CRNA leadership – Page 2

The OR Blame Game

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

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

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

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

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

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

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

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

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

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

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

The Satisfaction Connection

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

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

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

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

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

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

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

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

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

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

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

Coming soon: Values based Leadership Webinar series.

Encore Symposiums Cape Cod 2017

Meeting review by TD

Meeting Date: 10/9-12/2017

Meeting location: Chatham Bar Inn, Cape Cod

Meeting sponsor: Encore Symposiums

Strengths of the meeting: Great location with topics relevant to current practice and dynamic speakers to bring them to life. This particular meeting attracted a fully engaged audience of CRNAs eager to learn and participate. Overall, a great experience.

Value for the money: Nancy puts her heart into finding the best locations and then putting together a program that causes attendees too want to attend every session. If you are combining vacation with education, you can’t do much better than this.

Who wants to be a millionaire leader?

By Thomas Davis, CRNA

Keep up to date with healthcare leadership topics, Follow @procrnatom

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

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

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

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

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

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

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

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

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

Building Common Purpose

By Thomas Davis, CRNA

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

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

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

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

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

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

Create a common purpose

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

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

Implement Change

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

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

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

Advice from Mom

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By Thomas Davis, CRNA

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

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

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

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

Building a family

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

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

Building a business

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

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

Building a good name

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

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

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

The Value of Vision

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By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

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

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

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