Healthcare leadership – Page 4

Resolution Reality

Resolution Reality

(The art creating change)

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

Follow @procrnatom on Twitter

Santa has completed his aerial delivery, gifts are in use and empty boxes are in the recycle bin. With the new year rapidly approaching, attention quickly shifts from Christmas to football, New Year’s Eve parties, and finally to resolutions for the new year. Ah yes, resolutions…so easy to make and so easy to break. The good intentions put forth as the Rose Bowl is being played are but distant memories by Superbowl Sunday. Resolve to make this the year that you keep your resolutions. Here are 3 tips to get you going and keep you on track.

Work from the positive

Our brains work best and our chances for success are the highest when we make our own decisions are in control. Self-control is empowering and is most easily achieved when it arises from a positive point of view. When making resolutions, visualize the new desired state and the positive benefit that you will experience once your goal is achieved. Use proactive, empowering language with your internal dialogue and think in terms of what you can and will do with available resources. Conversely, avoid a negative approach and thoughts about what you must give up or stop doing. In his book, The Upward Spiral, author Alex Korb discusses the brain chemistry related to establishing new habits. Korb says that electric pathways for the old habits never truly leave the brain but fade when they are not actively used. Replacing old habits by establishing new behavior creates new pathways in the brain and makes the old habits irrelevant. Like learning any new skill, it is necessary to repeat the desired behavior many times to establish it as the new norm.

Work from your personal values

The most effective resolutions are a reflection of your inner character and the things that are most important to you. So before you make them, take time to reflect on the values that guide your decisions. Rather than trying to create a new you, the most effective resolutions are those that put you in alignment with the character traits that you value the most. Instead of thinking, “I need to lose 50 pounds,” tell yourself, “I value my health and, therefore, I will alter my behavior to align with my value.” Instead of thinking, “I need to be less critical,” tell yourself, “I value collaboration so I will align my behavior to create a collaborative environment.” If you are having problems identifying what matters the most to you, click here for a list of personal values and use them as a foundation for making resolutions.

Focus on today’s behavior

New Year’s resolutions tend to be global statements describing the new way of life that you imagine in your future. Your goal may be admirable however, jumping from A to Z can be overwhelming and cause you to abandon ship somewhere between B and D. Keep the final outcome in mind, focus on today and identify behavior that supports the goal. Step outside yourself and view your actions through the eyes of others by asking yourself what they see when they observe you. If your goal is to recover your health, how would others assess the decisions you made today? If your goal is to empower others, what would it look like to those around you?

Putting it all together

Resolutions must reflect your character. They must be well thought out, bringing your behavior into alignment with your ideal self. Resolutions that are made to please others or that do not reflect your values will fade before the January thaw.

Once meaningful resolutions have been developed, make a list of behaviors that will support achieving the goal. State your activities in the positive and align your values with your desired future state. Rather than, “I can’t have sweets,” a better behavior would be, “I choose to eat only things with nutritional value.” Once you have established a list of behaviors to support your goal, commit to 2-3 things on the list and start implementing them today. At the end of each day, take time to reflect on your success, identify areas for improvement and keep notes in a journal. When the new behaviors become habits, select another item from the list and make it a priority, then repeat until all the items are ingrained as new habits.

Here is your self-dialogue for success: My resolution for the new year is ___ and it supports my value of _____. To achieve the desired change, I commit to ___ and ____ for the next 60 days. Friends and family will recognize my commitment to change when they observe me ____.

Whether you are building an ideal self, a desirable workplace or an empowered team, start by identifying values and then aligning behavior in order to achieve success. Choose resolutions thoughtfully and make a commitment to the behavior that will make you successful. By establishing new habits, you will turn your imagined future state into today’s reality.

Tom is an experienced clinical anesthetist, educator, speaker and teambuilding coach. Participate in the next values-based leadership webinar and take your team to the next level. Contact tom@procrna.com for details.

The Social Media Connection

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

Follow @procrnatom on Twitter

Communication, collaboration and effective teamwork are essential ingredients for highly effective workplaces and insightful leaders must find creative ways to connect with the people on their teams. Use of social media has been woven into an essential piece of the fabric that shapes our lives. Rather than putting a ban on the use of electronic devices in the workplace, fire up your team by uniting them through social media. Login and get stoked!

Event scheduling Neither word of mouth nor notices posted on bulletins boards are reliable sources for disseminating information. Online calendar apps, however, are abundant and many are free. Instead of sending email schedules that require downloading, use an app and create a calendar that can be shared with your team. Your community calendar will always be available for reference and posting a calendar removes the I-didn’t-know excuse.

Teamup is one of several apps that offer a platform to create a shared calendar. It offers sub-calendars, it’s simple to use and it’s free. https://www.teamup.com/apps/

Employee recognition Employee contributions often exceed expectations and team members deserve recognition for their achievements. In an ideal workplace the employee feels valued, appreciated and has a sense that he/she has contributed to the overall success of the team. Follow up the hallway thank you with a brief post on social media to recognize each individual and each achievement. Several social media platforms encourage the reader to forward the message to others in their network thus expanding the number of people who are notified of the success.

Open a twitter account and have your team members follow you. Tweet each achievement and encourage re-tweeting. https://twitter.com/

Support Teamwork is enhanced when people feel that they are part of a larger community and that they have the support of their peers. Professional communities exist online that encourage individuals to connect with others who have the same credentials. Members of a virtual community can pose questions, share experiences and learn from the collective wisdom of others in the same profession.

AANA connect is a private virtual community for nurse anesthetists and has sub-communities with different focuses. https://connect.aana.com/home
Facebook is the go-to platform for connecting friends and interfacing spontaneously. Within the Facebook platform, user groups have emerged to unite people with special interests. In the nurse anesthesia Facebook community, dozens of sub-groups exist for everything from CRNA moms to CRNA brewers. https://www.facebook.com/

Team communication Keeping up with your profession is helpful. Communicating with your team is essential. App based programs are readily available that allow your group to connect through text messages, providing instant communication for time sensitive issues. This option requires each team member to download the app and join your user group, making the effort to connect worthwhile. .

Groupme is a text-based app that provides all member instant alerts by “ping.” It’s free and easily downloaded. https://groupme.com/en-US/apps

Video chat When the crisis of the day arises and instant communication is imperative, live video chat is a great option. Similar to SKYPE, LVC connects key members simultaneously for brainstorming and quick resolution.

Group video chat by Camfrog is an app that allows groups of people to connect via cell phone with live video and audio. https://www.camfrog.com/en/

Leadership requires powerful communication that effectively unites the team, and the most innovative leaders find creative ways to utilize social media in the process. Younger members of your team who were raised with technology will feel right at home with social media while the senior members of the team will experience personal growth as they master the technology. Everyone will be connected. Everyone will feel connected. Take an important step toward creating a workplace of choice by developing a sense of connectedness through the use of social media.

Thomas Davis is a noted speaker, author and team building coach.

“The book that goes beyond theory

and creates great leaders.”

Now available on Amazon Books

Don’t Be Distracted

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

Follow @procrnatom on Twitter

Little Alex is finally a big boy. Now that he is age 5, mom and dad eagerly sign him up for T-ball visualizing their future big-league hall-of-famer hitting a home run in the final game of the World’s series. Wearing his new T-shirt and oversized hat, Alex crouches standing ready to catch the ball in center field waiting for something to happen and then it does. A butterfly flits by drifting with the breeze and lands nearby. Five-year-old Alex abandons his position in center field and starts chasing the butterfly just as the slugger at the plate rolls one through the infield directly to the spot where Alex once stood. The distraction of one player effected the outcome for the entire team.

When children grow and mature into adults, life’s distractions increase as does the consequences of diverting attention away from the task at hand. The National Highway Traffic Safety Administration reports that in 2015 a total of 3,477 drivers lost their lives and another 391,000 were injured due to a lapse of attention while driving.

Distraction in the healthcare workplace is common and can cause mistakes that have devastating effects on our patients. Because interruption of attention has been linked to the injury or death of many people who entrusted their safety to the healthcare community, the Anesthesia Patient Safety Foundation assembled a panel of national patient safety experts to evaluate the harmful effects of diverting attention away from the patient in the operating room. An article by Maria van Pelt and Matthew Weinger published in the October, 2017 APSF newsletter reviewed the findings of the panel.

Personal Electronic Devices are the elephant in the room when the topic of distracted operating room workers is addressed. Although the use of PEDs remains a threat to the focus of attention on the patient, there are many other less obvious causes for concern. Here are 5 common causes for distraction in the operating room taken from the APSF:

Patient-related activity poses a risk by shifting focus from the technical aspects of ensuring safety for the patient at hand (ventilation, hemodynamics) and is diverted to considering the needs of other patients or new activities related to the current case. Attention is diverted when:

PACU or pre-op calls with questions about your previous or next patient.
You set up for the next patient during the current case.
Ultrasound is used to place a block after induction.
Another physician comes into the room to consult with your surgeon during the case.

Technology-related problems divert concentration from the patient to a computer that stores data and maintains records. Technology compromises patient safety when:

Either the anesthesia or the operating room computer malfunctions and requires re-booting or calling the help desk.
The required data entry is excessive and time consuming.
Time is spent searching data bases for lab or consultation reports.

Noise and alarms make conversation difficult or interrupts the train of thought of workers in the operating room. Noise and alarms divert attention from the patient when:

Alarm activation occurs due to inappropriate alarm limits or faulty equipment (loose wires on ECG or pulse ox).
The sound level of music is excessive.
OR workers and vendors participate in unnecessary chatter unrelated to the case.

Interpersonal dynamics cause drama and stress thereby disrupting collaboration between members of the operating room team. Interpersonal factors steal the effectiveness of team members when:

Threatening attitudes stifle communication and creative thought.
Hierarchal power structure inhibits the sharing of information.
Team member complain and engage others to talk about personal issues.
Disruptive behavior such as swearing, throwing instruments or disparaging others on the team is tolerated.

Self-induced distractions include unnecessary activity that the individual willingly brings into the operating room. We distract ourselves when we:

Use personal electronic devices while caring for a patient.
Read books or solve puzzles to fill the time on a long case.
Participate in unnecessary chatter about our personal or social interests.

One-hundred- fifty years ago vigilance in the operating room was the hallmark for safety. In the high technology operating room of today, vigilance is just as important as it was when ether was dripped onto cotton gauze. Regardless of your position on the healthcare team, be an advocate for your patient and keep your finger on the pulse when distractions emerge. It is up to you to commit to patient safety by reducing distractions and maintaining total focus on the patient. Keep your head in the game and your eye on the ball when the butterfly flutters by.

Thomas Davis is a noted author, speaker, leadership coach and clinical anesthetist.

The Satisfaction Connection

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

Follow @procrnatom on Twitter

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

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

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

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

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

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

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

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

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

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

Coming soon: Values based Leadership Webinar series.

Encore Symposiums Cape Cod 2017

Meeting review by TD

Meeting Date: 10/9-12/2017

Meeting location: Chatham Bar Inn, Cape Cod

Meeting sponsor: Encore Symposiums

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

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

Alaska Association of Nurse Anesthetists

Meeting review by TD

Meeting Date: 3/24/2017

Meeting Location:

Alyeska Resort, Alaska

Meeting sponsor: Alaska Association of Nurse Anesthetists

Strengths of the meeting:

Kudos to the Alaska Association for putting together a great agenda in a stunning location. Excellent weather and spring skiing at it’s best added to the enjoyment of the meeting. The stunning Alaska scenery was exceeded only by the hospitality of the association members.

Value for the money: This is a hidden jewel among State meetings. If Alaska is on your bucket list, this is a must meeting for you.

Connect Through Recertification

By Thomas Davis, CRNA

Follow @procrnatom

Nurse Anesthetists practicing in the United States are required to be certified and then recertified at intervals throughout their career. The recertification process is an opportunity for leaders to connect one on one with each member of their team, ensure that the person is qualified for recertification and improve employee engagement.

Management literature is filled with articles about the advantages of employee engagement and corporations pay millions of dollars every year on programs for improving it. Very similar to other types of employment when it comes to the advantages of engagement, healthcare organizations depend upon effective leadership within the organization to inspire and motivate employees. Among the advantages of having an engaged staff are the following:

Improved Safety Engaged factory workers are up to 5X less likely to be injured on the job. In healthcare not only are the workers less likely to be injured but they are less likely to make mistakes that injure others, including patients.
Improved health Engaged employees are less stressed, more relaxed in their interactions with others and are less likely to miss work due to illness.
Improved happiness Engaged employees look forward to coming to work and interacting with co-workers who they are more likely to view as friends.
Improved Performance Engaged employees tend to be more creative, have a better attitude and work at a higher level. Their high-end work is more likely to be reflected in a salary bonus than that of a less productive peer.
Improved sense of community Engaged employees tend to have the backs of their co-workers which is reflected in increased safety for the entire unit.
Improved retention Engaged employees are easier to retain. Costs of recruiting, hiring and orienting new employees can be significant and employee engagement saves time and money for the organization.

Although many crash courses and gimmicks exist to improve employee engagement, the one piece that is essential for success is a trusting one on one relationship between the employee and the supervisor. Whether you are the leader or the employee, developing the relationship is foundational to being a workplace of choice.

For several decades the Gallup organization has worked with employers to survey their workforce, assess engagement and make recommendations for improvement. The current Gallup engagement survey has been refined to 12 essential questions which give an accurate estimate of employee engagement. Three of the 12 can be addressed when the proactive leader uses recertification as an opportunity to connect individually with the employee.

Question 6 Is there someone at work who encourages your development?
Question 11 In the last 6 months has someone at work talked to you about your progress?
Question 12 In the last year have you been given opportunities to learn and grow?

The recertification process is a gold mine for the proactive leader committed to building a fully engaged team. Schedule a private, face to face meeting with each member of your team and discuss the following:

Determine eligibility for recertification Whether the person recertifies this year or is mid cycle, determine where they are in obtaining the required continuing education.

Review the professional education that the person has received over the past two years. Discuss ways in which they can share their knowledge with the group.

Plan professional education for the next two years. Make note of any special interest that the person may have and discuss ways in which developing the interest will benefit the group.

Explore enrichment opportunities beyond the required continuing education. Many organizations offer in-house learning opportunities that do not award continuing education credit. Discuss ways in which the individual can pursue interests and grow professionally regardless of the credit that is awarded.

Elevate your leadership by connecting with your team and motivating them to grow professionally. By encouraging team members to enhance their individual skills, you will address issues that have been identified as essential by the Gallup survey and you will improve the engagement of your team. Savvy leaders don’t wait for a stroke of luck to elevate the status of the team. A highly effective leader connects and engages with each individual by making use of a great opportunity like recertification.

Watch for the release of Tom’s book, Leader Reader 1, Authentic Healthcare Leadership scheduled for release on Amazon Books March 15, 2017

Start Tomorrow Today

By Thomas Davis, CRNA

Effective leaders in healthcare, and across corporate America, are known for being very busy and efficient using effective schedules. Those who make it to the top leadership positions may appear to have everything under control as they progress through massive schedules. Although top executives have a support staff to help them maneuver through the day, their ability to navigate the workload goes beyond a skillful staff. CEOs have learned early in the game to establish a daily routine and weave it into it an agenda that the support team helps bring to life. An important component of the daily schedule is the end of day routine where the leader closes today and plans for a productive tomorrow.

Healthcare leaders work in an especially chaotic environment and by the end of the day it is tempting to pack up and leave. But if you skip out the door too quickly, you will deny yourself the opportunity to grow as a leader. The end of the day is a special time for you to reflect on the successes and challenges of the day, and to prepare for tomorrow. Leaders at any level will benefit by following these examples for routine and reflection.

• Block the last slot on your calendar for your shut down routine.
• Clean the clutter from your desk and your computer. Remove scrap paper and throw away everything that you do not absolutely need to keep. When in doubt, throw it out. Close any open files on your computer and reply ONLY to urgent email. Caution: Do not sacrifice your EOD routine by browsing through email and social media.
• Review the tasks on today’s to-do list and assess your effectiveness in bringing things to closure. Assess whether or not you were successful in completing your top priorities and determine which items to move to tomorrow’s to-do list.
• Close your eyes and visualize your biggest challenge. Relax and ask yourself WHAT questions such as, “What are other resources that I have not used?” “What if I re-prioritized my to-do list?” or “What piece of information is needed to allow the project to move forward?” Writing in the British J. of Psychology, Wieth and Zacks note that your brain is most creative when it is groggiest. Relaxing you tired brain and thinking through your upcoming challenges may give you insight that will solve tomorrow’s problem.
• Thank someone for their contribution to your personal success or the success of the team. Regularly recognizing others puts you and someone else in a positive frame of mind. In addition to showing thankfulness, sometimes offering forgiveness is important and appropriate.
• Review both your schedule for tomorrow as well as your to-do list. Make sure that your list reflects your priorities and that you have adequate resources to complete your list.
• Leave work at work and go home. On occasion you may need to finish something at home but routinely extending your work day into the evening will cause burnout and actually detract from your effectiveness.

Place value on your own after-work activities and develop the routine that works for you. To end my day with an established routine after leading a team of 110 healthcare workers, I created CROTE. Clean, Reflect, Organize Thank, Exit.

It’s All About You

It’s All About You: Keeping Resolutions

By Thomas Davis, CRNA
Follow @procrnatom

For many of us, starting the New Year is an opportunity to hit the reset button and change things that are not working well. When you look back this year, do you see a list of good intentions that were never accomplished? Do you know why? Here is some solid advice for making New Year’s Resolutions that you can keep.

It’s All About You. Simply making a list of good intentions, does not solve a problem. To be effective, your resolutions must represent you and your resources. If you cannot reasonably achieve them, you are wasting your time and your commitment will only lead to frustration without results. When resolving to make change, consider the following:

Resolutions must be doable. By definition, a New Year’s resolution begins January 1. Be sure that a goal is within your grasp and that all the resources are available so you can start now.
The resolution must be within your control. You will not lose weight by asking others to give up cake for dessert. Likewise, resolving to help a child achieve straight A’s second semester is also a lofty goal, but you can’t control the final outcome. However, resolving to lose 5 pounds and to read 6 news books this year are goals that are totally under your control…as long as you are the one giving up the cake.
NYR’s must be specific and measurable. A resolution described in general terms leaves you with vague intent rather than firm commitment. “Ing” intentions like losing weight, exercising more, smoking less, or being happier are undefined with no end point. In contrast, “I commit to losing 10 pounds by exercising 30 min 3x a week,” or “I will stop smoking completely by April 1,” are both specific and can be measured. With an appropriate and measureable resolution, you will be able to answer yes/no as to whether or not the resolution was kept.

Accountability enhances success. Accountability can provide an incentive to actually make the change that you want. You can avoid the easy anchor of status quo and create accountability by attaching a timeline to your resolution. Ensure that your resolution is doable, under your control and measurable, and give yourself a deadline. After setting a goal of losing 10 pounds, resolve that you will lose 1 pound per week for the next 10 weeks so that by a certain date you will weigh ten pounds less. Important: Put your timeline on your calendar.

Share your intent with others. Telling others about your resolution is another means of accountability that puts you in a position to reach the goal and get praised, or to fail and look foolish. It’s even more helpful if a friend with a similar resolution joins you and holds you both accountable. If you mutually establish 3 workouts per week as your resolution, arrange to exercise or walk together several times a week.

Seek support on social media. Social media is another venue for getting accountability. Publicly sharing your goal and your progress takes courage and invites a large and connected community to cheer you on. Nobody wants to fail while their 400 best friends are watching, and by revealing your resolution, you may also generate support from your true friends.

New Year’s Resolutions mark the passage of time and open the door to opportunity. Create your list with confidence and use positive language by stating your goals like affirmations. Begin each item with the words “I WILL” and mean it, and if you lapse, don’t abandon your resolve. Double down and get back on track. Realistic New Year’s resolutions, combined with commitment and accountability, will ensure success.

Thomas Davis is an experienced clinical anesthetist, leader, speaker and CEO of Frontline Synergy. Enhancing leaders, Empowering teams

Who wants to be a millionaire leader?

By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

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

Effective Listening

Keys to Effective Leadership: Listening

By Thomas Davis, CRNA

Nurse Managers and other frontline healthcare leaders want to be known as the boss that everybody wants to work for. It is only natural to want to set goals that build your personal reputation and the success of your workgroup. Being a good listener is foundational to achieving your goal and here are 2 guaranteed ways to increase your listening skills

Listen to understand
Listen to emotions

Listen to Understand

People want to be heard and understood. When asked about the traits of their best boss, people will frequently say that it was a person who listened and at least tried to understand them. Conversely, when asked about their worst boss, they describe a person who was distant, isolated and out of touch with the needs of the individuals in the group.

The key to effective communication is effective listening. Leaders often put two barriers between themselves and effective listening: the hectic pace of the workplace and the demands on time. Both factors place the leader at risk to be distracted while talking with a member of the team. Just like the raffle at church, you have to be present to win. Somebody on your team finally has the courage to open up to you with a problem and your mind is elsewhere! Whether you’re in the hallway or in the office, value the information that each member of your team offers and give them 100% focus when they talk to you.

The second and more difficult barrier to overcome is the tendency to prepare your response while the other person is talking. I call it agenda listening. You can’t fully appreciate the message the person is delivering if you are focused on your rebuttal. Serious listening is like drilling into the mother lode. By listening to learn, you will gain insight that will elevate you as a leader. Forget about your reply and listen carefully and hear everything that is said. You don’t have to agree but you will benefit from knowing their point of view.

Points:

Learn from listening. Appreciate the gift you are being given.
Restate the other person’s position to ensure you both agree on what has been said.
Encourage the person to tell you more. Build on what they say with replies like, “Tell me more about…”
Encourage the person to clarify by asking how questions. “How can we do that?” “How will that benefit the group?”
Avoid questions that put the person on the defensive. Asking “why did you” puts them on the defensive and looking for an explanation.

Listen to emotions

As educated professionals, we listen with an academic ear. As team leaders, we must listen to both content (actual words) and the emotion that drives the words. We like to think that we are rational beings and that the argument founded in fact will win. Not so. We also have an emotional side and emotions frequently trump logic when interacting with troubled team members. In a famous study, Albert Mehrabian noted that only 7% of what is communicated comes from actual words. Tone of voice and body language make up the other 93% of communication. Maybe that is why so many email and text messages are misinterpreted. As an effective leader, listen not only to the words but also listen to the tone and watch the body language to pick up on the emotion behind the message.

Points:

Allow people to feel how they feel. Telling them how they should feel ends communication.
Make open-ended statements about the emotions that you observe and listen to responses.
- “I sense that you are uneasy with this proposal”
- “You appear concerned about….”
Welcome and encourage team members to suggest solutions.

As a leader, your greater goal is to have a cohesive and effective team where each member is valued not only for the work that they do but also for the person who they are. Listening is the foundational element to build a one on one relationship with each team member.

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

Building Common Purpose

By Thomas Davis, CRNA

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

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

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

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

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

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

Create a common purpose

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

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

Implement Change

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

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

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

Leading Frontline Change

Leading Frontline Change:

Today’s leadership investment yields tomorrow’s team dividends

By Thomas Davis, CRNA
Follow @procrnatom

Effectiveness as a leader is not based on popularity but rather on the ability to manage change

“The only constant is change.” Modifications to best practice protocols are initiated internally and are meant to improve both workflow and patient outcome. Other initiatives have an external source and are mandated by new regulations or alterations in reimbursement. Frontline managers and team leaders set the tone for how the work group will respond and the attitude projected by the leader will ultimately contribute to the success or failure of the initiative. Frontline Leaders are critical to success whenever the status quo is altered.

As recently as 5 years ago, in order to accommodate the need for Nurse Anesthetists and ICU nurses to work 12-hour shifts, several hospitals offered workers 3 X 12 hours per week to count and be paid as a 40 hour work week. The response was positive and the hospitals had a plethora of applicants working the popular shift. Over time, changes in healthcare reimbursement took place and the 36-paid-as-40 model was no longer viable. Hospitals were forced to implement new schedules that required 40 hours of work for 40 hours of pay. For example, two individual hospitals in the same community implemented the change to the 40-hour work week with very different results. Although the change was not popular at either hospital, one system made the change smoothly with the team focused on all of the other positive benefits offered by the employer. As a result, there were no resignations. At the second hospital, 18 members of the department abruptly quit their jobs. The difference was Frontline Leadership.

Status quo does offer a level of comfort, however, change is often an opportunity for the frontline healthcare leader to experience personal growth as well as growth and development of the team. The leader’s personal response to the change will set the tone for the entire workgroup. By using asset based thinking (ABT), creativity and good communication, your workgroup can lead the way in the implementation of change. Remember, change does not necessarily threaten your personal vision. With creativity, change can actually move your vision forward. In the example of implementing the 40- hour work week, the successful leader held true to the vision of making the hospital an employer of choice. The reason behind the change was thoroughly explained to the workgroup and the implications were revealed. The group learned that the change would bring financial stability to the organization and add security to their jobs. The group actively participated in creating a new schedule that was acceptable to all. When the change was made, even though they preferred the 36-hour work week, the change went smoothly. Conversely, at the other hospital the change was implemented as a mandate from above. The attitude was, “if you don’t like it, find another job”…and many did.

Build on a solid foundation

Change is commonly perceived as threatening when the frontline worker sees no personal benefit. Strong leaders have an opportunity to thrive during times of change as opposed to weak leaders who wilt and eventually perish. Leaders who are successful at embracing and implementing change are people who have a long history of being connected with the workgroup. A leader may safely assume that at some point policies and procedures will be altered. Establishing yourself as a trusted and confident person who cares about each team member on a personal level will give you credibility with the team when they feel threatened by the need to modify the status quo.

To be an effective leader:

Role model excellence in every phase of the job. Take your turn on the front line of patient care along with the members of your workgroup and earn respect for your skills.
Develop a one on one relationship with each member of your team. Know something personal about each person and have a sincere desire to promote their professional development.
Have a vision for the group and communicate it regularly. Every member of your team must know and support your vision. Encourage open discussion to clarify your vision.
Be upbeat and confidently demonstrate ABT. Anticipate success.

Do your Homework

With change comes anxiety and when people are uncertain, rumors emerge. You will be amazed at what a friend of a friend heard someone say in the elevator. Once gossip takes on a life of its own, it will taint how we perceive people and problems. Writing in Science, Eric Anderson states, “Gossip does not impact only how a face is evaluated – it affects whether a face is seen in the first place.” Once the gossip starts, time is of the essence to get it stopped. A leader must quickly understand the proposed change and the reasoning behind it, connecting the new policy to the greater goal of the organization, and then communicating it honestly and openly.

Before you talk with your team about the upcoming change, become the expert on the topic. Read the new policy and have a one-on-one conversation with your superiors and other stakeholders. Succinctly share your concerns privately in a proactive and asset-based manner. Always speak and listen with good intent and with a commitment to understand.

Before you meet with your team:

Clarify the specifics of the future state and the advantages that will emerge with the new policy.
Identify and utilize key stakeholders and sources of support.
Identify obstacles and explore ways to remove them.
Involve key people in the workgroup to help with the rollout of the new plan.
Develop a timeline and abide by it. Delaying will only give more time for rumors and gossip to spread.

Communicate

Sincere, two way communication is essential for implementing and managing change. Set a positive and confident tone when discussing the future. If members of your team perceive that you are uncertain and lack confidence, they will not openly support you. Your ambivalence will be compounded by the negative effects of rumors and gossip causing morale to drop along with the effectiveness of your leadership. Now is the time for you to display self-assurance and maintain control. Being recognized and respected as a leader is status that is earned over time. From day one a leader must earn the trust of the team. Once you have done your homework related to the change and you know the details of both why and how the change will be implemented, you are ready for one of the most important roles of a leader – keeping the team informed.

To keep the team informed:

Schedule a town hall meeting where the change can be openly discussed.
Be open and honest and share all that you have been asked to share. If you have been asked not to share something, don’t pretend that you don’t know. Simply state that you cannot yet share that detail.
Let people know that gossip is not acceptable(will not be tolerated?). Honestly answer all questions in order to prevent and dispel rumors.
Listen to each member of the team with the intent to understand. Acknowledge individual concerns.
Use ABT to focus on positive aspects of the change.
Where possible, connect the proposed change to your personal vision and the greater goal of the organization.
Challenge the team to actively participate with implementing the change.

As the leader of a team of frontline healthcare workers, you want everything to run smoothly on a daily basis with great workflow, safe patient outcome and a happy staff. Although change can be challenging to the team, it can also be an opportunity for the talented Frontline Leader to shine. Make a commitment to establish a solid foundation with your team and to connect with each individual. The groundwork that you lay today will pay huge dividends when it’s time to implement the inevitable change.

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

Advice from Mom

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By Thomas Davis, CRNA

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

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

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

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

Building a family

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

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

Building a business

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

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

Building a good name

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

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

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

The Value of Vision

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By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

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

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

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

Effective Leadership

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By Thomas Davis, CRNA

For centuries, leaders in both the Military and civilian world have attempted to identify and define the perfect leadership style. As far back as 500BC Lao-Tzu wrote in the Tao Te Ching, “The highest type of ruler is one of whose existence the people are barely aware….when the task is accomplished and things have been completed, all the people say we ourselves have achieved it.” On a grassroots level, people are empowered, engaged and have the self-satisfaction of a job well done.

Leaders in both business and healthcare are modifying their management style to encourage employee engagement. As noted by Edward Hess in the Washington Post, “leaders of the most successful companies do not have a top down style of management”. Collaborative management to encourage employee engagement is the key to success regardless of the type of business to include healthcare. In reviewing leadership literature a common thread is advocating leadership through shared responsibility. Collaborative Leadership is a sharing of power which recognizes the contributions of each individual and helps them develop and perform at their highest level.

Over the past 3 decades, I have observed many styles of leadership described with many different names. Without exception, the most efficient organizations with the highest employee engagement and morale were those in which the leaders followed the principles of Serving Leadership and shared governance. Use the principles below to establish yourself as an effective manager of an engaged workgroup.

There are no unimportant jobs or people in an organization that embraces shared governance. As a manager, develop a one on one relationship with each individual. When people are respected and their views heard, they become empowered and will seek excellence. Both managers and front line workers recognize that mistakes will be made. By treating a mistake as a learning opportunity, lessons will be learned, and the organization will become stronger because each individual is allowed to take risk. The key to success is to keep the team focused on the common goal. One of the powerful actions described by Covey is “Begin with the end in mind” where the mission and vision of the organization are known and shared by all. High functioning workgroups are founded in trust, collaboration and holding one another accountable. By affirming the common goal and using mistakes as teaching moments, effective leadership can pave the way to success.

Work is accomplished through relationships and trust is the glue that holds relationships together. Trust begins with you. Begin your journey toward becoming an effective manager by looking within. What is your capacity to trust? What would happen if you approached every interaction from a baseline of trusting that you and the other person share common goals and seek common outcomes? Because you may disagree on a step in the process does not mean that your greater goals are different. In the book Trust and Betrayal in the workplace, the Reina and Reina suggest the following for developing trust in relationships:

Share information
Tell the truth
Admit mistakes
Keep confidentiality
Give and receive feedback
Speak with good purpose
Take issues/concerns directly to the person involved

Effective communication is essential in healthcare for patient safety, efficient workflow and employee morale. Empowering Leadership upends the traditional top down leadership pyramid and makes each team member an equal participant in patient outcome. The best decisions are made when opinions are solicited from a broad base of individuals who have a common interest in a positive outcome. As a trained professional and leader, your insight and opinions are needed when decisions are being made however not all opinions are openly welcomed and received. Grenny suggests the following when confronted with a difficult conversation:

Share your facts. Let the other person know what is behind your opinion.
Tell your story. Explain how you see things and why they are seen as they are.
Ask the other’s path. Openly solicit the other person explain why they see things as they do and listen to learn. Do not argue or confront as the other person explains their position.
Talk tentatively. Ask “what if” or “what would it look like” questions to suggest your remedy and then listen as the other person responds.
Encourage testing. Come to a mutual agreement on a next step with the agreement that it will be reviewed and can be tweaked.
Being an effective manager does not require an MBA or that you were born into a family of corporate executives. Put the micromanaging aside and trust in the abilities of your team. By developing relationships, building on strengths, and communicating effectively, you too can be “the highest type of ruler” where your team achieves amazing results without your heavy hand.

Build on individual strengths to raise the collective performance of the group. Each member of your team brings different strengths to the workplace. The person with the most creative ideas is not always skilled at putting the plan into action. Teaming with others who can organize and execute the plan enables the creative genius of each individual to come to life. No individual can effectively do it all.

Hess, Edward, April 28,2013. https://www.washingtonpost.com/business/capitalbusiness/servant-leadership-a-path-to-high-performance/2013/04/26/435e58b2-a7b8-11e2-8302-3c7e0ea97057_story.html
Dennis Reina and Michelle Reina, Trust and Betrayal in the Workplace.
https://hms.harvard.edu/news/safer-patient-handoffs
Grenny, Patterson and McMillan, Crucial conversations: tools for talking when stakes are high

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