Healthcare leadership – Page 3

Artificial Intelligence: The future is now

By Thomas Davis, CRNA, MAE DNAP candidate

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“It’s likely that machines will be smarter than us before the end of the century—not just at chess or trivia questions but at just about everything, from mathematics and engineering to science and medicine.”

~ Gary Marcus, Professor/scientist, New York University

“Son, be smart and plan for the future. Get job security and land yourself a job as a conductor on a train, a great career job that will never go away.” The year 1899 was an exciting time for people who needed fast, reliable transportation and rail service appeared well up to the task of carrying its passengers into the 21^st century.

Fast forward to 1999 and the same conversation suggested the child enter the field of healthcare. After all, as long as there are people, there will be a need for healthcare caregivers. Today, nearly two decades into the 22^nd Century, though the need for caregiving remains high, the healthcare train circa 1999 has long left the station and a new train has pulled in powered by an engine called Technology.

Just as train travelers in 1899 could not imagine the 1903 debut of the flying machine, those of us in healthcare today, especially those on the frontline delivering hands-on patient care, view our future workflow through the lens of today’s practice and can’t imaging things that have not yet been invented. Although new hardware, software and devices are continually being developed, the awesome advance in technology that will have a monumental effect on healthcare will be artificial intelligence (AI).

Take an Exciting Glimpse Into the Future…

Artificial intelligence is defined as, “…machines that respond to stimulation consistent with traditional responses from humans, given the human capacity for contemplation, judgment, and intention,” says Darrell West, Director of the Center for Technology Innovation. Stated another way, artificial intelligence involves data bases and algorithms that think, respond as humans would, and do it faster and with more accuracy. Here are some current uses of AI in healthcare.

Sepsis

Duke University actively uses an AI based sepsis watch protocol in the emergency department. The program feeds vital signs, lab tests and patient histories into a database and opens it to digital scrutiny for analysis. Emergency room workers are alerted when the computer detects patterns suggestive of the early onset of sepsis.
The Johns Hopkins has its own life-saving sepsis alert program called TREWS. The miraculous protocol is being used in the many ICUs on the Baltimore campus simultaneously tracks 27 factors related to sepsis. Like the Duke protocol, when signs of sepsis emerge, ICU workers are alerted an intervention is initiated.
University of Tennessee Children’s hospital is equally committed to eradicating infection and has implemented AI in the ICU with a program like those utilized by Hopkins and Duke. Using digital insight to analyze multiple real-time factors identifies children in the earliest stages of distress and allows healthcare providers to initiate treatment early in the process.

Disease prediction

Mount Sinai Hospital has explored uses of AI going back to the deep dive project of 2018. Rather than looking for a specific condition such as sepsis, the project uploaded over 700,000 medical records into a database and gave the green light for the computer to “learn as you go.” Deep dive gave latitude for AI to assess the information in a “learn as you go” manner and report the findings. The program was able to accurately identify individuals who were most likely to develop hypertension, diabetes or other common diseases. An unexpected finding was the ability to predict those who would develop schizophrenia.
Case Western Reserve University has programmed a robot to use AI to detect emotions in people. The robot quickly detects the mood of the person at the moment as well as changes in mood and personality over time. Currently, the robot is being taught to respond with music, video or conversation to elevate the person’s mood when depression is detected.

Diagnostics

Ophthalmology The British Journal of Medicine reports that AI will continue to have a vital and expanding role in the future of ophthalmology. Digital analysis is particularly useful in diagnosing diabetic retinopathy, age-related macular degeneration and glaucoma.
Radiology The use of AI in radiology is predicted to be so successful that it will threaten the existence of the profession. The blog diagnostic imaging forecasts that AI will be able to read radiology images faster and more accurately than a radiologist. A digital radiologist has the additional advantage of being available 24/7 to a worldwide population.
Pathology Similar to radiology, AI is revolutionizing the field of pathology. Sophisticated programs are being taught to correctly identify the existing disease and will also be able to predict which cells will progress to a serious disease.

Anesthesia

Pharmacogenetics Webster defines genome as the complete set of genetic material found in every cell of a person. Pharmacogenetics is the relationship of an individual’s genome to their response to pharmacologic agents. After genetic mapping, a person’s genetic composition can be reviewed by AI to forecast their exact response to drugs. The anesthetic of the future will be based on the ability of AI to assess the genome and then provide a detailed prescription of the best combination of medications, the exact doses, and the re-dosing interval customized to the person’s genetic profile.
Ventilation Ventilators are being developed which allow AI to guide mechanical ventilation. Smart ventilators will analyze physiologic data and self-adjust to provide optimal exchange of respiratory gases. When used in an ICU setting, AI ventilators will also prescribe appropriate sedation to complement the ventilation.

Encouraging adolescents to enter the healthcare field is still solid advice, however preparation for a career on the frontline of patient care delivery will go beyond science and chemistry and will include preparation in basic digital technology. Moving healthcare into the future will require the C-word – collaboration between physicians, nurses, technicians and artificial intelligence experts. Designing a career path that establishes job security into the future does not involve punching tickets on a train. It requires boarding Starship Enterprise and “going where no [human] has gone before.”

Tom is a respected author, speaker leader, and clinical anesthetist.

Contact tom@procrna.com to book a speaking engagement.

Debrief, learn and excel

By Thomas Davis, CRNA, MAE, DNAP candidate

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All too often, opportunity knocks on the door and nobody is home. Despite our desire to have everything go smoothly and safely with each patient interaction, glitches occur and when they do, opportunities emerge for improving the care that every patient deserves. Rather than reprimanding the individual involved, insightful leaders respond by opening the door and welcoming the event as an occasion to debrief the entire team and develop a plan to ensure that the incident is not repeated.

“When a test pilot comes off a flight, typically there is another pilot to take it up and he believes in the debriefing. You don’t keep something to yourself.”

~Wally Schirra, NASA astronaut

The act of debriefing has been an important part of military teamwork for decades. Timely analysis of an event as it is occurring enables soldiers to address mistakes and make changes while on the battlefield. Debriefing encourages novel approaches to critical situations and has the additional benefit of fostering relationships that promote team learning. Similarly, the healthcare battlefield must address a never-ending flow of patients with unique needs that require addressing in a timely manner. Writing in the British Medical Journal, authors Freytag et al. note that teamwork is the key to reducing medical error and recommend regular team debriefing as avenue for proactively developing a collaborative plan that will reduce or eliminate future medical errors.

Debriefing a team does not need to be a punitive or daunting event, rather, it is a format for understanding why the current protocol failed and exploring ways to patch holes to prevent future recurrence. Leadership and strategy consultant Doug Sundheim proposes a simple four-step process to follow when conducting a team debriefing. His advice to business leaders is equally applicable in the healthcare community.

Specify a time and place. Emotions run high when an event occurs or a medical error is made, and knee-jerk responses seldom address the root cause of the incident. Having a one on one talk to reprimand the person involved destroys morale and does not address the foundational issue. A better solution is to designate a time and place for the entire team to review the glitch and collaboratively propose a solution.

Create a learning environment. For the first half of my healthcare career, our department had a monthly morbidity and mortality conference to present a bad outcome and roast the person involved. Over the years, the M&M conference morphed into a learning experience with the intent of process improvement based on the philosophy of Dr. Peter Pronovost, “every system is perfectly designed to achieve the results it gets.” Addressing a problem as a system error rather than a personal failure opens the door for the team to find novel ways to design a new system that does not allow the mistake to be repeated.

Gather information. As the leader, you are privy to information about what happened, however don’t assume that you have all the details of an event. Those on your team who provide direct patient care are the most knowledgeable about flaws in the system and have insight about correcting them. When the team assembles, use the time to clarify the following:

What was the goal?
What was the outcome?
Why did we achieve the results that we got?
What will we do differently in the future?

Develop a plan. Theory and intellectual understanding are great but they don’t repair a defect in the system. Take notes as the conversation progresses and use the insight of your team to change the existing system. The objective is to develop a plan that eliminates the possibility of anyone else repeating the error.

The purpose of debriefing is to modify a system, change behavior and improve outcome. Until the knowledge gained at the debriefing session is put into action, it is only an academic exercise. Apple CEO, Steve Jobs knew the importance of follow-up and assigned a designated responsible person for each agenda item prior to a meeting. Corporate trainer Paul Axtel affirms the importance of after meeting action as an essential part of the process for continuous improvement and makes two recommendations:

Summarize the meeting notes and distribute them to each person on the team. Written notes creates a document trail and serves as a reminder to each team member regarding the origin of the problem and the consensus for solution.
Clarify the plan and expected behavior of team members. When items need additional attention, designate who will be responsible and establish a timeline for completion.

The best leaders learn from every experience positive or negative, and constantly seek ways to improve results while promoting individual professional growth. Medical errors might have devastating consequences or they may create a “near miss” scenario where nobody was injured…but they were at risk. Glitches represent opportunity knocking on the door and perceptive leaders seize the opportunity to create a learning situation that fixes a defective system, improves safety, and preserves the self-esteem of the team member. Open the door and welcome a friend.

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

Older workers strengthen the team

By Thomas Davis, CRNA, MAE, DNAP candidate

We respect our elders. There is wisdom that comes from experience, and I am not going to stop learning from wise counsel. ~Marcia Fudge

Our baby boomers are aging, our healthcare needs are increasing, and our shortage of nurses and other healthcare providers is expanding…an unhealthy situation. Concurrently, many highly qualified healthcare providers who have reached retirement age are not quite ready to throw in the towel. Keeping experienced, qualified people on the job adds depth and diversity to the team and reduces the shortfall of workers needed to meet the expanding demand for healthcare services.

Arlene Donovan, Forbes.com contributor, confirms that seasoned workers add value to a workgroup. “They possess years of experience, have industry knowledge and are committed collaborators.” In addition, many older workers have a calming and unifying attitude based on their ability to withstand the battle-scars of past achievement. Blending the wisdom and experience of older workers with the knowledge and enthusiasm of younger workers creates a diverse workgroup uniquely positioned to meet the challenges posed by the expanding patient population.

Efforts to broaden the age range and retention in the workforce must go beyond making all capable workers welcome to remain. It must include active recruiting to bring experienced people back into the workforce. Many who have recently retired are having second thoughts and would welcome an opportunity to rejoin a team, even if part time, but feel too old to apply for a job. Reaching out to mature workers opens the door for their return to the job.

Glassdoor.com, author, Jacqui Barrett-Poindexter, highlights several characteristics of mature workers that make them valuable team members.

Problem solving With decades of experience, veteran workers have overcome challenges and deadlines, have a network of connections in place, and know the most efficient way to bring a project to completion. Along with adding insight, in stressful situations they have a calming influence that that generates confidence.
Perspective Seasoned workers know that not every project is urgent and not every deadline is firm or realistic. By drawing on experience, they are able to discern the difference and when to focus on urgent tasks prior to addressing other issues.
Knowledge Older workers may not have the same knowledge base as younger workers who recently completed advanced degrees, but, as described in the March 24, 2019 procrna.com blog, there is a big difference between knowledge and wisdom, and both are important. Where older workers lack textbook knowledge, they win the prize for perceptive common sense.
Capacity to grow/learn. It is a myth that older workers are set in their way and resist change. To the contrary, older workers have spent a lifetime implementing change and know how to do it. Today’s workers who are in their 60s and 70s were the activists of the 1960s and 1970s who spearheaded the civil rights movement and attended Woodstock. The hair may be gray, but the spirit remains.
Mentoring. Older workers want to share their stories and ensure that those who follow in their footsteps have the benefit of their experience. Older workers tend to be willing mentors who are eager to leave a legacy through the work of the next generation.

Attracting older workers to apply for a position in your organization should not be a daunting task. It is a myth that the long-serving people who join, or rejoin, your group will try to steal your leadership position or demand a higher level of pay. Experience from the business community has revealed the opposite; older workers want to share their experience, but they do not want the responsibility of being the boss nor do they expect top dollar in the pay check. Whereas younger workers are attracted to pay/benefits, school districts and flexible hours, older workers are working because they want to and are attracted by things that make them feel valued. When recruiting older workers, appeal to the following:

Competitiveness Senior workers who wish to remain in the workforce have been the innovators of change throughout their careers and even though they are no longer leaders, their competitiveness remains. Their desire to achieve will lift the performance of the team.
Wisdom The transfer of knowledge into action requires the judgment, foresight and prudence that older workers have accumulated over the span of a career. Your elders know how to get the job done.
Place in life Mature workers are at a place in life where they are neither harried by the schedules of their children nor encumbered by leadership responsibilities. Appeal to their needs by offering flexible work schedules that allow them to travel, visit their children and grandchildren or pursue the other activities that keep them in shape for continuing to work.
Flexibility Appreciate and place value on the flexibility that older workers offer the collective welfare of the team as they fill schedule positions that are difficult for younger workers who are raising young children. You’ll find that the grandparents on your team who have been there, done that, will help out where others cannot.

Baby boomers ARE aging, and their health needs ARE changing; and, they bring balance to the ever-expanding need in health care. Engage with the gray-haired and tie-dyed who still want to work and you’ll rediscover what, sooner or later, you will experience…decades of wisdom based on experience, a wonderfully collaborative spirit, and the dedicated dependability of those who truly want to help build the bridge to a healthy situation.

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

Compelling messages get results

By Thomas Davis, CRNA, MAE, DNAP candidate

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“Effective communicators make great friends. They’re open to many things and are able to translate their thoughts into meaningful words and actions.” ~Patrick Cogen

E-mail is an amazing and vital byproduct of the digitalization of America. At present, it is attractive, affordable and essential for communication between leader and team. Group messages are an effective way to update and inform an entire team about policy change, workflow alterations or any other topic that affects the group. Individual messages provide an avenue for private, two-way dialogue related to a specific issue. The electronic message platform is so familiar that an important message may blend in with the volume of junk mail and go unnoticed and unopened. Therefore, it is incumbent upon the writer to create a recognizable topic for the subject line, and a compelling message inside that catches the attention of the recipient and demands to be opened.

Caution

There are two important cautions to consider before delving into the finer points of writing effective email messages. Caution #1 Do not use email to avoid personal interaction. Relationships are essential and often make the difference between success or failure of a project. Janice Nadler Ph.D. published a study revealing that people who introduced themselves with a brief phone call were four times more likely to reach agreement when negotiating via email. Email used as a time-saving means of communication is a supplement, not a substitute.

Caution #2 Don’t send emails that pose the risk of creating an unwanted paper trail. Always consider that your messages may be stored or shared so check your amygdala at the keyboard and avoid writing emotional, unkind or nasty rhetoric. Assume up front that anything you publish thoughtlessly can and will be forwarded in mere seconds to the receiver’s support network.

Preparation is key

Before you shoot out a quick message, take a moment to consider the purpose. What is the single most important concept that you want the reader to remember? Recipients tend to remember one or two main points and if you shotgun too many topics in the same message, they may remember the one that affects them the most while overlooking the others. Combine and condense subjects to support a single concept and clearly state the desired respnse of the reader at the end of the message.

Identify your target audience and tailor the language of the message to make it easy to understand. Whether you’re sending a message to a single person or to an entire workgroup, never talk up or down to your reader. If you are implementing a policy change and notifying people at different levels on the chain of command, develop a separate message for each group. For example, a workflow change will affect technicians and nurses differently than physicians and APPs. Developing a message for each group ensures that the information is presented appropriately.

Capture the reader’s attention

You can control the words you write and who initially receives it; however, you have no control over whether the receiver opens and reads the message. Hubspot writer, Olivia Allen, suggests creating a subject line that piques interest, stimulates urgency or is personalized to the reader. For example, “Vendor sponsored dinner” sparks less interest than a subject line “Dine and earn CME at the Steakhouse.” If your goal is to get people to read a draft and offer feedback, a subject line “XYZ policy draft, reply by Friday” will stimulate both curiosity and urgency.

Power Words make Power Mail

Impactful messages begin with a powerful opening and your first two sentences will either win or lose your reader’s attention. Review your goal and write several versions of the first two sentences making sure to include a few power words. Blog author John Morrow offers 595 power words that can be incorporated onto your messages to compel the message recipient to continue reading. Words like amazing, fabulous, remarkable, spectacular, exciting and tremendous might be used to describe an opportunity or an achievement. Power words like frightening, revolting, toxic, scary staggering or scary can be used to give warning or to describe challenges. Regardless, your message content must be related to and flow from the subject line.

“Fools talk because they have to say something whereas the wise talk because they have something worth hearing.” ~Paul Bowden

Once the message is opened, remember, less is better. One or two short, concise paragraphs will be read attentively, whereas, a rambling message will be visually skimmed over before joining the trash barrel. Transparency gives the sender credibility, builds trust and maintains the writer’s integrity. If you’re sending a message that will alter the status quo, briefly state the reasons and the benefits. For example, an ambulatory surgery center required workers to copy two pages from the patient record at the end of each case and submit them to the billing department. Without prior notification by the employer, the usual copier was removed and workers had to walk down the hall to a different copier. The workers did not welcome the change and gave pushback. Had the leader sent the group a message informing them of the impending change, openly revealing that removing the extra copier would save $15,000 per year in ink costs, there would have been little dissent.

When the purpose of the message is to implement change, there must be a clear description of the next step for the reader. Workers are comforted when the leader takes charge and has the foresight to state clearly and without ambiguity the exact behavior that is expected from the reader. Soft messages that only imply but do not specify action will be misread and cause confusion. After giving a powerful opening to capture attention, a transparent description of the problem, and a clear directive to the reader, summarize the message in 1-2 sentences. Unless the message is urgent, save a draft and re-read it before it whooshes out to all.

Electronic communication is not the wave of the future, it is the reality of today. Like the junk mail delivered by the postman that you transfer quickly from the mailbox to the trash can, bland email messages go to the electronic trash can with one click. Communication is an essential component of leadership and email is currently the platform of choice for sending electronic messages. Honing your skills to use current and future digital technology wisely and well, will ignite your leadership and unite your team.

Tom is a clinical anesthetist, noted author and requested speaker

Build a Bridge

The Team Is The Trestle

By Thomas Davis, CRNA, MAE, DNAP candidate

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

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

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

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

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

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

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

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

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

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

By Thomas Davis, CRNA, MAE, DNAP candidate

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Are you capable, competent, committed to the job and yet feel like your daily routine has you mired in a muddy rut? You are not alone. One thing that business, industry and healthcare have in common is that each has a cadre of talented people who feel imprisoned by the status quo and are ready to break the bonds of mediocracy. Take control of your destiny, shake things up, and gain the recognition/promotion that you deserve.

Both those who are in leadership roles as well as those who are frontline workers must act to position themselves for advancement in the organization. Cameron Chapman, staff writer at skillcraft, says that it is foolish to wait to be “discovered” at your workplace when there are things that you can do to revitalize your career and increase your value to the organization. Chapman suggests that you start with self-evaluation and do an honest review of your capabilities compared to your actual work performance. Begin to resuscitate your career by taking action to close the gap between your current performance and the maximum potential that you are capable of putting into the job. Here are some simple ways to advance yourself in the pecking order of most valued employees:

Be more assertive. Confident extroverts infuse energy into a group and are catalysts for productivity, whereas introverts blend in with the environment and go unnoticed. Take the initiative to up your energy level and set a positive tone for your team. Even those who are not natural extroverts can be more outgoing by giving every colleague a friendly greeting and engaging in conversation. Be brave, set ambitious, attainable goals and have high expectations for yourself and colleagues. Positivity is contagious and as you increase your performance, your team will follow suit.

Learn new skills. Instead of arriving every day with a flat attitude and stagnant skill set, enhance to advance. Visualize the job that you desire, the skills required for that position, and then find a mentor or take the classes necessary to expand your capabilities. Taking a course in accounting, personnel management or team development will enhance your existing position as a leader. Mastering the use of new equipment or learning to perform new clinical techniques will advance you as a healthcare provider.

Ask for responsibility. Meet with your supervisor and ask about the most pressing needs in your workgroup or the organization. Better yet, identify an existing situation where your team could improve safety or efficiency and offer to head a project to strengthen the team in that area. For example, the patient handoff between the operating room and recovery room did not include all the basic information required for continuity of care. Alice, a nurse anesthetist talked to the supervisor and proposed a project to team with a recovery nurse and revise the handoff procedure. Completion of the project improved patient safety and having a defined format made the process more efficient.

Align yourself with the company culture. What does your company stand for, why do they exist, and how does your behavior enhance or detract from the greater goal? Read the mission, vision and values of the company and then assess/modify your behavior to ensure that your action supports the purpose of the organization. Behavior that is observable by others and supports company values will ensure that you are noticed when people are being considered for promotion.

Increase your networking. Progress, to include revitalizing your career, happens based on relationships at all levels. Solidify your relationship with others on the team and then expand your horizon by getting to know the people outside your immediate workgroup. Never miss an opportunity to extend your hand to meet new people regardless of their title or role in the organization. As you take on projects, it will become increasingly helpful to know others who can support or mentor your activity.

Eliminate deal breakers for decision makers. Attitude and physical attributes are components of the perception that you create for others to consider when they are selecting the next person for promotion. Characteristics that are unwritten, not discussed but affect the final decision include personal hygiene and habits such as a wimpy handshake or a boring communication style. Clean up your act, literally, interact with confidence and put yourself at the head of the line for the next promotion.

We are each known by our reputations, good or bad. Breaking the bonds of the status quo, increasing your status in the organization, and positioning yourself for advancement are all tied to the reputation that you build for yourself. Everything you say and creates a memory and it’s your job to make sure it is a positive picture. Master new skills, align behavior with company values, and connect with decision-makers to ensure that your name is the first one that comes to mind when your boss is asked to name his/her top performer.

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

7 Tips for giving Negative Feedback

By Thomas Davis, CRNA, MAE, DNAP candidate

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“She did what?” I said to the distraught person on the phone as he reported unacceptable behavior that just spewed from a self-assured subordinate whom I supervise. I took a deep breath and organized my thoughts knowing that the conduct of the arrogant offender required immediate attention and possibly disciplinary action. We were working in a major medical center with a significant population of international patients. My irate employee had just been in the face of a non-English speaking patient, shouted ethnic insults, and told the person to learn English or seek care elsewhere…totally unacceptable behavior.

In contrast, the infraction of another employee took the form of passive omission. Employee two was frequently 5-10 minutes late for work in the morning, took 30 minutes to get in sync and consistently extended lunch a few minutes beyond the allotted 30-minute break. Both situations, one an egregious act of commission and the other a passive act of omission, required honest feedback.

Leadership is multi-dimensional and can be simultaneously rewarding and stressful. When goals are met, and hard-working people exceed expectations, the leader is positioned to hand out recognition and reward to the high achievers. The unfortunate reality is that not all behavior meets standards and not all goals re met. Rather than being stressed, view lapses in employee behavior as an opportunity for you to grow as a leader and for the employee to learn valuable lessons about accountability.

Lisa Bodell, founder and CEO of FutureThink, writes in Forbes.com that more than 90% of employees would prefer their manager to address mistakes immediately rather than letting weak performance slide until presented in the annual performance review. This conclusion is affirmed and expanded upon by Social psychologist, Heidi Grant, who further contends the value of immediate feedback and notes that workers who are on the learning curve want praise and positive feedback, whereas experienced employees who want to improve skills desire a more critical review of their performance.

The trend for ongoing feedback has prompted companies such as The Gap and Adobe to do away with annual performance reviews altogether and to replace them with mandates for leaders at all levels to provide real-time, ongoing feedback to employees. The performance yard blogger, John Courtney, touts the benefits of providing negative feedback and recommends using a positive approach that is intended to change the behavior of the individual while preserving the integrity of the individual and the organization.

Negative feedback that is purposeful and thoughtful, ensures undesirable behavior is addressed and that offenders know the expected change in behavior. By following the techniques used by business leaders when you deliver negative feedback to those you supervise, the task of holding team members accountable does not need to be a daunting or stressful experience.

Avoid emotional responses. Both crisis-causing blow-ups and chronic poor performance can trigger an emotional response from the leader. Whether the behavior of a team member is outrageous or simply disappointing, take a deep breath and collect your thoughts before responding. Like Coach John Wooden role-modeled in his leadership, (ProSynEx blog, Feb 3, 2019) engage your thinking brain and imagine scenarios that caused the event along with several approaches that will bring resolution. Avoid a knee-jerk emotional response that will only pour kerosene on the fire to ensure the best outcome.

Gather the facts. The truth is seldom what appears on the surface. Attempting to address an issue before the facts are known, may force you to walk your decision back later. Expect only part of the truth from the person involved and verify what you are told as you get the rest of the story from other perspectives. A second benefit of fact-finding is that it creates time for your emotions to settle and enables you to find a better solution than your initial knee-jerk response.

Focus on the job. Don’t take or make the situation personal. Focus on your goals for the team and avoid making an attack on the individual. Placing an individual on the defensive will obstruct the work that you are trying to accomplish and render him unreceptive to feedback. Unless the event warrants an employee’s immediate dismissal, approach each situation with the intent of addressing and changing unacceptable behavior.

Be specific. An overt act of aggression is obvious, however chronic poor performance can be insidious and more difficult to describe. State your observation honestly and succinctly by giving examples so the individual clearly understands the issue.

Use questions. The best results are obtained when the person has an ah-ha moment so she can identify ways to correct the problem herself. Ask the person to explain how her behavior affects the team morale, outcome of the project, or how it affects the goals established by the team or the organization. State your desired outcome and challenge the person to identify alternative behavior that would better support the goal. An open dialogue with guided questions will lead to insight about action that will be more productive and achieve better results.

Develop a prevention plan. Feedback without a plan is just a discussion. Build on your intervention by creating a written plan to outline the expected new behavior as well as a timeline for implementing the change. A serious infraction may require an apology or formal discipline followed by ongoing monitoring, while other issues, like weak performance, may require mentoring and a renewed commitment to improve performance.

Follow-up. Establish a timeline and check in frequently with updated honest feedback. Give positive feedback when it is earned and reinforce boundaries if performance starts to slip.

The opportunity to provide negative feedback is a gift for all: Leader, employee and organization. Discussing deficient behavior and is intended to convert a negative into a positive and is most effective when viewed as an opportunity for both the leader and the worker. On the highest performing teams, people not only know what is expected of them, but also receive feedback frequently in an ongoing manner. Assume that most employees have a desire to meet your expectations and want to do the right thing; they desire your reaction to their performance, both positive and negative. Providing timely and constructive feedback enhances your stature as a leader, opens lines of communication and builds the morale of the team.

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

The Legendary Leadership of John Wooden

Wooden Wisdom:

3 lessons from a coaching legend

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

When asked to name the greatest college basketball coach of all time, many would argue that John Wooden has earned the honor. While coaching the Bruins at UCLA (1948-1975), the team made it to the final four 12 times, winning the event an astounding ten times. Even more impressive, he coached the Bruins to four undefeated seasons.

Without a doubt, John was able to recruit and coach talented players, but there was plenty of talent on competing teams. It was The Wizard’s character and leadership that congealed his players into a unified team with a single purpose, setting his program apart from the competition. Knowing that pushing good people to work harder would not deliver the desired results, the coach focused on developing individual talents and taught teamwork that capitalized on those innate abilities.

The legendary John Wooden had 3 rules for his team and they were enforced with integrity every day and in every situation. The same rules that propelled UCLA to basketball fame apply equally in today’s workplace and following them will propel your team to a winning season.

The Wizard’s Wizdom

Rule 1: Never curse. Cursing is an emotional response that results from feeling angry or threatened or when danger is perceived. Wooden allowed only socially acceptable language within his team and taught the players to control their emotions in order to keep “the thinking brain” engaged in the game. Research conducted by George & Dane (2018) affirms that anger undermines good decision-making and must be avoided in the workplace. UCLA’s coach was ahead of the times when he focused on keeping the thinking brain in control. Likewise, applying rules of civility and respect in the workplace eliminates knee-jerk emotional responses and promotes proactive, creative thinking.

Rule 2: Never criticize a team mate. The coach’s ban on criticizing a team mate built an attitude of interdependent collaboration. Nadidah Coveney, of the Forbes coaching council, agrees that collaborative relationships provide a spearhead to success. Tolerating criticism encourages people to see one another as competitors rather than collaborators and, subsequently, to vie for dominance on the team. The superb UCLA teams were expected to see themselves as a single unit in which criticizing a team mate equated with criticizing one’s self. John focused to create teams on which individuals worked to strengthen one another, elevating the entire team. Trust within the Bruins was earned by collaboration, honesty and actively helping one another. Applied in every workplace, a ban on criticizing team mates includes barring gossip and other acts of sabotage that undermine the morale or productivity of the team.

Rule 3: Never be late. Coach Wooden viewed promptness as outward sign of respect for one another. He insisted that practices start on time and, in turn, showed his respect for the group by ensuring that practice ended on time. He believed that sticking with the schedule was evidence of honesty and integrity, both key elements of a trusting environment. Corporate recruiter Chitra Reddy affirms this wisdom by noting that mutual respect enhances collaboration and overall productivity. Team solidarity is created through acts of integrity where members follow through and deliver as promised.

Many work groups are staffed with talented individuals who are competent and capable of doing the assigned job and yet, as with college basketball teams, individual talent may not be enough to win the trophy. Rather than winning with raw talent, the most successful teams win through collaborative team work. Following John Wooden’s three rules of controlling emotions, working collectively, and building trust through respect will enable a slam dunk for success. Now get out there and crash the boards!

Tom is a noted author, speaker and avid advocate

for healthcare leaders.

Scout out a promotion

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

Promotions play an essential role in the success of an employee and his organization. Workers who are recognized and rewarded for their job performance and work ethic tend to develop loyalty to the organization and work even harder to prove that they merit promotion. As a result, organizations benefit because morale and creativity will be high and employee turnover will be low; both of which are improved when deserving people receive earned promotions.

Employers collectively spend millions of dollars on research and consultants intended to improve the morale and production of the company workforce. Behavior and neuro sciences help the employer’s managers build superior teams by collaborating with psychologists to gain insight into the profile of the perfect worker. Author Emily Smykal (2016) identifies work ethic, positive attitude, dependability, and effective, team-oriented communication as skills possessed by the perfect team member. In a companion article, Smykal describes behavior geared to get high achievers promoted as collaboration, reliability, honesty, ownership, effort, creativity and hard work.

Save your research money and go back to your roots to find the secret of earning a promotion. In his book, All I really need to know I learned in Kindergarten, author, Robert Fulghum, lists 15 lessons learned in kindergarten that enable you to live a balanced and successful life both at home and at work. Tips such as, “clean up your mess,” and “don’t hit anyone,” are on the list of desired behaviors.

Based on my experience as a Chief nurse anesthetist, I am convinced that we make earning a promotion much more difficult than it needs to be. My 7-year old grandson learned socialization skills in kindergarten and is now a proud cub scout who is all in trying to learn and follow the scout law. In reviewing the 12 points of his new code for life, I am struck that his code of conduct describes my ideal employee and the person whom I would select for promotion. Tailoring your work behavior to follow the 12-point scout law will make you an ideal employee and first in line for a promotion.

The Scout Law

Be Trustworthy Trust is a foundational building block of a highly effective workplace and it requires that everyone on the team can be trusted. Show your trustworthiness by arriving on time, completing your assigned tasks and showing sincerity in saying what you mean and following through. Create an environment of trust by being scrupulously honest.

Be Loyal Show loyalty to your colleagues by sticking with them through good and bad times. Show loyalty to your superior and the company by doing your job well and taking pride in your work.

Be Helpful Those who are helpful freely give assistance to colleagues who are having difficulty with an assignment. Helpers assist and coach others without crossing the line and playing rescuer.

Be Friendly Being friendly and upbeat is something that we all understand and can be as simple as putting on a smile and a positive disposition. Take a sincere interest in colleagues as an act of friendship. Keep confidences. Friends don’t gossip.

Be Courteous Show respect for others by listening attentively when they speak and keep people informed when plans change. Never embarrass a co-worker and always respect their personal needs.

Be Kind Opportunities for acts of kindness exist with every interaction that you have with another person. Give sincere compliments, thank others promptly as appropriate and do small things for the team. As unremarkable as it may seem, making a new pot of coffee may be appreciated as an act of kindness.

Be Obedient Policies and procedures exist in the workplace for a reason and they set the boundaries for expected behavior. Follow the rules and guidelines, and never intentionally put your supervisor in a position where she/he must defend you or explain your behavior.

Be Cheerful Happy, pleasant workers elevate the mood of an entire team. A smile and a friendly greeting is contagious and prompts others to reply in kind. An upbeat attitude is energizing for both you and those around you.

Be Thrifty Overhead expenses exist with any job and the thrifty employee ensures that the department and the organization get value for the money. Eliminate wasting both time and resources by giving a full day’s effort every day. Never take-home supplies from the workplace.

Be Brave Demonstrating bravery in the workplace is not a matter of placing yourself in the path of physical harm. Rather, brave workers have the courage of their convictions, they are forthright and will not compromise personal values. Bravely stand up for what you know is right and never compromise your integrity.

Be Clean Cleanliness is all encompassing and includes your body, mind and workplace. Maintain your personal hygiene and the orderliness of your workspace. Think or verbalize clean thoughts regarding colleagues, clients, your employer and the bad referee call during Sunday’s big game.

Be Reverent A pervasive, deep feeling of respect arising from trust and loyalty unites a group of individuals into a cohesive team. View your job as a special place and feel privileged to work with colleagues who are also following the scout law.

Behavior scientists and business gurus have saturated the blogs with tips for those seeking promotion at work; however, none have offered advice that will position you better than following the scout law. At your next performance review, when you’re asked why you deserve a promotion, go through the 12 points of the scout law and give examples your behavior supporting each element. Consciously living the law will make it who you are and engrain it into your personality. Start as a cub, live the law, and fly like an eagle.

Tom is a respected leader, speaker and clinical anesthetist. Contact tom@procrna.com for a list of topics and availability to speak at your next meeting.

Plan for success

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter for leadership motivation.

“Without continual growth and progress, words such as improvement, achievement and success would have no meaning.”

~Benjamin Franklin

Keeping the workplace relevant involves updating goals, re-defining the workflow to provide better service to clients and staying ahead of competitors. Establishing new team goals that leverage new technology while reflecting social change, positions the organization to remain relevant in the foreseeable future. A positive spinoff of new team goals is the energy and enthusiasm that is injected into the team as the status quo is shaken when the group challenged with a new task. The time and effort spent assessing current priorities, anticipating future trends and establishing new goals will revitalize the team and paint them as the face of leadership in the organization.

Start with a comprehensive assessment. Review the team goals that were established a year ago and note which were achieved, discarded or ongoing. Goals that have been achieved deserve a high five and can be crossed off the list. Items that slipped off the radar screen and were not achieved deserve to be re-assessed. If they are no longer relevant, cross them off the list, however, if it’s a should do that lost momentum, move it back to the active list and create a plan to ensure completion. Ongoing goals merit a progress report and tweaking of the plan to ensure that the goal is achieved.

Develop a written list. Following your assessments, develop new goals for the upcoming year and put them in writing. A written list will organize your thoughts and give you something concrete to publish for others to review. Include all pertinent goals that remain from the prior year along with the modifications needed for successful achievement of the objective. Next, anticipate the new priorities needed to align your team with the greater goal of the organization and add them to your forecast. Following completion, prioritize and notate the items on your written list.

Clarify your goals. Teams suffer when a leader’s vision for the future is vague; people are most productive when they know exactly what is being requested of them, the resources that are available and the timeline for completion. Goals should be written in language that is specific, measurable and attainable and each should include a timeline with milestones to mark the team’s progress. Once the list has been presented to the team, each person should know exactly what is expected and their role in the plan.

A bonus for establishing and clarifying goals is the opportunity for mentoring. During the progression of self-reflection, the review of old goals and establishing new ones, invite one or two of the up-and-comers on your team to participate in the activity. Mentees benefit from being included in the discussion and learning the process of uniting a team with the greater goals of the organization. In addition, you will benefit from the insight provided by subordinates who view the workplace from the grassroots level.

After the goals have been established and clarified, organize a team meeting to present the new agenda positively, proactively and energetically. As described in Leader Reader 1, Authentic Lessons in Leadership, your leadership attitude during the roll-out sets the tone for the group and your enthusiasm creates an expectation for success. At the meeting, establish the importance for change, outline an overview of the plan, establish a timeline and identify key people to take charge of specific projects. A congenial team meeting that has been well-planned creates an atmosphere of shared responsibility wherein each person wants to contribute to the team’s success.

“Always plan ahead. It wasn’t raining when Noah built the ark.”

~ Richard Cushing, Catholic priest

Staying ahead of the times in the workplace can be challenging so take advantage of the changes that occur naturally with the passage of time. View social change as an invitation to renew and re-focus the priorities of your team. Like cleaning the closet and discarding old items to make room for the new, make an honest assessment of workplace priorities and remove the goals that have been completed or that no longer apply. Then boldly, confidently, and proudly introduce your team to the new priorities for the year. Your efforts will be rewarded as your team takes the lead and works with renewed energy to ensure that your clients and patients receive superlative service.

“Every minute you spend in planning saves 10 minutes in execution; this gives you a 1,000 percent return on energy!”

~Brian Tracy, author and motivational speaker

Tom is a noted author, speaker and team building coach.

Leader Reader 1, Authentic lessons in leadership is a practical guide that is loaded with tips for enhancing your leadership skills.

Make it a no go

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

The end of the year is a time to reflect on the good, the bad and the ugly. For some, reflection on recent work experience produces the conclusion; “I gotta get a better job.” They may be people who struggle in toxic environments in which the work they do is valued but, despite their contribution, they are not appreciated, recognized or rewarded for their efforts. Those stranded in an onerous workplace may benefit from a new job and can truly justify leaving. More frequently, however, people are motivated to seek a new position because they’re in a professional rut and no longer feel challenged or empowered by their ho-hum job. In a nutshell, they are bored.

According to Alison Doyle, author for The Balance Careers, studies indicate that 51% of workers in America are planning to leave their current job and 47% of American workers who feel that they are in a good job would leave if an ideal job were available. Millennials tend to not see themselves working at one job for the duration of their careers with 44% expecting to change jobs in the next 2 years.

Why People Leave

Business journalist, author, and CNBC business consultant, Suzie Welch, affirms the current unrest in the workforce and offers three reasons to explain why people seek new jobs.

They are no longer fully engaged in their work. People spend the early days of a job mastering the skills needed to be successful. Over time, work becomes routine leaving the person feeling like a spoke on the wheel.
They have been at the same company too long. As years turn to decades, people settle into niches and robotically do their assigned task. Not only is their spot on the pecking order assured, they are may have become embedded into the position with little opportunity to move either up or down the chain of command.
They are no longer challenged in their role. “You get good at what you do” remains true today and the risk of having acquired competent comfort is the onset of boredom. When a job no longer offers the stimulation of professional development, it loses importance beyond money earned, money paid.

Why People Stay

Are you ready to throw in the towel? Not so fast! Before you start a job search, consider some factors that make the current job a little more attractive.

Geographic ties The longer a person is in a community, the more engrained the person and their family become. Friendships have been formed, and trusted resources have been located. Leaving a community may require selling a home, packing and moving with the blind faith that the new community will be as good as the new job.
Interests of partner/spouse/family Those in a two-income family must consider both incomes before pulling up stakes and moving. Children have friends and school activities that would be disrupted by relocating. If your partner own/runs a business, moving may not be an option at all.
Current pay/benefits are good Among the many reasons a person works, paying the bills is always on the list. If the pay/benefits of the current job are good, it may be unwise at this point in your affairs to trade security for the stimulation of a new workplace.
Fear of the job hunt process Searching for a job, interviewing, credentialing and onboarding are stressful and time-consuming. In addition, applying for a position opens you to unwanted scrutiny or potential rejection.
Prospect of changing the current workplace culture A great reason to stay in the existing job is the realization that your dissatisfaction with the present position can be alleviated by taking the lead in shaking things up and infusing energy into the present job.

The grass isn’t always greener on the other side of the fence so before you sell the farm, step back and look at your job objectively. If the status quo is truly toxic or oppressive, and you’re able to move on, move on. However, if the root cause of your unrest is plain old stuck-in-the-rut, you’re almost always better served by running toward the problem rather than running away from it.

When You Stay

For those who are committed to staying in the current job and want to feel fulfilled with a sense of purpose and enjoyment, try these ideas.

Develop a friendship. A friend at work gives you a trusted ear for sharing personal thoughts and someone whose company you enjoy. Having someone in the workplace who you look forward to seeing each day increases loyalty to the organization and increases the likelihood that you will remain in the same job.
Just say no to negative talk. Negative talk and gossip are draining. Refuse to say anything unfavorable about your job, a colleague or the organization. When lounge talk deteriorates, change the subject or simply leave.
Leave it at work. Taking disagreeable thoughts home to share with a partner continues your discontent into your personal time. Going home and assuming the role of a victim garners sympathy and reinforces your dissatisfaction with the job. The emotions tied to victimhood will diminish your ability to make an intelligent decision about the potential benefits tied to the current job.
Take a break. Some people seek to make a job better by working longer and harder. Doing too much for too long puts you at risk for burnout and even minor irritants at work become major issues. Take a break, relax and return refreshed.
Acknowledge your own value. The importance that is tied to your good work may not get the recognition that it deserves. End each day by reflecting on your positive contributions and your importance to the team.
Be proactive. Don’t expect the world to be placed at your feet; go after it. When you have ideas for improving workflow or making the workplace a better place, take the initiative to make it happen. Even little things can make you feel empowered and create a big difference for you and your colleagues.

In just a few days the new year will arrive, and you can quit the old job. Start the new year with a new job by re-defining your position at your current workplace. All that is required is renewed self-confidence and a shift in focus from, “I gotta get a better job,” to, “I can and will make this a better job.” Don’t allow yourself to become a victim who enjoys wallowing in the mud of negative thought. Instead, accept responsibility for making your job more satisfying by approaching the challenge with proactive, optimistic enthusiasm. Expand your friendships, leverage group dynamics and consistently reflect on the positive. When you think it’s time to go, reconsider and make it a no-go.

“Grass is greener at other people’s feet because they watered it. You need not to let your environment control you; you have what it takes to make it look beautiful!”
~Israelmore Ayivor,

Tom is a respected anesthesia clinician, author, speaker and leadership coach. Forward this article to friends and help expand the network of healthcare leaders.

Better habits through science

By Thomas Davis, CRNA, MAE, DNAP candidate

follow @procrnatom on twitter and retweet to a friend

Men’s natures are alike; it is their habits that separate them.

~ Confucius

Resolutions are intentions related to the changes that we desire in our personal lives and are often based on notions and emotions. Being “a better person” is a nebulous term that means different things to different people. Habits, by contrast, are observable behaviors that define us as individuals. The transition to each new year encourages people to make resolutions; however, the reality is that good intentions come up empty when theoretical concepts about the person you want to be do not change the behavior of the person you are. Resolutions seldom work because they are simply ideas, and ideas do not change behavior. It is actual behavior in the form of habits that define us as individuals.

The key to personal change is in transforming the abstract concept of a better you into observable, habitual behavior that will define you in the future.

The fields of neuro science and behavior science merge when addressing the issue of changing behavior. Scientists affirm that when behavior is repeated, neural pathways (grooves) develop in the brain, and when new behavior is repeated frequently, it becomes a habit. Christine Comaford, a behavior scientist who specializes in coaching CEOs to be more effective, states in Forbes.com, “First it’s key to know that neurons that fire together, wire together. This means to learn something new, to set a new habit in place, repetition is required. When you practice something deeply, intentionally, and with some element of struggle, a neural pathway is formed. Neurons are now firing together in a new sequence, and thus are wiring together as a collective.” This statement is great news for those who are willing to learn by repetition because the behavioral patterns we repeat most frequently are etched into our neural pathways. Neuro science presented in Psychology Today affirms that through repetition, it’s possible to form and maintain new habits.

Applying the wisdom of the neuroscience community allows you to convert the abstract concept of a New Year’s resolution into observable new behavioral habit. Show your commitment to changing your behavior by signing a personal contract to follow three rules for 30 days.

Bring the desired change to mind and repeat the new behavior at least 5 times per day, every day, without exception. You may not be able to go to the gym 5 times per day but you can bring fitness to mind and take time to stretch. The change you desire must be etched in your brain at least 5 times per day.
Prioritize the repeated behavior, especially if it’s difficult or inconvenient. Let nothing deter your effort.
Repeat the new behavior with intensity, constantly visualizing yourself as successfully practicing the desired behavior.

Rather than seeking a total overhaul of yourself, select one behavior and use a 30-Day Challenge to make meaningful change. Every time you duplicate the new behavior, the neural pathway becomes stronger and over time the new behavior will become your default action. When the new behavior becomes a habit, do a self-assessment, then select a second behavior that you want to change and start another 30-DC.

To get started, below is a list of categories and possible resolutions that are crying out to be included in a 30-day challenge. Select one, follow the rules above, faithfully complete the challenge, realize the results and celebrate success. If none of these bullets hits the mark, come up with your own idea and pull the trigger. The goal is to implement the 30-day plan, alter neural pathways and build a new habit.

Personal health
- Exercise 20-60 minutes per day.
- Commit to a healthy, plant-based diet.
- Restrict/eliminate one negative food such as sugar, caffeine or alcohol.
Professional development
- Learn a skill that will enhance your work performance.
- Learn key words in a language spoken by your international clients.
- Write in a journal daily.
- Select a topic and read one pertinent blog article per day.
Time management
- Limit social media to 30 minutes in the morning and 30 minutes in the evening and SET A TIMER.
- Make a daily list of realistic “must do” items and don’t stop doing until they’re done.
- Set a personal boundary, ie turn off electronics at a specific time in the evening and go to bed at a time that ensures a minimum of 7 hours of sleep.
Workspace at work and at home
- Organize and keep everything in its place.
- De-clutter and do not leave the workspace until clutter is cleared
- Set aside one item per day to donate and do it.
- Give away or trash one item daily.
Social interactions
- Speak to at least one stranger daily.
- Once a week, extend an invitation to an acquaintance to meet for coffee with the intent of learning new things about the person
- Send a thank you email or text to at least one person per day.
- Give a sincere compliment to at least one person per day.
Financial
- Stop eating out.
- Log all money that is spent during the month…no exceptions.

We are counting down the days until we count down the final seconds as the ball drops. Rather than experiencing another year with good intentions in January that end up as February failures, try a using a new method for building new habits. Combine the wisdom of the neuro and behavior science communities with your personal tenacity to commit, and follow through and enjoy lasting results that improve your leadership and last a lifetime. Using your new neural grooves, get into a groove that will set the stage for a successful 2019. Happy New Year!

“You can do anything you decide to do. The most difficult thing is the decision to act; the rest is merely tenacity.”

~Amelia Earhart

Tom is a noted author, frequently requested speaker, and leadership consultant

There’s no harm in charm

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

What do Winston Churchill, Nelson Mandela, and John Kennedy have in common? They are all recorded in the history books as being charismatic leaders. To some, the stereotype of a magnetic personality carries the negative connotation of an all-show predator who is constantly on the look-out for a sucker who will fall prey to a con scheme. However, a closer look at charisma reveals a more positive view of the importance of an alluring personality in dynamic leadership. Some of the most memorable people in history and in our personal lives are those who use personal appeal constructively, and when you think back over the span of your career, it is likely that your favorite boss was a person with appeal beyond the actual job.

Engaging leaders use powerful communication skills to connect verbally, non-verbally and emotionally with all whom they encounter. Larger than life leaders are able to articulate a compelling vision and are masters at motivating individuals to embrace their cause by inspiring people to give effort that transcends what is required. In the words of Robert House, professor at the Wharton School, “Charismatic leaders cause followers to become highly committed to the leader’s mission, to make significant personal sacrifices, and to perform above and beyond the call of duty.” Charisma can be learned and all it takes is the desire and the commitment to add dynamic magnetism to your list of positive traits.

Writing a guest article in recruitloop.com, author Hannah Lewis, UK-based educationist, recommends infusing charismatic energy by keeping the workplace light while displaying self-confidence and making every person you encounter feel as if they have your full attention. Maintaining personal integrity while role modeling behavior consistent with your vision adds to your credibility and creates a desire in others to be loyal supporters of your vision and plan.

Captivating charm is not an inborn leadership trait, but rather a skill that is learned. Writing in Business Insider, Author Vivian Giang affirms that anybody can learn to be more charismatic and offers advice for improving personal appeal.

Focus on others. Make everyone you interact with feel as if they are the most important person in the room. Eye contact, listening and follow-up questions all give a sense of importance to the person talking to you.
Be present. Give every interaction your full attention even if only for a short period of time. Checking mobile devices or having side bar conversations are taboo.
Relax and smile. Think of something pleasant…your body will respond and change your facial appearance.
Don’t be physically dominant. Put yourself at a similar height. Stand as if you are sitting and don’t tower over others when you stand.
Give a warm greeting. Use a friendly facial expression and a firm but not overwhelming hand shake.
Value the other person. Listen, pause and ask questions. Always seek a deeper level of understanding.
Leverage your physical position. Sit next to or 90 degrees from the other person…never across. Sitting across puts a physical barrier between people and increases the likelihood of disagreement/argument.
Avoid name dropping or gossip. Don’t compare yourself to others or talk about people who are not present.
Demonstrate moral integrity. Show inner strength through the way you conduct your business. Yes means yes, no means no, and commitments are honored when brought to completion.
Be confident both verbally and non-verbally. Don’t be distracted with self-doubt. Use positive language and confident posture.
Seek personal growth. Put yourself into uncomfortable situations so that you can practice your skills.

In today’s workplace a charismatic leader at any level of the chain of command is bound to elevate the team and add to the organization. Winston Churchill proved that you don’t have to be physically attractive to be magnetic; all that is required is the ability to connect, communicate, motivate and inspire every individual you encounter. Great Britain might not have survived WWII, Apartheid might never have ended, and Russian nuclear missils might be in Cuba if not for the charismatic leadership of Churchill, Mandella and Kennedy. These three dynamic and captivating people used their ability to connect, inspire and motivate others to change the course of history. You can do the same in your workplace by infusing genuine, dynamic charm into your leadership style.

Tom is a respected author, speaker, leadership coach and clinical anesthetist

Patient satisfaction is transforming healthcare

By Thomas Davis, CRNA, MAE, DNAP candidate

One hundred years ago, American culture was in a time of rapid change with an influx of new technology changing the way people lived their lives. Being phased out, the horse and buggy, kerosene lamps and outdoor privy were quickly replaced by autos, electric lights and flush toilets. In the hundred years that followed, the shift in healthcare delivery has affected our lives to the same extent as the technology changes of a century ago. In the 1960s, healthcare was physician-centric with little concern for the needs or desires of the patient. It was a time in which “the doctor knows best” governed healthcare and patients were lucky that the doctor agreed to provide treatment. Moving forward another fifty years to the 21^st century we find a system in which patients manage their own health records and have mobility to seek care wherever they desire. Role reversal has put the patient in the driver’s seat leaving doctors and healthcare organizations to compete for the patient’s business. In today’s medical marketplace, patients select doctors and hospitals based on both the quality of care delivered and their memory of how they were treated. Healthcare providers who survive are those who are sensitive to patient satisfaction while providing state of the art treatment.

Patient satisfaction is the person’s perception of their overall experience with you and your organization. A patient’s perception is his/her reality so the impression that you make is the memory that they will share with others, sometimes for years after receiving treatment. Toma Kulbytė, content marketing specialist at SuperOffice, says “If they like you and continue to like you, they are going to do business with you and recommend you ….” Does satisfaction count in a patient’s assessment? According to Kulbytė, a positive customer experience creates a 42% increase in loyalty (likelihood for repeat business) and a 33% increase in satisfaction scores.

Loyalty is earned

Regardless of whether the need is for a car, computer or colonoscopy, today’s consumer demands a quality product at a fair price, delivered by people who understand their specific need and treat them with respect and dignity. To build a loyal base of satisfied customers, three factors are foundational: People, product and presentation.

People

It can be argued that the most important person in a healthcare facility is the first person a patient encounters at the point of entry desk. The congeniality with which a person is greeted, and the expertise shown by the attendant when entering the patient into the system create a lasting impression. Ciotti, blog author and marketing strategist, confirms the importance of customer service skills and recommends that those delivering health care, master this list.

Patience	Attentiveness	Clear communication skills
Clinical competence	Positive attitude/language	Acting skills
Calming presence	Ability to sense patient’s mood	Tenacity
Persuasion skills	Empathy	Willingness to learn

Patients moving through the healthcare system encounter many people along the way and feel reassured by being introduced to the next person by name and their role in the treatment process. With the patient’s wellbeing as your top priority, always use a positive language and an undistracted, welcoming attitude when providing care

“Nobody cares how much you know until they know how much you care.”

~Theodore Roosevelt

Product

People expect those delivering a service are competent, capable and committed to excellence. It doesn’t matter if you’re delivering a double cheese pizza, or an anesthetic, in order to earn your customer’s satisfaction, you must be skilled at your job and create expectations that are realistic. In the healthcare arena, connect with your patients pre-operatively, clearly describe what can and can not be done, and then deliver on the service as described. The bottom line is that your patients want you to be good at what you do, and they expect to receive the product and experience the outcome that they have been promised.

Presentation

Healthcare delivery is a competitive business and people are free to seek treatment wherever they desire. Marketing analysis by Keona Health reveals that 77% of patients use online reviews to find and select a physician. The physician compare area of the CMS web site makes rating healthcare providers quick and easy. Likewise, when a physician uses more than one hospital, patients rely on online reviews when requesting their hospital of choice. Once a provider has been selected, patients use mobile devices to schedule appointments and judge the organization by the degree of user-friendliness of their web site. When online sites are difficult to navigate, patients move on to another provider with a more user-friendly online presence.

Indiana University Orthopedic surgeon, James Rickett, links patient satisfaction to outcome by documenting that reduced hospital stay, reduced readmission rates, and overall better quality of care all correlate to high patient satisfaction scores. Dr. Rickett’s observation underscores the importance of delivering healthcare services in a manner that ensures patient satisfaction. The physician driven hierarchy for patient treatment that existed several decades ago no longer applies in our web-based, patient-centric world. The healthcare marketplace is becoming more and more competitive and patient satisfaction may be the key factor separating those who lead the industry from those who are forced to close the doors and turn off the lights. Patient satisfaction does matter.

Thomas is a respected author, speaker and clinical anesthetist.

Robert Greenleaf; The first serving leader

By Thomas Davis, CRNA, MAE, DNAP candidate

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“Where there is not community; trust, respect, and ethical behavior are difficult for the young to learn and for the old to maintain.”
― Robert K. Greenleaf,

Health care delivery in the United States and around the world is in a state of transition as traditional physician-driven hierarchies are being replaced with collaborative teamwork. At the root of this drive is a hope for improving employee engagement, productivity and loyalty to the organization. More than at any point in history, empowering leadership at all levels is being viewed as the key to building powerful teams and the serving leadership style is being promoted as the panacea for workplace woes.

Robert Greenleaf was born in Terre Haute, IN, in 1904, the son of a machinist and community steward. Robert attended Rose Polytechtic and Carlton College earning a degree in engineering. He took a position with AT&T where he worked as a loyal employee for 38 years and became known for his theories about empowering leadership. During that time, Robert headed a division for management training and created the first center for corporate assessment in America. One of the first to promote women and blacks into non-menial positions within the AT&T organization, Greenleaf became well known as a pioneer in leadership by seeking ways to utilize each person to his/her fullest capability.

Following retirement from AT&T at age 60, Robert worked as a consultant to businesses that had an interest in leadership development and taught them to implement his core belief that effective leadership is a partnership wherein “the organization exists as much for the person as the person exists for the organization.” In 1970, Greenleaf published his essay, The Servant Leader which coined the term and introduced the notion that the best leaders are servants first. The style of leadership that he espoused proved to be effective and requests for his leadership coaching grew into creation of the Greenleaf Center for Servant Leadership. The center states as its mission: “to advance the awareness, understanding and practice of servant leadership by individuals and organizations.” Long after the death of Robert Greenleaf, the center remains a strong advocate for servant leadership and continues to offer training through the Greenleaf academy.

Writing in EmergingRNLeader, nurse and author Rose Sherman identifies the leadership style described in The Servant Leader as an essential component of a highly effective healthcare workplace. Crediting the work of Robert Greenleaf, the following were described by Sherman as essential characteristics of the Greenleaf serving leadership style.

Listening
Empathy
Healing
Awareness
Persuasion
Conceptualization
Foresight
Stewardship
Commitment to professional development of staff
Building community

Click here for an explanation of the 10 principles listed above.

Robert Greenleaf had an unshakable belief that through collaboration and the creation of a work environment that empowers people to work at their highest capability, people will be happy, engaged and highly productive. History records that Robert was never driven by a quest for fame or fortune, but by a belief that the potential within each person that could be released, can be released, through servant leadership. Etched in his grave stone are the following words, “Potentially a good plumber; Ruined by sophisticated education.”

In the decades following the publication of his famous essay, Robert’s principles of servant leadership have become the foundation for many versions of leadership development in America and worldwide. Books, videos, and workshops may put a new spin on Greenleaf’s original work; however, when all is said and done, the beliefs of Robert Greenleaf are still alive and evident in leadership development worldwide.

“A better society, one that is more just and more loving, one that provides greater creative opportunity for its people.”

~Robert Greenleaf

Tom is a noted author and popular speaker at State Association meetings.

Make it Safe; Essential Resources for Patient Safety

Thomas Davis, CRNA, MAE, DNAP candidate

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In 1999 the Institute of Medicine rocked the healthcare world with the scathing report that every year up to 98,000 people in the United States die due to medical errors. Despite nearly 20 years of safety initiatives being introduced in hospitals nationwide, medical errors continue to be the third leading cause of death in the United States; a situation that can best be corrected by healthcare providers on the frontline of patient care.

It is easy to get the consensus of doctors, nurses and support staff to commit to patient safety; however, changing the workplace culture and making patient safety a priority can be a daunting task. Fortunately, organizations have emerged to assist frontline workers who are committed to making healthcare safe and reliable for the patients they serve.

If you are committed to ensuring patient safety, you are not alone. Here are resources to help you achieve the goal of eliminating ALL preventable medical errors.

Anesthesia patient safety foundation (APSF) The APSF was founded in 1985 with the defined goal of improving patient safety related to anesthesia. The board of directors is a group representing a wide variety of stakeholders including anesthesiologists, nurse anesthetists, nurses, manufacturers of equipment and drugs, regulators, risk managers, attorneys, insurers, and engineers. The APSF newsletter is published in 5 languages and provides a wealth of information related to patient safety that supports the organization’s mission: “The APSF’s mission is to improve the quality of care for patients during anesthesia and surgery by encouraging and conducting patient safety research and education as well as related programs and campaigns.” The AANA is an active partner with the APSF in promoting patient safety.

Patient safety movement The patient safety movement has a stated goal of zero preventable medical errors by the year 2020. The organization approaches patient safety by identifying risks to patients, challenging technology to assist by creating solutions, ensuring that providers follow established policy, and directly providing education to patients and their families regarding risks. The patient safety movement bypasses the medical establishment by directly providing information to patients and their families to alert them to the risks of hospitalization. The organization now offers the patient aider app that alerts family members regarding risks to their loved ones and provides questions to ask those who are providing care.

AHRQ (Agency for Healthcare Research and Quality) The AHRQ has the organizational mission; “…to produce evidence to make healthcare safer, higher quality, more accessible, equitable and affordable, and to work with HHS and other partners to make sure that evidence is understood and used.” The AHRQ website has a section titled “evidence now” that outlines evidence-based information designed to help healthcare providers with clinical decision making. The AHRQ site is a valuable resource for those who constantly update their practice based on the available best practice statistics.

Armstrong institute for patient safety and quality (The Johns Hopkins) The Armstrong institute for patient safety is housed at The Johns Hopkins Hospital and is committed to making healthcare safe for every patient, everywhere. The organization is dedicated to their mission: We partner with patients, their loved ones and all interested parties to end preventable harm, to continuously improve patient outcomes and experience, and to eliminate waste in health care. To ensure that providers at the grassroots level have the tools necessary for safe practice, the Armstrong institute provides patient safety courses for healthcare workers. Individuals can earn CME by attending courses in Baltimore or their employer can arrange for the Armstrong institute to travel to their location and present safety workshops.

Institute for Healthcare Improvement (IHI) The IHI has a global interest in improving the overall health of the world population through initiatives aimed at public health as well as education of healthcare providers in developing countries. In the US, the IHI focuses on system improvement, whereas in developing areas of the world, issues such as vaccination and water purification are priorities. As self-described on their web site, “We are an institute without walls, and together, we work as a cohesive unit with, common knowledge, common systems and unconditional teamwork. In all we do, we adhere to the principle of “all teach, all learn.”

AANA The AANA has a commitment to patient safety and their web site has numerous articles intended to improve patient safety. Topics such as opioids, radiation and OR distractions are just a few of those available on the AANA web site. The Professional practice division has published evidence-based practice resources to aid clinical decision making.

AORN CRNAs are not the only people in the OR who are committed to patient safety. The AORN “is committed to promoting patient safety by advancing the profession through scholarly inquiry to identify, verify, and expand the body of perioperative nursing knowledge.” The organization has published a patient safety position statement to guide the activity of nursing staff in the OR.

Center for Medicare/Medicaid services (CMS) CMS is a major payor for healthcare services in the US and has a vested interest in patient safety. The organization establishes standards and updates them annually to create criteria that must be followed in order to receive reimbursement for services. CMS seeks to improve patient safety by making healthcare providers accountable for the quality of care that is provided.

The Joint Commission (TJC) The Joint Commission accredits healthcare organizations throughout the United States and certifies that they meet or exceed established standards, including standards for patient safety. TJC has released the National Patient Safety Goals for 2019. Currently, safety priorities are patient identification, syringe labeling and blood administration. Areas of emphasis are updated to reflect perceived threats to patient safety.

Center for patient safety Established in 2005, the Center for patient safety is an independent, non-profit organization dedicated to promoting safe and quality healthcare. The organization is a resource for healthcare providers and offers information via blog, safety alerts and legal updates.

Centers for Disease Control and Prevention (CDC) The CDC is a government agency with the mission “to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.” The CDC national healthcare safety network tracks medical errors, issues statistical reports and issues alerts related to patient safety.

Patient safety company The patient safety company is an important bridge between safety initiatives and digital technology. The company offers software to support safety initiatives including incident management, patient satisfaction, workplace culture assessment, information security and peer support. They will also develop custom software for unique safety projects.

Patient safety is everybody’s business and making a commitment to ensuring a safe environment for your patient is easy on an intellectual level. Reviewing the resources listed above provides information and support for your effort; however, knowledge is useless until it is put into action. Making the transition from good intention to good practice requires a plan. The Kotter model for implementing change is a useful way to initiate a safety initiative in the healthcare environment. My previous blog, Kotter, for a change (Oct. 21, 2018), describes the model and how it can be used to make patient safety a priority in your workplace.

This article introduces the vast resources available to those who are committed to improving patient safety and provides a model for implementing change. It is up to each individual reader to convert patient safety from a theoretical “we ought to” to the reality of a workplace where safety is job one.

“Safety is not an intellectual exercise to keep us in work. It is a matter of life and death. It is the sum of our contributions to safety management that determines whether the people we work with live or die” ~Sir Brian Appleton

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

Legend in Leadership: John C. Maxwell

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

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“Leadership is not about titles, positions or flowcharts.

It is about one life influencing another.”

~John C. Maxwell

John C. Maxwell has bestowed a lasting gift to those in leadership positions throughout the world by his commitment to developing leaders at all levels of the chain of command. Born in 1946, John Maxwell is the son of a minister who followed his father’s call to the cloth, earning a bachelor’s degree at Ohio Christian University and a master’s degree from Azusa Pacific University. While working as a pastor, he found that his greatest gift to society lay in leading others to discover their true talents.

John and his brother Larry are the co-founders of EQUIP, a non-profit organization that is founded on the premise “We believe that every person is born with the potential to influence others.” The organization is based on Christian values and has taught over 5 million people in 126 countries techniques to motivate and empower one another. Maxwell’s style of leadership coaching is based connectedness and the development of interpersonal relationships which create a synergy and makes everyone a better person.

John’s success with his approach to leadership coaching has grown into a multi-million-dollar organization that offers books, articles, seminars, and keynote speaking to audiences worldwide. With sales topping $18 million for copies of his 12 books and having written countless articles, John Maxwell has established himself as a legend in leadership development.

Reviewing the lifelong work of John Maxwell reveals that his highly successful approach to leadership is built upon five essential elements – Vision, Values, Relationships, Attitude and Communication.

Vision “Great leaders always seem to embody two seemingly disparate qualities. They are both highly visionary and highly practical.” ~Maxwell. Effective leaders can visualize what their workplace would look like if collaborative teamwork opened the door to peak performance. Leading a team starts with being able to see the end point and relentlessly working to get there.

Values “The respect that leadership must have requires that one’s ethics be without question. A leader not only stays above the line between right and wrong, he stays well clear of the ‘gray areas.'” ~Maxwell. Values provide an essential navigation tool for guiding a team. Aligning personal and organizational values will establish the standard for behavior that is acceptable in the workplace and forms a basis for decision-making.

Relationships “The bottom line in leadership isn’t how far we advance ourselves but how far we advance others.” ~Maxwell. Productivity moves at the speed of relationships and in John’s own words, “interaction fuels action.” Maxwell describes 5 levels of leadership and at level 2 the leader connects one on one with each team member. Those who make the effort to connect with others open the door to two-way relationships that produce unexpected rewards. “The rewards leaders give are counterbalanced by the results that their people give in return.” ~Maxwell

Attitude “The leader’s Attitude is like a thermostat for the place she works. If her attitude is good, the atmosphere is pleasant, and the environment is easy to work in. But if her attitude is bad, the temperature is insufferable.” ~Maxwell. Attitude is contagious and how you show up each day is quickly perceived and copied by members of your team. Per John Maxwell, “people hear your words, but they feel your attitude.” Be a leader and set the tone for your workgroup. Leverage your position and exude the attitude that will elevate your team.

Communication “If you really want to be an uncommon leader, you’re going to have to find a way to get much of your vision seen, implemented, and added to by others.” ~Maxwell. The key to communication is delivering information in an open and transparent manner and then listening to feedback that it generates. In his book, Everyone communicates, few connect, Maxwell reinforces the importance of listening to understand the other person as a way of broadening diversity of thought. “As a leader, you will never get ahead until your people are behind you.” ~Maxwell

Now in his 70’s, Maxwell’s lifelong commitment to leadership development has earned him the status of being a legend in leadership. His books, seminars and leadership coaching has directly touched the lives of millions of leaders and indirectly touched the lives of those they supervise. In the words of John Maxwell, “leaders stretch with challenges, followers struggle with challenges and losers shrink from challenges.” Follow Maxwell’s five essential elements for effective leadership and become a legend in your own workplace.

Tom is a noted author, speaker and mentor. Contact tom@procrna.com for information about the 4-part values-based leadership webinar series.

Pharm to Table: Direct Marketing Works

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

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

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

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

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

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

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

Leveraging Boomers

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

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According to the Pew Research Center, Gen X and Millennials combined make up around 34 percent of the workforce. Many Gen X workers, born 1965-1984, have already earned leadership positions and the super-stars in the advanced guard of millennials, born 1981-1987 aren’t far behind. At the other end of the workforce age spectrum are the baby boomers, born 1946-1964. Even though the elder boomers are retiring in droves however, many boomers now in their 50’s and 60’s continue to play a key role in the workplace of today. As younger workers take charge, it is common for entry level millennial leaders to supervise baby boomers. To a neophyte, it may be daunting to supervise workers who are the same age as their parents; However, the maturity that boomers add to your team creates an opportunity for you to leverage their experience. Enhance your position and by capitalizing on the many positive things that elder workers bring to your team.

Dependability Children of the late 40’s and early 50’s were raised by parents who worked their entire career for one employer and retired after forty-plus years at the same job. Their parents were survivors of the Great Depression who taught their children to value work ethic. Boomers hate to let you down and will do everything within their power to accommodate work schedules and complete projects.

Leverage their commitment by developing work schedules compatible with their advanced age and including them when maturity will enhance the outcome of a special project.

Loyalty Older workers who are still in the workforce have a loyalty to the employer and if you are their supervisor, they are loyal to you. They may have seniority on your team, however, those working for you do not want your job. They do want to be part of a highly productive team and that means they will support your every effort in achieving the mission, vision and values of the organization.

Leverage their loyalty by putting them in charge of projects where a steady hand is needed to guide a group of younger workers through new challenges. Smaller projects can be completely turned over to boomers with a high likelihood that they will be completed correctly. You will be amazed at the effort they invest into bringing the project to completion.

Experience Baby boomers often have 20-40 years of history working in their career fields. Writing in Forbes.com, author Craig Malloy notes, “Boomers need to feel their experience in the workforce counts for something in the organization. These employees are, in part, motivated by mentoring team members, who may just be starting off on their career paths.”

Leverage the wealth of knowledge that the boomers possess by soliciting their opinions. Develop learning partnerships between elder and younger workers.

Interpersonal skills Boomers were born into homes wired for land-line telephones and television sets that received only 3 channels. They communicated by talking to one another as opposed to email and texting. Those born before 1964 have flourished due to their ability to effectively communicate face to face with others.

Leverage their verbal skills by allowing them to mentor you when developing strategies to present your position to the team or to those in your chain of command. In addition, boomers went to school at a time when learning correct grammar and punctuation was required for graduation. They are amazing editors for the written material that you intend to send up the chain of command.

Networking People who have been in the workforce for 30-50 years have a vast network of professional and personal acquaintances. It is likely that they know someone who has experience in just about anything that you want to accomplish.

Leverage the connections of your most experienced workers by asking them for references and connecting you with sources.

Stability Boomers have been there and done that. It is difficult to ruffle their feathers and their depth of experience can bring a sense of calm to the chaotic modern workplace. Over the years, these hardy workers have survived crisis after crisis and have learned that when the dust settles, a viable answer usually emerges.

Leverage their real-life experience by allowing them to tutor you when you perceive an impending crisis.

Adaptability Older workers may be perceived as being set in their ways, however, this older generation has lived a life of adaptability. They were born before computers or space travel and our current world is a totally different planet than the one on which they were born. Yet, as their workplace has evolved from paper to digital, they are still on the job.

Leverage their adaptability by including them in technology updates; After all, clearly, they aren’t too old to learn.

Rebels Boomers were born in homes listening to 40’s big band, grew up with rock and roll and now enjoy modern music. They were also born in a segregated America and were the driving force for social justice and civil liberty. Boomers were rebels who saw the status quo as something that could be improved and jumped right in to make the changes. Maturity has not altered the rebel spirit that makes them want to shake up the status quo and build a better world.

Leverage their rebel spirit by establishing a team goal to build a preferred workplace and include boomers as leaders in the movement.

Generation X and Millennials who are being promoted to leadership positions do not need to be intimidated by the age or experience of older workers on the team. Take advantage of the diversity of thought and experience that older workers bring to the team and ensure your own success by learning from them. Once you realize that older workers want you to be successful and are more interested in visiting their grandchildren than stealing your job, you are free to open lines of communication and build on the wealth of experience that they possess.

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

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

The Magic of Feedback

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

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Feedback is the process of taking output and returning it to the source so that adjustments can be made to improve the quality of future output. On the job, receiving and giving feedback are key components for improving performance and building a preferred workplace with fully engaged employees who are committed to excellence. Writing in Cognology, author John Windust notes that the majority of workers would like more performance feedback than they currently receive, yet there is a reluctance of supervisors to candidly discuss performance with workers. Providing constructive feedback is giving a gift to your team; A gift that transforms personal relationships and elevates team performance.

The transition to continuous, informal feedback has turned the traditional annual performance review into a dinosaur at many businesses that focus on the future. The standard APR happens only once a year and looks back on where the person once was. In contrast, frequent feedback identifies where the person currently is and looks ahead identifying opportunities for improvement. Organizations such as Dell, Microsoft, IBM, Lear, and General Electric have retired the APR in favor of frequent discussions between individual worker and supervisor. With recurrent discussions, workers have a clear picture of:

What they are supposed to achieve
Whether or not they are reaching goals
Things that are done well and things that need improvement
The impact that they have on others and the overall achievement of the team

Both leaders and workers gain respect from their colleagues when they solicit and give honest feedback regarding work performance. Welcoming comments and criticism from colleagues and having a, “Make me better,” attitude displays self-confidence and encourages others to openly share observations and offer suggestions for improvement. Over time, a culture of benevolent feedback will elevate the performance of the entire team.

Advantages of frequent feedback

Opportunity is always there. Fully engaged supervisors have boots on the ground and interact with team members daily. Each interaction is an opportunity to share observations, both successes and areas for improvement in real time. Ongoing feedback does not require an appointment on the supervisor’s schedule nor does it require formal documentation.
Frequent check-in cultivates a relationship. Ongoing interaction, in which comments are offered with sincerity and kindness, demonstrates transparency and the desire to help the other person improve. It opens the door for the person on the receiving end of the remarks to reciprocate making the feedback a two-way process. Over time, honesty and transparency will lead to a solid trusting relationship.
Disclosure is motivating. Sharing your observations in a manner that is intended to enhance the skills and performance of another person is energizing. When information is shared effectively, the other person sees a current weakness as a temporary condition and she will be stoked to correct the problem. Informing a person that he is just a little behind another more skilled individual will motivate him to close the gap and strive to be the best.
New skills are learned. Often, when a person is not achieving at their full potential it is not due to a lack of effort but to a lack of specific skills. Frequent non-confrontational discussion of a person’s performance will reveal areas where a little training could make a significant difference in outcome. Draw on your network of resources to facilitate mentoring to fulfill the knowledge or skill deficit of the worker. By taking an active interest in the person’s professional development, you are sending a message that he is important to the team.

Maintain a consistent presence within the team and have the courage to candidly criticize areas of weakness while openly showcasing success. Keep on your toes by reversing roles and inviting your team to make you better through the same feedback process. The trust that emerges from a two-way relationship based on transparency and sharing of information will be the cement that bonds a group of colleagues into a highly motivated and productive team.

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

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

Let go and Empower your team

Let go and Empower your Team

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

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Micromanaging is a manifestation of the Authoritarian style of leadership in which the manager closely observes the details and controls the work of subordinates to an unnecessary extent. It is an aggressive form of management that places workers in a fishbowl where every action is watched, and any infraction of the leader’s vision is quickly corrected. Those who work for a micromanager seldom feel as if their opinions count and are in constant fear of repercussions for having expressed original thoughts or attempting new ways of accomplishing tasks.

Micromanagers were not necessarily born to be bullies; instead, according to an article by Andy Molinsky, the practice of usurping the power of others arises from the leader’s own personal fear and insecurity. High achieving workers are commonly selected as leaders, but once in place, they may realize that they lack background and training as a leader. Insecurity soon arises because despite being successful as a worker, they are fearful of not meeting the leadership expectations of the team or the organization. To reduce the chance of failure, a fearful, but highly competitive manager becomes an authoritarian who takes rigid control of every aspect of the job, insisting on giving approval before any action is taken.

The cost of Micromanaging

Micromanagers take pride in setting a high standard by producing perfect results. Perfection comes with a cost to both the team and the organization and eventually the drain on team morale and company resources may cost you your job. Here are some of the costs associated with micromanaging.

Workers may become fearful. When every independent thought provokes the ire of the controlling leader, workers tend to do only as told. Rather than putting their energy into creating the best experience for the clients, workers focus on NOT making mistakes and follow rules without exception. Over time, the insecurity of the leader spreads to the team and everybody walks on egg shells.

Creativity and innovation are lost. The insecure micromanaging leader who takes control of projects and insists on absolute compliance to his/her demands quickly puts an end to independent thoughts that may arise from team members.

Staff turnover is high. When subdued by a micromanager, creative workers feel stifled and look elsewhere for more fulfilling work and those who remain acquire an attitude of robotic compliance to the manager’s demands. Resources of the organization are drained as the cost of employee replacement grows and morale plunges.

Are you a micromanager?

Most leaders want to do a good job, and few would describe themselves as micromanagers. If the question were put to your team, how would they describe you? Self-awareness is the first step to overcoming your controlling tendencies and here are some signs that you may be a micromanager.

You are rarely satisfied with the work of others.
You rarely delegate and when you do, you tend to take the work back.
You must be involved with every aspect of a project.
Projects run behind schedule because you are bogged down in the details.
You expect to be copied on every email message.
Subordinates hesitate to act or refuse to move ahead without your approval.
You need to know what everybody is doing and where everyone is at all times.
You feel as if the only way to get it done right is to do it yourself.
Your team has unexplained high turnover.

Breaking the Micromanaging habit

If some of the signs above describe your leadership style, you and your team may have some tough times ahead. At some point, your team will either surrender and become low-producing zombies, or they will revolt and stage a mutiny. Either way, you will fail as a leader. Here are some tips for letting go of MICROMAGEMENT and laying the foundation for EMPOWERMENT.

Assess your own insecurity. Because the foundational emotion that drives micromanagers is insecurity, your management behavior will not change in a meaningful way until you address your own doubts. In most cases, you have more support than you realize, and people really do want you to succeed. View yourself as being a competent rather than competitive leader, leverage your resources and confidently lead your team by empowering each team member.

Let go of perfection. Perfection is in the eye of the beholder and those you assign to complete a task may visualize the final product differently than you. If the result meets the criteria established up front and benefits the organization, congratulate the team and celebrate their success. The sense of validation and accomplishment that team members feel when projects come to completion are more important than the project perfectly matching your vision.

Resist checking-in. Rather than demanding constant updates, arrange to check in at milestones or pre-arranged time intervals. Agree on goals in advance of the project, provide necessary resources then allow workers time and space to solve problems.

Require cc on only certain types of email. Take time to review the messages in which you have been included. Determine the type of information that you really need and that which is extraneous. Reduce your involvement further by requesting that your team NOT include you in every email exchange.

Designate a point person. Give total control of a project to a top performer and stand back. If releasing control makes you uneasy, start with a project that is easily within the capability of the point person. Based on your history as a micromanager, the person may be skeptical and you must give him/her a reason to believe that this is not a gimmick and, in fact, it is their project to complete.

Don’t get bogged down with the small stuff. As the leader your most important duties are defining goals, providing resources and motivating team members to accomplish tasks. Don’t get mired in the nitty gritty. If the project is staying on the timeline and progressing toward the goal as anticipated, keep your fingers out of the pot.

Micromanaging seldom works and is often associated with toxic work environments in which both morale and productivity suffer. Instead of tightening the screws on your team, empower them. Support your organization, improve relationships, build trust and elevate your position as a leader by loosening your grip on the reins and allowing your team to demonstrate its worth.

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

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

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

Receive in Kind

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

Follow @procrnatom on twitter

“No kind action ever stops with itself. One kind action leads to another…A single act of kindness throws out roots in all directions, and the roots spring up and make new trees.”

~ Amelia Earhart

Kindness can change the entire culture of your workplace. The essential elements of a preferred workplace, including civility, mutual respect, and collaboration, are interwoven with the thread of kindness. The same level of thoughtfulness in the delivery of care to patients increases patient satisfaction. Kindness is contagious in the interactions of cohesive workgroups and can be the difference between staff retention and resignation. Take your team to the next level by doing catching acts of kindness that will quickly spread throughout your workplace and increase the effectiveness of your group.

Acts of Kindness. I recently worked in a busy suite of operating rooms where anesthesia providers pushed patients on carts or hospital beds from the pre-op area to the OR and then again from the OR to the recovery area. Many carts had defective steering devices and hospital beds were always heavy. Staff would make room for the struggling patient pusher to pass, then stand back and watch. Two newly hired people who noticed the difficulty of transporting patients, started helping direct carts around corners and through doors and within two weeks several others joined the practice. Within two months, with the simple act of assisting instead of watching, the culture of the entire work area changed. Not only did people continue to help one another transport patients, they started aiding in other areas as well.

Several Jewish CRNA friends in the mid-Atlantic region always volunteer for call on Christmas and Easter to enable their Christian colleagues the opportunity to be with family.

A nurse manager in the Midwest always greets patients and their families in the hallway and provides directions when needed. Despite being confined to a wheelchair secondary to an auto accident, she holds the door for people of all ages and gender, not just seniors…and does it with a smile.

My CRNA friend Sal and his wife Carol travel to Honduras to work as anesthesia provider and nurse one week every year. Augustine is a CRNA and friend who solicits other CRNAs to join him on mission trips.

James, a Chief CRNA in the Midwest, takes his office manager and one staff CRNA to lunch quarterly to reward each for their work, and to build a bond between the office staff and the frontline providers.

Michelle arrives early each morning, sets up her room and then goes room to room asking her colleagues if they need help.

Another chief CRNA, who began this practice long before the advent of Facebook, emails a personal Happy Birthday well-wish to each of his staff, and copies the group.

Kindness is contagious. An article in the highly respected APA peer reviewed journal, Emotion, describes a study done in a workplace where employees were placed in 1 of 3 groups. Those in the first group were assigned to perform designated acts of kindness for specific people in group 2. The third group acted as the control group for the study, neither offering nor receiving acts of kindness. The study revealed that those on the receiving end in group 2 were more likely to react by offering kindness to others. In the spirit of pay it forward, the thoughtfulness of a few spread rapidly and changed the culture of the work environment.

Kindness elevates patient satisfaction. Kindness affects the overall experience of our patients and their families as reported by www.winnipegfreepress.com with feedback from a Canadian patient by the name of Z. Soloman. Ms. Soloman’s experience is exactly the one all healthcare wish to provide. “Kudos to Victoria General Hospital for recruiting and retaining staff who treat patients with (such) respect and kindness. I rate my stay as 10 out of 10.” Ms. Soloman’s experience elevated her satisfaction and raised the hospital’s scores.

Give gladly and receive in kind! You can be a catalyst in changing your healthcare workplace to a culture defined by kindness just by being more attentive to the needs of others. Pay it forward by offering assistance when appropriate, or challenge yourself to perform several unsolicited kindnesses daily and watch the culture change. It starts with you.

“The greatest work that kindness does to others is that it makes them kind themselves.” ~ Amelia Earhart

Special thanks to my wife and editor, Liz Sanner Davis for contributing to this article.

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

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

Ear of Empathy

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

Follow @procrnatom on Twitter

Empathy depends not only on one’s ability to identify someone else’s emotions but also on one’s capacity to put oneself in the other person’s place and to experience an appropriate emotional response.

~Charles G. Morris

From day one, Nursing School students are taught the importance of empathy when helping patients and their families through stressful, and sometimes life ending, events. There are countless stories describing the dedicated work of Florence Nightingale and Mother Teresa who alleviated so much suffering for those in need. Neophyte nurses are encouraged to connect with, understand and share the emotional experiences of their patients in order to foster a sense of trust. Full of good intentions and a sincere desire to become pillars of support, new students are thrown into the hectic and demanding world of patient care where completing a task is frequently more important than providing emotional support, thus losing an opportunity for empathy. Lost opportunities for empathy due to the high demands of healthcare and affects relationships in other areas of business and industry as well.

In the modern workplace, leaders with deep understanding are as important in developing effective teams as compassionate nurses are in supporting troubled patients. Writing in the DDIWorld blog, Author Stephanie Neal identifies empathy as a top 10 topic for effective leadership. A companion article states, “Overwhelmingly, empathy tops the list as the most crucial driver of overall performance.” Clearly, grassroots understanding is a valuable skill that is essential for high performing teams and deserves the attention of anyone committed to developing a team in which performance is high, and workers are valued.

What Empathy is

The Oxford Living Dictionary defines empathy as “The ability to understand and share the feelings of another.” This unique capacity to understand goes beyond listening and requires using your past experiences to comprehend what the other person is feeling and to respond in a manner that shows you care.

Whether you work in a busy healthcare setting or in some other business environment, every person you encounter brings a separate set of experiences, emotions and concerns to the workplace. You may not be able to solve another person’s problem, but when they perceive that you understand and care about their wellbeing, they are better able to relax, lower their defenses and have a more productive day.

What empathy is not

Empathy is not sympathy. When being sympathetic, one person shows pity or sorrow for the misfortune that another has experienced. The person offering sympathy may have a sincere desire to comfort the other person; however, with sympathy the focus is on the misfortune rather than sharing the emotion that your colleague or friend is feeling.

For example, several months ago while teaching leadership skills to a group of managers, I moderated a practice session in which one person was assigned to ‘listen empathetically’ to a person who described a problem that she was experiencing with her team. Person A described the problem and the negative effect it had on her team. Person B replied, “I know exactly how you feel, this is what happened to me,” and went on to tell of his woes. To which person A replied, “Yes, but you didn’t have … going on.” The discussion quickly digressed into a competition where each unknowingly sought to be the victim who had suffered more. Because Person B focused on his own external events while ignoring Person A’s internal needs, both people quickly became combative and alienated.

Connect using empathy

Powerful leaders recognize the negative effect of emotional baggage which burdens a worker and blocks his ability to function at the highest level. Connecting in an empathetic manner offloads some of the inner stress and lets the worker know that someone cares about their concerns. Here are some tips for using empathy to deal with a stressful situation. Each tip builds on the previous one and when applied consistently, will have lasting results.

Have a physical presence. Interacting with members of your team on a personal level requires that everybody knows you and that you know them. Policies, procedures and planning are all important; however, they are not an excuse to stay in your office. Having daily, friendly conversation with team members builds a foundation of trust that will serve as a platform for finding solutions to personal problems. Developing trust with the team member means they feel comfortable sharing with you, knowing you will listen, understand and maybe shore them up when needed. Plan several daily walk-arounds in your workplace to become acquainted with every person and remain connected to the team.
Recognize stress in others. Knowing each team member individually places you in a position to sense when something is wrong and that if you perceive a person doesn’t seem to be him/herself, you are probably right. A solid inter-connection tells you that an issue is hiding below the surface. Trust your senses and don’t ignore the change that you have detected.
Listen to understand. If you intuit a problem, find a private place and have a conversation that encourages the distressed person to talk about their problems/concerns. While listening to the words, try to expose the emotions that are driving the person’s concern. Between the lines you may hear them shouting, “I am afraid, I feel inadequate, I feel threatened, I feel invalidated,” or some others spoken response.
Label and name the emotion. Once you have listened to the details of the person’s concern and sensed the underlying emotion, put a name on it. Call it what it is, perhaps fear, insecurity, disrespect, frustration, anxiety, anger.
State the emotion. Stating the emotion that you detect sends the message that you understand what the other person feels. Re-state the basic details of what the person said and if your understanding of the problem is confirmed, continue by naming the underlying emotion that you observe. Here are some examples:
- “I sense that you do not feel respected.”
- “I sense that you feel alone on this project.”
- “I sense that you are concerned about your patient’s safety.”
- “I sense that you are fear harming your patient.”
- “I sense that setting boundaries makes you uncomfortable.”

Connect the dots

You have listened to gain depth of understanding and you have restated the issue and agreed on a label for the emotion that the individual is experiencing. Now you can thoughtfully suggest some solutions to ease the individual’s distress.

Responsiveness is a crucial leadership skill that improves employee engagement and productivity. You may be a natural or you may have to learn to be a truly concerned listener, one who understands emotions and cares about people on a personal level. As a leader you can engage with an empathetic ear to build relationships, improve morale and increase productivity – a triple win for you, your team and your organization.

When you show deep empathy toward others, their defensive energy goes down, and positive energy replaces it. That’s when you can get more creative in solving problems.

~Stephen Covey

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

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

Mark your calendar and Join Tom and a group of leaders for the next values-based leadership webinar in July 2018. Click here for information.

Keep Your Drive Alive

Keep Your Drive Alive

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

Follow @procrnatom on Twitter

Whether you’re doing a google search for effective leadership, reading a leadership book or attending a motivational presentation, you will learn that both leadership and teamwork take effort. Successful leaders are driven from within, exuding optimism and high energy like the little engine that could. However, the process of being energetic while motivating others can be draining and can wear down the inner spirit of the leader. Here are some thoughts on maintaining your self-motivation and a few simple tips for stoking your inner engine.

Know your internal motivators

The specific motivators that flip your “on” button and get you going vary from person to person; however, the following are known to be intrinsic motivators for high achievement in both your professional and personal lives.

The feeling of self-satisfaction Leaving your job at the end of the day and knowing that your work was high-quality gives you a sense of accomplishment that makes you want to come back tomorrow for another dynamic day. The upbeat feeling can be carried home to continue as you make a difference in the lives of those who are significant to you.
The pursuit of knowledge According to the Gallup engagement survey, opportunity for improving your knowledge and your skills is a motivator and contributes to making one workplace better than another. Don’t wait for your employer to offer a professional development plan, rather, take it upon yourself to identify an area of interest, develop a personal plan and learn new skills.
The challenge of solving a problem The release of inner creativity provides powerful incentive for self-motivation. Being dared to streamline a process or solve a problem is energizing and makes you want to take on larger challenges.
The feeling of self-worth Knowing that you make a difference, or the difference, to a patient, co-worker, or organization is a strong self-stimulant. It creates connectivity and inspires the desire to return tomorrow for another opportunity to serve others.

Seek external rewards

Along with intrinsic motivators, extrinsic factors bolster optimism and fuel you with the energy to continue your commitment to the job.

Tangible rewards Working at an elevated level of achievement may uplift self-worth however is does not pay the bills. Tangible rewards in the form of pay and benefits are strong motivators for showing up and doing a respectable job. Extra rewards in the form of a prize or bonus motivate good workers to give even more effort to the job.
Public recognition/praise In addition to winning a prize, being held up as an example of excellence in a public forum is a strong motivator. Whether in a team meeting or on the company billboard, being cited as a positive example is motivating.
Promotion Being selected to move up in the organization and take on additional responsibility creates an inner desire to give more and show that you deserve the trust that has been placed in you.

Simple Tangible Tips

Built on known internal and external stimuli, these tangible tips will motivate you to feed the fires within, without burning out.

Release feel-good hormones. Writing in The upward spiral, neuroscientists and authors Alex Korb and Daniel Siegel document that gratitude and optimism make you feel good because they cause the release of dopamine and serotonin in the brain. Both hormones elevate your mood and create a sense of well-being which ties into a more positive attitude. Set aside 10 minutes for daily reflection, preferably at the same time every day. For some it will be at the beginning of the day and for others it will be at bedtime. In the first 5 minutes, recall people and things for which you are grateful. In the second 5 minutes, think of upcoming events or opportunities that create a sense of optimism within you. Those two activities will stimulate the release of dopamine and serotonin which, according to Korb and Siegel, will make you feel and sleep better.
Complete a task. Building success on success is motivating and creates the feeling that you can handle even bigger tasks. If you don’t know where to start, pick something simple that can be done easily. Something as modest as committing to take out the trash is a tangible activity and may even motivate you to do something else when you return.
Make a healthy choice every day. Recognize your self-worth by doing something healthy for your mind or body every day. Making a plan and enjoying an activity that promotes nutrition, sleep, exercise or meditation today restores the energy level needed to have a productive day tomorrow.
Close the day with positive thoughts. End your day by identifying something that you are looking forward to tomorrow and give yourself a reason to get out of bed bright-eyed and bushy-tailed. If you combine optimistic thoughts with gratitude and thanks, you will experience the bonus benefit of the release of your brain’s happy hormones as you drift off to sleep.

You may be a team leader, or you may be a productive team member, regardless, it can be difficult to maintain your inner motivation constantly. Pace yourself in your work and become aware of the intrinsic and extrinsic activities that encourage your intent to remain highly productive. Use the tangible tips in this article to pour fuel on your inner fire and, like the little engine that could, never stop until you reach your goal.

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

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

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

Step It Up

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

Follow @procrnatom on Twitter

Regardless of whether you call them resolutions or goals, many people start the new year seeking self-improvement in both their professional and personal lives. Leaders hope to find ways to do a better job guiding and motivating their team and team members hope for professional development that will earn them respect and recognition for their work.

“Hope rarely enters into it. ‘Tis action moves the world.”

From: The Winter Sea by Susanna Kearsley

Whether your official role be leader or team member, here are some ways to convert hope into action.

Ask I recently worked at a clinic where OR personnel wore a color-coded paper hat – blue for staff, red for vendors and pink for students. A popular anesthesiologist with 30 years of experience who commonly served as clinical coordinator frequently opted to wear a pink student’s hat. When I asked him why, he replied, “I am a student and learn every day.” His commitment to self-improvement was contagious, setting the stage for everyone to learn. When working with him, there were no dumb questions so the entire team was able to benefit from his commitment to sharing knowledge. As a part of your personal professional development plan, learn from everyone you encounter during the day and freely share your knowledge so that others can learn from you. You will be amazed at the things they know about their jobs and a free exchange of information enhances collaboration. Over the years, I have learned things by listening to my anesthesia colleagues, anesthesia techs, OR nurses, and from housekeeping. Create a pink-hat environment in which all are free to exchange information without the fear of being belittled for asking the wrong question.

Listen to understand In the high stress healthcare environment people don’t want to make mistakes or be blamed for an undesired outcome. When issues arise, it is easy to default into the it’s-not-my-fault mode and build a wall that stops communication. Open your mind by assuming the other person has a valid point and then listen carefully to understand his concern.

Tactical Empathy is the ability to share someone else’s feelings while executing a plan to achieve a goal. In his book Never Split the Difference: Negotiating as if your Life Depended on it, Author Chris Voss uses the term tactical empathy to describe a preferred approach to listening. According to Voss, listening is more inclusive that just hearing words; tactical empathy includes listening to the emotion behind the words. After attentively listening, state the emotion that you sense and allow the other person to agree or clarify. For example, say, “I sense that you value teamwork and have concerns about our team.” Then be quiet and let the person respond. It is likely that the person will validate the emotion that you sense and shift their concern/anger from the problem at hand to a discussion of the underlying problem. If you are wrong with your assessment, the person has your attention and can provide additional information. Another way to show tactical empathy is saying, “I sense that you have a deep commitment to patient safety and fear that someone will be injured.” As before, listen to the response and open the door for additional information. The key is to detect to the emotion that is driving the words, state the emotion, then listen. You will add depth to your understanding by having the person describe the desired behavior they would expect if things were going well. When done, you will have a new perspective on the issue and the person will feel as if his/her opinion was valued and understood.

Be positive We are social creatures and our attitudes affect those around us. Develop the habit of approaching issues from a positive point of view. Instead of reacting to a situation, be proactive and view a problem as something that is temporary and correctable. Keep the desired outcome in mind, identify resources, and tap into the collective wisdom of your team. A We Can Do It Together attitude quickly spreads throughout a team and stimulates creative solutions.

You’ve already stepped up to the plate by being a leader, now step up your game. The New Year is here and it’s a great time to convert good intentions and high hopes to tangible action by changing your status quo. In a recent interview, investment advisor, Tony Robbins, suggested, “Leaders anticipate; losers react.” It’s impossible to know the details of the challenges that will arise in the upcoming year, but one thing is sure, you can’t anticipate all of them, and being a lifetime learner, effective listener and optimistic problem solver will position you for success.

Tom is a noted anesthetist, leader, educator and speaker. Join Tom and a group of frontline healthcare leaders in the Values-based leadership webinar series.