Tag: Healthcare leadership

5 ways to get more from your video meeting

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

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

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

Ace your video interview

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

Ace your virtual interview

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

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

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

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

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

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

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

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

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

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

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

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

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

~John Maynard Keynes

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

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

Inclusion; The key ingredient for successful diversity



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Social media is abuzz with strong opinions about diversity, social justice, and equality for all.  Facebook, twitter, and professional discussion boards such as AANA connect display hundreds of comments from passionate people who want their opinions to be heard.  Overnight, diversity has become a hot topic for discussion throughout our society.  While cultural diversity is important, it is the assurance of inclusion, both in society and in the workplace, that adds equality to the equation.

Diversity versus Inclusion; what’s the difference?

Diversity

Throughout its history, the United States has been referred to as a cultural melting pot.  We are a nation of immigrants where most people found their way to our country seeking an opportunity for a better life while others were captured, enslaved, and brought to our shores against their wishes.  Regardless of the circumstances for immigration, every individual currently in our society adds a unique perspective to the diversity of the nation. 

Without question, we are a diverse nation; however, that does not ensure that all people are respected and treated equally.  The decades of struggle by women and African Americans to obtain the right to vote highlights an instance of segments of a diverse population that were excluded from full citizenship and serves as an example of diversity without inclusion.

Inclusion

Inclusion is living one’s life with the belief that all people are important and deserving of respect.  It is overtly manifested by behavior affirming that the best and most creative ideas arise from many ideas and mandates participation by each segment of our diverse population.  Writing for Forbes.com, author Dan Schawbel stresses the importance of workplace inclusion by noting, “Inclusion is a call to action within the workforce that means actively involving every employee’s ideas, knowledge, perspectives, approaches and styles to maximize business success.” 

On the job, behavior ensuring that every member of the team can participate fully and equally in creative thinking, problem solving, and the development of innovative practice protocols are examples of inclusion.  In an inclusive environment, all voices are heard, and all opinions are thoughtfully considered.

Creating inclusion in the workplace produces positive consequences as noted by The Denver Foundation;

  • Higher job satisfaction
  • Lower job turnover
  • Higher employee morale
  • Improved problem solving
  • Increased creativity and innovation
  • Increased organizational flexibility
  • Improved quality of applicants for open positions
  • Decreased vulnerability to legal challenges

There is no downside to a culture of inclusion in the workplace.

Avoid subtle forms of exclusion

Overt exclusion involves behavior that is blatantly discriminatory and is illegal in most workplaces; However, covert forms of subtle discrimination are more difficult to identify and occur more frequently.  Author Jane O’Reilly identifies behavior such as failure to respond to a greeting from a colleague or looking at the phone while talking to a person as being dismissive and are examples of social exclusion.  Psychology today author Lynne Soraya adds to the list of workplace behavior that exclude team members and increases polarization of the workgroup.  She identifies the following as killers of inclusion:

  • Publicly reprimanding of an employee
  • Selectively not inviting all stakeholders to a meeting
  • Using sarcasm / ridicule when speaking to another employee
  • Dismissing those who do not speak up quickly as having nothing to say
  • Judging a colleague as less than committed if he/she does not participate in off duty activities
  • Committing a colleague to travel or extra work without discussing it with them
  • Punishing an associate for speaking up truthfully when something is not right
  • Cutting off and dismissing a person if they have a complaint
  • Finishing a sentence or thought for another person if they speak slowly
  • Bullying in any form

Writing for Quill.com, author Lindsay Kramer adds isolation, minimizing, and ignoring to the list of subtle behaviors that exclude people from full participation on a work team; behavior that must be taboo in the workplace.

Build an inclusive workplace culture

Human Resources has done their job and staffed your workplace with a multi-cultural, multi-gender, and multi-generational team; they have created diversity.  Now, it is up to you to add the magic ingredient of inclusion to capitalize on the ingenuity that each person adds to the group.  Here are some behaviors that will promote inclusion and transform the culture of your workplace

Examine your assumptions and become aware of hidden bias that you may have.  Ask yourself, “What if the opposite were true?”   For example, instead of assuming that James is not capable of taking on a project, consider that he is fully capable but has never been encouraged or given the opportunity to show his talent.

Seek opinions and ideas from a broad range of people.  Move beyond the comfort zone of your inner circle and ask for opinions from staff members who will most be affected by your decision.  Have a small, diverse group of workers meet to discuss issues and go around the table to ensure that each person speaks.  Listen attentively and if someone does not express an opinion the first time around the table, go back to that person and ask him/her to comment on a suggestion made by another person. 

Focus, listen, and ask questions when you are speaking to others.  Even the quietest people among the team have opinions and often they are quiet due to a history of being marginalized.  Actively listening and asking questions to expand the person’s train of thought sends a clear message that they are valued and builds a sense of inclusion.

Defuse drama and have zero tolerance for gossip or bullying in your workplace.  Drama focuses on a problem, creates a victim and is divisive to a team.   Instead, focus on finding a solution and encourage mentoring and coaching.  My previous article, 4 keys to eliminating disruptive behavior has additional tips for leaders who actively fight drama in the workplace.

Showcase the achievements of each team member and tie their individual accomplishments to the success of the team.  Demonstrate your belief that all jobs are important and praise grassroots workers for their commitment to the job and the team.  Post a Kudos Board in the break room and spotlight each team member several times per year and turn all birthdays into special days hailed by the entire team.

Promote cultural awareness by celebrating ethnic special days.  Plan festive displays in the break room for Cinco de Mayo, Kwanzaa, St. Patrick’s Day, Ramadan, and other holidays that are celebrated by individual members of the team. 

Encourage multigenerational collaboration among team members.  The Boomers on your team were born and raised in a world without cell phones or computers whereas the youngsters cannot imagine a world without them.  My previous article, Older workers strengthen the team,notes that combining the street sense of the elders with the tech savvy of Gen Y & Z is a great formula for success.  In a highly productive workplace, mentoring is two way and trans-generational with each demographic learning valuable lessons from the other. 

Build a gender-neutral environment where rewards and recognition are based on achievement.  Harvard Business Review author Tara Sophia Mohr advises against listing qualifications for a job because women don’t apply unless they meet 100% of the items whereas men apply when they meet 60% of the qualifications.  Rather, list the desired behavior and achievements expected from the new person and more women will apply.  Writing in Forbes Magazine, author Peggy Yu advocates gender neutral language in all management policies to include pay and benefits.  In addition, she notes that gender friendly bathrooms complete with pads and tampons promote an inclusive culture.

Diversity and Inclusion

Several centuries of American history have documented that diversity without inclusion marginalizes segments of the population and sets the stage for the protests that we are currently witnessing across the country.  Politicians can pontificate and pundits can tell us what we ought to do, but meaningful change will only happen at the grassroots level.  I cannot change the world, but I can change my world starting with my workplace and that mandates a culture of inclusion.  It is time to stop talking and get to work.

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



Setting the Standard

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Standards are essential

High quality patient care must be delivered in a consistent and safe manner; professional organizations set standards to define it, institutions develop policies to provide it, payors demand it and patients deserve it.  Frontline workers must deliver it.

The history of standards for patient care can be traced to the 1800s when obstetrician Ignaz Semmelweis demanded handwashing by those providing medical treatment.  Several decades later, surgeon, Ernest Codman, became a relentless champion for hospital standards and the assessment of outcomes.  Legendary nurse, Florence Nightingale, identified the link between living conditions and death rates among soldiers and became a powerful advocate for basic nutrition of soldiers and setting sanitation standards for the barracks.  In each case, a healthcare  champion pushed the medical profession to set standards – a minimal expectation below which care cannot be allowed to drift.

Throughout the 20th and into the 21st century, there is an ongoing focus on improving patient safety and outcomes through the development and enforcement of standards for care.  The topic of reliable evidence-based medical treatment has gained front page prominence and is now included in the AMA Journal of Ethics for physicians.  This, from the ethics journal:

  • Standards of quality are statements of the minimum acceptable level of performance or results and what constitutes excellent performance.
  • Medical practice guidelines are evidence-based statements to assist practitioners in their decision making.
  • Medical review criteria are statements used to assess the appropriateness of specific decision, service, and outcomes in the delivery of care.
  • Performance measures are observable and measurable criteria that indicate compliance with medical quality standards

In 1965, Congress passed legislation that created the Medicare and Medicaid programs intending to create a medical safety net for the elderly and those who were otherwise uninsured.

Authors Youssra Nariousa and Kevin Bozic. note that along with entitlements, the bill established “conditions for participation,” conditions which, in subsequent years, evolved into a mandate for the establishment of standards of care; criteria that must be met if reimbursement for service is to be obtained.  By default, the Center for Medicare and Medicaid services became a powerful force demanding the creation and enforcement of standards of care in healthcare.

Professional organizations and patient safety advocacy groups also play an important role in the establishment of standards of care for practice.  The American Medical Association and the American Nurses Association collectively set practice standards that are applied broadly to the healthcare industry.  Sub-specialties in medicine and nursing also have professional organizations that establish performance criteria for providers in their sub-specialty.   For example, anesthesia related organizations establish practice standards that affect the entire perioperative area.

Specific to the practice of anesthesia, the American Association of Nurse Anesthetists, the American Society of Anesthesiologists, and the Anesthesia Patient Safety Foundation have all established minimum criteria that must be met to ensure safe practice.  Although each organization’s differing views on supervision may affect the wording, most of the standards are essentially the same between the three anesthesia specific groups.  Current standards for the delivery of anesthesia include:

  1. The constant presence of a qualified anesthesia provider.
  2. Adequate oxygenation including continuous analysis of the fresh gas flow, pulse oximetry and clinical observation
  3. Adequate ventilation as evidenced by continuously observing the level of expired carbon dioxide during moderate sedation, deep sedation or general anesthesia.  Verification of correct placement of any artificial airway device.  The use of ventilatory monitors as indicated
  4. Physiologic monitoring of blood pressure, heart rate and respiration with documentation at least every 5 minutes.  Monitors must have audible alarms that are turned to a pitch that is easily heard by the anesthesia provider.
  5. Cardiovascular monitoring to assess the patient’s heart rate and cardiovascular status.
  6. Thermoregulation when clinically significant changes in body temperature are intended, anticipated, or suspected. 

Although specific hands-on techniques have changed due to the threat of COVID-19, standards of care remain in effect and must be met.

Look beyond the horizon

As cutting-edge technology becomes routine evidence-based practice, standards of care are updated and the baseline for minimal acceptable care is elevated.  For example, the pulse oximeter was introduced to clinical practice in the mid-1980s and by 1987 rapidly became a standard of care for the administration of general anesthesia in the US.  The sudden elevation of monitoring requirements created a scramble to obtain the necessary equipment for meeting the new criteria.

Therefore, before morphing into a standard of care for the profession, new technology and techniques that are safe and effective are often introduced as local policy and evolve over time into a new minimum requirement.  Rather than waiting for requirements to change, be a workplace champion and elevate your practice by developing local policies that exceed current minimum standards.  Once done, push to make your elevated level of care a standard for the profession.

Future standards of care

Implementing new standards of care must be done judiciously and within the capability of providers to comply with the mandate.  Once a standard is set, those who do not meet the requirement are legally liable and might not be reimbursed for their services.  Stay ahead of the curve by considering these items for inclusion in the policies that govern your workgroup.

Video laryngoscope   Fiberoptic endotracheal intubation was introduced to clinical practice in the 1960s and by the 1980s became the first line of defense for a difficult airway.  Now, the video laryngoscope has proven itself to be faster, lighter, and equally reliable to the technology of the 80s making fiberoptic intubations a rare event.

With the outbreak of the COVID-19 pandemic, anesthesia providers are seeking ways to separate themselves from the patient’s airway and many who intubate opt to use the video laryngoscope to create distance from the patient’s face.  Because the video scope has proven itself to be an exceptionally reliable first backup for a difficult airway and offers the added protection of distancing the provider from the airway, many anesthetists believe that the video laryngoscope should be a standard of care for the future.

Ultrasound for nerve blocks   Anesthesia providers toward the end of their careers can remember the days of seeking paresthesia while placing a peripheral nerve block.  Not only were results of landmark guided blocks less reliable, actual damage to the nerve was not uncommon.  Currently, ultrasound is being used to visualize the placement of local anesthesia in the space surrounding the nerve and has reduced the incidence of nerve damage associated with administering the block.  The improved patient safety and reliability of ultrasound guided nerve blocks will mandate this technique as a standard of care.

Multimodal pain therapy   The spectrum of sedation through general anesthesia does get the patient safely through the surgical procedure but it does not provide adequate analgesia for the immediate postoperative period.  Multimodal pain management uses a combination of different classes of analgesics which opens the door to comfortable, opioid-free recovery from surgery.  The effort to eliminate addiction to opioid drugs will mandate that multimodal pain become a standard of care.

Change the status quo by raising your standards

Quality healthcare is a platitude that arises from the C-suite; however, it is a way of life for the frontline workers delivering hands on service to clients.  To ensure positive outcomes, standards of care draw a line that quality patient care must not fall below; however, they do not necessarily represent the optimal treatment options available.  Healthcare providers in every specialty can raise the bar and exceed minimal requirements by constantly developing policies and procedures that exceed existing standards.  Anesthesia providers implement policies that require the use of new technology to protect the provider and improve the safety of the patient.  Surgeons implement policies that provide effective, opioid-free pain control postoperatively.  Perioperative nurses alter workflow policies to ensure the delivery of high-level care while maintaining social distancing. 

Today’s policies will become tomorrow’s standards.  Be a champion for your profession by constantly updating policies and procedures to reflect an elevated level of care and then be an advocate for establishing them as a new standard of care.    You may be on the frontline, but your initiatives will have a greater impact on healthcare than all the slogans coming from the front office.

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

Life lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

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

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

You are only a leader if others are willing to follow

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

You must be present to win

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

Protect your reputation

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

Be good to people and build good relationships

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

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

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

Establish your health early and maintain it for life

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

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

Invest wisely

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

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

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

Celebrate the Fourth of July by Teambuilding

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Enhancing teamwork is an essential task for leaders who want to empower workers, promote their collaboration, and increase their commitment to the job.  Writing in Forbes Magazine, author Brian Scudamore notes that group activities for the team “builds trust, mitigates conflict, encourages communication and increases collaboration.”  In addition to bringing people together, teambuilding activities break the daily routine and adds pizazz to a special day.   Author Eric Schad agrees that teambuilding is essential and notes that group activities promote socializing, friendly competition, and improves team performance.  Planning and implementing events to challenge cooperative interaction requires time, energy, and resources on your part as the leader and the organization; however, the ROI is worth the effort. 

The fourth of July is a mid-summer celebration that historically draws families to parks to eat hot dogs, sip on soda and watch fireworks.   Similarly, the week leading up to Independence Day is often a festive time in many workplaces and a great opportunity to infuse a little fun and energy into your group with team building activities.   Distancing restrictions are being eased, people are returning to the workplace and insightful leaders are leveraging their position by planning activities to re-unite the workgroup.  Here are some tips for lighting a fuse that will unite and motivate your team.

Individuals play the game, but teams beat the odds. 

~Seal Team

Virtual teambuilding

Americans are creative people and have found a way to continue to function within the parameters generated by the social distancing rules.  The traditional company July Fourth picnic is likely taboo but that does not need to shut down the opportunity for group events.  The internet offers a great platform for virtual events that are fun an interesting.   Look over these activities to get started, then use your imagination to invent more.  

Games People Play

Who-is-it competition   Ask each person on the team to write something about themselves that others would not suspect.  Post several each day leading up to the 4th of July and have team members guess who it is.   A variation of the game is to name the person and post 3 “facts” of which only one is true.  Have the team consider the person and select the true statement.

Riddles   The internet is “riddled” with them and some are quite complex.  Find one, post it then challenge your team to solve the riddle together, as one.  Slack and WhatsApp are two popular platforms that are user friendly for team chats that allow the group to work together to reach the solution.

Online games   Chess, checkers, Yahtzee, and many other traditional games are online.  In addition, Parade Magazine lists 25 online games to be enjoyed while social distancing.  Set up a tournament and let team members go head to head until one champion is left standing.

Quizbreaker   This is an online app that each team member can join.  A question is posed to the group and each team member replies.  This is a favorite for remote workers who want to remain connected with one another.

Build a story   Start a story line and then challenge team members to add to the tale, one person at a time, until the last individual brings the story to a surprise ending.   A group “reply all” email or one of the chat platforms listed above will facilitate this activity.

Picture contest   Create categories and have people submit pictures.  A variation is to have each person submit a picture of something in their home and have others guess who posted the pic.

Online happy hour   With or without alcohol, gather on a zoom or skype platform to share music, stories, and a glass of whatever floats. A variation would be to have a bartender’s happy hour where each person shows the group how to mix their favorite drink.  Danger:  Active participants may not remember the last few recipes that were shared.

Getting good people is the easy part.  Getting them to play together is the hard part

 ~Casey Stengel

Workplace teambuilding

Those of us who remained on the job over the last historic months have learned very quickly how to work around others while preventing the spread of the deadly disease.   Even though masks are being worn and social distancing is enforced, most workplaces continue to have common areas where workers gather in small groups, take breaks and share stories.  On the day before the holiday break, bring in extra people to help cover the workload and offer an extended lunch break for each worker.  Allow the team to filter through the break area in small groups and have activities set up for them to enjoy. 

Hot dogs and ice cream   Hey, it is the 4th of July and some traditions must be maintained.  Give the workers a free lunch while they mingle among the activities.

Puzzles.  Start a jigsaw puzzle on a table and encourage everybody to add a piece to the puzzle as they filter through the room.

Bean bag toss.   This game comes in all sizes from tabletop to targets large enough for the park.  Assess your space and start tossing.

Guessing games.  Fill a jar with gourmet coffee beans or red, white, and blue Jelly Bellies and have each person write down their guess with the jar going to the closest guess.

Basketball hoop.  OK, you are inside but a mini hoop with a nerf basketball is an open invitation for a free throw contest.  Watch the hot shot secretary shame the high school letterman.

Foosball table.   Space permitting, set up foosball for those who want to expend a little energy on head to head competition with a colleague.

Giveaways.   Make it a day to remember by sending each person off with a gift.  A R,W,& B facemask with your company logo demonstrates your commitment to safety and advertises your company to the local community.

Outdoor activities

With July 4th falling on a Saturday and most state and city parks open again, plan a long social distance walk in the city park, a hike on the trails in a wonderfully wooded State Park or a group bike ride.  Designate a central location where a variety of activities can begin and end, then coordinate a time for everybody to return for BYO recovery treats.  Breaking into small groups and using multiple routes respects social distancing requirements while providing healthy outdoor activity.

It’s time to emerge from the COVID cave

The best and most productive workplaces know the value of teambuilding and actively seek mentally challenging and physically stimulating ways to bring the group together.  Reuniting teams after the COVID separation is essential and the fourth of July is a holiday that naturally draws people together for active relaxation.    Give your team a red, white, and blue experience to remember, and one that will unite them, augment relationships, and improve productivity.

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

Can you hear me now? Communicating in the COVID workplace

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Communicate, communicate, communicate…a message that has been drilled into all of us as a key ingredient for effective leadership, patient safety, teamwork, and the future of mankind.  Collaborative teamwork requires that the vision of the leader be understood by the team and empowered workers deserve to know exactly what is expected of them.   Partial or ineffective communication sets the stage for disaster regardless of knowledge or level of experience of those involved, as evidenced by the greatest loss of life in aviation history.

On a foggy morning in 1977 on the island of Tenerife, just off the coast of western Africa, KLM flight 4805 was awaiting clearance for takeoff as PanAm flight 1736, still on the runway, was rolling toward the nearest exit point.  Pilots in each plane and the controller in the tower were all speaking in English, a learned second language for each person.  Fog prevented visual contact from the tower to the runway so verbal talk in a non-native language via a radio was the only way to communicate the positions of the planes.  Interpreting a message from the tower as clearance for takeoff, the KLM flight went to full throttle, accelerated, and hit the PanAm plane killing 583 people.  Communication failure cost many innocent lives that day on what was otherwise a beautiful vacation island.

Communication is equally important for safety in healthcare.  The Institute of Medicine published a report in 1999 stating that up to 100,000 deaths occur annually in the United States due to medical error.   Current statistics published by the CDC and CMS indicate that death due to medical error has not been reduced in the past 20 years and root cause analysis of closed claims prompted the Anesthesia Patient Safety Foundation to list communication errors as a major risk for patient safety.  Poor communication in healthcare does not leave hundreds of people dead on a runway; however, the results are equally devastating to the family and friends of the injured person.  Just as in aviation, effective communication among healthcare providers prevents errors and saves lives.

Shrouding the body in plastic, masking the face, and shielding the head stops more than the COVID virus, it muffles sound and removes visual ques.

The threat of the COVID 19 virus mandates that healthcare providers utilize personal protective equipment (PPE) for their own security as well as the safety of friends and family that they interact with after work.  Along with the protection provided by the PPE barrier comes the unintended threat of patient harm caused by difficult communication among those wearing full PPE.  For example, recently a surgical technician in our break room commented, “I’m glad I know his routine because I didn’t understand half of what he said to me.”  My personal experience while wearing PPE is that I find myself speaking louder, standing closer and asking people to repeat themselves frequently.  The option of being like the KLM pilot and acting based on what was thought to have been said rather than seeking clarification is not acceptable in healthcare.

An internet search related to communicating while wearing PPE revealed the story of a nurse who was hard of hearing, dependent upon lip reading and was forced to retire when masks became a requirement in her workplace.  No doubt, many of our elderly patients, with or without COVID, share her inability to fully understand words spoken through a mask and face shield.  Even when word are heard and understood, masks present a barrier to developing trusting relationships with patients as evidenced by a study by Wong et al (2013) published in the BMC Family Practice journal.  The study revealed that family practice physicians who wore a mask while interviewing patients were less likely to create an empathetic, trusting relationship.  The findings reinforce the importance of removing the facemask if possible when around non-COVID patients while maintaining strict social distance rules.

Am I suggesting that we should NOT be using PPE?  Emphatically NO because PPE is crucial for provider safety; however, we must take steps to ensure that PPE is not a barrier to collaborating with colleagues or connecting with patients.  Here are some tips for effective communication while wearing protective equipment.

Communicate clearly in the COVID workplace

Use closed loop communication.   Advocating for patient safety, the CDC recommends closed loop communication while wearing PPE to ensure understanding.  With closed loop communication, the sender initiates the message, the receiver acknowledges the message by giving feedback, and the sender verifies the feedback.  For example, one person may ask another to draw up 0.5 mg of atropine.  The second person repeats, “I will draw up 0.5 mg of atropine” to which the sender says, “yes, 0.5 mg of atropine is correct.”

Use technology.  We live in a digital world and technology abounds to assist communication.  When words are muffled, mobile devices can be used for typing and sending messages to others while wearing PPE.  Always protect devices in a plastic wrap and wipe them frequently with disinfectant.  In addition to personal devices, walkie-talkie type gadgets can be worn under the PPE garment and provide a channel for clear communication.  The Vocera system is but one example of an electronic device designed to provide effective communication while wearing PPE.

Create trigger words and signs.  Pre-arrange both verbal and non-verbal ways to bring the team to a halt if something is not understood or is not correct.  Make a large sign that says “STOP” or have a red card to hold up for all to see when immediate help is needed.  Agree on a hand gesture such as the “timeout” signal given by a football referee or the “halt” sign given by a police officer to stop any procedure that you feel is unsafe.  Next, consider other supplies that are needed or events that happen frequently where a sign would be appropriate for informing colleagues.  Make sure that signs are appropriately cleaned between uses.

Use body language and facial expressions.  Writing in Health News Hub, author Ken Harrison offers advice for using the body to enhance communication while wearing PPE.  Recommendations include maintaining a relaxed posture and using hands and arms to reinforce the words that are spoken.  Stand where you can see one another’s facial expressions.  Psychology Today author Karen Krauss Whitbourne notes that the eyes tell the story when it is difficult to hear words.  Joy, fear, anxiety, and excitement are all expressed through the eyes and eyebrows add emphasis.  Use them to your advantage when your words are difficult to understand.

Gestures and nods.  Several years ago, I was told that traveling in Italy is easy because Italians talk with their hands; just ask for directions and watch their hands.   When in PPE, do as the Romans and use your hands to reinforce your words.  If you need two syringes, hold up two fingers. When a patient needs to move to a new position, use your hands to indicate what you want the patient or your assistant to do.  While talking to another person, use head nods to indicate understanding of what was said.

Flash cards and pictures.  Being sick, fearing death, and receiving treatment from people in space suits can be very frightening.  Take and print a picture of yourself, wrap it in plastic and pin it to the outside of your gown to let patients know that there is a human inside.  Create flash cards for instructions that are frequently given to patients and hold them up as you talk to the patient.  As above, use your eyes, gestures, and body language to reinforce the message you are sending.

The COVID crisis has caused healthcare workers to pause and re-define their workflow to ensure that patients receive effective treatment while solidifying the safety of providers.  The first step toward safety is to become aware that others may not understand what you say, and the second step is to immediately halt the other person and ask for clarification if you do not understand them.  With some thought and pre-planning, the barriers put in place to protect providers need not pose a threat to those in need of their care.  Rather than behaving like the pilot sitting on a foggy runway and taking action based on a garbled message, use all your resources to creatively ensure that messages are accurately sent and received.  Who knows, learning to speak loudly while using facial expressions and hand gestures might position you for a career on stage when theaters reopen.   

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

Get Results

By Thomas Davis, DNAP, CRNA

Follow @procrnatom on Twitter

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

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

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

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

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

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

How to Achieve Results

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

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

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

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

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

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

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

Tom is an experienced leader, author and requested speaker. 

When it’s up to you



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on Twitter

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

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

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

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

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

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

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



Welcome to Club 85

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Preface to Prevention

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

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

Club 85

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

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

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

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

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

Connect the dots

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

Preparation for Prevention

Exercise

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

Nutrition

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

Hydration

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

Sleep

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

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

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

Tom is an experienced leader, author and requested speaker. 

COVID 19; A Call to Leadership

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

The Corona virus (COVID 19) has upended the mundane daily routines that seemed “a bore” just a few short weeks ago.   Fear and panic now drive decision-making and trigger bizarre behavior like visiting Walmart at 3:00 am. for bathroom tissue and an overnight reduction in the sale of Corona beer.  With retirement plans decimated, restaurants empty, national parks and beaches closed, everyday life is on hold and the practice of medicine has changed, probably forever.  In a crisis, effective leadership is necessary at all levels in order to defuse the chaos and develop a reasonable approach to combating the deadly enemy.

From my daily personal conversations with friends across the nation, and a regular review of the CRNA social media, here is a snapshot of the frustration that is being reported by the anesthesia community.

  • My academic friend, a program director in Florida, reports that one hospital converted all CRNAs to 1099 employees, sent them home without pay, and told them they would be called when needed.   His education program converted all coursework to an online format and the University pulled students from the clinical area due to lack of protective equipment (PPE).
  • Likewise, the program director at my alma mater in Arizona reports that all classes are now online, and students have been pulled from the clinical area.
  • Despite the downturn in the surgical case load, the VA hospital in the Baltimore area has kept the CRNAs on the payroll by making them available to assist throughout the hospital as needed and to complete education modules.
  • From several CRNA user groups on Facebook, come these reports; a CRNA posts, “For the first time, I have applied for unemployment compensation.”   Another CRNA posts that her facility has shut down for 4 weeks without pay.  From the GI CRNA user group come numerous reports of GI clinic closures around the country; and the few centers that are open report that, like a growing majority of CRNAs who work in hospitals, they do not have adequate protective gear.   Most anesthetists who work in outpatient surgery centers state that they are out of work, with or without pay. 

Leadership is essential

In times of crisis, someone must be at the helm.  Down the road you may not remember the details of the event, but you will remember how the leader handled the problem and how you were treated.  In today’s turbulence some leaders will flounder while others will flourish, earning both trust and respect from their team.  Here are some ways to ensure that you and your team survive the current COVID challenge and walk away even stronger and more cohesive than ever before.

Stay informed.   Every healthcare organization has developed and dispersed policies/procedures to be followed during the COVID epidemic intending to ensure the safety of workers and clients.   Know the rules and follow rules.

The bombardment of COVID information has filled email inboxes with more information/solicitations/finger pointing than most of us can read.  Select a few reliable sources and check them daily for updates.  Recommended sources for information include the CDC COVID web page, the APSF COVID resource center, and the APSF COVID perioperative recommendations.

Over-communicate.  “I can’t get a straight answer out of anybody and I feel as if I’m being deceived.”   People want to know what is happening and if they don’t hear it from you, they will grasp onto every rumor that is circulated.  Show your respect for the team by being consistently forthright and sharing the good news along with the bad.  Crises, i.e. COVID, are usually fluid and your statements may need to be revised as additional information is gathered.  During a time of crisis, start each day with a short face to face briefing (email doesn’t cut it unless everyone has been sent home) providing updates and listening to concerns.  Avoid overreacting to rumors, hose the hype and quickly address any safety issues that are raised by the team. 

Be resilient.  “I just want to hide in a cave until this whole mess is over and things are back to normal.”  We are in uncertain times and resilient leaders embraces the uncertainty while adapting to change.   After finalizing a plan based on what is known, anticipate a government proclamation or local regulation to issue forth and put the total kibosh on it.  That’s the time to keep your cool and adjust your approach based on the new rules, openly communicating to your team both the new plan and the reason for the change.  Don’t fight uncertainty; take pride in your ability to manage whatever comes your way.

Build trust.  “I don’t believe anything that my boss or the company tells me anymore. They don’t have my back and they think only of their bottom line.”  Teams follow leaders they trust and quickly abandon those they don’t.  Make the personal welfare of each team member a priority and listen carefully to issues that affect either their professional or personal lives. Join your team on the frontline, put on your PPE, and show them that you are all in it together.  If work loss or financial hardship is inevitable, take your share along with the team.  Take all safety concerns forward and your team will see that you are not just working for them; you’re working with them.

Focus on safety.  “How can I effectively care for the patient when I don’t have the equipment that I need to protect myself?  What happens when I get the virus?”  In addition to treating patients with life-threatening conditions, team members must know that their personal safety is your priority.   Make sure that every person has received proper training and that PPE is available.  Take a hard stand and do not allow your organization to withhold safety equipment or force your team into hazardous exposure to the virus. 

Delegate and empower.  “There is so much to do and I’m only one person…I need help.” Professional development is an important component of a great job and the COVID crisis is an opportunity to draw on the talent of your team members.  Whether the need be obtaining supplies, keeping records, providing safety training, or creating a reasonable work schedule, you have people on your team who are eager to help.  Establish the criteria and a timeline and then let team members share the administrative burden.   Keep a finger on the pulse and resist the urge to micromanage.

Be sensitive to individual needs.  “School is closed, and my kids are home until I can’t find day care.  The neighbor is looking in but I’m worried…I can’t keep my mind on my work.”  Working their assigned shift is but one component your team member’s busy life.  Everyone has personal needs that affect the way he/she functions on the job.   For many, childcare during school or day care closures is an issue.  For others, obtaining the family’s basic food and supplies is the bigger difficulty.  Be proactive and adjust/stagger work hours to create the time needed to take care of personal needs.

Keep workers whole.    “I was told to stay home and use PTO if I want to get paid.  What happens when the PTO runs out?  What happens to summer vacation?”  In addition to the virus threatening the physical health of individuals, the economic well-being of the country is also suffering.  Shelter in place regulations have closed businesses and put people out of work.  Healthcare is no different as elective surgery has been banned and caseloads have dropped.  As reported previously, many groups simply furlough the CRNAs without pay.  Take up the mantle and fight for your team, making a strong case for your employer to provide at least partial pay while ORs are closed.  Use every resource including PTO, sick time, or unemployment compensation to maintain cash flow to workers.  There may not be cases now, but once the ban on elective surgery is lifted, employers will want CRNAs to be on the job and eager to go.  Don’t make the mistake of throwing them under the bus now and expecting them to be happy to return when called.  Those who sense that they are not being treated fairly may be using furlough time to find other employment.  Do your level best to preserve pay and benefits for your team during mandated down time.

Look at the big picture.    “Our group is so totally focused on the virus that patients with other problems are slipping through the cracks.”  Healthcare workers, our patients, and our families; we are all in this together and will have a common experience to share once the crisis has abated.  Despite the chaos and disruption to business as usual, review the Mission, Vision and Values of your organization and remain true to them.  Most likely, your MVV describes the role that your organization plays in ensuring the health of your community.  Your purpose for existing will remain long after the virus is gone, serving as a beacon to guide you through difficult times.

Prepare for the future.   “We were not prepared, and many workers have been placed at risk.  Let’s make sure we are ready next time, and this never happens again.”  Preparation requires record-keeping. Make your team a part of the solution by keeping a record of glitches as they occur, challenge your team to find creative solutions, and take notes accordingly.  Push for after-action review with other leaders in your organization and develop a comprehensive plan, including an abundant supply of necessary equipment, that positions you to face the next crisis hidden behind enemy lines.

COVID is a crisis without international boundaries.  But it does not need to be a crisis in leadership.  When the dust settles, teams with a strong leader will feel empowered by the experience, minimizing the burn-out and PTSD while shoring up supplies, improving skills and building relationships.  Your “Call to Leadership” in a crisis demands the will to survive and the determination to thrive.

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

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. 

Workplace champions

champion post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

On the sports field, the champion walks away with the trophy; in the workplace, the champion scores high points for being the catalyst that converts an idea into the modus operandi.   When introducing a new protocol or implementing a policy change, having a champion who is all in for the change and works with personal passion can make the difference between success and failure.   The person who champions a cause is not always the designated leader, rather, he/she is a person who has a deep belief that the change is both necessary and possible to achieve.  In contrast, a change agent is a person hired to implement a new policy and often lacks the internal drive and commitment that is found in a champion.

Workplace Champion; a person who voluntarily takes extraordinary interest in the adoption, implementation and success of a cause, policy, project or product.  The person will force the idea through entrenched internal resistance and will evangelize it throughout the organization.

~businessdictionary.com

Speaking on the topic of implementing an opioid sparing anesthetic technique, Dr. Gary Brydges, former president of the AANA was asked what to do when resistance to change came from within the workgroup.  First among his recommendations was assuming the role of champion and then locating and teaming with a surgeon champion and a nurse champion.  Then, move forward as a team of champions to educate all stakeholders about the necessity for and the benefits of the change.

During my tenure as Chief CRNA at The Johns Hopkins, I witnessed first-hand the wisdom of Dr. Brydges’ recommendation to engage champions who are committed to implementing change.   The institution was entrusted to develop and implement an early recovery protocol for patients receiving bowel surgery; a plan that required a radical change to the usual perioperative flow, including the anesthetic technique.   To move the strategy forward, champions, including an anesthesiologist and a nurse anesthetist, joined surgery and nursing champions and formed a united front to overcome resistance and implement the new plan for bowel surgery patients.  Meetings were held, a protocol was developed, and champions from each area aggressively marketed the new plan to their respective groups.  The champions were essential and, with their dedication to the project, the protocol was successfully implemented.

In 1996 John Kotter introduced an eight-step model for implementing change and although he did not specifically use the word champion, several of the steps in his model describe actions that are commonly taken by those who are the driving force for change.   The Kotter model calls for the leader to create a sense of urgency, build a coalition of supporters, create and communicate a vision, and push for buy in from stakeholders…all actions commonly taken by a champion.

Building on the John Kotter’s recommendations, the University of Georgia published a white paper outlining the role of a change champion to include:

  • Streamline implementation/reduce complexity
  • Take ownership and build accountability
  • Enhance speed of project completion
  • Maximize productivity
  • Promote understanding
  • Advocate position change
  • Explain “what’s in it for me?”

So, you want to be a champion…

A key to job security and promotion is becoming the person that the workgroup can’t live without and being a driving force for change places you in the coveted position of being indispensable.  First and foremost, you must believe in the new protocol that you are striving to achieve and then actively work to develop the skills required to create momentum and achieve the goal.  Writing in People Development Magazine, author Julie Gordon lists the essential personal traits of a successful change champion:

  • Willingness to listen
  • Skilled at networking
  • Understanding of the workplace culture
  • Not afraid to take risks
  • Openly markets the positives
  • Solicits help from colleagues and other champions
  • Emotionally intelligent/sensitive to people needs
  • Openly supports the goal, quickly correct misinformation
  • Driven by the value of the change

Recognizing a need for change and having a desire for it to occur is not enough; follow these steps and become the workplace champion who elevates your team and organization.

Be knowledgeable.  Keep up with current best practice guidelines, attend meetings and communicate via social media with colleagues who have a professional practice like yours.  Recognize techniques that produce the best results and then review your current method looking for alterations that could be made in order to improve results.  In addition, keep a keen eye on the culture of your workplace and the receptiveness to change.  Finally, tie your proposed practice upgrade to the stated vision of the organization to increase the likelihood of buy-in from upper level management.

We can do better.  Always work with the mindset that there is room for improvement.   As a change champion, your belief in the new method must be apparent and contagious to those around you.   Be vocal in convincing others that there is a different method that will produce better results.

Team with another champion.   The ultimate outcome is often dependent upon the work done by many parallel workgroups with a common interest.   In the previous example from The Johns Hopkins, implementing an enhanced recovery program affected the workflow of the surgeon, pre and post-operative nursing and anesthesia.  Having champions from each area who were equally committed to achieving a positive result increased the likelihood for success.

Develop a plan.   Work collaboratively and develop a comprehensive plan that works best for all and explain the plan to your workgroup.  Remember, the best plan for your individual workgroup may not be the best for other stakeholders.

Market the change.   Here is where you must have superuser knowledge and exude passion to persuade colleagues that the change is essential.   The first pitch to the team will let them know about the project; however, the ongoing push over the next days, weeks and months will take the plan across the finish line.

“Change does not roll in on the wheels of inevitability, but comes through continuous struggle”

~ Martin Luther King Jr.

Change doesn’t happen in a vacuum, nor does it happen by default.   There must be an apparent need, a belief that it can/must occur, and an individual with the stamina to push the project forward.  The next time you think, “we ought to,” take the next step and commit to making the desired change happen.   Become the champion who looks back and says, “this is what we have done.”

Tom is a noted author, speaker, educator, and dedicated clinical anesthetist specializing in leadership development and team building.  Contact tom@prosynex.com to book a speaking engagement.

Feel the Burn

burnout post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

Last week a headline in the Linkedin daily update caught my eye; Millennials are experiencing job burnout at a high rate.  My initial gut response was; “Really? You are too young and it’s too early in your career to be burned out.”  When I stepped back and considered the topic, I realized that burnout is not tied to advanced age or a person’s position in the chain of command.  “The physical or mental collapse caused by overwork or stress” is the full-blown Webster definition of burnout, and it can happen to anyone at any stage of his/her career, including millennials.

 

I recall talented athletes from my youth with parents who thought that with a little more effort, their kid would be wearing Olympic Gold.   Even after Betsy upped her gymnastics practice to four times per week and Jason increased his swimming to two-a-days, neither made it to the Olympics.  Both young people longed for high school graduation, not for the diploma, but for the termination of the unreasonable expectations for achievement.  In short, what began as fun turned into a physical, mental obsession that took its toll and left both individuals flat, weary, and burned out.

 

Employee burnout is real, unrelated to age or years of experience and the affect can be devastating to both the employee and the employer.

 

Young workers are fresh out of college, excited to start a career and eager to pay off student debt.  Most intend to pull their weight on the team and want to earn respect for ability and tenacity.  What they find is a workplace that welcomes their enthusiasm by piling on the long hours, offering advancement by combining two jobs into one, and frequently offering inadequate support.  Many young workers are running out of the energy that got them hired in the first place.

 

 

 

Burnout arises from unrealistic expectations and can happen when production pressure becomes excessive.  Sometimes the burden is placed on the individual by the organization and other times the individual places unrealistic expectations on him/herself.  Either way, as the burden becomes unbearable, the victim breaks internally and does one or both of two things:   He/she pauses to refresh and/or moves on to a different job.  Writers at Workplace Strategies for Mental Health identify the following as personal perceptions or actual causes of professionals becoming burnout victims.

  • Expecting too much of themselves
  • Never feeling that their work is good enough
  • Frequently feeling inadequate or incompetent
  • Feeling unappreciated for their work efforts
  • Working in a role that is not a good fit

 

 

Pushing employees beyond their mental or physical limit has consequences.  In addition to fatigue, stress and anger/irritability, other health issues may develop.   For the employee, high blood pressure, heart disease and type 2 diabetes are correlated with burnout as well as alcohol and substance abuse.    Consequences for the employer include high employee turnover and the financial cost of filling vacant positions.  Overall, there is a loss of productivity and a general deterioration of morale among the work group.

 

Extinguishing burnout is a shared responsibility and there are actions that both the worker and the leader can take to cool the embers.

 

What the worker can do

Ultimately, it’s up to you to monitor your stress level and make changes before falling victim and externally acting out at work or internally developing a physical illness.  The Adult Health Department at the Mayo Clinic offers you these suggestions for assessment or prevention.

  • Evaluate your options both with your current job and finding a new employer.
  • Seek support from co-workers, friends, family or professional counselors.
  • Engage regularly in a relaxing activity such as yoga or meditation.
  • Exercise consistently to help you better deal with stress.
  • Value your sleep and let it restore your well-being.
  • Develop friendships with one or two colleagues at work.
  • Become mindful of your activity, energy, and feelings every moment.

 

 

Creating a culture of burnout is opposite of creating a culture of sustainable creativity…This mentality needs to be introduced as a leadership and performance-enhancing tool.

~Ariana Huffington

 

 

What the leader can do

There several behaviors that can be incorporated into your leadership style to take the fan off the flames and prevent the fire.  Combined, all will elevate team morale, boost productivity and improve employee retention.

  • Provide clear expectations and ensure that they are understood by workers.
  • Make sure that expectations are reasonable and align with priorities.
  • Furnish necessary resources including the training required to meet expectations.
  • Enforce fairness in reasonable work hours including sending people home on time.
  • When overtime can’t be avoided, mandate that those who work extra hours are given time off to recoup.
  • Utilize mentoring and professional development to create a sense of personal value for the worker.
  • Strongly encourage breaks at work away from the workplace.
  • Encourage friendships and social support among the group.
  • Provide a sense of purpose by linking employee tasks to the greater mission of the organization.
  • Encourage physical activity by planning stretch breaks at work, encouraging gym memberships, and arranging group activities away from work.
  • Encourage employees to use rather than save their vacation time.
  • Know your team and adjust your leadership to a style that fosters collaboration.

 

 

Employee burnout is a very real equal-opportunity threat.   Both the high school swimmer doing two a day workouts and an ICU nurse working 4 twelve-hour shifts per week (and being kept over at the end of the shift) can easily perceive that the work is never ending and whatever they do is not enough.  Whether it’s a monster workload, a paucity of resources, or sense of being overwhelmed and isolated, burnout is a constant threat best addressed by frontline leaders who are directly linked to the team.  Sometimes, the quick solution can be as simple as showing you care by providing resources and giving compliments where appropriate.  The long-term remedy, however, must involve an emphasis on physical and mental well-being while instilling a sense of purpose and worth in each worker.

 

 

What was once thought to be the consequence of being in a job too long is now known as a threat to workers at any age or stage of their career.  The cure for burnout starts with self-awareness within the employee and a commitment by leadership to create a climate where the workload is reasonable, resources are available, and employees gain a sense of self-worth from the work they accomplish.  Look beyond the crisis of the day and treat workers today in a manner that leaves them fulfilled and wanting to return tomorrow.

 

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

 

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.

Speak easy; The art of overcoming glitches

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By Thomas Davis, DNAP, MAE, CRNA

Lt. Col (ret) USAF

Follow @procrnatom on twitter

Recently I was scheduled to be the last faculty speaker on the final day of meetings at Encore Symposiums.  Attendees had various reasons for checking out ahead of my presentation – prior engagements and airline connections among them – but having spoken to this group for several other sessions throughout the weeklong meeting, I felt entirely comfortable with this schedule. Practically speaking, I anticipated an audience somewhat diminished in size and just hoped Leonard’s joke would not materialize.

 

Leonard’s joke:

After the morning coffee break on the last day of the meeting, there were two talks left before the meeting adjourned.  In the meeting room were the speaker and only one other person.  The speaker suggested sitting together at a table and going through the slide set.   The other person replied, “I don’t care what you do, I’m the last speaker.”

 

 

If you’re a healthcare speaker, or a public speaker in any industry, no matter how well prepare you are, the potential for glitches is ever present.  It’s your job as the leader of that moment to “speak easy.”

 

Recover Fast

In mid-September, our local Frederick Art Club, featured the well published women’s rights advocate, Edith Mayo, Curator Emeritus of The Smithsonian to speak to its membership. In anticipation, twenty additional guests were invited to join the audience at a luncheon enhanced by several displays by the iconic clothing designer, Claire McCardell.  This was a “not-to-be-missed” presentation.  According to attendees, Edie introduced herself and quickly announced without apology that her computerized presentation materials had not arrived, and she would be relying on her slides and an old-fashioned, borrowed projector. Without any further mention, Ms. Mayo reportedly immediately launched her spiel while the enhanced audience ate their meal.  Edith gave the audience of art lovers a lot to remember and only a little to forget.  At dinner that evening my wife gave the glitch a scant dishonorable mention, then talked about the pics that had been shown, the new museum being built and other interesting tidbits.

If your props or materials do not arrive, if the sound system fails, or even if the dog ate the homework, recover fast; think on your feet and do what you have to do to move forward, acknowledge the road hazard only if necessary and then get on with it. That’s leadership and leadership makes it look easy.

 

Tough Love

What do you do if it’s a tough audience?  The best advice is to prepare the fall-out shelter.  In addition to knowing your stuff and using cutting edge material, be there ahead of your scheduled appearance long enough to sit in on other speakers with the same audience.  Get a feel for them. What makes the audience laugh, what annoys or bores them, are they text savvy, senior workers, foodies? Where are they from, why are they there, how are they dressed, is the sunny or gloomy weather affecting their attention or attendance? If you can’t be there early or if “sitting in” doesn’t apply or isn’t appropriate, get the answers from others.  As a last resort, be a politician and ask the audience.  “Good evening O-kla-ho—ma-how-are-you?!”  Whatever you do, do not tell these pay-on-demand customers they’re a tough nut to crack. Along with disrespecting your whine, chances are they can get tougher after that. They can walk out.

 

Shift Gears

Nancy LaBrie, founder and owner of Encore Symposiums tells the story of the group of attendees and faculty whose driver delivered them to the Pier AFTER the cruise ship had sailed. Oops! The creative faculty made a seamless transition into delivering their presentations for two hours – outside, – while the ship returned to retrieve them.  The speakers became the Captains of the situation with a truly captive audience! A solid optimistic leader can almost always pull up, even if your ship has sailed.

 

L.O.L

Speakership is leadership and if you intend to make public speaking part of your professional profile, you must handle glitches, tough audiences, unwelcoming venues or schedules along with all other unforeseen events, as part of the routine, with professional grace and aplomb. Indeed, a little humor could be called for.  My wife loves to tell about the wide-girthed MS Vocal Mus Ed candidate back in the day.  The singer, whose half-slip fell to the floor during her graduate performance of O Mio Bambino Caro, kicked it to the side of the grand piano while completing the aria to the roaring applause of the audience. Grace.  Aplomb.  It’s not the glitch you want the audience to remember; it’s the way you handle it.

My last two Encore presentations during the last two hours of an intense four-day schedule went very well. I could have encouraged the down-sized group to gather closer to the podium, but instead I walked out into the group, avoiding reliance on notes and focusing on the individuals in attendance. We communicated interactively with a professional phone texting activity. It was fun, it was professional, they stayed, and the speaking was easy.

Tom is an experienced leader, author and requested speaker.  Contact Tom for an appearance at your next meeting.

Be a social (media) climber

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By Thomas Davis, CRNA, MAE, DNAP candidate

 

Work completed for my DNAP degree and conversations with colleagues has taught me that just about everybody knows what social media is, and that many people use it in one form or another to socialize with friends, family or colleagues.   What many people fail to appreciate is that social media is a powerful tool that can either enhance or kill your career.  Leveraging the power of social media will position you to be recognized, rewarded and promoted within your profession.

 

Advancing professionally in all industry requires that you are known and respected by your peers for the quality of your talents and interests.  Marketing is essential for the success of any venture and social media is a great launching pad for gaining recognition.  Careerbuilder.com notes that over 50% of employers use social media to recruit the best talent, and that of those entities seeking highly qualified workers, 35% will not offer an interview to a person who has no online presence.  To sell yourself locally and globally, it is critical to be seen online consistently creating a positive professional and social image.  

 

Build your online image

The first step in building your image is discovery and damage control.  Even if you have never used social media or posted a comment online, you may appear online linked to your profession, employer or social group.  Begin by searching yourself on google and click on any link that is connected to you.  If you like what you see, update the content and make sure that others can find it easily by doing little things to ensure that the information is linked to you.  Tom S Davis immediately pops up as CRNA while Tom Davis labels me as a former University of Iowa basketball coach!  Even small changes like adding a middle initial to a common name will help direct readers and save time.  After viewing what others see, take note of anything that is not flattering.  If you don’t like what you see, rebuild or clean up all unflattering content. If you posted a blog years ago that is embarrassing to you or anyone else, take it down. If you posted a less than professional picture or used offensive language, delete it.  A selfie from the college kegger will not score points when viewed by a potential employer.  If some other entity controls the material you have previously posted, contact them and ask that the outdated material be removed. Your profile must be spic and span clean and professional.

After the D&D is complete, continue the rebuilding by making sure that current professional postings are easily linked to you.  If you have completed a degree, published an article, or have recent pictures from a professional meeting, make sure they appear online and are linked to your name. Recognizing the achievement of others, garners their appreciation, elevates both of you in the online community and raises the level of activity on your own site.

 

Use multiple platforms

Because there is not a single best platform for creating a professional image online, gaining exposure requires that you appear on multiple platforms.  Start by opening three essential accounts and update them frequently.  Give time and attention to completing the profile information when establishing an account.

Twitter.  Due to the 280-character limit on Twitter, tweets (posts) are short and to the point.  Open an account, let colleagues know your username, and always being positive and professional when you tweet.  You will earn a reputation for being a “thought leader” by posting URLs for articles that inspire colleagues and elevate your profession.  Be sure to follow other leaders in your profession and “like” or “retweet” as the case may be.

 

Facebook/Linkedin.  Originally, Facebook was designed as a social site and LinkedIn was viewed as a Facebook for professionals.  Both now have user groups specific to just about any profession.  Create an account on each platform and join at least one user group related to your profession. Read what others are posting, comment where appropriate, and when you gain a little comfort and courage, start posting original topics.

 

Professional site.  Many professional organizations have online discussion boards where members of the vocation can share thoughts and debate issues.  For nurse anesthetists, the AANA connect forum is an excellent place to interact with colleagues.

 

Social media is meant to be interactive, so don’t hesitate to add material or continue conversations. As you read other’s comments, your interest may be piqued and your intellect challenged, and you may wish to join the conversation to expand the topic and share your thoughts with the online community.  Regardless of the breadth of your interaction, sometimes all you need to do is like another person’s comments and your name will be linked to the discussion thread.

 

Tips for posting on social media

Update your profile.   Social media sites encourage you to create a personal profile and as you gain followers, your profile becomes your identity.  Post a professional picture, accurate contact information and links to professional work that you have accomplished.  You are creating an online identity so use your real name and get full credit for your contributions to the cyber world.

Be authentic.  Online scholarly articles are not in short supply.  Social media is your opportunity to show colleagues that you are informed in a less academic way.  Be yourself and have a short conversation with your readers, leaving the lectures for the classroom.   If your natural self tends to be academic, work on altering your language enough to sound relaxed and to be engaging.

Set the tone.  Emotional intelligence is a current buzzword and a concept that encourages readers to look beyond the words and sense the emotion tied to the topic.  As you post online, avoid sounding authoritative, dogmatic or robotic.  You are a professional responding in a social climate so choose positive, empowering words with an optimistic tone, even when you’re addressing an industry problem or potentially heated topic.

Involve other posts.  Jumping in to contribute to an ongoing discussion thread, or to comment on a blog post, creates an online presence.  If you don’t have time to develop and post an original topic, make a quick remark or give a thumbs up to something that a colleague has posted.

Stay out of a rut.  Always talking about the same topic is about as exciting as repainting the fence every weekend.   Social media is fast paced and redundancy is guaranteed to turn off and turn away your readers.  Likewise, always talking about yourself, or never talking about yourself, lowers reader regard and should be avoided.  It’s okay to share your personal experience when it’s clearly appropriate to the conversation, but don’t be a prima donna (or primo uomo)  by making yourself the focus of your social media post.

Don’t shoot yourself in the foot.  What you post is out there for everyone in the world to see, including your colleagues and potentially, your next employer.  Keep it professional and avoid trigger topics such as politics, religion or alternative lifestyles.  Your readers have their opinions and you are unlikely to change any minds; however, you will be forever linked to dogmatic rhetoric.  Never forget, bashing or otherwise bad-mouthing individuals whether they are coworkers, political figures or competitors of any kind (and whether or not you refer to them by name), is unprofessional, unbecoming behavior.  Stay about of the mud and be squeaky clean.

 

Having a dynamic online presence does not guarantee employment, promotion or popularity; however, you are invisible without it.  Social media offers many interactive platforms that enable you to create or reinvent a public identity as you connect with colleagues and promote your profession.  If you have earned an advanced degree, achieved professional certification and been granted a license to practice, shine a light on yourself by joining the Global Country Club.  As card-carrying, informed and connected member, you can tweet, blog, post online and harvest the rewards.

 

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

Tech Savvy Leadership

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By Thomas Davis, CRNA, MAE, DNAP candidate

 

“The first thing we ought to recognize is that mobile is now part of the fabric — every day in everybody’s life. So, if you’re not looking at mobile solutions, then you’re not really looking at all solutions.” ~Mal Postings, Global CTO

 

The world is wired.   From preschoolers to grandparents, cab drivers to health care workers, our lives are infused with digital technology in both obvious and subtle ways.  We locate directions and connect with friends, we take online courses and purchase real estate, we buy groceries and have them delivered, we organize, strategize, socialize and generally utilize technology to run our lives.  We make business choices based on the company’s online presence and, as noted by PatientPop, 80% consumers search for healthcare information online and 41% say that social media affects their choice of healthcare provider.  Healthcare workers provide a vital service to patients; however, healthcare is a competitive business that must generate a positive cash flow to remain operational.

 

The Harvard Business review reports that the most digitalized corporations see an increase in profits two to three times the average rate of less digitalized competitors.  Likewise, healthcare organizations with a user-friendly digital platform are easy to find, easy to use, easy to forward to a friend, and attract loyal clients.  Your digital presence makes a difference.

 

Writing for Linkedin, product marketing director, Mark Hughes, offers these thoughts about increasing the digital presence in your workplace.

  • Abandon old stereotypes about IT geeks.  Healthcare leaders usually arise from a medical or nursing background and lack sophisticated knowledge about digital technology.  Combine your leadership with a personal relationship and create a techno-partnership with the IT department.    Collaboration enables you to blend your ideas with their technical expertise and develop web-based applications that enhance the patient experience.  The first step to becoming a tech-savvy leader is developing a first name relationship with a skilled person who can create the programs that you need.
  • The customer has the final say. Team leaders must follow hospital policy and remain mindful of the patient’s HIPAA rights.   The patient, however, has no limit to the things that he/she can post on social media.  They can and will rate both the quality of care that they received and the ease of obtaining it.  Part of your job as a leader is to create a client experience that the patient will want to share in a positive way.  The things your patients post on social media can make or break your organization.
  • Understand why a platform works. Rather than becoming distracted about how to use a social media platform, explore the various platforms and figure out why they work.  Why does one platform target a certain demographic more effectively than another?  Select the right platform and then challenge your IT support to make it work for you.  In some cases, you may need to use multiple platforms to target different demographics.
  • Always look to the future. Whatever technology works to connect your team with clients today will be replaced by something else tomorrow.  Never rest on your laurels.  Constantly remain aware of new social media platforms as they arise and always question how they can be used to the advantage of your patients and your staff.

 

Becoming a tech-savvy leader is a great way to connect with existing clients and attract new business to your organization.  However, technology can become impersonal and create a buffer between you and your team.  Author Inger Buus, leadership developer at JP Morgan, offers suggestions for solidifying the connection with your team as you add technology to your workplace:

  • Value human connections. The best teams are those that value interaction and collaboration between the team leader and team member. As you increase your digital presence, make sure that personal relationships are maintained.
  • Embrace change. Adding technology to the workplace requires that the workflow be altered to adjust to the change.  Take the lead and set the example for your team to follow by willingly modifying your routine to accommodate the technology upgrade.
  • Encourage diversity of thought. A recurring theme in Leader Reader 1, Authentic Lessons in Leadership is “The best idea arise from many ideas and yours may not be the best.”   Review your goal with the team and listen as they describe the ideal app that would best accomplish the goal.  Not only will the final concept be stronger, team members will have a sense of inclusion and will be more likely to participate in bringing the project to life.
  • Ask for help. Patient safety advocate Dr. Peter Pronovost notes that everybody is fallible, including the leader.  The best leaders acknowledge that they don’t have all the answers and rely on a working relationship with team members to help find solutions to challenges.  When developing new technology, rely on your team to identify and correct glitches.  Have a goal, create a vision and then ask the team to help develop the plan.  Active participation shows trust and builds engagement.

 

Patients and their families are hungry for technology that will enhance their healthcare experience.  They desire appointment scheduling similar to booking seats on an airline and appreciate GPS based assistance when navigating the halls of busy medical centers.  Families want to connect to nurses via mobile device rather than pushing a call light and wondering when it will be answered.

 

User-friendly digital connections produce impressions and influence decisions to do business with the vendor.  Confusing or cumbersome technology is quickly abandoned leaving you to look elsewhere for goods and services.   Bond with IT specialists and develop cutting edge technology in a user-friendly format that you would enjoy using.  Chances are that your patients share your expectations when using web-based sites, including those related to healthcare.  Be a catalyst for digital technology and keep your organization a step ahead of the competition.

 

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

Micromanagement; A lens on leadership

micromanagement post

 

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

“Train people well enough so they can leave, treat them well enough so they don’t want to”      ~Richard Branson

 

Control is a funny thing.  It’s necessary and can improve results when the boss wields it, but it is oppressive and demoralizing when you’re on the receiving end of the heavy-handed version.  Keeping the boss informed as a project is tackled is one thing but having all the small parts directed is quite another.  Unfortunately, many well-intended supervisors become over-zealous while attempting to produce exact results, crossing the line from coach and encourager to micromanager.

 

Micromanaging is the enemy of both collaborative empowerment and creative thinking and can have devastating effects on a team.  Writing in Careeraddict.com, author, Chris Leitch lists the following as consequences of micromanagement.

  • Employees develop more health problems
  • Staff turnover is increased
  • Productivity is reduced
  • Personal relationships suffer
  • Job security is questioned
  • Progress is slowed
  • Teamwork is destroyed
  • Morale is lowered

 

Clearly, micromanaging blocks any attempt at creating a preferred workplace and must be avoided; yet Market Watch reports that over 50% of employees feel as if they are micromanaged.  Keeping out of the micromanagement swamp starts with self-awareness and a sincere desire to release the creative energy in team members.  Not sure whether you are a micromanager?   Try the online self-evaluation offered by The Workzone.

 

Managing by “control patrol” is a sign of insecurity and often originates from fear; fear of losing control, fear of project failure and fear of not being viewed as the authority figure in charge of the team.   To escape the fear, a leader must develop a keen sense of self-security that is clearly evidenced in the way he/she interacts with the team.  Leaders who are secure in their position seek to gain stature through the empowerment of others.  Author Goeffrey James offers the following insight for those who want to abandon the micromanaging style of leadership:

  • Rethink your role as a leader. Visualize yourself as a leader who is meant to guide and develop your team rather than a boss charged with controlling behavior.  View your team members as the capable and competent people they are and individuals who desire is to meet your requests and serve the organization while developing their own personal skills.
  • Delegate projects. Assigning responsibilities to others eases the burden of leadership and sends an important message that you trust your team.  When you delegate, make sure that the assignee understands the goal, the parameters within which he/she must work, and the timeline for completion.  Agree on checkpoints that keep you in the loop then set the boss’s binoculars aside and trust that the team will come through on the project.
  • Ask how he/she plans to proceed. As the project or assignment takes off, remember that the goal is to go from point A to point B.  Anticipate that someone else may solve the problem differently than you would, allow the individual to select the route and be okay with it.  The intent is to bring the project to closure, not to dominate the process.
  • Establish reasonable check in via email. Check in must be appropriate for the complexity of the task and the experience of the person assigned to complete it.  Requiring a person to check in more than necessary does not convey trust in the person’s capability and implies that you don’t trust your own decision to assign him/her the job.        Limit yourself to checking in once a week by email so as not to intimidate the person you delegated for the project.  Keep the tone cordial and collaborative.
  • Focus on developing others and giving them credit for their work. Micromanaging and empowering are polar opposites and mutually exclusive.  The best and quickest way to change your reputation as a micromanager is to re-direct your attention to developing others.  Be a thinking partner as well as a support system for team members who seek additional responsibility and have the desire to learn new skills.

 

Many people describe the “worst boss I ever had” as the controller who managed everything and everyone through a telescopic lens.  If your team has trouble with high turnover, low morale or other consequences associated with micromanagers, consider the possibility that you may be one.  Turn the lens on yourself, loosen your white-knuckle grip, embrace the concept that there is more than one way to achieve a goal and more than one person who can do it.  Ironically, by releasing authoritative power, you strengthen personal power and emerge as the recognized leader of a loyal and productive team.

 

 

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

Atlas Shrugged again

Atlas post

By Thomas Davis, CRNA, MAE, DNAP candidate

 

Follow @procrnatom on twitter

 

In 1957, author, Ayn Rand, released the powerful novel, Atlas Shrugged.   Over 60 years later, the book continues to provide insight for creative entrepreneurs and fodder for heated debate between capitalists and socialists.

 

The storyline of the novel showcases business tycoons who use only objectivism, rather than faith or emotion, to obtain evidence, ascertain the truth and set the best course of action.  The courageous Atlas characters who use evidence to gain insight and then act rise to the top, and the compliant, under-achieving sycophants become dependent upon the government for protection.  As the story progresses, the most creative minds and bodies vanish one by one until, finally, their previous importance/value to national socioeconomics is revealed.  Readers who doggedly complete the 1168-page book until Dagny departs, will gain a new appreciation for the value of logic and individualism in the creation of success both in business and one’s personal life.

 

“What greater wealth is there than to own your life and to spend it on growing? Every living thing must grow. It can’t stand still. It must grow or perish.”   ~Ayn Rand

 

Today’s workplace continues to have leaders with insight who can create a vision, look at reality and develop a plan to achieve a goal.  Author Robert Tracinski applied the principles from Ayn Rand’s classic novel to modern business leadership in his article published in The Federalist (2017).   Building upon Trancinski’s work, allow me to take the 7 lessons that he identified in Atlas Shrugged and apply them to healthcare leadership.

  • Know the business from the ground up. The quickest way to fail is to lead people who know more about the business than you do.  A grocery store chain in Texas is known for requiring every manager/leader hired by the company to spend the first 6 months stocking shelves and running cash registers before moving on to their intended position.  Likewise, healthcare leaders at every level must know more than how to do their job; they must also know the culture of the organization.  A Chief CRNA or an OR manager must know the overall workflow of the perioperative process and then follow up by appreciating the jobs done by other members of the team.
  • Earn respect. Entry level respect is earned by bearing the title of “designated boss,” whereby, authority is based solely on position.  True respect is earned over time and grows from personal relationships based on honesty, transparency and integrity.  Recognizing and rewarding excellence while mentoring those in need of improvement shows that the leader knows the difference between high and low quality work – an insight that will earn respect from the entire team.
  • Always take responsibility. Crisis management is an important aspect of leadership that comes with the job.  You might not be responsible for creating the state of affairs, but when a worker presents you with a problem, don the mantle of leadership by finding a solution.  Your title places you in a position to deliver like Dagny, and when you’re asked, “Whose responsibility was this?” there is only one answer; “Mine.”
  • Deal with the best talent. When you’re hiring personnel, look beyond technical skills by recruiting and hiring only people who are competent and who share your vision/values.  You can teach skills that are needed for success however you can’t teach work ethic, honesty and integrity.  Hire for values and teach the skills.  When seeking a mentor or expanding your professional network, “play up” and associate with those who have a proven record for success.
  • Set an innovative vision. Focus on the work at hand and insist on excellence in all you do, but never stop looking over the horizon and planning for the future.  You can break the monotony of status quo by having a vision, sharing it and motivating your team to achieve it instead of creating a Groundhog’s Day  Every today is another step toward a better tomorrow.
  • You are not a leader unless you have followers and gaining support is essential. A vision that enhances your personal profit and someone else’s loss is doomed for failure; however, a shared vision that encourages others to gain in tandem with you is likely to be achieved.  It’s OK to reap personal gain but not at the expense of others.
  • Don’t prop up the losers. When a new leader inherits a team, not every member is a high achiever, and some people are dead weight.  With mentoring and professional development, the low achievers will either come to life or they will sink further into being parasites and hangers-on who drain the whole team’s energy and resources.  If the less productive members of The Team do not respond promptly with a change of attitude, cut them loose quickly and cleanly with serving leader civility.

 

The fact that Atlas Shrugged continues to be discussed and debated decades after its publication underscores the impact of the lessons put forth in the book.  The characters who made an impact were the ones with a vision; they used solid personal values, they dealt fairly with others and, collectively, they elevated society.  Modern Hanks in healthcare are NOT building railroads or marketing Reardon steel.   They ARE leading the medical industry into the future using the lessons from Atlas Shrugged to build a new paradigm; one that is patient-centric; one that ensures safety and guarantees better outcomes for each client.  Hop aboard the Taggart train and ride the Rearden rails over the horizon to a healthcare system that is built upon the lessons put forth by Ayn Rand: The assurance that Dagney Delivers.

 

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

Uncommon Courtesy

courtesy post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

 

I arrived at a clinic to sign in for a medical appointment as the receptionist at the check-in window was having an energetic headset phone conversation with a friend.  While continuing planning the food and entertainment for a big birthday party, she handed me a clipboard stacked with forms, indicated with her finger that I should fill them out, and air-pointed toward a chair without missing a word of animated conversation.  Not one word was exchanged between us.  My first encounter as a patient left me feeling as if I were a distraction in her life rather than the reason for her job.

 

Driven by me-centered technology, civility is more and more frequently replaced by indifferent, disrespectful behavior, even in our benevolent healthcare industry.  Common courtesy has become uncommon.  While focusing on the medical task at hand, healthcare workers often ignore the value of using common courtesy to build a relationship with each patient, thereby, improving outcomes and solidifying a client base.  In writing about courtesy in Pharmacoeconomics review, author, Megan Dubina agrees, noting that common courtesy is essential when building positive patient relationships.  In a courteous environment, patients are more trusting of their healthcare providers and more likely to comply with treatment that promotes better overall outcomes.

 

Integral to courtesy is respect.   Though most of us have never had a face to face argument with a patient, there are many less obvious ways in which we may have been unintentionally rude and disrespectful to them.

  • Respect for the right to know. Healthcare providers are very efficient at obtaining informed consent prior to doing a procedure but fail to fully inform the patient about other things related to their care. Introducing yourself and your role in the process opens the door to dialogue that will enable your patient to clarify other questions that he/she may have.
  • Respect for ability to understand. Those with healthcare concerns frequently consult Dr. Google prior to a medical visit and arrive loaded with information from renowned institutions, but the new knowledge is only valuable if the healthcare team listens. Patients may not have medical terminology at the tip of the lip or understand advanced physiology, but they do know their own bodies. They do know how they feel and the changes that have occurred.  On several occasions my non-medical friends have told me that they will never see a certain doctor again because he/she “does not listen.”  They did not feel as if their insight into their own condition was respected.
  • Respect for time. The most common way to generate negative feedback at our ambulatory surgery center is failure to follow a schedule. Patients who sit in the waiting area several hours beyond their scheduled procedures feel as if their time is not valued and they are just another job for the provider to accomplish when he/she gets around to it.  The patient may be losing wages. Their designated drivers may be losing wages.  They all feel inconvenienced and disrespected.

 

Courtesy matters

The Disney corporation and others in the entertainment industry exist at the will of the client.  Since its creation in 1955, Disney has built an empire on four key principles; Safety, Courtesy, Show, and efficiency.  Regardless of the job, each Disney employee is viewed as a cast member and extensive training during orientation is focused on building a culture founded on courtesy. From front office executives to grassroots workers, courtesy in the form of respect is expected during every interaction with a client.  Disney’s loyal customer base is the best evidence for the importance of courteous behavior in the workplace.  In his book, If Disney ran your hospital; 9.5 things that you would do differently, Fred Lee underscores the importance of courtesy, civility and respect for every client and applies Disney’s key principles to healthcare.

 

The culture of courtesy and civility starts at the top and is job one for every member in the organization.  Dr. Reuven Paternak, CEO of Stony Brook University Hospital, sets a high standard with his emphasis on the importance of courtesy and respect as tools to improve the overall patient experience within their system.  His message to the organization includes the following points, equally applicable across the healthcare industry.

  • Introduce yourself. Start conversations by asking open-ended questions about the other person.  Show interest in the person and ask follow-on questions to increase your understanding of the individual and his/her concerns.
  • Listen carefully. Patients can sense changes in their bodies that may not be apparent in tests that have been performed.  Listening attentively adds to your pool of information regarding the symptoms as well as any fear or anxiety that may accompany them.  Avoid interrupting, cutting off or rebutting the patient.
  • Be considerate. Accept what the patient tells without discounting their observations or concerns.  Academic arrogance or dismissiveness will be perceived as rudeness and block the establishment of a collaborative relationship with the patient. Practice saying, “I understand,” and use a demeanor that shows you do.
  • Be on time. Show that you value your patients by valuing their time.  Intentionally overbooking your schedule may make the productivity numbers look great, but it also mandates that patients spend prolonged periods of time in the waiting area.
  • Use basic manners. Saying please, thank you and asking the patient’s permission before starting a procedure are all ways to show your respect for the person on the receiving end of your treatment.
  • Be honest and transparent. Delivering a diagnosis is not always easy, but it must be done openly and with respect for the person receiving the news.  Be empathetic while avoiding false optimism.
  • Take the extra step. Every day there are opportunities to do small things that make a big difference to the patient.  Follow up quickly with anything that is promised to the patient and make referrals immediately. Look beyond your patient and help others in the system who appear to be lost or confused.

 

Several positive consequences emerge when courtesy permeates the workplace.  First and most important, the overall outcome of the medical treatment improves as satisfaction increases. Second, because payors are beginning to link reimbursement to patient approval, the bottom-line financial status of the organization improves. Third, the morale of the staff is elevated due to conscious civility, high quality outcomes and satisfied patients. Finally, a culture of courtesy and collaboration is created that supports the concept of a preferred workplace, a major tool for recruitment and retention.

 

Building an environment that promotes courtesy as an essential element will ensure long-term viability of the organization.  People want to visit the Disney parks, stay in Disney hotels and eat at Disney restaurants because they know the Four Keys will be practiced – they will be treated with courtesy in every respect and the total experience will be amazing.  Families leave their vacation fantasyland wanting more and anxiously awaiting the time when they can return and build newer, greater memories.  As a healthcare leader, you should know, likewise, the value of creating a happy and loyal customer base by building positive memories for each patient and his/her family.   Establishing courtesy as a top priority in your workplace creates the only place that a loyal patient would ever consider going for treatment.

 

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