, radio and social media, direct marketing works.  Pharmaceutical companies spend millions of dollars every year on direct marketing campaigns for one and only one reason; selling directly to the consumer works.  As healthcare providers, we must learn from the business community and use direct marketing techniques to promote our individual practice as well as the status of our profession.  Writing in Becker’s Hospital review, author Nick Ragone notes the importance of direct marketing and the use of technology to connect directly with future patients as well as the use of mobile devices to make access to care convenient, accessible and personalized.

 

Regardless of whether you are marketing your personal skills, your profession, or the organization where you currently work, Laura Dyrda (Becker’s ASC Review) offers suggestions for direct marketing your healthcare services.

  • Direct mailing  Snail mail may feel “so yesterday” but we still have postal service.  A colorful, thoughtfully formatted postcard will catch the eye and advertise your group.  A short newsletter outlining the ways in which consumers benefit from your services will attract a percentage of those in need.
  • Attractive and interactive web site  By necessity, direct marketing is a brief encounter with a potential client that may leave questions unanswered.  Marketing should link people to a web site that is visually appealing and functional in every area, Including quick links to frequently asked questions and an interactive area for questions and answers.
  • Social media It is not enough to have an award-winning web site; a presence on social media is needed to augment your direct marketing.   Link your web site to social media and increase the number of potential clients that you capture.
  • Write an article for a local rag or mag  Newspapers have a health column and trade magazines are always seeking human interest stories.  Put on your creative cap to assess the needs of your community and write an article to address local hot topics.
  • Send a monthly newsletter  Newsletters allow you to present your information in greater detail.  Always keep the newsletter relatively short and very interesting to build a cadre of readers who look forward the next installment. Newsletters can be delivered via regular mail or via email with a link to a blog page on a web site.
  • Conduct a local charity event Your group is placed in the spotlight and you can develop trust with the local community when you successfully sponsor an event to benefit a local charity.  Pick your cause, design an event to promote the charity and do the work to make it a success.  In my local area, CRNAs recently promoted our profession by sponsoring a blood drive.  Last year the group did a children’s book drive to benefit the pediatric area of the hospital.
  • Talk to civic groups Local groups such as Rotary, Lions, or VFW have monthly meetings and are always seeking local experts to enlighten the group on a variety of subjects.   Select a healthcare-related issue and give a talk to a local civic group.  When the group or an individual in attendance needs the services you provide, they will seek you.
  • Support community events  Many events in your local area can only happen with the assistance of people who volunteer their time to provide support.  Local running events need teams of people to man the water stations.  Health fairs need booths of eager healthcare workers to assist in health assessment.   Career day at the local high school is dependent upon local experts entice students to take an interest in their line of work.   All donations of time, energy or money help make it happen.
  • Hang signs in waiting rooms Working long hours behind closed doors limits visibility and the opportunity for others to truly appreciate the valuable services provided by skilled advanced practice professionals.  During CRNA week, rather than hanging signs in the lounge, hang them in patient waiting areas.  “Wanted” posters picturing the CRNA or a healthcare worker of the month and his/her outstanding contribution can be simultaneously consciousness-raising and amusing while marketing the profession.

 

Pharm to table marketing works.  When it’s implemented judiciously and in the right spirit, you are rewarded with a positive return on the resources invested.  In a connected and mobile society, patients are not geographically tied to a specific area or provider; they are free to shop for services and select the provider who best serves their needs.   Direct marketing has taught patients to request preoperative hydration as a means of improving outcome and direct marketing has the potential to build a population of patients who request Nurse Anesthesia to accompany their drink.

 

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

Teaming with Trust

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

Follow @procrnatom on twitter

 

Preferred workplaces are interesting, welcoming, stimulating venues where employees enjoy spending their time along with a feeling of personal satisfaction as they head out at the end of the day.   Trust is an essential element that must be present for a preferred workplace to exist; however, in many workplaces trust is low, and instead of enjoying their work, employees spend each day feeling anxious and wondering when, where and why the next assault will take place.   Rather than focusing on team goals, worried employees revert to a defensive position and focus on avoiding making mistakes.  Both morale and productivity suffer in a low-trust environment.

 

Writing in his personal blog, The Workplace Therapist, Brandon Smith offers a list of characteristics of a  low-trust environment, including the following:

  • Food is routinely stolen from the break room.
  • You worry about what others say about you when you turn you back.
  • No one praises each other, ever.
  • No one helps if someone is struggling. It’s “everyone for his / herself” combat at work.
  • You are encouraged to compete and beat your co-workers at all costs.
  • Your boss plays favorites.

Changing the culture of your team requires effective communication, commitment and consistency; with effective leadership, it can be done.   Leaders can build a trusting environment by making expectations known and creating boundaries for the behavior of team members.   Increase trust and move toward becoming a preferred workplace by enacting these recommendations.

 Share information   Absolute honestly is essential in building trust because no one trusts a liar.  Disseminate information openly and transparently to let those around you know that you have nothing to hide, nor do you have hidden agendas.  Have frequent team meetings on which you share information freely, solicit feedback, and listen attentively.  Ask your team to describe their views of a trusting environment; take notes and make some suggested changes.

Promote professional development   People who know that you have a benevolent interest in their personal development will trust your intentions and will reciprocate by behaving in a manner that earns your trust.  Elevating the skills of every member on your team establishes a spirit of collaboration and reduces dog eat dog competition that is found on low trust teams.  As you focus on mentoring and developing those you supervise, they will take an interest in helping one another with a “pay it forward” attitude.

Give praise   Recognizing and thanking those around you is a quick and effortless way to build trust.  Not only will workers feel valued, praising them reduces the fear that you will take credit for their work.  Never let a day pass without recognizing and thanking at least one person on your team for a job well done.

Stop gossip    Gossip is a trust killer…always.   When someone tells you something negative about someone else, you can be assured that they will also talk about you behind your back.  Do not participate in or listen to gossip…stop it in it’s tracks.  For example, one day in the lunch room where I work a person joined our table and quickly started to say negative things about another person on the team who was not present to defend himself.  Rather than participating or allowing the gossip to continue, a second person at the table replied, “I’m sure he would be disappointed to know that you feel that way.”  Quickly and effortlessly, she brought the gossip to a halt and the conversation moved to another topic.

Take the first step toward establishing a preferred workplace by building a secure environment where pats on the back replace the knives that were previously placed there.  Meet with your team and openly discuss the desired behavior needed to increase trust and then lead by example.  By communicating with clarity while promoting the skills and interest of every person on your team, morale and productivity will increase and you will gain a reputation for being a highly desired and enjoyable place to work.

 

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

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

Core Skills for Leadership

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

Follow @procrnatom on twitter

 

The road that a person must travel to become a fully certified/credentialed member of a profession is often long and demanding.  In addition to gaining a body of knowledge, critical skills and competencies must be mastered in order to gain entry into the career field and successfully establish yourself as a qualified member of the professional community. Effective leaders in a profession must also master essential leadership skills and competencies, and, as with professional proficiency, skillful leadership expertise can be learned.

Skillful leaders have a vision.  Develop the ability to formulate a picture for your workplace of the future by acknowledging where you’re at 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 own experience, my vision has always been to create a preferred workplace, so I am constantly seeking ways to promote collaboration and mutual respect within the team to achieve our desired future work environment.

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 such a way that the listener receives information 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 commit.   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 aren’t the ones living in a conflict-free zone.  They’re the ones who quickly and confidently address issues and achieve democratic 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.

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 team as a whole as well as for individuals and take the time to celebrate.  Public recognition of success is motivating and makes your team eager to take on the next project.

leaders display personal integrity.   You can’t 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 and is absolutely foundational to leadership.

Administrative authority is more than a title.  It requires core competencies, and, as in any profession, requires life-long learning.  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.

 

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

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

Five Essential Questions

Five Essential Questions

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

follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

 

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

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

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

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

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

Now available on Amazon books

Leader Reader

Busy or Productive?

Busy or Productive?

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

Follow @procrnatom on twitter

               

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

 

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

 

Are you busy or productive?

Busy people …

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

Productive people…

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

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

 

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

 

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

 

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

 

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

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

 

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

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

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

Leader Reader

Hidden Jewels

Hidden Jewels

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

Follow @procrnatom on Twitter

 

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

~Ralph Nader

 

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

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

 

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

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

 

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

 

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

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

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

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