Tag: Nursing leadership

Ace your video interview

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

Ace your virtual interview

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

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

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

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

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

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

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

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

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

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

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

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

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

~John Maynard Keynes

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

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

Inclusion; The key ingredient for successful diversity



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

Diversity versus Inclusion; what’s the difference?

Diversity

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

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

Inclusion

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

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

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

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

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

Avoid subtle forms of exclusion

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

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

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

Build an inclusive workplace culture

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

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

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

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

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

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

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

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

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

Diversity and Inclusion

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

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



Setting the Standard

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Standards are essential

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

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

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

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

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

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

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

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

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

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

Look beyond the horizon

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

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

Future standards of care

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

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

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

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

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

Change the status quo by raising your standards

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

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

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

Life lessons for leaders

By Thomas Davis, DNAP, MAE, CRNA

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

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

You are only a leader if others are willing to follow

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

You must be present to win

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

Protect your reputation

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

Be good to people and build good relationships

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

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

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

Establish your health early and maintain it for life

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

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

Invest wisely

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

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

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

Can you hear me now? Communicating in the COVID workplace

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

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

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

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

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

Communicate clearly in the COVID workplace

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

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

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

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

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

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

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

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

4 Keys to eliminating disruptive behavior

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Disruptive behavior is a killer

Disruptive behavior kills team morale and productivity in several important ways, some more obvious than others.  When unsettling behavior is allowed to continue, tension and anxiety become the mood of the group.   Even worse, constant complaining is often contagious and can cause some co-workers to respond with, “If you think you have it bad, this is what happened to me.”  Disgruntled workmates may overtly retaliate and respond with anger and acts of sabotage.  Eventually, the team will break down and become totally dysfunctional.

Adding to the problem are the less obvious negative effects of disruptive behavior; workers risk their physical health as they lose sleep or begin unhealthy activities to cope with the workplace stress.  When animosity builds and collaboration breaks down, there is an increased risk of injury both for the workers and the clients they serve.  In addition, the organization suffers when productivity drops, clients become dissatisfied and the most talented members of the team find a new job.

Have you worked with these people?

Supertech’s story   A surgical technician, working in a busy surgery center, happens to be exceptionally good at her job.  She is also the most predictable person employed at the center, but not in a good way.  Supertech has a toxic personality and you can count on her to deflate the morale of the group daily.  At every opportunity, she dominates the conversation and dwells on one of several topics – problems in her personal life, inept co-workers, incompetent management. While her skills are respected, her mere presence creates an undercurrent of tension that is exhausting to her colleagues and damages the entire group. 

IckyU’s tale  At a nearby hospital, an experienced ICU nurse who wants what he wants when he wants it has scant tolerance for disappointment.  Because he needs people to like him, he remains pleasant with a smile on his face, uses an agreeable tone of voice, but relies on passive-aggressive behavior to give pay-back and reek workplace havoc.  Once a co-worker is on his bad side, he will intentionally withhold both information and assistance because he takes pleasure in watching others struggle and fail.  Both IckyU’s insidious sabotage and Supetech’s in your face attitude keep the pot stirred at their respective workplaces and both damage the team.

“Peace is not absence of conflict, it is the ability to handle conflict by peaceful means.” ~Ronald Reagan

Types of disruptive behavior

It is easy to address a problem that is seen and known by all.  Overt acts such as harassment, bullying and aggressive behavior are easily witnessed and documented, and the leader has tangible reasons to hold the perpetrator accountable for his/her actions.   Addressing covert acts such as those displayed by the disgruntled ICU nurse is more challenging but equally necessary.  Writing for Chron, Author Molly Thompson identifies the following as behaviors that upset the team:

  • Bullying
  • Harassment
  • Tardiness / absenteeism
  • Gossip/bad attitude
  • Insubordination
  • Know it all
  • Primadonna
  • Office romance
  • Personal issues

When left unopposed, these negative forces form a powerful vortex that sucks the life out of the team and the workplace.

            Keys to combating disruptive behavior

Problems seldom go away on their own.  Leaders have a choice between stopping a bad behavior when it first emerges or dealing with it later after it kills the spirit of the team.  Anticipate that perpetrators will use every possible excuse to rationalize their behavior so make sure your facts are correct before jumping in to call a foul and hand out a red card.  That said, do not let analysis paralysis prevent you from taking necessary action.  Try these four actions to help you confront and address issues created by the problem child on your team.

Listen  Those who lack courage or power to address issues head on will fight back via passive/aggressive behavior and sabotage.  The essential first step toward correcting the situation is active listening because the feeling of not being heard, understood, or respected leaves a person feeling unappreciated and powerless.  You do not have to agree with or pacify the person, but you must actively listen before acting.  Showing empathy and clarifying misunderstandings will often convert an enemy into an ally.  Sometimes, just feeling as if he/she is understood is enough to defuse anger and modify behavior.  

Review the purpose of your team.  When there is an overall negative vibe throughout the group, the problem will not go away until the culture changes.  Call a team meeting to discuss the need for common courtesy and collaboration in the workplace.  Ask leading questions such as, “How would we behave if we truly respected one another?”  “What behaviors do we need to either promote or eliminate in order to demonstrate collaboration and appreciation?”  Allow your team to develop lists of desired and taboo behaviors and use those lists for step 3, developing a code of conduct. Note: do not be surprised if  your team puts some of the behaviors of your bad actors on the taboo list.

Develop a code of conduct.  Build on the feedback from the team and develop a code of conduct for your workplace.  The code must outline behavior that is expected when staff members are working with each other and with your clients.  Print the code on a form with a signature block and invite team members to sign a pledge to use only positive behavior.  Once done, challenge team members to hold one another accountable for abiding by the new rules that they have helped to create.

Enforce zero tolerance.  Once the groundwork has been completed and the stage has been set for a culture change, assume that you will be challenged.   If disruptive behavior continues, have a formal one on one talk with the person, review the code of conduct, and then tell the person, “If this code is not you, this is not your job.”   As you build your team, discuss the code of conduct with each applicant to ensure that he/she knows up front the expected behavior in your workplace.  Have applicants sign a pledge to adhere to the code of conduct as a condition for joining the team.

Some leaders inherit troublesome workers like the scrub tech and the ICU nurse when they sign on to be the boss; others watch behavior deteriorate over time as one bad apple ruins the bunch.  Superteach trash talks everybody around her, insists that she is a victim and drags down anybody who will listen.  IckyU is more elusive and acts out his victim role by sabotaging the group and by being unwilling to work collaboratively.   Both behaviors are disruptive and violate a normal code of conduct for a collegial workplace.  Build upon the consensus of those on your team who want to create a positive culture and take a stand against bad behavior.  Have some courage, do the right thing, and disrupt the disruptors.  Both you and the others on your team must be allowed to do your job without the anxiety caused by unruly workers.

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

Get Results

By Thomas Davis, DNAP, CRNA

Follow @procrnatom on Twitter

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

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

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

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

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

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

How to Achieve Results

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

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

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

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

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

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

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

Tom is an experienced leader, author and requested speaker. 

When it’s up to you



By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on Twitter

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

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

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

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

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

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

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



Welcome to Club 85

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Preface to Prevention

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

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

Club 85

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

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

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

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

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

Connect the dots

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

Preparation for Prevention

Exercise

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

Nutrition

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

Hydration

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

Sleep

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

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

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

Tom is an experienced leader, author and requested speaker. 

COVID 19; A Call to Leadership

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

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

Leadership is essential

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Get wise to the elderly

Get wise to the elderly

Follow@procrnatom on Twitter

“Age should not have its face lifted, but it should rather teach the world to admire wrinkles as the etchings of experience and the firm line of character.”  ~Ralph Perry

Statistics reported by the Population Reference Bureau revealed that in 2016 over 51 million Americans were over the age of 65, and it predicts that the number will increase by over 50% in the next 20 years reaching 78 million by the year 2036.   This precipitously increasing demographic has implications for current healthcare leaders related to how we interact with our customer base and how we prepare our teams to meet the challenges that accompany the aging population.  If there were ever a fertile ground for honing leadership abilities, this is it.  The rapidly expanding elderly population is a veritable gold mine of opportunities for leadership skill development. 

Emotional intelligence

Emotional intelligence remains a buzz word in the human resources/management community. A highly desired skill for leaders at all levels, it has an internal component that requires you to  gain insight about your personal emotional reactions and their effects on others, and an external component that requires the development of social awareness and of skills related to relationship management.  Working with aging patients opens the door for a leader to connect with and gain social awareness about the features that make this population unique.  Learning to relate to one demographic smooths the path and makes it easier to learn about other populations of patients.

Take a sincere interest, ask questions, listen

Older patients are full of amazing stories and will eagerly share if asked.   Expand your listening skills by asking questions and then listening to the stories that emerge.  Your 74-year-old patient who is next in line for cataract surgery may be the one who scored the winning touchdown in the 1970 Rose Bowl; his wife (and designated driver) might have been a flight nurse evacuating casualties from Viet Nam.  You won’t know until or unless you strike up a conversation.  When you have time to chat with boring old people, consider the following:

  • Those now in their 70’s were the students marching for civil rights in the late 60’s and were back in the streets marching for women’s rights in the early 70’s.
  • Senior citizens were born into a world with hard-wired phones and TV sets connected to an antenna on the roof and receiving only 3 channels.
  • Many Seniors remain actively attached to social activism in the form of “volunteer” at hospitals, museums, schools and civic events.
  • Seniors have traveled to your bucket list places and many have interesting hobbies.
  • Those in their 80’s were children during World War II and remember the air raid drills, food rationing, nighttime blackouts and energy conservation.  Some had relatives who did not return from battle. 

Emotional intelligence involves connecting on a personal level and getting to know the other person beyond the information published in their medical records.  Start a chat session by asking your gray-haired patient a general question about events that happened while he/she was a child and be prepared to hear wonderful, perhaps astonishing, stories.  In my daily clinical practice, I regularly discover what is currently important to them by asking, “Tell me something about yourself that is not on your medical record.”  Often, the answer is tied to their personal identity and response you get may take you by complete surprise.  

Establish best practice guidelines based on physiologic changes

Managers typically publish policies and guidelines related to best practice recommendations.  Subsequently, it is incumbent upon leaders to build a team of knowledgeable workers who want to follow the guidelines and deliver the highest quality of care to all age populations, including the elderly.  When working with your team to create best practice protocols, consider these physiologic changes that are common in the elderly.

  • Cardiac   Atherosclerosis is common in the elderly American population and arises from a lifetime of smoking, hypercholesterolemia, hypertension, type 2 diabetes and obesity.  The result is ventricular hypertrophy, with reduced ventricular compliance, contractility and cardiac reserve.  Normal doses of induction drugs take longer to circulate and may produce significant hypotension.
  • Renal   Glomerular filtration is reduced as is the ability to regulate sodium and potassium.  The kidney is less able to concentrate urine and may have difficulty removing free water from the system.   Elderly patients are less tolerant of hyper or hypovolemia. Drugs dependent upon renal clearance have a longer duration of action and smaller doses are required. 
  • Pulmonary.  Like an old rubber band, the lung loses elasticity with age.  Combined with reduced chest wall compliance, one can expect a reduction in FVC, FEV1, and VC as the person’s age increases.  Small airway collapse is common and presents problems with VQ mismatch.  The elderly patient is at a greater risk for atelectasis and impaired diffusion of gases.  Anesthetic techniques that further suppress ventilation put the elderly patient at risk.  Volatile anesthetics require more time to leave the system and should be used sparingly in reduced doses.
  • Nervous system.   Both vision and hearing diminish as the person ages and eye-related procedures are common in this demographic.  Autonomic nervous system dysfunction makes the elderly patient more susceptible to labile blood pressure and postural hypotension.  In addition, thermoregulation is impaired in the elderly patient making him/her more susceptible to hypothermia and less able to mount a physiologic response.
  • Cognitive dysfunction.   Altered mental status is a common fear among the elderly and causes concern for those awaiting anesthesia and surgery.  For many, the fear of mental decline exceeds the fear of death. Slowed drug metabolism/clearance, hypotension, hypothermia, and hypoxemia are all listed as potential causes of POCD.  More recently, neuroscientists have correlated the inflammatory response with cognitive dysfunction.  Attention to detail and strictly keeping the patient within physiologic parameters will reduce the incidence of POCD.  Opioid-free multimodal anesthesia with little or no volatile agent is the technique associated with the least amount of POCD.

Begin with a thorough pre-operative evaluation and then the development of a plan that addresses the specific needs of each patient.  In general, elderly patients do best when the anesthesia provider has a is gentle and provides a slow induction with plenty of time for drugs to circulate.  A regional nerve block with sedation is preferred over general anesthesia, but when general anesthesia is the only option, a propofol based TIVA technique that includes multimodal pain control and anti-inflammatory drugs is the least likely to cause respiratory compromise or cognitive changes.   Opioids and inhalation anesthetics should be avoided if possible, in the elderly patient.

Leadership

Embrace the rich history and learned wisdom of your simultaneously interesting and fragile older patient by tuning in to their special needs.  Conduct meetings with your team to review the physiology of the aging and mentor them to work collaboratively in developing best practice guidelines.  Listen carefully to elder patients and hone your skills at understanding, treating and enjoying the elderly population.   Lead by example and become aware of the fears and concerns, the strengths and the joys that each of your elderly patients brings to the operating room.  Some day you, too, will be older, maybe even wiser. 

Tom is an experienced leader, author and requested speaker. 

The Future of Healthare: 2020 and beyond

 

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Crafty clairvoyants claiming 2020 vision, can’t wait for the New Year to arrive so they can capture the spotlight and publish their predictions.   However, history reveals that although forecasts from the know-it-all pundits may have sounded logical, many predictions completely missed the mark.  For example:

 

  • In 1876 Western Union Telegraph stated that the telephone had too many flaws and zero inherent value, LOL.
  • In 1954 radio host, Eddie Bond, advised Elvis to keep his day job, predicting the soon-to-be-heartthrob would never make it as a singer. And eight years later, Decca Records opted not to offer the Beatles a recording contract, publicly predicting that guitar music was on the way out and Beatle music would never sell.
  • 50 years ago, when Neil Armstrong took the first steps on the moon, prognosticators said that within 50 years we would have a colony on the moon and that shuttles would take vacationers back and forth. I enthusiastically bought into that concept but have yet to receive my boarding pass.
  • Again in 1954The National Cancer Institute stated that even if excessive smoking played a role in lung cancer, it was only a minor role.
  • In 1988, Dr. Thomas Neff proposed that the newest medical technology – pulse oximetry – would be considered as a basic vital sign along with blood pressure, pulse and respirations. The experts of the day predicted that within 5 years pulse oximetry would eliminate hypoxic brain injury yet, today hypoxic brain injury continues to be a cause of anesthesia related death.

 

Predicting the future is not a foolish pastime; visionary leaders keep a step ahead of the competition by looking over the horizon.  That said, the future is seen through the lens of today which distorts the view of the world that is yet to exist.   Prognosticators use current trends to create a logical foundation which guides the predictions of the world’s wizards, whom I am about to join.

 

In the spirit of full disclosure, I do not possess psychic abilities, nor have I won awards for my spot-on insight into the future.  Rather, I have spent the past several years working full time providing anesthesia, reading professional literature, publishing, speaking and observing trends in healthcare delivery.   Based on emerging technology and current trends, here is what I see when I read the Crystal Ball.

 

Artificial intelligence    Simply put, artificial intelligence (AI) is the use of computer systems to perform tasks normally performed by humans such as visual perception, speech recognition and decision-making.  Computers are being trained to read X-rays better than a radiologist and to read tissue slides better than a pathologist.  The Johns Hopkins has developed and deployed the TREWS system that utilizes AI to detect early signs of sepsis in ICU patients, and other organizations are developing complex AI programs that allow the computer to take a deep dive into medical records and identify trends that predict future healthcare needs for individual patients.   Writing for builtin.com, author Sam Daley gives 32 examples of current uses of AI in healthcare.   Tom’s Crystal Ball reveals an expansion of AI to include computerized a pre-op record review for each patient followed by a prescription for the ideal anesthetic to include choice of anesthetic technique and ventilator settings.

 

Robots    Machines that can replicate certain human functions are referred to as robots.  Factory assembly lines currently use robotic arms to accomplish tasks previously done by human appendage.  The push for automation is extending beyond the factory and managers are actively identifying human functions that can be replaced by machines.   Currently, a robot called TUG is being introduced into the hospital environment.  The TUG device uses programmed maps and complex lasers to navigate its way through the hospital, delivering food and supplies where needed.  Tom’s CB believes that within 5 years, self-directed delivery carts will be commonplace in hospitals.   Indeed, large organizations with multiple buildings covering a medical campus will employ driverless vehicles to transport patients from the parking area to their designated appointment.

 

Pharmacogenetics   The use of the patient’s individual genetic profile to predict their response to drug therapy is termed pharmacogenetics.   For example, anesthesia lore includes the belief that those with red hair require higher doses of anesthesia.  Pharmacogenetics has confirmed that notion and identified the actual genetic cause for the increased anesthetic requirement in red heads.  TCB shows an expansion of pharmacogenetics that includes obtaining cells via a cheek swab on all pre-op patients.  The cells will then be given to AI to determine the patient’s genetic profile and the appropriate prescription for anesthesia will be generated; based on the person’s DNA profile, specific drugs, doses and re-dose intervals will be recommended.

 

Disease targeted anesthesia care   The protocol for early recovery following bowel surgery and the trend for opioid sparing anesthesia technique has shattered the historic one size fits all approach to anesthesia care.  Tom’s Crystal Ball reveals an expansion of anesthesia techniques designed to address patients with specific risks.  For example, anesthesia techniques to reduce recurrence of cancer and protocols to reduce the risk of post-operative cognitive dysfunction are two areas currently being developed.  Over the next few years, additional medical conditions will be targeted for the development of disease specific anesthesia protocols and AI will be used to connect the dots and ensure that every patient receives the best possible combination of drugs.

 

There you have it.  My predictions may prove to be spot-on, or they may result in a disappointing mis-read of the tea leaves.  Robots and AI may join the moon colony in the junk pile of bad predictions, or they may usher in the future generation of healthcare.  But regardless, I think we can all safely predict that Beatle Mania is here to stay.

 

Tom is an experienced leader, author and requested speaker. 

Workplace champions

champion post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

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

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

~businessdictionary.com

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

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

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

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

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

So, you want to be a champion…

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

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

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

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

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

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

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

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

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

~ Martin Luther King Jr.

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

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

Feel the Burn

burnout post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

 

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

 

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

 

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

 

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

 

 

 

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

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

 

 

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

 

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

 

What the worker can do

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

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

 

 

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

~Ariana Huffington

 

 

What the leader can do

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

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

 

 

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

 

 

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

 

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

 

Artificial Intelligence; Be a Transformer

AI vs leader post

By Thomas Davis, DNAP, MAE, CRNA 

 

Follow @procrnatom on twitter

 

The exponential growth of AI (artificial intelligence) has proven that computer-driven software and robotic hardware are the future for business and industry, including healthcare.  Factoid:   People cost a lot of money and a growing number of jobs can be done better by computers or robots than by expensive humans.  Replacing us with AI is a no-brainer.   Writing in ddiworld.com, author Menggiao Liu, Ph.D. notes that by the end of 2020 five million jobs will be replaced by technology and that by 2055, fifty percent of workplace activities will be automated.  From trading online to driving driverless cars, to robotic assembly lines, the need for human decision-making and skilled labor is vanishing like a wave at high tide washing up on the beach.

 

Our healthcare industry has always considered itself immune from the threat of job loss due to technology; however, that will rapidly change over the next decade in a number of ways.  Much of it is already evident in the places you work. As scheduling becomes automated, fewer office staff will be needed to coordinate patient visits.  Electronic records that feed into the billing department will continue to reduce the need for medical coders.  AI analysis of patient records will detect changes in the patient’s condition early in the hospital stay and recommend treatment long before the person becomes seriously ill.  With AI driven protocols, the length of hospital stay will be shortened as will the need for nurses to staff the diminished patient load.  As AI proves its ability to read tissue slides and X-rays faster and more accurately than pathologists and radiologists can, fewer physicians in those specialties will be needed.  Even the field of anesthesia will be affected by technology as AI uses pharmacogenetics to prescribe and administer the perfect anesthetic based on the patient’s specific gene composition.

 

The transition from a human to a digital workforce raises the question,

“What happens to the leaders?”

 

Those who have an eye to the future believe that leadership will always be essential.   Traditional leaders focus on getting the team to do tasks that AI and robots will do in the future.    Leaders of the future will focus on connecting one on one with workers and forming an important bridge between those who directly serve the clients and upper level administration.   Moving into the technology-based future, traditional leadership will transform into a new style that welcomes and capitalizes on technology while maintaining a focus on the so-called “soft skills” that the computer lacks.

 

Technology, including AI, is here to stay and institutions are investing millions of dollars to position themselves ahead of the competition.  Employers expect their leaders at all levels embrace and utilize the new technology to the fullest extent of their capability.  Moving forward, it is essential to leverage the things that AI can do better than human workers.

 

What AI does best

Gather data   AI isn’t limited by the time and hassles of a manual literature or data search.  It can connect to every article ever written on a subject and collect large volumes of information in a short period of time.   Likewise, AI can filter information and gather data on a specific patient population or disease entity and sort data as directed.

Analyze data   In 2017, scientists at Mount Sinai trained AI computers by feeding 700,000 patient records into the system and then allowing the program to analyze and make conclusions.  They found that AI was very good at predicting disease including psychiatric disorders, in their patient population.   Similarly, the TREWS system at The Johns Hopkins uses AI in their ICU units to detect the earliest signs of sepsis, triggering treatment before the disease becomes life threatening.

Interpret results   Lab, X-ray and pathology findings have traditionally been reported as facts and reported as real numbers or descriptions. AI looks at slides and images, describes what is seen and then makes a diagnosis.  In addition, AI can look at trends and predict future diseases.

Recommend a course of action   Building upon interpreting results, AI takes the next step and recommends the treatment of choice based on best practice guidelines.

Implement a course of action   Depending upon the nature of the disease, AI can put recommendations into action by making follow-up appointments or scheduling future treatments with the proper specialists.

 

What Humans do best

Never fear.  R2D2 isn’t replacing you with its clever technical achievements, but you will have to compete to stay in the game.   Those who wish to emerge as the top leaders will need to focus on the human aspects of the job.  Leaders must demonstrate the instinct for what clients want from the organization and what workers need in order to ensure their continued engagement and loyalty.  Your job security will depend upon your skills in the following areas.

Emotional intelligence   As noted on Forbes.com by author Falon Fatemi, emotional intelligence starts with the ability to understand and control our own emotions followed by the ability to recognize, understand and influence the emotions of others.

Adaptability   Computers are programmed, whereas, people can sense their environment and the reactions of those around them.  As we are bombarded with fresh information, leaders must be able to capitalize on opportunities and learn from mistakes.  Being willing and able to change course based on new data will be a valuable strength.

Vision   As new technologies are developed in a parallel fashion, lasting leaders will be able to assess many different platforms and establish a vision that combines several modalities; and they will do so in a manner that best meets the expectations of the client base.  Mission statements will be revised to address needs as seen through the eyes of the consumer.

Professional development    A database can store information related to continuing education, but it takes one on one interaction with a worker to learn what is important to him/her and develop a plan for personal growth.  People mentor people and AI will have difficulty functioning as a counselor or a coach.

Humility AI is what it is; highly intelligent but programmed, sterile and lacking emotion.   Admitting errors and admitting that others may know more than you do about a specific issue introduces a human emotion that computers can’t match in the high-tech workplace.

Feedback    Computers spit out numbers and report discrepancies but lack the ability to determine the cause for non-compliance or help an individual chart a course to correct a problem.  When it’s time for the boss to have a difficult conversation with an employee, human interaction is essential.

 

The workplace of the future will be rich with technology and have instant access to large volumes of information.  Algorithms will quickly assess data and either suggest or implement an appropriate action.  Many of the hands-on tasks that were historically done by workers, such as scheduling appointments, billing for services, or ordering supplies will be automatically done by computers.  As the nature of the work shifts, so will the role of the leader.  Rather than competing with AI, a Transformer will focus on the elements of leadership that that a bot cannot; understanding, motivating and connecting with clients and workers.

 

Tom is an experienced leader, author and requested speaker. 

Contact Tom for an appearance at your next meeting.

Visionary innovation

visionary intelligence post

By Thomas Davis, DNAP, MAE, CRNA

Follow @procrnatom on twitter

Visionary leaders are hot commodity.  How can you go wrong with a leader who can see into the future and position an organization to stay one step ahead of the competition?

In 1995, Jeff Bezos saw the potential of the internet marketplace and visualized a virtual bookstore that would be open 24/7 and could deliver reading material either in print or online with the click of a mouse.  Naming the company after the famous South American river, Amazon books was established and rolled out from the founder’s garage in Seattle.  The Bezos vision expanded via the kindle reader eventually developing into the shopping market that we know today as amazon.com.

The creator of Amazon was not lucky nor was he unique.  There are other leaders in business and industry, including healthcare, who share the traits of a forward-thinking individual.  In working to build a better future for the clients they serve and for themselves, the more successful leaders are able to strike a balance between creative thought and observable action.  They listen keenly to clients and co-workers and use emotional intelligence to learn what people really want.  They establish a desired end point, formulate a plan, and work relentlessly until the goal is achieved.  They favor innovation, accept responsibility, and regard a setback as a learning experience.  “…glad we don’t have to do that again.”  In some cases, new technology must be created to address a need but at other times the leader with an eye to the future finds new applications for existing technology.  Bezos did not invent the internet or the bookstore; however, he did foresee that readers would flock to the convenience of online access to any book in print with immediate delivery to a mobile device.

 

CRNA inventor

Diane Miller is a pediatric CRNA and inventor whose life was changed by her inner drive to develop a playful way to initiate general anesthesia for pediatric patients.  Motivated by an experience inducing anesthesia on Zeke, a 4-year old “frequent flyer” with PTSD from previous anesthetic inductions, Diane felt compelled to develop a lighthearted induction technique.  Rejecting the decades-old tradition of “cyclo-brutane” used on fighting children, Diane developed the Pedia device for induction of anesthesia.  Widely accepted by young children, it resembles a balloon with a whistle and makes induction of anesthesia entertaining for the pediatric population.  Pedia has been awarded a patent and has been cleared by the FDA.  The Pedia device is a game changer for pediatric induction of anesthesia and I predict it will quickly become the standard for our industry.

Diane’s story and device are featured on the pedia web site

 

Point of care ultrasound

Ultrasound imaging can identify the gender of an unborn child, determine the size and shape of a tumor or locate nerves prior to placing regional anesthesia.  However, the device comes in size extra-large and it frequently isn’t available where the patient is located.  These handicaps opened the door for Dr. Jonathan Rothberg to introduce an ultrasound system that did not require transport of a cumbersome machine to the patient’s bedside.   Rothberg selected a team with whom he shared his vision and together they worked tirelessly to create the butterfly point of care ultrasound device.  The device uses a standard sized ultrasound probe with quartz crystals and, uniquely, connects to a smart phone, pad or other mobile device to display the image.  The probe can be carried in a holder on the individual’s belt and literally anyone with a modern phone can keep a personal ultrasound system at their fingertips round the clock.

You don’t have to be an inventor to foresee uses for existing technology as evidenced by anesthesia leaders who have quickly adopted the butterfly system to enable immediate ultrasound images of their patients.  In addition to the obvious use of facilitating nerve blocks, the system is being used to assess gastric volume, vascular access, ventricular movement, pulmonary fluids, bladder retention or other conditions where an image could alter the anesthetic plan.  Those boarding the butterfly bandwagon appreciate the flexibility that comes with having immediate access to ultrasound images and forecast improved patient outcomes due to information gained by this creative device.

More information can be found on the butterfly web site.

 

Some think of visionaries as having a crystal ball while others picture the mad scientist busy inventing things in the workshop.  Although there may be a touch of truth to each stereotype, the truth is that most visionaries are ordinary people visualizing extraordinary things in order to solve both ordinary and extraordinary problems.  Their mantra is, “We can do better!” and their work ethic is indefatigable.  Sometimes, a new product will emerge, and other times new uses will be found for existing technology.  Jeff Bezos developed an online marketing system that has changed the world economy; Diane Miller developed a playful way to induce pediatric anesthesia, and Dr. Jonathan Rothberg put real time ultrasound imaging into the hands of every healthcare worker.  Now it’s your turn.  Use your visionary skills to discover resourceful ways for making the new technology a standard of care in the workplace.   Identify a need, imagine the best possible outcome, develop steps to get there, communicate your plan and work relentlessly until your goal has been achieved.  When the new standard has been set, you will join the ranks of visionary leaders.

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

Your Professional Meeting: Plan the Adventure

meeting post

By Thomas Davis, Lt. Col. (Ret.) CRNA, MAE, DNAP

 follow@procrnatom on twitter

Professional meetings are a golden opportunity to socialize and expand your network of colleagues while updating your knowledge and skills.  Originally published in 2018, this article has been updated to provide a roadmap for getting the greatest personal benefit from attending a state or national meeting.

 

If you’re one of those thousands of dedicated workers who’ve survived the intense summer heat, enjoyed and endured the daily demands of children on break and dutifully covered many extra shifts for your vacationing colleagues, it’s your turn to take a break.  Attending your fall state or national meeting enables you to combine business with pleasure while renewing old friendships and making new ones.  More importantly, planning for an upcoming meeting, places you in an advantageous position to learn more, to expand your network and to get optimal enjoyment during your post summer escape from the daily grind.

 

Organize

Prior to departure, spend some time on a google search. You can select the meeting based on location, content, name-brand speakers or proximity and ease of travel, but during or after selection, do a google search.  Activities in the area such as hiking, biking or walking may be appealing as well as dining, shopping or shows.  Tours, walking, biking or by bus, are typically plentiful at destination locations, and attending sporting events or meeting at a sports bar may be the perfect venue for renewing friendships with classmates. Every community is unique and history buffs, amateur archaeologists and birdwatchers may all discover something of interest in their pre-travel search.  If you’re including your family as part of a business vacation, be sure to include their interests in your google.  Whatever your pleasure, it has become incredibly simply to research and reserve the activities that will make the memory of your experience more than a blip on the radar.

 

Note:  Well before the flight, confirm your hotel and reserve transportation for arrival at and departure from the destination airport; review the meeting agenda and download the meeting app if there is one.  During flight, spend your time reviewing information regarding the meeting and local community to ensure that you take full advantage of both.

 

 

Some attendees are sponsored by employers and are required to submit documents for reimbursement while others pay out of pocket and need documents to claim a tax deduction.  Either way, “travel-by-tech” allows you to submit documents seamlessly.  Here are some tech tips for organizing your travel.

  • Use your phone to organize travel information that you will want at hand. Upload flight information and boarding passes as well as the airline’s customer service phone number. Using the note pad app, store the address and phone number of the hotel where you will be staying to simplify the process when Uber arrives.
  • Use your computer to set up a folder in the document section specifically for the meeting. The folder can have sub-folders for travel, lodging and daily expenses and for personal expenditure.  When you book your flight and hotel, immediately drop receipts in the folder.   At the hotel check-out, request an email receipt and when it arrives, save it in your meeting folder.  Excel has several pre-made templates for spreadsheets to collect travel expenses such as meals or Uber fare; download and use them to simplify the tracking of reimbursable expenses.   I find it useful to create a word document that highlights flight, hotel and rental car information and then email the document to myself so that it is easily retrievable on my phone as I travel.
  • Stay current Functionality of our devices, especially phones, is developing and advancing almost daily. Yesterday it was email driven but today its app driven, and new phones and function are introduced annually. Stay ahead of the curve and don’t hesitate to try new and useful concepts.

 

Socialize   

Your professional meeting offers the gratification of renewing acquaintances with former classmates and coworkers along with the networking opportunity to meet national leaders and those who are recognized in education, innovation or leadership.  Your physical presence at a meeting makes it possible to match faces with names and achievements, as well as providing fertile ground for expanding your network of peers.  Be social at gatherings, extend a hand to the leaders of the organization and open yourself to the concept of connecting with new people who may add depth to your network.  Securing their information gives you more certainty that follow-up will take place.

Members of many professional organizations have created user groups on social media.  If you belong to an online community, consider scheduling and posting a user group meet-up to interact with one another during your educational excursion.

 

Customize

Although there’s social value in “Hello” and a handshake, the real value of networking is in establishing a conduit for connection in the future.  For starters, have business cards readily available.   To avoid packing a stash of newly acquired cards, create a business card photo album on your phone.  Once you’re back in your hotel room each day, take a snapshot of each business card you wish to keep and save them in your card photo album.  To by-pass using business cards, simplify and facilitate the smooth sharing of contact information by adding yourself as a contact on your phone and then quickly exchange information by sending your contact information directly to those whom you meet.  Remember, securing contact information gives both of you and your colleague more certainty that follow-up will take place.

 

Optimize   

Prior to the meeting highlight the sessions that are most appealing and seem most beneficial based on your personal interests and educational needs.  When two concurrent sessions capture your interest, enlist a friend to attend one talk while you attend the other, then share notes by phone call, phone mail, phone text or over a drink at dinner.

Scan the meeting room and try to sit with new acquaintances you have just added to your network. Getting out of your comfort zone adds to your confidence and satisfaction and enhances the stories you can tell when you return to work.  Everyone has worked with, gone to school with or served in the Military or on a committee with someone who turns up at a meeting.  Plan to enjoy the adventure and become part of the connection.

Optimize the time you spend with vendors by first assessing your department’s greatest needs for equipment before you travel then seeking out vendors with products that coincide with need.  The larger the meeting, the more eager vendors will be to introduce innovative equipment and updates to existing devices. Sign up for samples and demonstrations and if you discover a must-have, collect vendor contact and follow-up quickly after the meeting.

 

Summary

Whether your autumn plans include a national meeting, a state gathering or both, your return on investment will be enhanced by pre-planning.  Beyond earning continuing education credit, a live meeting provides a wealth of opportunities to connect and grow professionally, and to have a great time doing it.

 

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

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.

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.

Atlas Shrugged again

Atlas post

By Thomas Davis, CRNA, MAE, DNAP candidate

 

Follow @procrnatom on twitter

 

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

 

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

 

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

 

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

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

 

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

 

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

Uncommon Courtesy

courtesy post

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

 

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

 

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

 

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

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

 

Courtesy matters

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

 

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

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

 

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

 

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

 

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

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.