Tag: Leadership

Leadership; It’s more than a title

By Thomas Davis, DNAP, MAE, CRNA

Leaders: we love them, we hate them and then we become them

In the workplace and in our personal life, the concept of leader and leadership are often intertwined and misunderstood.   Let’s start this article by explaining the difference between the role of a leader and the behaviors that are associated with effective leadership.

Leader

A leader is a designated individual who has been given the responsibility to organize, guide, and manage a group of individuals.  Commonly, the leader is a person who has been handed a title and job description that outlines the expectations of the role.  Some of the common descriptions of a leader include:

  • Being the selected person in charge of a team or group.
  • Maintaining the status quo while achieving objectives outlined by the organization.
  • Delegating tasks, supervising work, and ensuring that resources are available.
  • Rigidly enforcing policies and procedures outlined by the organization.
  • Motivating team members to achieve production goals

Leadership

In contrast to being a person who carries the title of the leader, leadership is a concept or process that involves influencing and motivating a team/organization to achieve goals.  Leadership goes beyond day-to-day management and involves having a vision and the tenacity to move the organization forward while developing the individual talents of each team member.  Ideally, the person designated as the leader goes further than managing a team and exhibits leadership behavior.  Robert Smith Leadership identifies specific behaviors that are tied to effective leadership.

  • Coach and mentor.  Be a content expert and freely share your knowledge with team members.
  • Facilitator.  Ensure that the team has the required resources to accomplish the task.
  • Communicator.  Use emotional intelligence to deliver the message clearly and hone listening skills while being receptive to honest feedback.
  • Conflict resolver.  Listen attentively and use emotional intelligence to reframe the facts so that each side sees the conflict differently.
  • Innovator.  Constantly seek ways to improve the workflow.
  • Decision-maker.   Ensure that your authority is sufficient to enable you to be decisive with your responsibilities.   Align decisions with the mission, vision, and values of the organization.
  • Motivator.  Clearly define the goal, motivate the team and show resilience when setbacks occur.
  • Delegator.  Enhance professional development by delegating duties where appropriate.
  • Performance manager.  Use data-driven evidence to establish benchmarks and timelines which keep the team on track to achieve the goal.

Moving from leader to leadership

Designated leaders are often given their position as a reward for past performance and loyalty to the organization.  Often, the “go to” worker is bestowed the title as the boss with the expectation that they continue to effectively guide the workgroup and develop leadership traits.  Writing for Forbes, author Mark Murphy notes that it is difficult to transition from having a title to demonstrating leadership behavior because it requires transitioning from task-oriented work to empowering and motivating others.   He identifies the following as challenges that must be overcome when assuming a leadership role.

  • Trust others.  Designated leaders feel personally responsible for the outcome and tend to micro-manage to ensure the desired results.  Leadership is about surrounding yourself with competent people, trusting their capability, and relinquishing control.
  • Develop your leadership skills.   Communication, emotional intelligence and conflict resolution are all essential leadership skills and must be learned.
  • Delegate duties and authority.  Those in leadership set goals, provide resources, and motivate competent people to get the job done.  Leadership must ensure that workers have the authority to complete assigned tasks.   Micromanagement kills creativity must be avoided.
  • Professional development of others.  An essential component of long-term success for the organization is the continued professional development of every member of the group.  Effective leadership ensures that every employee can hone existing skills while expanding their role in the organization. In so doing, both productivity and retention are increased.

Being a designated leader with a title is all about you and how well tasks are completed.   Exhibiting leadership behavior is about the team and the success of the organization.   The most effective people in leadership positions have a vision, hire the right people, provide resources, ensure professional development, and trust team members to use their creativity to achieve the goal.  The challenge for those designated as the leader is to increase your value to the team and the organization by developing the leadership behaviors described above.

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

Create an empowering workplace

By Thomas Davis, DNAP, MAE, CRNA

The times they are a changing.  Not long ago, applicants who lined up to compete for healthcare jobs hoped to be the lucky winner of the coveted position.  Now, due to many factors including COVID burnout, healthcare organizations are competing to attract candidates to fill the void created by open positions.  More than ever, employers are seeking ways to retain current workers while creating a positive reputation that will attract additional qualified people.  In short, organizations have a new focus on implementing employee friendly activities and have discovered that professional development is a core element of a preferred workplace.  Investing in all aspects of worker growth improves morale, engagement, productivity and retention.

Writing for Insperity, author Celenia Estime identifies the following as characteristics of a great workplace:

  • A sense of belonging
  • A sense of purpose
  • Allowing employees to have fun
  • Provide an opportunity for development and advancement

Clearly, Celenia is in alignment with other writers who tout professional development as an essential component of a highly desirable workplace.

The Gallup organization has been collecting information related to staff engagement for several decades and have refined their engagement assessment tool to 12 basic questions referred to as the Gallup Q12.    Savvy employers note that many of the twelve questions are designed to generate positive responses from workers when the organization has an ongoing commitment to the professional development.  These questions from the Gallup Q12 that support the importance of a robust professional development program.

  • In the last seven days I have received recognition or praise for doing good work
  • My supervisor or someone at work seems to care about me as a person
  • There is someone at work who encourages my development
  • At work, my opinions seem to count
  • The mission or purpose of my company make me feel as if my job is important
  • In the last six months, someone at work has talked to me about my progress
  • In the last year I have opportunities to learn and grow.

The Gallup team know that affirmative responses to these questions indicates that the team is highly engaged in their work and are likely to be both productive and loyal to the employer.

At this point, you may be all in for professional development but unsure about where to start.   If your workplace does not have an ongoing staff development program, step up and look for opportunities to learn new skills and to share your knowledge with your teammates.  An active combination of teaching, coaching, and mentoring will provide opportunities for personal growth for you and your colleagues as you learn and grow together.

“You will get all you want in life if you help enough otherpeople get what they want.”

~Zig Ziglar

In a podcast interview with Richard Wilson, CRNA, the importance of teaching, coaching, and mentoring are discussed.  Although there is overlap between the three approaches, Richard discusses the subtle differences and offers insight into how to effectively apply each approach to introduce professional development to your workplace. Click on the podcast at the end of this article.

Teaching is designed to impart academic information and instruction to a group of learners.  In most cases, the material is presented in a pre-determined manner and is designed to fulfill a specific need.  Teaching is often confined to working with neophytes in the classroom however when best practice guidelines are updated, opportunities for teaching arise for experienced workers.

Coaching occurs in the actual work environment and is often an extension of the classroom.  Typically, the coach builds on classroom knowledge by using his/her experience to teach hands on skills to less experienced people on the team.  As Richard points out in the podcast, coaching moves the learner from understanding concepts to acquiring the skills necessary for completion of a task.  When a leader arranges for an experienced person to coach a new member of the team, both the coach and the new hire have opportunities for professional growth.

Mentoring is a special relationship between two people in which the senior, more experienced person helps the underling define a vision, develop a plan, and achieve a goal.  Mentoring goes beyond teaching and coaching by introducing elements of professionalism and networking to the process.  The mentoring relationship is built upon trust and often develops into a lifetime friendship between the two individuals. 

“Never doubt that a small group of thoughtful, committed people can change the world. Indeed. It is the only thing that ever has.”

– Margaret Mead, American cultural anthropologist

Professional development is the ultimate win/win for the organization, frontline leaders, and individual workers.  By actively engaging workers to participate in professional development, an important step is taken toward creating a preferred workplace that will attract and retain the best employees.   Author Trevor Antley notes the following as positive outcomes related to professional development:

  • Professional development expands your knowledge base.
  • Professional development boosts confidence and credibility
  • Professional development increases earning potential and hireability
  • Professional development can provide networking opportunities
  • Professional development keeps professionals current on industry trends
  • Professional development can open the door to future career changes

Congratulations if your workplace encourages and supports professional development because you landed a great job.  However, when the boss does not provide avenues for personal growth it is time to step up and be a leader regardless of your seniority or position in the workgroup.  Stay current with professional literature and freely share your ideas with your colleagues.  Establish both formal and informal times to share what you have learned by teaching and coaching.  Volunteer to be a coach for new hires and seek coaches for yourself when you want to learn a new skill.  Seek out a mentor who will help you move into a leadership role initially in your workgroup and later in the organization.   Look outside your organization and consider completing an advanced degree or gaining certification in a related area such as ultrasound nerve blocks or pain management.  Finally, listen to the advice provided by Richard Wilson in the podcast.

Click here to listen to the Podcast

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

Develop leaders on your team

By Thomas Davis, DNAP, MAE, CRNA

Leaders don’t create followers, they create leaders.

~Ralph Nader

Having the right leader in the right position is a key to success for any organization regardless of the type of business or industry that they represent; but where do leaders come from?  Recruiting and hiring leaders is time consuming, expensive and a bit risky because you never know that the person is a good fit until he/she is on the job.  Often, a better option is to promote from within and that requires a pool of workers who have the necessary skills to be successful in a leadership role.  Developing leaders from within is a great opportunity for professional growth for both the current leader and the workers being groomed to step into a leadership position.

Writing for The Training Associates, author Rebecca Gendron notes that 77% of organizations are experiencing a leadership shortage due to the great resignation triggered by COVID and the retirement of baby boomers.  Her data estimates that by 2025, 75% of the workforce will be composed of millennials and surveys reveal that 63% of millennials self-report that they are not prepared to assume leadership roles.  Insightful leaders will jump on this opportunity and incorporate leadership skills into the professional development plan for the team.

Advantages of internal leadership development

  • Enhance your position as a leader.   John Maxwell’s classic book, The 5 levels of leadership identifies a fourth level leader as a people developer.  Placing emphasis on professional development to include mentoring future leaders elevates the team while taking the leader to level 4 on the leadership scale.
  • Improve staff engagement.  The Gallup Q12 has been the gold standard for measuring employee engagement for several decades.  A review of the 12 indicators of employee engagement as outlined by Gallup finds that 6 of the 12 markers are enhanced by developing staff from within.
  • Cost savings for the organization.  The process of advertising, interviewing, credentialing, and onboarding is both expensive and time consuming.   For licensed professionals, the cost of finding and hiring a new person can exceed their annual salary.  Internal leadership development takes time and commitment while saving money for the organization.

Identify your future leaders

Keep your eyes and ears open and your future leaders will identify themselves.  They are the ones with a positive attitude, solid work ethic and who are skilled in the use of emotional intelligence to connect with their colleagues.  A review of business literature identifies characteristics of the workers who will be your future leaders:

  • Aptitude for motivating others
  • Perseverance to overcome obstacles
  • Skill in building trusting relationships
  • Ability to create a culture of accountability
  • Insight to make balanced decisions that will benefit the group and the organization

Create an opportunity for growth

The key to successful leadership development is a sincere desire to enhance the strengths of the other person and the quickest way to knock the train off the track is to try to clone yourself.  Trying to make the other person a better version of you ignores the talents that they bring to the table and is a recipe for disaster.  Instead, connect with the other person, become aware of their talents, and then build on their strengths and interests. 

Leadership developer Michael Page identifies the following activities as great ways to stimulate leadership skills in others.

  • Create opportunities for wider exposure in the group and organization
  • Change their roles and responsibilities to create an opportunity for developing new skills
  • Challenge with increasingly difficult projects
  • Provide a support system that includes mentoring and coaching
  • Give frequent feedback
  • Reward completed projects

Professional development with a focus on leadership skills is a win, win, win for you, your team, and your organization.

Start the ball rolling by understanding that regardless of how good you are at your job, your way is not the only way.    Tap into the talent on your team by assigning tasks to those who show an interest.    Give guidelines, criteria, and determine the desired outcome then step back and allow others to solve the problem.  Make sure that resources are available and take an active role as a mentor when the person tackles the problem.  Appreciate and reward creative problem solving after criteria are met regardless of the approach chosen by the person.  Finally, reap the benefit as team morale skyrockets, your workload is shared with others, and the future leaders of the organization are ready to step in.   Down the line when members of your team are asked to remember the best boss that they have ever had, your name will be the first to come off their lips.

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

10 Behaviors that generate powerful results

By Thomas Davis, DNAP, MAE, CRNA

People are always looking for an edge; a way to position themselves a half step ahead of the crowd.  To that end, they throw caution to the wind, use money or power to get their way, and rationalize their extreme behavior because it justifies the results that are achieved.   For example, Lori Laughlin made the headlines when she was caught paying thousands of dollars in what is now referred to as the college admission cheating scam.

Leaders at all levels who are climbing the chain of command can fall into the same trap as Lori by using their current position to bully their way to the next level.  Ironically, instead of positioning themselves for promotion, their bullying creates a toxic workplace environment that becomes a roadblock and prevents promotion.  Rather than flexing political muscle or throwing money at a problem, the savvy leader wins the day with behavior that costs nothing.   Start on the road to success by eliminating negative behaviors and quickly follow with positive actions to affirm and unite your team.

Eliminate the negative

Travis Bradberry, author of emotional intelligence 2.0 notes several behaviors that generate ill will must be avoided by those who want advance in their career. Activities to be shunned include:

  • Overworking people
  • Lack of empathy for co-workers
  • Taking credit for other’s work
  • Banning socializing / punishing fun
  • Making stupid rules
  • Letting others struggle / withholding help
  • Controlling the agenda / ignoring feedback

Rather than using heavy handed authoritarian leadership to bully those on your team, ease up and remember that the most effective leadership behaviors are free.

It does not take a heavy hand, threats, and bullying to get the results that you want. An article in the archives of prosynex.com titled Scout for a promotion leveraged the boy/girl scout code of conduct with hot tips for grassroots leaders who want to create a preferred workplace  Similarly, an article by Molly Fletcher posted in Linkedin lists behaviors that require zero talent, are cost free, and enhance your position within the organization.  Combined, the two articles are a treasure chest of behaviors that are based on common sense and reap huge rewards.  Incorporate these principles into your leadership style and you will become a preferred boss.

  1. Be on time.  Legendary basketball coach John Wooden had three rules for his team and one was punctuality.  He felt that being on time was an overt display of respect for others so he always started and finished workouts on time.  Being where you need to be in a timely manner creates a foundation of trust and finishing on time respects the personal needs of your team members solidifies their sense of being valued.
  2. Demonstrate an honest work ethic.  The most trusted grassroot leaders know the job and frequently pitch when needed.  Schedules, payroll, and supplies are important however working shoulder to shoulder on the front line to ensure that the mission is accomplished sends a powerful message and contributes to team morale.
  3. Give full effort.  Leadership is not an 8 hour per day job, rather, it is ongoing.  The best leaders pitch in and do whatever needed to support team members including responding to team member’s personal issues even when they arise in off hours.  Tireless work to guarantee that goals are met reflects positively on the team as well as the leader.
  4. Use appropriate body language.  How you show up in the morning matters, as does your aura that others perceive throughout the day.  Your appearance and behavior sets the tone for your team so stand tall, put a smile on your face and some pep in your step.  Let your image portray you as a competent and capable person.
  5. Increase your personal energy level.  Personal wellness is important for you and for each of your team members.  Adequate rest, healthy nutrition and focus on goals all combine to boost your energy, stamina, and positions you as a positive role model for your team.   Your energy level is contagious and will elevate the morale of your team.  Conversely, dragging in with low energy and a negative attitude is equally contagious and will draw your team down with you.
  6. Improve your listening skill.   Move beyond forming your rebuttal while listening and focus on hearing to understanding the message that is being sent.  It’s more important to grasp the other point of view than to defend yours.  You don’t learn anything new while you are talking; you only learn new information when you are receptive and listening.
  7. Focus on emotional intelligence.   Accept and appreciate how your words and actions affect the members of your team.   Face to face discussions, preferably without masks, allows you to view expressions and judge the reaction of others.  Email and texting quickly transmit information but blocks your awareness of the person’s emotional response.
  8. Be receptive to feedback.  Creating diversity in the workplace includes encouraging diversity of thought and learning from one another.  You hire the best and brightest people for your team and now it’s time to showcase their talents and encourage their creativity by being receptive to their ideas.  By actively listening, you may find novel ways to solve a problem and leave team members feeling as if they are valued.
  9. Role model loyalty.  Loyalty is a two-way process and starts with the leader being loyal both individually and collectively to team members.  Never take credit for the work of others and never throw a team member under the bus just to save your ego.  When you establish that you have their back, they will have yours.
  10. Have fun.   Nobody says that work can’t be fun.  Celebrate birthdays and holidays by decorating the break room and supplying a cake or other food.  Reward the team when goals are achieved.  Sponsor quarterly events that promote teambuilding and create and opportunity for team members to know one another outside of the work environment. 

Leadership can be lonely especially for an authoritarian boss who feels that success or failure rests exclusively on his/her shoulders.  Rather, use the tips above to connect with and promote the talents of your team members.  Being interested in the team rather than forcing them to be interested in you opens the door to diverse thinking and new solutions to old problems.  Being a great leader does not arise from your knowing all the answers, instead great leadership arises from the trust that develops when team members feel valued, and their ideas are rewarded.   Replace authoritarian power with common sense and watch your team soar to new heights.  It’s true, the best approach to leadership is free.

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

Show your face; Empathy and Trust in the mask-wearing workplace

By Thomas Davis, DNAP, MAE, CRNA

This article is not intended to make a political statement, pass judgement on the CDC, or coerce healthcare providers to do anything that would compromise their safety or that of their patients.  Rather, the article is written to increase awareness about the negative effects of face covering when interacting with patients and to stimulate thought about creative ways to enhance connectedness while maintaining a safe environment.

The importance of emotional intelligence in both your personal and professional life was documented in a recent article published on prosynex.com.   The article noted that emotional intelligence is built upon a foundation of trust and empathy, both requiring connectedness between two individuals.  Development of those core elements is enhanced by being sensitive to verbal and non-verbal cues that are sent including tone of voice, body language and facial expressions.  Barriers such as facemasks and personal protective equipment (PPE) inhibit sensing the full message that is being sent and negatively influences the development of trust, empathy, and connectedness between providers and patients. 

Learning from the past

Over a decade ago, family practice physicians realized that they were constantly being exposed to every contagious organism in the community and opted to protect themselves by wearing facemasks when interacting with patients.   In the ensuing months/years family practice patient satisfaction, trust and compliance scores dropped and many speculated an association between facemasks and the relationship between physicians and patients.   A 2013 (pre-COVID) study done by Wong et al and published in BMC Family Practice found that a physician wearing a mask during a patient visit had a significant negative effect on the perception of the doctor’s empathy.  The study demonstrated that when doctors wear facemasks during patient appointments, there is a decline in empathy and relational continuity.

Fast forward to today’s mask wearing COVID society and there is concern across the board about the negative effects of blocking non-verbal cues for the detection of feelings which affects the provider/patient relationship.  Writing in Psychology Today, author Cara Goodwin PhD notes that infants only a few months old begin looking at the mouth for visual cues about emotions and we continue to assess facial cues throughout life.  Her research demonstrated the wearing masks makes positive emotions seem less happy, thus making children less likely to perceive positive emotions from mask wearing adults.

In an article recorded in the National Library of Medicine, author Felix Grundmann explored the effects of mask wearing on the elderly population noting that we tend to deduct a stranger’s trustworthiness and likability from facial expressions. Remarking that neuron density and neurotransmitter changes in the elderly already impede the perception of emotions, the author found that mask wearing hides facial cues and makes the detection of emotions even more difficult for elderly patients.

Being mindful of the negative effects mask wearing on the physician/patient relationship, Kratzke, Rosenbaum, and Cox conducted a study published in JAMA Surgery, 2021, where clear, see-though masks were compared to traditional hospital masks when surgical residents interacted with patients.  With the clear mask, facial expressions were visible and, as expected, those wearing transparent face covering were rated as being more understandable, empathetic, and trustworthy.

Improving provider/patient trust

Evidence-based medicine that predates COVID clearly demonstrates the wearing a mask while interacting with a patient has a negative effect on the provider/patient relationship.   Addressing the issue begins with the awareness that you are already at a disadvantage for building trust solely due to the requirement to wear a mask.  Therefore, being animated with eye and hand expressions will help the patient perceive your sincerity and mood.  Assume that your voice is muffled by the mask so speak loudly and solicit feedback to ensure that you are understood.  When possible, use a clear mask that reveals facial expressions.

Be COVID cautious and resist crossing the line to COVID crazy.  If you are working in a COVID unit or other area with high risk for exposure, full PPE may be appropriate.  However, if you are in a controlled environment where the risk for exposure is low, consider a plexiglass divider separating you from the patient and remove your mask during an interview.  When it’s time for hands-on contact, put the mask back on.  Ask your materials manager to order clear plastic facemasks for use when talking with the patient.    If your patient is at low risk for having COVID, consider removing your mask and maintaining the recommended 6 feet of social distancing from your patient while doing an interview.    However, if local protocol always requires the use of a traditional mask, speak loudly, have expressive eyes, and maintain an energetic, upbeat attitude.  The COVID pandemic has created safety requirements that impede the ability to use emotional intelligence when interacting with patients.  Be aware, be creative and develop a positive relationship with each patient.

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

Non-disruptive by design

Disruption post

Thomas Davis, CRNA, MAE, DNAP candidate

follow@procrnatom on twitter

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

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

~Ben Franklin

 

 “Stay Out of Trouble…”

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

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

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

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

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

 “Get Out of Trouble.”

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

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

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

 

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

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

 

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

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

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

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

After Halftime

halftime post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

It’s the first week in July and the half-time show is over. If you joined the throng of hopefuls in January by writing a list of initiatives to accomplish by year’s end, it’s time to revive and resuscitate, or discard and delete.   Here’s how to recover your footing and breathe new life into dead projects.

  • Review your goals. Reflect thoughtfully on the list you generated so enthusiastically six months ago and decide which things are keepers and which ones can go to the bin.  Which items can potentially have a positive effect on your workplace if achieved?  If the team or the organization has moved on and a listed item no longer applies, delete it or store for later; however, if a particular goal remains pertinent or will set you and the group up for future success, leave it on the list.
  • Condense your resolutions. Following your review of goals, shrink the “good list” further to those that will have the most impact. Notate your priorities and commit to accomplishing them within the remaining time frame.
  • Re-write your goals. Your notated priorities must be realistic, specific, and written in a format that is easily understood.  For example, “improving efficiency” is nebulous; but, adding “as evidenced by” provides clarity and focus to the intended outcome.  Rather than having a goal “to improve pre-op efficiency,” you might clarify the goal by adding “to speed the pre-op workflow as evidenced by a 50% reduction in the number of first case delays.”  A goal to ensure that supplies are available could be stated as “ensure the availability of supplies as evidenced by completion of the inventory every Monday, and submission of order form every Tuesday.”  Put into writing both the goal and a quick description of what constitutes success.  Review the list at established and realistic intervals – weekly, bi-monthly, monthly – to maintain your focus on a positive outcome.
  • Change your mindset.   Proactive, asset-based thinking turns your attention to what resources are available and what can be accomplished.  Dismiss all thoughts about what or why goals were not achieved in the past and laser-beam on what can be done in the upcoming months.   You have already reduced your goals to one or two achievable items, now block the extraneous distractions and stick with the plan.
  • Develop the plan. If the majority of your expectations during the first half of the year are still unfulfilled, something needs to change.  Start again by developing and following a realistic, results-oriented plan over the next 6 months. A viable plan should help get you back on track while teaching you valuable lessons about organizing future projects.   Other aspects of a solid plan should ensure that you have the necessary resources available.  It should include modifying your environment to remove clutter and fill the void with items that support achievement of the goal.  Acknowledging that time is a valuable resource, your plan should create a new schedule eliminating activities that sabotage, while adding a block of time for activities that support achievement.  Stay aware that some activities are mutually exclusive; if you have a personal plan to increase networking by engaging in more one on one time with colleagues, you may have to reduce the time you spend answering email or doing other administrative tasks.
  • Work for small victories. Your desired outcome can seem daunting based on today’s new starting line of six months out.   To stay grounded, remember:  Completing a 26-mile marathon is an overwhelming concept for many people; however, celebrating the passing of each mile marker generates an image of progress and makes the goal seem attainable.  Acknowledge each challenge and celebrate each milestone.

 

Among the many benefits of having a personal vision for improving the workplace are two significant ones – improved team morale and elevated respect for the leader.  Being the driver for those improvements should empower you and trigger a thirst for even greater success.  If you have brought closure to your professional initiatives for 2019, kudos to you; start another list.  If you reached halftime with your goals stalled in spam, revive, reboot and get back in the game.  July first is chance to double down after halftime.

 

 

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

Workplace Patriots

Fourth of July

By Thomas Davis, CRNA, MAE, DNAP candidate

 

Following closely on the tails of the summer solstice is the celebration of our day for patriots, the Fourth of July.  It’s the entire nation’s holiday to enjoy summer activities with friends and family while honoring the memory of the dedicated patriots who put country ahead of self and drew a line in the sand, demanding, “Give me liberty or give me death!”   The great experiment of government of the people, by the people and for the people was put into motion by the courageous acts of defiance in 1776 and we are still reaping the rewards from their Herculean sacrifices.

 

As a summer celebration, the Fourth frequently includes having a picnic at the park, out at the lake or right in the back yard followed by fireworks after sunset.  It’s a day of relief from business as usual and an opportunity to kick back, relax and have some fun with friends.

 

For many people, the workplace is an extension of personal life and co-workers are viewed as extended family.  Expanding the holiday celebrations to the workplace is healthy, promotes the development of a sense of community, strengthens teamwork and stimulates creativity. Seize the opportunity to use the holiday theme for teambuilding by challenging your group to create entertaining ways for having some fun at work in the days leading up to the 4th…here’s what others have done.

  • Dress for the occasion. Designate the 3rd of July as a casual dress day at work and encourage workers to wear red, white and blue.  Encourage RWB hair accents, holiday jewelry, or other adornments to add to the festive feeling.   Have a patriotic hat contest with rewards for the creativity of your team. Challenge those with the time and resources to wear full patriotic costumes and have a good chuckle as George Washington, Betsy Ross or Paul Revere walk through the door.
  • Decorate the workplace. Decorate halls, doors and desks liberally in RW and B.   Find a funny holiday poster for the bathroom wall.  If you have personal space such as a locker or a cubby box, decorate it for the occasion.   Don’t forget your patients!  Make their trip to the operating room fun and memorable by decorating the side rails on the cart.  When it’s time to mark the surgical site, give the patients colored markers.
  • Play 4th of July music. Substitute a 4th of July playlist and spice things up a little with fife and drum. You can play Sousa marches, Springsteen, Madonna or Simon and Garfunkel tunes to set a patriotic tone; or take a road trip down the golden oldies lane to generate some enthusiasm worthy of the holiday.
  • Have a Patriotic Workplace Picnic. Workplace potluck lunches are the frequent response to celebrations throughout the year and the 4th of July is no exception; what a great opportunity for decorating the lunchroom and serving a community meal with a theme. Bring hot dogs and watermelon to simulate picnic fare and ask team members to bring their favorite picnic salads and side dishes to augment the dogs.  Don’t’ forget to enlist the bakers on your team to whip up some red, white and blue desserts.
  • Wear lapel flags. Show your patriotic spirit by wearing a lapel flag.  Better yet, supply lapel flags for everybody working during the holiday week.  If you can’t find them, get a roll of flag stickers and make sure everybody has one.  Include patients in the festivities by giving them flag stickers for their hospital gowns.
  • Play games. A picnic just isn’t a picnic without games.  Set up some games for your team members and give prizes.  A workplace scavenger hunt is fun and can be done individually or in teams.  Fill a jar with RWB jellybeans and have workers guess how many are in the jar.   Set up a bean bag toss or a mini nerf ball basketball hoop in the break room and keep a leader board with scores.
  • Engage in a Community service project. Consider sponsoring a community service project in honor of the 4th or any holiday.  A children’s bicycle rodeo or a picnic for the members of a nursing home are two teambuilding activities that are sure to present your organization in a positive light while enhancing community relations.

 

Our nation was united by Patriots who developed a strong loyalty to one another by working hard and playing well together.  Likewise, a good leader can unite a hard working team by offering activities that promote collaboration and that free the people to enjoy themselves.  A great leader creates an environment of loyalty enjoyed with liberty, bound by justice and united by loyal Workplace Patriots.

 

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

Tech Savvy Leadership

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By Thomas Davis, CRNA, MAE, DNAP candidate

 

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

 

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

 

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

 

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

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

 

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

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

 

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

 

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

 

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

Micromanagement; A lens on leadership

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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

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

 

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

 

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

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

 

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

 

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

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

 

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

 

 

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

The family friendly workplace

 

 family friendly post

By Thomas Davis, CRNA, MAE, DNAP candidate.

 

The United States is currently experiencing economic growth that has created a record low unemployment rate and increased the competition for skilled and motivated employees.  The 2016 census reports that 32% of the active workforce have children (per: Bureau of Statistics).  Among those who have graduated from college in the past 20 years are men and women with advanced degrees who are eager to participate in the workforce but must balance the demands of the job with the responsibility of raising children or caring for elderly parents.  In order to capitalize on the talents of those who wish to work, corporations are taking steps to make the workplace more friendly for those with family obligations. The intent is to attract highly qualified people to join their team and to provide incentives to retain those already filling key positions.

 

Every year Fortune magazine posts its list of the 100 Best Workplaces in America and, no surprise, those at the top are known for their family friendly approach to developing human resources.  This year, Wegman’s, a food market headquartered in New York, moved into the #2 position on the list partly because they offer many perks to help those who are juggling career and family. Wegman’s management puts an emphasis on building a preferred workplace for every employee and then provides incentives that boost their family-friendly rating.  Special benefits offered by Wegman’s include lactation rooms, fertility treatment, and paid leave to care for a sick child.   Family-friendly at Wegman’s includes measures to make the store kid-friendly for customers.  The store in St. Louis boasts of 15 kid-friendly features in their store.

 

A blog posted on care@work rates Edward Jones as #5 on the short list of top ten family-friendly employers.  At EJ, families can opt for a baseball tickets overnight family retreats at company expense.  And new moms “can take up to 120 paid days off for maternity leave.”

 

Attracting and retaining highly skilled workers is just as important in healthcare as it is at the supermarket.  Like the workers on Main street, many who work in healthcare must balance personal and professional lives using multi-dimensional equilibrium that ensures quality patient care and meets personal family needs.   Frontline healthcare team leaders are seldom able to implement sweeping changes in corporate benefits; however, there are things that they can do to make an individual workgroup more family friendly.

  • Listen and connect. Connecting with team members on a personal level is a key element of good leadership and is especially important when building a family friendly workplace.   Take an interest in things that are important to those you supervise and learn the names, ages and interests of their children.  Be sensitive to the coordination that the worker must do daily to ensure that children are able to attend activities, eat meals, do schoolwork and keep a reasonable sleep schedule.  Having empathy will elevate your understanding of the workers needs and open your eyes to ways to help the person meet his/her obligations.
  • Flexible time. When it comes to a work schedule, one size does not always fit all.  Workers coordinate with their partners for delivery and pick-up of children and the timing may not always fit your traditional schedule.  For example, Ana is a valuable team member but can not deliver children to school and be at work promptly at 7am.  Her creative manager shifted Ana’s work schedule to have her arrive at 8am and then be the person to stay an hour later than the others in the afternoon.  With the flexible schedule, Ana’s needs are met, and the workplace has a reliable person who ensures the afternoon shut-down process is done correctly.
  • Job sharing. All-star workers who have just become moms may not have the stamina to work full time and meet home obligations.  Rather than losing highly effective workers, offer the opportunity other team players to combine and cover one full time position collectively.  For example, at our workplace a young mom-to-be does not want to quit her job, nor does she feel able to work full time and care for her baby.  Another person on the team who is toward the end of her career feels the need to cut back and work only a few days per week.  Encouraging them share a position retains skilled workers and leaves the manager with one position to fill rather than two.
  • Switch to part time. Building a flexible part time schedule for a worker whom you don’t want to lose is another key to maintaining a cohesive team.  Often, the request to convert to part time comes from a worker who has obligations caring for an elderly parent, or grandchildren or who has earned his stripes and wants to cut back.  Accommodating the cut-back request sends a message that you value the person and want him/her on the team, even if only part time.
  • Remote work. Although working from home is not possible for a person delivering hands-on care, there are behind-the-scenes jobs that do not require the person to physically be at the workplace.  For example, a busy GI center makes two pre-procedure calls to each patient to ensure that they understand the bowel prep and know when and where to report the day of the procedure.  In addition, every post procedure patient receives a phone call.  The process requires two nurses to spend the entire day on the phone; calls that could be made from home just as easily as from the GI center.   Other tasks such as ordering supplies, building work schedules or revising policies/procedures could also be done from a home computer.
  • Healthy family days. Think beyond the traditional workday and offer family friendly days for healthy activities.  Schedule a Saturday morning day at the playground or a Sunday afternoon picnic in the park and have activities for children of all ages.  Adults will network, children will play, and a fun time will be had by all.

 

Does family-friendly matter?  Ask a colleague who has been challenged with a special family need.  Those who were supported by their employer feel a bond of loyalty with the organization and become highly committed to the job.  In contrast, those who were treated as #1 Nuisance feel no loyalty and become disgruntled employees.   Here are a few examples that I have personally witnessed:

  • An anesthesiologist friend of mine reinforced the importance of supporting family needs by sharing the story that his wife required 6 weeks of bedrest prior to the delivery of their first child. His employer told him immediately that his wife was his top priority and that the team would work around whatever schedule was needed to accommodate his wife’s care.  Following a successful delivery of a healthy baby, he is a loyal employee who continues to sing praises for the employer.
  • A member of our small perioperative team had a child with a special event at school at 7:30am.  All members of the team agreed to start the room at 10am that day and stay late if needed to complete cases.
  • A member of our team suffered a severe burn that required ICU and follow-up surgery. He was on the low end of the pay scale and could not afford his $5000 medical deductible.  The team rallied and in short order raised the required money to ensure that our colleague received the best possible care.

 

Teams that go the extra mile to take care of colleagues with family needs are rewarded with a team member who is totally committed to the group and ready to step in when others are in need.  The return on investment is high.

 

When it comes right down to it, blood is thicker than water.  Water is important, of course.  It nourishes the family, even makes the family possible.   But, as a leader, never forget that family will always be the first concern of all workers; the reason they work extra hours when needed, the reason they agree to imperfect contracts, and the reason they are loyal to a family-friendly workplace.  When you hire a worker, you are hiring his/her family and it behooves you and the entire healthcare industry to listen, to learn and to lead accordingly.  The time and effort that you put into creating a family friendly workplace will reap benefits for decades into the future.

 

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

Perception; The first step to success

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By Thomas Davis, CRNA, MAE, DNAP candidate

 

“All our knowledge has its origins in our perceptions.”

~Leonardo da Vinci

 

John is an experienced, highly motivated worker who is frequently assigned important projects with a short timeline.  Regardless of the demands that are placed upon him, John can hunker down and gitter-done to complete projects on time.  MaryAnn, John’s colleague, holds him in high esteem and respects his tenacity and ability to focus on a project.  Kevin, another colleague, views John as aloof, hidden behind his computer in order to avoid interaction with others. He judges him with disregard.

Mary Ann and Kevin have witnessed the same person and the same behaviors and draw opposite conclusions. Yet, in their own minds, both colleagues have developed perceptions that are fair and accurate.

Perception is reality to the observer and how you are perceived by others will have a lasting effect on your career.  People who create a positive memory of themselves tend to advance while those who project a negative image do not.   Stephanie Ketchum, contributor to fairygodboss.com, agrees that the memories created through observation have a lasting effect noting that “…a positive perception generated by visibility is a key factor for earning a promotion in an organization.”  Ketchum offers four suggestions for creating a positive image that others will remember.

  • Get assigned to important jobs. Let you boss know that you are ready to step up by asking to head a project or join a team working on a vital issue.  Once the assignment is made, deliver more than is required in a timely manner to demonstrate your effectiveness.
  • Gain face time with leadership, make personal contact. Being in the presence of people at all levels of the chain of command makes you a known commodity and a person to be considered when projects are assigned.  Gaining personal interaction with those at the executive level is more difficult but possible.  Attend receptions and participate in community projects that are endorsed by your CEO.  Upper level leaders of your organization want a positive public image and often will put on the gloves and spend a day working on a service project…hopefully, next to you.
  • Speak up and share ideas. Those who do the job are the experts who best know areas in need of change and have ideas for improving workflow.  Trust your observations and share your ideas.  Frequently, those who identify a problem and propose a solution are the ones who are put in charge of the project and earn recognition when the job is brought to completion.
  • Become known. Creating a positive image within the organization requires that you expand your boundaries and become known beyond your workgroup.  Actively seek to participate in projects that involve collaborating with people from other work teams.  For example, a perioperative safety program requires people from pre-op, intra-op, post-op and anesthesia to work together to achieve a common goal.

 

As healthcare workers, we are skilled professionals who provide vital services to the patient population. In the process, our activities and attitudes are constantly under surveillance by both co-workers, patients and leaders.   As such, our careers will be advanced or broken based on the perception we create as we do our jobs.  MaryAnn is impressed by John’s efficiency and ability to complete a task; however, Kevin is put off by John’s lack of people skills.  Although John’s expertise and commitment to timelines is a magnet for significant assignments, he doesn’t appear to work collaboratively and make personal friends with others who can participate in the project.  Consequently, the vital work that John does to advance his team remains unknown to others in the organization.  It’s each emerging leader’s responsibility to be a magician who can create the image of being the person who can take an idea, develop a plan and engage others to bring the project to completion.   Combine hard work, self-confidence and collaboration to create a perception that the team cannot function without you.

 

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

Uncommon Courtesy

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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

 

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

 

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

 

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

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

 

Courtesy matters

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

 

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

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

 

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

 

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

 

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

Take charge of change

change management

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

“Somebody ought to…” “If they were smart, they would…”  Workers frequently discuss the management flaws during small talk in the lounge and call on those in charge to fix the system; however, it is common for the very people who criticize and call for change to adamantly resist any disruption of business as usual.  Whether it arises from the front office or from a grassroots movement, and regardless of the merit of a new plan, variation of routine can be intimidating and evoke both active and passive resistance from the same people who are essential for putting a new strategy into action.  Successfully guiding a team through a revision process is a multi-faceted task requiring a leader to unite the workers; a demand that will challenge the skills of even the most experienced boss.

 

“The world hates change, yet it is the only thing that has brought progress.”

~Charles Kettering

 

 

Writing in The Balance Careers, Susan Heathfield connects effective leadership with managing change by emphasizing the importance of the leader’s commitment to implementing the new policy.  She suggests 5 essential elements for the leader to put in place if modification is to occur smoothly:

  • Have a vision
  • Communicate the vision
  • Be involved in planning
  • Provide structure to support the change
  • Designate an executive champion

 

 

At the core of implementing change is effective communication of both the proposed plan and the reasons that drive the need for adjusting current procedures.   Author Steve Weber (Speakinggump.com) affirms that most people will accept workflow alteration if they understand the vision, are allowed to participate in development, and feel ownership during implementation.   According to Weber, transparent disclosure of the plan and its necessity will have the following effects:

  • Defective systems will adjust
  • Redundant systems will be eliminated
  • Major flaws will be exposed and eliminated
  • Minor flaws will be tweaked

 

Leadership is essential for change implementation and management (CIM) regardless of its scope.   In a recent conversation with a patient, Joe, an executive level consultant for managing change at USAA insurance provided additional insight about the importance of leadership by sharing actual stories from his work. According to Joe, meaningful and lasting change is difficult to impossible without Active Invisible Management (AIM)  Like a duck that appears to be peacefully floating on top of the water and whose legs are churning below the   surface, effective leaders display calm confidence in public while churning out some hard work behind the scenes to push the project forward.  When I asked Pete about obstacles to anticipate when asking workers to set a new course, he noted two things that can derail implementation.

  • The first signs of success  Most of us assume that signs of success are a good thing, but Pete noted that top leaders are busy people and as soon as it appears that success is on the horizon, attention gets diverted to other areas and the project loses its AIM.  Having a designated executive champion who actively works until the new way becomes part of the team culture is essential, particularly when things appear to be going well.
  • Recognition and reward achieved under the old system High achievers who were rewarded under the old system have a vested interest in maintaining the status quo.  Leadership must be sensitive and ensure that the most productive people under the old system can also anticipate gaining recognition and reward with the new system.

 

Even after clearly communicating the proposed plan and its necessity, you may still need to address a question from your team; “what’s in it for me?”   Answer the question in a confident manner with a focus on benefits for both the individual and the organization with emphasis on the following:

  • Achieving personal / professional growth
  • Developing adaptive flexibility
  • Challenging old beliefs and accepting alternative methods
  • Showcasing strengths
  • Mastering the stress associated with the unknown
  • Breaking ho-hum routine
  • Opening the opportunity to create a fresh future

 

“Change has a bad reputation in our society. But it isn’t all bad – not by any means. In fact, change is necessary in life – to keep us moving, to keep us growing, to keep us interested. Imagine life without change. It will be static, boring, dull.”
–~Dr. Dennis O’Grady

 

Successfully guiding a team through the process of change is a multi-faceted process that can cause trepidation from even the most experienced leader.  Rather than cowering in fear of the lunchroom nay-sayers, clearly communicate the new plan and engage high-achievers from the old system to assume a prominent position in the new scheme.  Confidently position yourself and your team to be the trailblazers within the organization and be the first to reap the rewards that accompany successful implementation of change.

 

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

Find the right boss

hire your boss

By Tom Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

The blog-o-sphere is clouded with management and leadership articles about how to attract fabulous applicants, how to build an elite team and what it takes to retain the top performers.  On the flipside, there is a paucity of information to guide workers who are searching for the right job with the best boss.  Unfortunately, highly qualified workers are sometimes wooed into joining a team only to find that they have hitched their wagon to the wrong horse.  The Balance Careers writer Susan Heathfield affirms the importance of finding the right boss, noting that that working for a poor boss is the most common reason given by a person who leaves a job.  People don’t leave jobs, they leave bad leaders. In fact, having the right boss may be the single most important factor related to happiness and success in a position.  When you hit the job market, be an informed shopper who avoids chasing pay and benefits. Focus your search on finding the right boss.

 

Chief Technical Officer at Dailymail online, Oleg Vishnepolsky writes, “Choose a boss, not a job. A boss that supports you, trusts you and believes in you will make a great difference in your career.”  That sounds simple and would be if only you could go online and click “order” and “submit.”  Ordering a boss from Amazon is not possible, yet, there are a few things that you can do as you apply and interview for your next job.  Adopt the mindset that you are interviewing them just as they are interviewing you and take responsibility for your future.

 

Start your search by doing your homework and reading blogs regarding the common traits of a great boss.  From the articles, make a list of traits that satisfy your own requirements.   If your list parallels the essentials identified by others, it will include some of these items:

  • Communicates effectively with a pleasant personality
  • Has a vision
  • Makes decisions based on shared values
  • Sets expectations and provides resources
  • Provides timely feedback
  • Demonstrates honesty, transparency and respectfulness
  • Cares about each worker on a personal level
  • Values the perspective that each person adds to the group
  • Is focused on team development
  • Has your back, cuts you slack while maintaining standards
  • Is a working partner who provides mentoring and professional development
  • Makes the workplace enjoyable
  • Recognizes and rewards superior performance

 

The list is followed by the search.   Stumbling on Happiness author Daniel Gilbert gives a comprehensive, evidence-based review of how people perceive and react to various situations. Based on solid research by behavior scientists, he concludes that one of the best indicators of whether you will like something are the reviews of others whom you trust.  So, ask questions of someone who knows your next boss.  Is the person happy at work, fulfilled by his/her job and would he/she recommend the job to a best friend?  According to Gilbert, it is likely that your experience, good or bad, will parallel theirs.

 

After talking with people who know your next boss, your quest continues during the application/interview process.  If you detect a heavy presence of red tape and bureaucracy as you apply, don’t expect it to be any different once you are on the job.  Be certain to read the job description carefully, looking for key words related to teamwork, collaboration and professional development.  Read the mission, vision and values of the organization and determine if they are reflected in the job description.  If not, they are just words on a web site and are not part of the corporate culture.

 

At some point during the interview you will be asked whether you have questions and that is the opening that will allow you to learn about the leadership style of your next supervisor.  Have a list of written, open-ended questions that will get your next boss talking about him/herself and your future colleagues.  IMPORTANT: Word your questions in a manner that does not make the person defensive.  Asking, “How do you…?” or, “Why do you…?” is personal and may generate a cautious answer.  Instead, “Tell me about…,” or “How does the organization handle…?” gives a platform for the person to spill the beans without being put on the spot.  NOTE: if someone other than your next boss does the interview, it is a red flag that you will have a supervisor who is isolated and does not connect with workers.  Listen carefully as the person answers.   Dialogue that is “I” oriented with the leader describing all the wonderful things that he/she has accomplished is a red flag.  Empowering Leaders who elevate their workers and create preferred workplaces will respond in terms of “we” while crediting the team for accomplishments.  It is a particularly good sign when your next boss names people on the team who played an important role in implementing a plan or achieving a goal.  Here are a few questions to ask when you interview

  • Why is this position open? This is a question to ask “trusted others.” If it is due to expansion or retirement, that is fine and you will be told; however, if the void was created by people jumping ship, after you sign on, you will quickly learn why they left.
  • What is the greatest achievement of your team in the past year? This indicates whether the job is ho-hum, day to day routine or if there is a vision and shared goal.  It also gives you one more opportunity to listen to the leader taking credit or giving it.
  • How does the organization handle staffing shortages? A supply of local per diem workers that cover vacations can be healthy; however, if a significant number of shifts are filled by expensive locums who were imported from other parts of the country, it indicates that the team is having difficulty hiring new members locally and leadership may be the reason.
  • What is your favorite part about leading this team? Listen and you will learn about the person’s basic leadership style.  Is the focus on command and control or is it on empowerment and professional development?
  • A year from now I’m at my first annual performance review and I have had an exceptional year; describe it. Listen to the response and discern what is most important to your new boss.  Some will emphasize compliance with policy and high production numbers.  Others will talk about professional growth and the important contribution that you make to the team the organization.  In the middle are those who describe managing the status quo.  You know which to choose.

 

Some people go through an interview and get lucky, happening into an job in a supportive workplace; others roll the dice during the process, hopeful that the job works out but ready to move on if it doesn’t.  A lot of preparation is required for both interviewer and candidate in the process of learning about each other. As part of the prep, acquiring the attitude that you are choosing your chief will position you to weed out poor bosses and sign on with a real leader who wants to hire and promote the best and is the best.

 

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

Debrief, learn and excel

Debriefing post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

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.

Evidence Based Leadership

 

evidence based post

By Thomas Davis CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

 

Dr. David Sackett, an epidemiologist from McMaster University in Canada, is credited as being one of the early individuals most associated with evidence-based medicine.  “Evidence based medicine,” in the words of Sackett, “is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”  The intent of using data to guide care is to move patient care beyond traditional lore and personal experience to a level of treatment based on solid evidence authenticated by research.

 

Building upon the success that evidence-based medicine created in healthcare, insightful business leaders are actively seeking ways to apply evidence-based management in the business community.  Writing in the Harvard Business review, authors Jeffrey Pfeffer and Robert Sutton note the importance of gathering and using information to support leadership and management decisions.  Their insightful article, Evidence based management, gives examples of business leaders, like GE and Adobe, gathering information in order to revise policies/procedures founded upon documented validation.

 

Examples of evidence-based management in the business community include GE and Adobe making the bold move to eliminate the dreaded annual performance review.  Evidence revealed that APRs focused on the past, caused anxiety and impaired rather than improved performance.  With the clear intention of building a collaborative culture, those same companies now require managers to have frequent one on one talks with employees instead of the APR.  The new system requires managers to discuss ways in which workers can enhance their future performance.  Inherent in the process is listening to employees suggest ways to improve the workflow and efficiency.

 

Communication, mutual understanding, respect, and ability to work together are four essential pillars that support highly effective workgroups.  Gathering and using evidence to implement those essential items builds a foundation for solid management decisions.  Managing a group of frontline healthcare workers is much different from directing a division at IBM, however the same principles apply.  Taking the time to accrue information will position you as a solid thinker and will earn you the respect of your team and your chain of command.

 

Implementation of evidence-based management within your healthcare team is a 4-step process

  • Ask questions. What are the policies and procedures that make the least sense to you or cause the most stress and anxiety in your team?  Ask further, “Why do they exist, are they effective, and are they necessary?”
  • Search for evidence. Review the literature, survey or interview other leaders, develop a questionnaire for your team and gather real information from every possible source.  Often, similar management issues exist in the business community as in healthcare, and data is available online to guide your leadership decisions.
  • Evaluate the data. Following the collection of information, set up a process to evaluate the data.  A survey with interval and ratio data can be scrutinized with statistical analysis.  Qualitative information collected by the interview process can be coded into themes that identify strengths and weaknesses of current policy.
  • Act on the evidence. Develop a plan to implement the new data and roll it out with a pilot plan.  Agree up front that the pilot is a trial that will be carefully assessed and modified before permanent changes are made to existing policy. Specify a period for the pilot and assess the results to determine if goals were met.  Modify the plan to address deficiencies identified in the trial period and introduce the final version of the new policy for implementation by the entire team.

 

For example, a healthcare team was not satisfied with the results achieved by their current one size fits all bonus system where each person received the same amount of money regardless of productivity. Using the four-step process, the system was questioned, and team members agreed that the system was not fair, nor did it reward high achievers.  Literature was reviewed and other leaders were questioned in the process of gathering information about alternative applications of bonus money.  With fresh information in hand, a new plan was developed with defined metrics that when achieved, moved the person to a higher bonus level.  Under the new system, everybody had the opportunity to receive the highest bonus, however benchmarks were required in order to earn the reward.  Some on the team were driven by the money and others were driven by the status of achieving the upper tier.  Regardless of the personal motivation, the productivity of the team soared under the new system.  At the end of the first year, a committee of peers reviewed the process, updated the benchmarks for achieving the highest reward and rolled out the plan for year two.

 

Evidence-based thinking that is currently being applied in the business community emerged from the concept of evidence-based medicine and now has come full circle as it is being applied to healthcare management.  The shift to data-driven decisions breaks the burden of being tied to tradition and opens the door for you to guide your performance and the dynamics within your team in new and insightful ways.  Applying evidence makes healthcare leadership healthy.

 

Tom is a noted author, speaker, clinical anesthetist and is a strong advocate for nurses in leadership roles

Prevail over office politics

politics post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

When experienced leaders are asked to list things that they like the least about their position of authority, “office politics” will be high on the list of annoyances.   Similarly, when rank and file workers are asked to name several things that they dislike about their work environment, “office politics” makes their list too!  Disruptive sub-agendas in the workplace cause trepidation among leaders and create conflict among workers, yet politics is accepted as a natural component of the environment.

Webster and Wikipedia both agree that office politics involves the use of power and authority to gain and keep an advantage over co-workers or business competitors.  The concept is simple; those with P&A constantly use politics to expand and solidify their position.  Strong, designated bosses can use authoritarian power that goes with the position to enforce compliance however, savvy leaders know that using a touch of politics will create a team that wants to follow rather than a team that must follow.

In contrast, where strong leadership is absent, quasi leaders emerge to shape the opinions of co-workers and undermine the agenda of the designated leader.  Opinion leaders claim power by controlling the emotions of their peers, often by starting rumors that generate fear and anxiety.  In dysfunctional workgroups that are void of effective leadership, the quasi-leaders often have more power than the person with the title.   Workers who want to be loyal to the organization are stressed by the conflict of choosing between the designated leader and the opinion leader.  When left unchecked, opinion leaders gain power and can ruin both morale and productivity.

 

“One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors” ~Plato

 

Politics in the workplace may arise from many different sources.  Harvard Business Review contributor Michael Jarrett identifies several dynamic forces that fuel office politics, including the following.

  • Grassroots politics – generated by the buzz that exists just below the radar screen of the designated leader or organizational administration. Opinion leaders spin and spread enough fear to undermine just about any initiative put forth by leaders.  Because gossip and rumor are the vehicles for spreading discord, there is seldom accountability for instigators.
  • Authority politics – linked to the official title or role of the individual. The designated leader or a person appointed to head a project may use her position to coerce others into obedience.
  • Policy politics – wielded by individuals who memorize the rule book and quickly report anyone whose behavior is suspect. Rather than addressing an issue with the offending person, the rule mongers quickly file a complaint with HR or any authority who will listen and act.
  • Status quo politics – emerging from established norms, assumptions and unspoken routines. “We have always done it that way,” rules the day and those in the cocoon of comfort generated by routine will fight any disruption to workplace habits.

 

Stop the shaking at your knees and lead with confidence.  As the leader, you have an opportunity to view workplace politics as a dynamic source of energy that can be tapped and directed to produce impressive results.  Put the harness on runaway politics and channel team energy into more productive activities by adopting and practicing the following leadership behaviors.

Learn the office culture.  Be confident of your ability and agenda while discovering who the opinion leaders in your group are.  Identify your sources of support and use positive politics to ensure that they are allies.  Assess the status quo of your workplace and consider that many elements of the daily routine serve a positive purpose and enhance the workflow.  Before implementing change, evaluate the level of support for the new policy, and be politically aware by fully informing the team of the need for change well in advance of implementation.   “Knee jerk” policy implementation fuels the furnace of political rivals and ensures sabotage.

Don’t burn bridges.  Divide and conquer is an established military strategy and those who would steal your political power are energized whenever you have a rift with another person.  Avoid emotional responses that poison personal relationships and consider that today’s foe may be tomorrow’s ally.  Don’t turn a blind eye to bad behavior, instead, address every issue in a mature manner that addresses the problem while maintaining a positive relationship with the individual.

Never allow gossip.  The undercurrent of gossip that is ubiquitous in many workplaces only serves to empower opinion leaders and may be used to sabotage you.  Do not participate in gossip and cut it off immediately by dispelling rumors.   As a leader charged with improving the morale of a group, I gained political respect by publishing a weekly update which included the “rumor mill”.  In that space I directly addressed any current rumors by transparently informing the group of the truth.  In short order, rather than gossip, people came to me unswervingly to clarify rumors.

There are no unimportant people.  Display charismatic politics by connecting with everyone on the team on a personal level including, and especially, the opinion leaders.  Be professional and remain on alert that they will try to control you.  Take responsibility for your relationships and give the loyal opinion leaders on your team additional responsibility and then recognize/reward them when they are productive.

Be strategic.  What is your long-term goal for the team and what are the steps that must be taken to get there?  Start with small projects and put others in a logical sequence so that you can build momentum as you go.  Again, give appropriate recognition to your all of your high achievers whenever possible.

Be collaborative.  The positive use of politics augments effective teamwork, unites individuals, enhances morale and eliminates power struggles that fuel office politics.  Creating interdependence and a sense of shared responsibility puts you clearly in control as the leader and strips power from those who would take yours.

 

Think of politics as a use of power.  The politics of the 60s united a nation and landed a man on the moon whereas the politics of the 70s divided a nation and mandated the retreat from Viet Nam.  Workplace politics are less sensational but equally control the mood and productivity of a team.   Capitalize on the collective strength of your team, take charge, and use the political capital that comes with your position to build a cohesive and productive workplace.

 

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

Boost your credibility

 
credibility post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

Would you have faith in the information that you received from a person for whom you had little respect and trust?  Even if you gave the person the benefit of doubt, you would be likely to view the information with skepticism and validate the report before fully it.  That is because respect and trust go to the heart and soul of being believed.  Whether you are starting to climb the professional ladder, or reaching down to assist others with their ascent, when you’re dealing with others, your personal credibility will either enhance or kill the results you achieve.

Business is conducted at the speed of relationships and credibility is the gatekeeper that will makes or breaks the deal.  Forbes.com contributor, Victor Lipman, reinforces the notion that credibility puts spurs to the process of making a deal.  For example, at one point, Warren Buffett’s company sought to make a 23 billion-dollar deal that normally would take months, or even years, for lawyers to complete.  Based on the personal credibility established during previous deals between Mr. Buffett and his counterpart, both parties felt secure that the other was working honestly and in good faith.  As a result, the monumental deal was completed in a few short months.

In the movie The legend of Bagger Vance, Rannulph Junuh, played by Matt Damon, is the local favorite locked head to head in competition with the two greatest golfers in the world.  Having trailed for much of the match and now tied with the pros, Junnuh hits a ball into the rough.  “He has a chance to win the match on the final hole but has the integrity to call a penalty on himself when his ball moves after he tries to remove a loose impediment.” (wikipedia).  A young boy and eager fan implores him not obey the mandate, saying, “But nobody saw it move.”  Junnuh replies, “I saw it.”  Honesty and integrity provide credibility, and Rannulph Junnuh had both. Sometimes personal integrity leads to an immediate loss, but it always creates a long-term winner.  You will have to watch for yourself to see who finally wins the match; however, the young golfer’s high ethical standards set a precedent that would build a foundation for honest dealing beyond the golf links.

Follow the example from Bagger Vance and build relationships like those of Mr. Buffett by focusing on behavior to boost your credibility.   Incorporate the following behaviors into all your interactions and establish yourself as an honorable trusted person in all that you do.

Be honest. The call for honesty appears so often in self-help articles that it is almost a meaningless cliché; however, without honesty there can be no trust and without trust, there is no credibility.  A retired used car salesman whom I’ll refer to as Pompous Patient, told me, “If a used car salesman told the truth, he would never sell a car.”  Do you want to do any kind of business with a person who is a professional liar?  In your leadership transactions, move beyond mostly honest and establish a goal of totally honest.  Admit your mistakes and assess yourself a penalty when needed.  Total honesty also involves refusing to turn a blind eye and proactively holding those around you responsible for following established standards.

Deliver results.  It’s easy to volunteer and say yes when someone is needed to tackle a project; however, saying yes puts your integrity on the line.  Credibility is established when the task comes to fruition in a timely manner and achieves the desired outcome.  Protect your reliability by refraining from over-promising and treat all tasks, large or small, as opportunities to deliver results.  When you agree to perform, keep your word and deliver.

Be transparent.  Credible people have the courage to share information, both good and bad, to those who have a need to know.  Trying to shield those around you from bad news is a losing proposition. When you’re the messenger of bad news, put it into context by discussing the reasons behind the decision. Eventually, people always learn the truth and if you have not been forthright, they will have good reason to doubt you in the future.

Be consistent.  Human beings, including your colleagues, thrive on routine and are more relaxed and trusting when the behavior around them is predictable.  By making certain that policies, procedures and rules are known by all and equitably applied, predictability is reinforced.  When administering discipline is required, it must be appropriate for the offense and be meted out evenly to every offender.

Be principled.  Situations change but guiding principles remain constant.   What are the principles that you stand for and guide your deciaion-making?  If you need your consciousness raised, go to jamesclear.com to review a list of values, select 5, and practice, practice, practice.   Your credibility is enhanced when others observe that consistent, principled behavior is who you are and not just something you do.

Lead by example.   Imagine yourself with impeccable credibility and then be the person you visualize.  It’s easy to want or intend to be honest, trusted and credible, however intentions do not change reality.  Personal credibility can only be present when people know your integrity not by what you say, but by what you do.  Your behavior is being observed and will determine the reputation that you create for yourself.

Credibility is a visualized, rehearsed, observed, taught, role-modeled behavior that, lucky for leaders, can be learned. It is often said that we are who we are when no one else is watching. If you consistently set high standards for yourself no matter who’s in the audience, you will earn the reputation of a straight-shooter with whom people want to do business.  You will garner respect and trust, the key components of credibility.

 

Tom is a noted author, speaker and team builder

The Listening Leader

The Listening Leader

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

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listening

 

Leaders who listen are positioned to build productive teams.  According to the Harvard Business Review analysis of employee engagement and productivity, employees are 31 percent more productive with 37 percent higher sales on average when they are happy or satisfied.  Building a happy, satisfied team of employees is multi-faceted and based on the worker’s perception of being valued and respected.  At the core of feeling valued and respected is the perception of being heard by leadership, that “my opinion matters.”  Ergo, effective leaders listen.

 

Writing in Inc.com magazine, author Samuel Edwards offers 6 tips for enhancing employee satisfaction.  At the top of the list is listening.  Edwards emphasizes the importance of listening when he says, “By listening to your employees, you show that you respect their opinions and truly value them as part of the organization.”  The same can be said of the importance of listening to your clients as evidenced by the 2013 report issued by CMS that indicated 6 in 10 patients stated that they were not listened to or respected.  Satisfaction is enhanced by Value and Respect.  Sound familiar?

 

In a recent Prosynex on-line webinar for CRNA leaders, we discussed listening as a powerful tool for leaders who are intent upon building a productive team and preferred workplace.  We had a stimulating dialogue regarding the levels of listening, after which, we reviewed techniques for improving listening skills.  Below is a summary of our discussion of the three articles covered in the webinar.

 

Team members seek the attention of the leader and want to share personal or professional thoughts with the expectation that they will be heard; but, if the leader’s mind is elsewhere, both people walk away empty.  In our first article from the Black Swan group, Derek Gaunt notes that there are 5 levels of listening:

Level 1   Listening for the gist   The listener’s mind is elsewhere while the person is talking.  The listener may nod and say, “ya, ya” as the person talks but very little is absorbed.  If the listener is texting or checking email while talking, the speaker is tuned out.

 

Level 2   Listening to rebut   The listener is actively preparing a reply as the person is talking.  The listener is more intent on defending his/her point of view than learning about the issues motivating the talker.  The listener learns nothing new and the talker walks away feeling invalidated.

 

Level 3   Listening to logic   The listener is aware of both the words that are being spoken as well as the logic driving them.  Without the need to be defensive or rebut the talker, the listener is able to learn new information and gain insight into the speaker’s point of view.

 

Level 4   Listening to emotion   The listener is aware that many issues emerging to the surface are triggered by emotion.  Moving beyond the logic of the points being made allows the listener to observe body language and voice inflection that may reveal any underlying emotions, such as fear or anxiety, at the core of the concern.

 

Level 5   Listening for the greater world view   The listener walks away with an awareness of the foundational values that the speaker.  During the conversation, the speaker may leave clues about whether he/she is liberal, conservative, religious, financially responsible and many other basic personality traits.

Our consensus during this part of the Prosynex discussion was that “most leaders tend to listen at levels 1 and 2.”  But, by semi-consciously tuning out, or consciously rebutting a speaker, the leader shows disrespect and misses a valuable opportunity to connect with team members.  Avoid assuming a defensive posture and move to the preferable next step of listening by attentively tuning in to the logic behind the other person’s words.  Effective listening is respectful and empowering for both parties.

 

We pursued this pithy discussion by reviewing 6 tips for becoming a more effective leader as suggested by author, Glen Llopis, in Forbes magazine.

  • Show that you care. Have a physical presence with your team and take an active interest in their concerns.  When people talk to you, give them your full attention and never allow yourself to be distracted with mobile devices while listening.
  • Engage yourself. While you are interacting with your team, ask members for their opinions.  Many people wait until they are asked before sharing.
  • Be empathetic. Problems affect people on a personal level and an emotional one.  Commonly, issues are either triggered by emotions or the issue triggers an emotion.  Either way, learning to sense the subtle non-verbal signs that accompany a person’s words will increase understanding and reinforce the perception of being heard.
  • Don’t judge others. One of the quickest ways to cut off dialogue is to tell the other person that he/she is wrong and why.  If you don’t have all the facts, pre-judging ensures that you won’t get them.  Listen attentively even if you think the other person is wrong.
  • Be expansively mindful. Put the other person’s words into the context of their environment, personal background and emotional state.  Imagine how you would look at a problem from the other person’s point of view.
  • Don’t interrupt others. Just like being judgmental, interrupting will shut the other person down.  You know what you know, and nothing new is learned by interrupting and stating your point of view.  Resist the urge to be the expert leader and be the expert listener and learner instead.

 

The giants in leadership agree:  Employee happiness and sense of self-worth affects their commitment to the job and ultimately, productivity.   It is no accident that effective listening will enhance scores in 6 of the 12 identified on the Gallup Q12 employee engagement survey.  Effective listening is at the core of effective leadership.  Show each member of your team that he/she is valued; be a listening leader.

 

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

Kotter, for a change

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

  Follow @procrnatom on Twitter

managing change

 

     “Change is the only constant in life.”  

– Herculitis, Greek philosopher (535 BC – 475 BC)

We know that change in the workplace is unavoidable and that it can sometimes be painful, making people cling tightly to the secure comfort of status quo.  Savvy leaders know that modifying and implementing new policies or guidelines is inevitable and to make the changes less difficult, they find ways to rally the team.

Writing in the Forbes.com blog, author, Larry Alton, agrees with the Greek philosopher and recommends addressing change head on.  Culture evolves based on relationships.  Therefore, to achieve a successful rollout of a new policy or plan, it is essential to build an energized team of individuals who can accept variation and take the lead during implementation.

John Kotter, professor emeritus at the Harvard Business School studied both the necessity for and the resistance to change.   In his book, Leading Change (1996), the Kotter 8-step model for managing change is presented as a thinking framework to smooth the process of making modifications in the workplace.  Repeatedly and successfully used in business, industry and healthcare, the Kotter model can be applied to just about anything that requires transformation.  Here is an example of how we used this dynamic, interactive model to improve the workflow at our ambulatory surgery center.

One of the myths that our ASC embraced is the belief that every female patient who is not post-menopausal must have a pregnancy test before receiving anesthesia.  Being a fast-paced GI center with rapid patient turnover, any delay caused by waiting for a urine specimen slowed the work flow and ultimately caused subsequent patients to experience delays.  Many of our patents have zero likelihood of being pregnant and the drugs we use pose no risk to the pregnant patient, therefore, many on our staff felt strongly that it was time to change the policy. A grassroots movement was emerged and we were well on the way to fulfilling the requirements of the first step on the Kotter model:

  • Create urgency Often when things don’t seem to be quiet right, the initial response is “somebody ought to change that” and the sentiment quickly progresses to “we gotta fix it.”  At our ASC, Doctors, CRNAs and nursing staff all complained about delaying cases while awaiting a pregnancy test.  The concerns of the staff were reinforced by negative feedback from patients when they were solicited to evaluate their experience at our center.  Specifically, evaluations from patients expressed dissatisfaction with the ASC due to the required pregnancy test.  ASC staff and managers sensed urgency to change the policy and we collectively agreed that we WILL address the issue head-on and take corrective action.
  • Form a powerful coalition There is strength in numbers.   When building a coalition to support a proposed change, it is important that all stakeholders are on board with the new plan.  Building a coalition involves gaining consensus among your peers who share your view point as well as from collateral professionals who look at the same problem from a different perspective.  Our coalition of stakeholders included doctors, nurses and support staff; all of whom were included in the development of the new policy to modify our current practice.  Patients were the ultimate stakeholders and, although we took their feedback seriously, we did not include them in revising the policy.
  • Create a vision Having identified the problem, we clearly knew what we didn’t want:  Unnecessary testing that slowed the workflow without adding value to the process.  We turned our attention to what we did want:  A policy that maintained patient safety, facilitated workflow and elevated patient satisfaction.  After a “best practice” review of the literature to ensure that we were on solid ground, our efforts were rewarded when the new plan was developed to support our goal.
  • Communicate the vision  Before implementation, the new plan was shared with every worker at the ASC through email and informal discussions.  The sense of urgency already in place from step 1 smoothed the process of sharing the plan with the entire group.  The ASC team quickly embraced the vision that would improve workflow and patient satisfaction.
  • Remove obstacles There were very few obstacles for our proposed change.  Knowing that involving stakeholders would increase buy-in, we reduced potential resistance by making sure that everybody was kept informed.   In addition, we made sure that everybody knew that our new policy was in line with safe practice.
  • Create short-term wins This was a change to a local policy and it did not have a big impact on the organization, so the sense of achievement was confined to our workgroup.  We gave recognition to those who were instrumental to developing the plan; however, the nature of the project did not warrant a major celebration.
  • Build on the change The Institute for Healthcare Improvement (IHI) recommends the plan, do, study, Act (PDSA) model for improving a plan.  The PDSA model involves implementing a pilot plan, evaluating the results, modifying the plan and re-implementing a better version which, hopefully, will produce even better results.  Our plan improved the overall workflow by eliminating mandated pregnancy testing and had the collateral effect of improving patient satisfaction.  Success with this project motivated us to look at other workflow issues and seek ways to make further improvements.
  • Anchor the change in corporate culture “That’s the way we’ve always done it,” does not mean that it’s still the best way, nor does it mean that we must to continue a non-productive practice.  Our new corporate culture includes the knowledge that grassroots initiatives are received in a positive light and that change can be initiated by any person in the organization.

Eliminating the need for every female to receive a pregnancy test before undergoing anesthesia is only one example of the use of the Kotter model for introducing and managing change.  What is the greatest need for revision in your organization?  Take time to pre-plan and practice the Kotter model when change is required.  Apply it chronologically, one step at a time.  It will be self-defeating to build a coalition before creating the sense of urgency or trying to implement a vision without first developing a plan.  Embrace transformation and proactively use Kotter’s model to reach your desired outcome.

Heraclitus observed that change is inevitable, but he did not say that change is a bad thing.  The great philosopher also said, “You could not step twice into the same rivers; for other waters are ever flowing onto you.” Today, one thing that has not changed over time is that the only constant is change.

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