Tag: Nursing leadership

Artificial Intelligence: The future is now

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By Thomas Davis, CRNA, MAE DNAP candidate

Follow @procrnatom on Twitter

 

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

~ Gary Marcus, Professor/scientist, New York University

 

 

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

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

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

Take an Exciting Glimpse Into the Future…

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

 

Sepsis

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

Disease prediction

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

Diagnostics

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

Anesthesia

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

 

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

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

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

Evidence Based Leadership

 

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By Thomas Davis CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

 

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

 

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

 

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

 

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

 

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

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

 

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

 

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

 

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

Older workers strengthen the team

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By Thomas Davis, CRNA, MAE, DNAP candidate

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

 

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

 

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

 

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

 

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

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

 

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

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

 

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

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

Prevail over office politics

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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

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

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

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

 

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

 

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

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

 

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

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

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

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

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

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

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

 

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

 

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

Boost your credibility

 
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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

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

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

 

Tom is a noted author, speaker and team builder

Compelling messages get results

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By Thomas Davis, CRNA, MAE, DNAP candidate

follow@procrnatom on twitter

 

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

 

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

 

Caution

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

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

 

Preparation is key

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

 

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

 

Capture the reader’s attention

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

 

Power Words make Power Mail

 

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

 

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

 

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

 

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

 

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

 

Tom is a clinical anesthetist, noted author and requested speaker

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

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

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

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

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

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

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

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

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

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

 

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

7 Tips for giving Negative Feedback

 

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

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

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

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

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

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

 

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

 

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

The Legendary Leadership of John Wooden

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Wooden Wisdom: 

3 lessons from a coaching legend

 

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

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

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

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

 

The Wizard’s Wizdom

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

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

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

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

Tom is a noted author, speaker and avid advocate

for healthcare leaders.

Scout out a promotion

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

 

 

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

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

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

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

The Scout Law

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

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

CRNA week 2019

 

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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

The AANA national headquarters in Park Ridge, Illinois is the nerve center of the organization and a hub for activity designed to enhance the practice of every CRNA and to bring credit to the profession.  The team of full time professionals at the home office work diligently to provide a broad spectrum of services for the members.

 

January 20-26, 2019 marks national nurse anesthesia week (CRNA week), a time to raise the flag in reflection and an opportunity for nurse anesthetists to celebrate and promote their profession.  In addition to giving recognition to CRNAs for the valuable service that they provide in the medical community, this special week also spotlights the importance of the professional organization in providing a foundation to support its members.

American Association of Nurse Anesthetists (AANA) is the professional organization representing over 50,000 CRNAs and SRNAs (students) the US.  This active, Chicago-based organization plays a vital part in uniting members, creating positive energy, establishing practice standards and ensuring the right of each qualified CRNA to work to the full extent of his/her capability.

Since it’s founding in 1931, the AANA has fulfilled a vital service to the members through its focus on uniting CRNAs, keeping them informed, and providing opportunities for each individual to experience a lifetime of personal growth.

  • Professional development. The professional practice division of the AANA is a repository of valuable information related to every aspect of the clinical practice of anesthesia.  The division publishes a professional practice manual and has sample policy/procedure suggestions for many of the common areas of practice.  In addition, the division sponsors workshops to address specific practice skills such as the use of ultrasound in the placement of nerve blocks.  Ewa Greenier, director of professional practice, welcomes queries from members and provides answers to common questions related to the practice of anesthesia.
  • Publications. An AANA journal is published and available both by mail and online to active members of the organization.  The magazine contains a wealth of evidence-based research including a journal course that provides continuing education credit.  The AANA Newsbulletin, is the printed platform for the AANA President and Board of Directors to update all of the members with timely information.
  • Annual Congress. Yielding still another opportunity for professional growth, the annual AANA congress provides the stage to personally hear from and talk with leaders in every area of practice, learning from the best.  Networking opportunities abound at the national meeting and post meeting follow-up extends the relationship throughout the year.
  • Professional support. The professional organization supports not only the clinical practice of the members, but the business aspect of practice through insurance and legal advice.  The AANA sponsors workshops designed to inform members about the business of anesthesia.
  • Research. An important aspect of being in a homogeneous consortium is the expectation that it will add to the body of knowledge related to their field of expertise.   The AANA Foundation plays a crucial role by sponsoring independent research related to the practice of anesthesia.  Foundation dollars have sponsored large-scale professional research to document the safety and cost effectiveness of CRNA practice and has also funded studies done by students.
  • Mentoring. Opportunities abound for experienced members to share their knowledge with neophytes via the AANA.  Adopting students at the Annual congress, sponsoring students at State meetings and connecting online are all opportunities for connecting and developing mentoring relationships.  Online webinars open the door for members at all levels of experience to learn from content experts related to every aspect of practice.
  • Jobs. Professional organizations are in a unique position to unite applicants with potential employers.  Job boards abound on State association web sites and meetings are fertile ground for those seeking employment to connect with the next boss.

 

Here’s what CRNAs are doing to celebrate CRNA week

The public relations department at the AANA and state CRNA associations work full time to promote the practice of nurse anesthesia and showcase the important talents that members provide to the patient population that they serve.   The PR department offers promotional material for CRNA week and offer suggestions to help local workgroups and state organizations promote themselves.   Below is a sample of projects designed to honor CRNAs during their special week.

Radio interview.   CRNAs from Mississippi and Alabama have been interviewed by local radio stations.  The on-air discussions highlighted the education and skills of CRNAs as well as the vital role that they play, especially in rural communities.

Video promotion.   The Michigan association of Nurse Anesthetists and the US Military are two organizations that have released videos to promote the profession year around.  Click on the names and view the videos.

Official proclamations by the Governor.   State associations from Illinois, Louisiana, Michigan and Mississippi have all received official proclamations signed by the Governors of their respective states.  By the time CRNA week arrives, the list will be much larger.

Legislator visit to the OR.   Members of the Texas association of Nurse Anesthetists arranged for local legislators to visit them at Northwest Hospital in Amarillo, TX. and learn about the important role CRNA play in rural healthcare.

Community service projects.  CRNAs tend to be generous with a desire to make their local communities a better place.  Community service projects ranging from local food kitchens and the Ronald McDonald house to high school career day, and wounded warier events are some of the activities done by CRNAs that build positive relationships with the community and give recognition to the profession.

Team building “extraclinical” activities.   During CRNA week, workgroups around the country gather for team building activities as well as happy hours, lounge celebrations, attendance at local entertainment events or participation in group walks.

These examples only scratch the surface of the projects done by nurse anesthetists to promote CRNA week.  Share your CRNA week activities with colleagues by using the comments box at the end of this article to describe your project.

CRNA week is a time for recognition of the valuable work done by nurse anesthetists.  In addition to receiving recognition for their work, it is also a time for CRNAs to reflect and appreciate the value of their professional community.  CRNA week puts nurse anesthetists in the spotlight and gives them a platform for connecting with their medical institution and their community.  The symbiotic relationship of each individual nurse anesthetist with the patient population and the professional organization is in focus annually during the third week of January – CRNA week.

Tom is a clinical anesthetist, author and speaker committed to promoting nurse anesthetists as leaders in the healthcare industry.

Make it a no go

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By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on Twitter

 

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

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

 

Why People Leave

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

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

 

Why People Stay

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

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

 

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

 

When You Stay

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

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

 

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

 

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

 

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

There’s no harm in charm

By Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter

Charisma

 

 

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

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

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

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

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

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

 

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

Robert Greenleaf; The first serving leader

 

By Thomas Davis, CRNA, MAE, DNAP candidate

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

 Greenleaf

 

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

 

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

 

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

 

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

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

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

 

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

 

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

 

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

~Robert Greenleaf

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

Make it Safe; Essential Resources for Patient Safety

Thomas Davis, CRNA, MAE, DNAP candidate

Follow @procrnatom on twitter for leadership updates

Safety

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

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

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Voice against Lateral Violence

By Thomas Davis, CRNA, MAE

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LV

 

In the nursing community, Lateral Violence (LV) is the term adopted for “bullying.” Consequently, an angel of mercilessness who might otherwise be labeled a bully is officially said to be “inflicting lateral violence.”  In medsurg nursing, authors Becher and Visovsky describe lateral violence as “hostile, aggressive and harmful behavior by a nurse or group of nurses toward a coworker or group of nurses via attitudes, actions, words and/or behaviors.”  Lateral violence often goes beyond things that are done to another person to include things that are not done or that go unseen.

“Never be mean to someone who can hurt you by doing nothing.”

~Matt Hearnden

 

 

Recently, an anonymous post by a nurse anesthetist student on the Facebook CRNAs and SRNAs user group page described the meanness directed at him in his clinical training site because of his status as a learner.  The student started the post by humanizing himself as an attentive student committed to mastering the skills and the knowledge to become a CRNA.  Then he described his personal history – background, family, hobbies.  His post went on to inform readers that his clinical training included accusations of being “lazy, stupid, inept, and disrespectful…” and other demeaning allegations.  Clearly, he was on the receiving end of outrageous behavior at a clinical training site in which lateral violence is a toxic staple in the culture.  Given the opportunity, the student would likely change training sites tomorrow and not look back, and you can be certain that he will never seek employment there.

 

In-your-face yelling or a punch in the nose are obvious examples of hostile and aggressive behavior; however, the daily manifestations of LV in the workplace are often subtler and less obvious.  Here are some examples of behavior that qualify as LV and, over time, will have a toxic effect on your team.

 

Overt LV Covert LV
Name-calling Sabotage
Intimidation Unfair work assignments
Blaming Withholding information
Fault-finding Withholding credit or praise
Threatening Exclusion from group activities
Ethnic slurs

 

There is a cost associated with allowing lateral violence to exist in your workplace.  As noted by nurse educators Becher and Visovsky, all levels of persecution damage the self-esteem of workers, reducing productivity and ultimately having a negative impact on the entire profession.  The reputation that “nurses eat their young,” didn’t arise from nowhere; LV is a problem that has been associated with the nursing profession right along with other professions for decades.  It’s time to stop LV and turn the corner.

 

Avoidance of conflict fuels the flames of lateral violence in workplaces where bullying is tolerated.  Rather than confronting an aggressor and drawing a red line, it is easier to turn a blind eye and hope that you are not his next victim.  Writing in the CPI blog, Emily Eilers, author and editor for the Crisis Prevention Institute recommends team training that focuses on changing the workplace culture and establishing zero tolerance for bullying.  For training to be effective, the team must openly discuss the problem and develop a code of conduct that defines acceptable behavior.  Affirming Eilers emphasis on team training, nurse educator Ericka Sanner-Stiehr, PhD, recommends a 3-step approach to eliminating lateral violence: 1) Add lateral violence awareness to the curriculum of teaching programs; 2) establish and enforce a code of conduct;  and, 3) role model the respectful, courteous behavior expected of the team.  Your strong leadership combined with commitment to change will position you to transform your workplace culture. 

Stopping lateral violence starts with you.

Make it a priority.  Whether you are the official leader with the title or the opinion leader to whom others listen, draw the line and vow to end lateral violence in your workplace.  Show your commitment to culture change by establishing a policy of zero tolerance for LV and confront each offender immediately.  During the interview and hiring process, include a discussion of acceptable behavior.

Discuss bullying at team meetings.  An elephant in the room won’t go away until it is acknowledged, and conflict avoidance is akin to feeding the elephant.  Dedicate a team meeting to discuss the negative effects of lateral violence and have the team identify areas for improvement.  A one-time discussion will not have a lasting effect.  Address the topic repeatedly at subsequent meetings and elicit every person’s commitment to changing attitudes and behavior toward one another.

Develop and enforce a code of conduct.  Once the team understands the dimensions of lateral violence and has committed to change, use a subsequent meeting to develop a Code of Conduct. Reinforce zero tolerance as your policy for addressing covert or overt behavior that violates the Code.

Simulate triggering scenarios.  Help your team find better options for situations that commonly trigger lateral violence.  Take time at a team meeting to role play interactions that have generated negative behavior in the past.  After completing each scenario, challenge the team to come up with professional and productive ways to more appropriately address the same or similar situation if it arises in the future.

 

The CRNA candidate who posted on Facebook knew first-hand the devastating effects associated with being a victim. He perceived himself to be powerless, at the mercy of the sharks swimming around him in the waters – not an optimal training ground.  If you allow intimidation, oppression, bullragging or any form of persecution in your workplace, you will have team members like the student, living each workday in constant fear of the next attack, and ready to jump ship at the first opportunity.  Be the voice that stops lateral violence. Lead the other voices. Then direct the choir.

“knowing what’s right doesn’t mean much unless you do what’s right.”

~Theodore Roosevelt

 

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

Legend in Leadership: John C. Maxwell

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

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“Leadership is not about titles, positions or flowcharts.

It is about one life influencing another.”

~John C. Maxwell

 

Maxwell

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

Legends in Leadership: W. Edwards Deming

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

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Deming

Edwards Deming was an impactful thinker in transforming post WWII Japan into an industrial power that would challenge the rest of the world for a share of the international marketplace. Deming did not have a background in business or economics; rather, he was a statistician who knew how to gather and interpret information. Immediately after the war, the US government sent Deming with a group of advisors to assess the damage and to assist in the post-war rebuilding of the country.  When the Japanese business and manufacturing communities needed advice, Deming evaluated the numbers and shared what the statistics revealed.  Based on the willingness to take advice from Deming, the Toyota Corporation jumped to world prominence.  From the work of this America statistical thinker, the Toyota style of management emerged and has been adopted by many healthcare organizations throughout America.  Here are some lessons and suggestions for implementation from this month’s Legend in Leadership, W. Edwards Deming.

  • Have a purpose  Before you embark on a project, Deming advises taking time to identify what it is that you are trying to accomplish.   Most large organizations have a vision for the success that they are working to achieve.  Aligning your team with the vision provides a sense of direction to guide decision-making.  In addition, your team can create its own vision with the proviso that is in alignment with that of the organization.  Once established, constantly remind your team of their shared goal and when a project arises, develop a plan that moves your team and your organization toward achieving the vision.
  • Stop inspecting Inspection creates a focus on defects and shifts attention away from the goal of zero defects.  In healthcare, many safety initiatives spend too much time discussing the problem and not enough time discussing ways to create a new workflow that is free of glitches.  Rather than inspecting, spend the time looking forward with the intention of designing a system in which it is not possible to create a defect.
  • Eliminate complacency Whatever is done today may not be effective tomorrow.  Don’t bask in success; instead, remain aware that victory is temporary and motivate your team to constantly seek ways to improve the quality of the service that you provide.  With the desire to consistently make things better, you establish a dynamic environment wherein creativity is encouraged, and the team stays one step ahead of competition.
  • Promote staff development Foster education and self-improvement among your team to build knowledge, improve skills, and further engagement.   Mentoring provides a unique opportunity for both the mentor and the mentee as ideas are shared through two-way dialogue and the networks of each person are expanded.  Often, a coaching/authoritarian style is effective in mentoring relationships.
  • Be a leader Deming advises, “don’t supervise, be a leader.”  Connecting one on one with each person on your team satisfies the requirements for Maxwell’s level 2 leadership; however, going to the front and working shoulder to shoulder to increase team productivity earns respect and takes you to level 3 leadership.  Stop telling others what to do, be a working partner and show them the way.
  • Work collaboratively    At the heart of Deming’s teaching is collaborative work in an environment free from fear of fall-out.  Within the Toyota model, barriers between work teams are torn down and people talk directly to those with the information that they need rather than sending messages through established conduits.
  • Make quality job one  Coming full circle, the purpose of the organization must include delivering a product that is free from defects.  Quality must be at the front of each team member’s mind and the basis for creating a process that ensures safety, satisfaction and maximum outcome for each of our clients.  At each team meeting, openly discuss the reason the company exists, what it is trying to accomplish, and the role each person plays in achieving the goal.

 

Seventy-five years ago, W. Edward Deming disregarded the wisdom of Harvard Business School and recommended a plan for manufacturing that he knew was statistically correct.  At the heart of his plan was collaboration among workers and a focus on the desired outcome of delivering a defect-free product.   Follow his sage advice and adopt a motto that continues to survive the test of time:  We deliver healthcare defect-free.

Tom is a noted author, speaker, educator and clinician.   Join Tom the second Tuesday of each month on the Leadership journal club webinar

Get the most from your professional meeting

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

  Follow @procrnatom on Twitter

prof meetings

Professional organizations of every description tend to favor autumn for gathering their respective flocks and commonly select popular locations for their meeting.  You survived the heat and the extra shifts that were required to cover your colleague’s summer vacations, now it’s your turn to enjoy a well-earned break by attending a national or state meeting of your profession.  Pre-planning for the Meeting Season positions you to learn more, make more contacts and get more enjoyment during your time away from home.

 

Organize

Prior to travel, spend your google time discovering venues that you will enjoy.  For some, activities such as hiking, biking or walking is appealing, whereas others may prefer dining, shopping or shows.  Every community is unique and history buffs, amateur archaeologists and bird-watchers may find something of interest if they look.  Whatever your pleasure, research what is available in the community and make reservations for the things that enhance your travel experience.

 

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 must submit documents for reimbursement while others pay out of pocket and need documents to claim a tax deduction.  Either way, pre-planning allows you to submit documents seamlessly.  Here are some proven tips for organizing your travel:

  • Use your phone to organize information that you will want at hand while traveling. Upload flight information and boarding passes as well as the customer service phone number for the airline that you are using.  Use the note pad app to store the address and phone number of the hotel where you will be staying…it simplifies the process when you get in a cab.
  • Use your computer to set up a folder specifically for the meeting in your documents section. The folder can have sub-folders for travel, lodging and daily expenses and personal expenditure.  When you first book your flight and make hotel arrangements, put 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 to simplify tracking reimbursable expenses.

 

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.  A meeting can also provide fertile ground for expanding your network of peers.  Socialize at gatherings and extend a hand to the people who have names that you know, opening your vision to connect with new people who may add depth to your network.

Members of many professional organizations have created user groups on social media. Meet those whom you connect with online by posting a time and place for the group to meet in person and interact with one another.

 

Customize

Hello and a hand shake is a social start, but the real value of networking is being able to connect in the future.  For starters, plan to exchange your contact information with those you meet by having business cards readily available.   To avoid losing the stash of newly acquired cards, create a business card photo album on your phone to capture and store information that will enable you to initiate future contact.  Once you’re back in your hotel room each day, take a picture of each business card you wish to keep and drop them in your card album.  Add yourself as a contact on your phone and then quickly exchange information by sending your contact information directly to those you meet.

 

Optimize   

Prior to the meeting assess your personal interests and educational needs, then peruse the agenda and make sure that you attend the sessions that are most beneficial to you.  When two sessions that capture your interest are held concurrently, enlist a friend to attend one talk while you attend the other and then compare notes later.  Look around and try to sit with new people who you have just added to your network.

Optimize the time you spend with vendors by first assessing your department’s greatest needs for equipment and seek out the vendors with the products that you need.  The larger the meeting, the more eager vendors are to introduce new equipment and the latest updates to existing devices.   Sign up for samples and demonstrations and if you make a must-have discovery, collect vendor contact information for follow-up after the meeting.

 

Summary

Whether your autumn plans include a national meeting, a state gathering or both, your return on investment will be enhanced with a little 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.

 

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

 Join the online Leadership Journal club the second Tuesday of each month.  Click here for information.

Be an Awesome Boss

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

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The distinction of being a great boss is a recognition that you cannot give to yourself; however, members of your team are constantly observing your behavior, judging you through their eyes and are the ones to bestow the honor when appropriate.  Those whom you supervise may not be able to name your leadership style, but they know first hand how it affects them on a personal level.   When you connect with your team in a way that conveys respect and promotes the development of each member, they take note and respond in kind.  For example, the heartfelt accolades that my recent patient gave to her boss.

 

While waiting for an overbooked doctor to arrive and start a procedure, I passed the time talking with my stressed patient in hope that pleasant conversation would allay her anxiety.  She told me about her work at a restaurant and then mentioned that she worked for the most fantastic boss that she could imagine; “She is so amazing that I would do anything that she asked.”  “What makes her a great boss?” I asked.  Grateful for the distraction and eager to reply, the patient enthusiastically answered with details.  “She likes me as a person, wants me to do well, and she shows me a better way of doing things without criticizing me or complaining.  She listens to me and wants me to be the best I can be.”  Wow, under stress and on delay, my patient gave a great tribute to a person who is not only a boss but clearly changes the lives of people on her team.

 

The killer testimonial that my patient gave regarding her awesome boss mirrors the theme found in leadership/management books and journals.  In The 5 levels of Leadership, Maxwell (2011) states that level 1 leadership is conveyed with a title that identifies the individual as the boss but carries no clout beyond the title.  Level 2 leadership is dynamic and builds upon an essential connection between an engaged boss and willing workers.  In level 2 leadership, workers trust the inspiring leader and, therefore, they want to perform at a high level.  Maxwell reinforces the importance of one- on-one bonding between the leader and each team member by stating that at level two, “…people follow because they want to and not because they must.”  Being connected by having a sincere concern for personal and professional growth of team members creates a bond that elevates trust and loyalty.  My patient and her boss could be poster children for the maxim of Level 2 leadership; being mutually committed to one another works for them and it will produce a mindblowing transformation of your workplace when you follow their example.

 

Naturally outgoing people connect easily but where do people with a more reserved personality start?   The answer is simple; you start by making a commitment, learning simple techniques and then jumping in and gaining experience.  Building a viable link between yourself and your team requires spending time each day interacting with people and, validating them by practiced listening.   In an article, Did you know there are 5 levels of listening? author Derek Gaunt implores the reader to move beyond listening as a means to prepare a rebuttal to the other person; rather, train yourself to listen to understand both the meaning and the emotion behind what you hearing.

 

Make a commitment to do the following for 30 days and marvel at the response that you will receive from your team.

  • Have a positive presence. Make your team a priority and block space on your calendar to spend a minimum of 1 hour per day in casual interaction with your team.  A cheerful attitude and a sincere desire to learn about the personal and professional goals of everyone sends the message that you care about more than simply getting the job done.  Investing time in your awesome team delivers a persuasive message that each person is valued not only for their work but also for who they are as individuals.  As you gain a greater understanding about what motivates each team member, you are able to develop a valuable plan for professional development that will help each person meet his goals.
  • Learn to listen. In a hectic workplace it is easy to have your mind on other issues while listening to people and only get the gist rather than the full message that they are trying to deliver.  It is also common to feel as if you must defend the status quo and prepare a rebuttal while the other person is talking.  Effective listening requires that you leave your defensive position and focus on the other person, listen carefully, and actively seek more information.  Rather than digging in your heels, prepare a follow-on question that will encourage the person to disclose more details and increase your depth of understanding what they are saying; “Tell me more about…”, “What next?”, “What is your desired outcome?”, “If you were in charge, what would you do?” are all responses that show your interest and encourage the person to continue talking.

 

Like my patient’s boss, you can inspire productivity while transforming the lives of those you supervise by connecting, listening and empowering.  Transforming your leadership style and earning the “amazing boss” recognition described by my patient is neither a daunting task nor a natural talent.  It is a behavior that can be learned.  The process involves using the tested theory of spending time with your team and actively listening to their thoughts to learn what makes them tick.  Set Level 2 Leadership as a goal and start by committing to a 30-day journey to an empowered and collaborative workplace.

 

 

Maxwell, J.C. (2011). The 5 levels of leadership. New York, NY: Hachette Book Group. ISBN
978-1-59995-365-6

Gaunt, D.  (2018) https://blog.blackswanltd.com/the-edge/did-you-know-there-are-4-levels-of-listening

 

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

Uncertainty; Survive and Thrive

 

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

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“life is uncertain, eat dessert first”

Jim, the auto salesman, is dependent upon commission and never knows from month to month just how much money he will take home; Jim lives his life with worry about whether or not bills will be paid.  Fred, an OR nurse, works in a hospital where the number of surgical cases is dwindling, and he constantly worries about the dreaded lay-off.   Amanda, a Nurse Anesthetist, has just heard an unverified rumor that her group is in the process of being taken over by a larger anesthesia management company; Amanda fears that her pay and benefits will be reduced or that her job will be eliminated.  Francis is a parent and watches anxiously as her daughter leaves on her first date.

Living in world in which uncertainty is the norm causes many people to be distressed as evidenced by behavior that clearly driven by fear and anxiety.  In contrast to the safety and security that accompany stability, an aura of unpredictability arises from a situation in which the facts have yet to emerge.  Fear of the unknown results in subjective speculation that may leave some people feeling weak and vulnerable.  For those who worry about becoming victims, the mind quickly imagines doom and gloom scenarios that always end poorly; however, for others, uncertainty is linked to change offering an opportunity to alter of the status quo and thrive in the process.

Those who prosper and grow during times of uncertainty have learned to implement design thinking when faced with ambiguous situations.  Writing in Interaction Design foundation, authors Dam and Saing describe design thinking as. “…an iterative process in which we seek to understand the user, challenge assumptions, and redefine problems in an attempt to identify alternative strategies and solutions that might not be instantly apparent with our initial level of understanding.”  To implement design thinking, the individual must first investigate to uncover facts that are available rather than jumping to conclusions based on partial or faulty information, and then remain positive while visualizing a variety of potential outcomes.

Abandoning the natural tendency to link fear with uncertainty transforming to the development of a mindset that produces a better outcome is not difficult; however, it does require conscious effort.  In order to thrive while others are struggling to survive uncertainty, use the following habits to design a plan that works for you.

Control your Amygdala

The first step in flourishing during uncertain times is to quiet the emotional brain.  The amygdala is the area of the brain linked with fight, flight, or freeze and kicks in quickly during times of stress.  Once the amygdala is activated, stress hormones are released, and the emotional centers of your brain scream so loudly that the thinking brain is silenced (the amygdala hijack).  Be aware when you are stressed and rather than succumbing to a knee jerk, emotive response, challenge your thinking brain by assuming that the facts are not yet known and seek more information

Name your feelings

When apprehension produces anxiety, take a moment to explore your feelings and how they are connected to your stress.  Name the emotion you are feeling – fear, anger, genuine concern –  then ask yourself if the facts that are known justify your emotional response.  Determine other emotions that could be warranted if the initial information is not completely true and don’t forget to consider positive emotions such as joy, satisfaction or fulfillment.   By considering other emotions, you are also acknowledging that other outcomes may arise from the uncertainty.

Choose your response

After you’ve gathered information, acknowledged how you feel and identified a variety of outcomes that could emerge from the uncertainty at hand, use the facts, your personal goals and the available resources to develop a response that will promote your best interest.   When the outcome involves a group, make an effort to quiet the emotions of those around you and enlist them as allies in your plan to create the best possible outcome under existing circumstances.

Develop a contingency plan 

Despite your best effort, some situations really are as bad or worse than the rumors and it’s time for plan B.  which may involve moving on.  Developing a contingency plan has two advantages; it gives you a sense of being in control and it provides an alternative outcome.  Often, implementing a contingency plan and seeking employment elsewhere allows you to thrive in ways that were never possible in your current position.   Uncertainty can be a mixed blessing and force your hand in making a necessary decision.

Uncertainty is a certainty in one’s life both on and off the job.  We can never predict changes that will be thrown our way.  However, we can develop personal skills and design our own plan that will enable us to not only to survive, but to thrive.  Whether you are selling cars, putting patients to sleep or staying awake til your daughter gets home from her first date, take control and turn ambiguity to advantage.

 

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

 Join a group of your healthcare colleagues in the on-line leadership journal club at 7:30 Central time the second Tuesday of each month.   Click here for more information.

Fixer-Upper Leadership

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

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In the popular HGTV reality TV show Fixer upper, Chip and Joanna Gaines work with buyers to select a run-down and under-valued home and then using vision combined with hard work, turn it into a showplace. The Gaines walk the buyers through three potential homes, all in need of repair.   Typically, the buyers are openly disappointed with the current state of the property whereas Chip and Jo look at the same mess focusing on the potential beauty that it could become.  The remodeling experts ask the buyers about features that are most important to them and listen carefully to preferences that are stated during the walk-through.  The show progresses with the buyers selecting a property, establishing a budget, reiterate the items that are most important to them, and then turning the project over to the experts for remodeling.  Midway through the project, Jo meets with the buyers, updates them on the progress and ensures that everybody agrees with the final design.  The show ends with the amazed buyers walking through the newly remodeled home in disbelief that it could be the same property that they selected weeks earlier.

 

In the reality of the work world, some teams are run-down, underproductive and in need of a leader who will transform the current workplace into an employment showplace.  Like doing a fixer-upper on a home, transforming a low-achieving workplace into an environment where people want to spend the day involves listening, developing a shared vision, leveraging resources and motivating team members to work hard to implement change.  Be a fixer upper leader and create a workplace where employees are stimulated, motivated and want to spend their day.

 

Establish your goal

Your team must share your vision as well as your commitment to make things better.  Encourage your team to share your vision by openly discussing the status quo, including the things that currently drain team spirit from the group.  Ask them to describe their ideal workplace and the behavioral changes needed to move the ball in that direction.  As in the TV show, listen attentively to reveal the most important needs and make a list of behavior changes needed to improve the morale of the group.  Next, tune in to the group’s order of preference.  After identifying 1-3 items for immediate focus, develop a plan and hold team members accountable for its implementation.

 

Identify your resources

Once the Gaineses have a solid vision for repairing the property, they quickly assess the resources at hand and make plans to obtain additional supplies that are needed.   Likewise, take the lead in the remodeling of your team and how they interact with one another.  Ensure that it has the resources needed to make the desired changes.  You may need to modify work schedules, implement a streamlined method for communication or even place an absolute ban on gossip in order to get the job done.  Do everything within your control to activate the priorities identified by your team.

 

Demo day

Chip’s favorite day on any project is demo day.  Everything that is not necessary for structural integrity is ripped out and carted off to make room for reconfiguring the house and to allow for a make-over.   To make room for your new way of conducting business, old thoughts and habits will have to be “ripped out and carted off.”  During demo, be prepared to rid the construction site of behavior and of things that prevent the group from achieving their collective goal.  Ultimately, the leadership goal is to guide your team to the promised land while keeping it intact.

 

Rebuild

Once the old thoughts and habits have been removed, the vacant space is fertile ground for new and fresh ways to conduct business.  Keep your hands on the wheel and make sure that the void you created draws in feelings of collaboration and commitment.   Remind team members frequently about their consensus of creating a preferred workplace and encourage only positive thoughts and creative energy to exist among teammates while on the job.  Implement a spirit of accountability in which shared responsibility creates positive outcome.

 

Give frequent updates

Keep your team members in the game by meeting with them frequently and openly sharing the overall progress.  Discuss both the areas in which the team is doing well and areas that lack progress. Routinely review the original goals, tweak the plan, and motivate individuals by sharing your anticipation of success.  Toward the end of the HGTV show, excitement grows as the project nears completion.  The children deliver food in preparation of Joanna’s all-nighter to ensure that the property is perfect for the grand showing the next day.  Likewise, as your preferred workplace becomes a reality, be inclusive and harness the excitement of team members by having them participate in the planning of a celebration in honor of the changes that have been made.

 

Celebrate success

HGTV Fixer Upper ends each show with a segment where the finished project is presented to the buyer.   The new residents of the house high-five in near disbelief as they walk through a structure that only vaguely resembles the structure they selected to recreate.  As part of your leadership, celebrate with your team when attitudes and behaviors have changed and your workplace has been upgraded to become a magnet for fully engaged workers.  Carve out time for a team meeting complete with treats and high-fives for those on your team who most aggressively pushed colleagues to a new and better place.

 

By challenging your team to fixer upper restoration, you no longer need to lead a team that’s at at the low end of productivity.  Choose a reconstruction plan and get consensus, develop a strategy that’s inclusive and hold one another accountable for implementation.   You too can restore, repurpose and lead a team that delivers the best possible service to clients and the organization.

 

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

Surviving Mistakes

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

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All men make mistakes, but only wise men learn from their mistakes.

~Winston Churchill

Surviving mistakesMistakes, we all make them.  I have made them, so have you and so has everybody else.   Paul, the barista at Starbucks, makes an offensive tasting non-fat chai latte, dumps it down the drain, starts over and voila, problem solved.  Laurel, a candidate for congress, makes an offensive comment about immigrants, the media takes over and voila, her campaign spirals down the drain and drowns.  Minor mistake are no big deal, easily corrected, but major mistakes have launched world wars.  Most mistakes fall between the two extremes.  Leaders at all levels are faced with making daily decisions based on the available information as well as their personal bias related to the issue.    When the choice is spot on, high fives ensue, and the team celebrates success.  But if the option misses the mark, damage will result and damage control by the leader must begin.

Making an error in judgment doesn’t have to be a career breaker as evidenced by the ability of high profile people to recover from bad decisions.   The Ford Motor company launched a new line of cars and quickly the Edsel became the biggest flop in automotive history.  Later, Ford went on to launch the highly successful Mustang.  In 2012, Netflix CEO Reed Hastings perceived the trend for an increased demand for access to streaming videos and launched a plan to split the company into DVD and streaming divisions, each requiring membership and separate fees.  The public quickly rejected the new structure, balked at joining and caused the CEO to walk back the decision and remain with a single membership to include both DVD and streaming access to entertainment.

Although your goofs and gaffes may not get worldwide media attention, they can affect those around you both at work and at home, and as with high-profile leaders, if you can learn from your mistakes, you can recover.

 

Own it 

Looking good to your team and the chain of command is important and making a mistake can undermine your credibility as a leader; therefore, it is natural for you want the blame to fall elsewhere. Despite your desire to be blameless, others, review exactly what was said and done so they know who made the error, and if it’s your lapse, own it.  Denying your responsibility will further erode the respect of those familiar with the situation.  Put yourself back on the path to success by candidly recognizing your mistake and accepting responsibility.  As most politicians have discovered, projecting an attitude of, “I did it but it really wasn’t my fault,” does not garner respect or support from those around you.  “I made a mistake and it was my fault,” is a much better starting point when trying to recover from a bad decision.

 

Apologize

After owning it, the next step on the road to correcting the error is a sincere apology to those affected by your decision.  Choose your words wisely and focus on apologizing for your action rather than the way others reacted to the blunder.   Admit what was done was wrong and acknowledge the unintended consequences of the action, including any negative effect it had on the team.  People who apologize because others were offended instead of admitting personal fault, aren’t really accepting blame and will quickly lose both respect and support from those affected.

 

Correct the damage

Very few decisions are absolute and final.  In spite of the damage that has been done, with time, patience, and a good plan most damage can be repaired.   There are times when we kick ourselves and wish for a do-over because, in retrospect, a better decision was obvious.  In cases where the better decision was clear, walk it back, repair the damage and proceed with the correct choice.  In other cases where the answer is less obvious, involve the team in a group-think process to produce a better solution than your original choice.  If penalties are required, pay them and then move on/forward.

 

Learn from the experience

The harm caused by a bad decision creates an opportunity for personal growth that will position you as an expert who can help others who face similar challenges.   Damage control looks back on a situation and tries to fix something that has already taken place.  Instead, seek a type II solution that not only addresses your problem but also keeps others from making the same error.  Think of preemptive measures to update or change the current system and prevent a recurrence.  Again, involve the team in an open discussion, “What did we learn?” and, “How can we prevent this from happening again?”  Involving others in producing a permanent solution shows good faith in your desire to correct your judgment error and to learn from it.

 

Rebuild trust

Trust is foundational to a positive working relationship with your team.  You take the first step in re-building a trusting relationship by owning, apologizing and correcting the error.  The final, and by far the hardest part, is convincing your team or institution that you’re sincere and solid, all is well.

  1. DON’T compound the problem by making more mistakes.
  2. DON’T revisit the circumstances or the behavior that caused the mistake except as a reminder of what not to do or say.
  3. DON’T dwell on guilt and don’t allow yourself to feel shame or to be shamed. Get over it.
  4. DO use honesty and transparency when correcting the problem.
  5. DO encourage others to participate when selecting a new course of action.

 

Summary

Our world is composed of over seven billion people, each with independent thoughts and goals.   What may seem logical or obvious to you and support your personal point of view may be perceived very differently by others.  Leaders, followers and people in general all make mistakes in virtually every aspect of daily life and a few of those seven billion may occasionally take offense.   When it happens, and it will, face it head-on, focus on immediate resolution and continue a lifelong commitment to building trust.  And in your moments of reflection, always remember:  Your blooper is your problem; others’ reaction to it is theirs.

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

Emotionally Intelligent Leadership

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

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Emotional intelligence is the ability of a person to be aware of and control his/her own emotions, to sense to the emotions of others and to handle interpersonal relationships in a manner that preserves the integrity of both parties.   Writing about emotional intelligence in Forbes.com, author Christine Comaford states that emotional intelligence accounts for 58% of your team’s performance regardless of the industry in which you work.  Clearly, the most effective leaders control their own emotions while boosting the self-esteem of those they supervise.  Conversely, leaders who lack emotional intelligence quickly undermine collaboration and demoralize individuals on the team.

A busy Gastroenterology center commonly schedules 12-18 cases per room per day and assigns patients an arrival time based on starting a new case every 20 minutes; productivity and efficiency are top priorities.  Today the outpatient endoscopy center has an irate patient in the waiting area; MaryJane arrived at the designated time and has been waiting 2 hours for her procedure to begin.  She demands to talk with George, the clinic manager and doesn’t hold back when unloading her anger about the excessive waiting time.  When the scheduled cases are completed, the stressed clinic manager assembles his workers to pass on the patient complaint and puts the blame on them for the delay stating, “If you were competent and knew your job, this would never happen.”  He went on to threaten the team with disciplinary action if things did not improve.  Having no control over the speed at which the physicians can complete a case, the chastised team members felt demoralized.

Leaders who lack emotional intelligence may alienate either an entire team or selected individuals through thoughtless comments.  In a similar event at the same center, a technician set up for the next scheduled case, however the patient brought into the room was out of sequence and was scheduled for a procedure that required special equipment.  The doctor entered the room at the same time as the patient, found the wrong equipment in place and became irate demanding that the technician be replaced by, “someone who knows what he is doing.”  The rejected technician left the room feeling completely devastated and defeated.

Your reaction to stress matters and affects the performance of your team.   Emotionally intelligent leaders can challenge a team to correct a problem and have the group walk away feeling empowered and committed to resolving the issue.   If the leader lacks emotional intelligence, teams feel demoralized and defeated when faced with similar challenges.  Here are some tips for infusing emotional intelligence into your leadership style:

 

Tune into yourself 

As the gatekeeper of your emotions, be aware of the moment the gate starts to open and react quickly.  If something is not quite right and causes a little twinge of anxiety, trust that something is driving your gut feeling and don’t dismiss the emotion that you perceive.

  • What to do: Take a moment to identify your sentiment and put a label on it; “I’m feeling nervous,” “I’m feeling defensive,” “I’m sensing that I’m being unfairly blamed,” or “my GERD is acting up.” Putting a label on what you feel requires you to shift from an emotional response to one that is intellectual and diminishes the likelihood of a knee-jerk reaction that will add fuel to a smoldering fire.

 

Slow your reaction 

The emotional area of the brain, called the amygdala, kicks in when you are stressed and triggers a fight, flight or freeze reaction.  Unfortunately, when the emotional brain takes charge, the thinking brain shuts down and you may respond in ways that you later regret.

  • What to do: Take control by pausing when you first perceive that your emotions are being challenged; take a deep breath, count to ten and ask yourself, “What is my desired outcome?” or “What do I want?”  Continue the intellectual activity by clarifying facts asking questions to gain insight into the other person’s point of view.  This process quickly quiets your emotions by stimulating problem solving areas of your brain and saves you the embarrassment of saying or doing something that will require an apology.

 

Assess and leverage your resources

Leaders of collaborative teams never need to face a problem alone.  When challenges emerge, take a moment to assess your resources and utilize those that will help you resolve the problem.  Two of your most powerful yet frequently overlooked assets are your team and your positive attitude.

  • What to do: Approach a stressful situation with confidence and avoid dictating a quick fix or assigning blame until facts are known. Explain your desired outcome to your team and solicit their ideas for resolution.  Use your emotional intelligence to be inclusive and harness the creative power of your team rather than shutting them down.

 

Focus on the desired outcome 

Focus on the desired outcome in a positive and proactive manner that looks beyond the immediate problem at hand.  A type I solution fixes your immediate problem whereas a type II solution ensures that the problem will not recur for you are anybody else on the team.  In the case of the GI center, the goal was more than appeasing today’s irate patient; the type II solution involved realistic scheduling that reflected the reality of the patient flow.

  • What to do: Create a group-think environment, assume that your team shares your goal and use emotional intelligence to validate and implement their creative ideas. Those who work on the front line have personal knowledge of problems as well as solutions.  Tap into your team’s fountain of knowledge

 

Take control of your emotions and gain a sensitivity for the feelings of those around you.  This does not mean that you should ignore problems for fear of hurting feelings; instead, address every problem in a forthright manner that preserves the emotional integrity of the person you are correcting.  George could have brought the team together to discuss the patient flow problem, gain a better understanding of causes and create a solution that offered a feasible chance for success.  Had he talked to the team, George would have learned that the average time per case was 32 minutes and scheduling a new case every 20 minutes was a receipt for failure.  The first step toward staying on the timeline was to develop a realistic schedule that allotted enough time for each case.   Rather than working harder or more efficiently, the solution rested in creating a schedule that reflected reality.  Similarly, had the doctor in the second example been sensitive to the fact that the technician had set up correctly for the scheduled patient, he would not have launched into a personal attack on a competent worker.

Emotionally intelligent leaders know and control their own feelings while tuning into and uplifting those around them.  Elevate the productivity of your team by being sensitive the emotions that drive behavior.

 

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

Manage Workplace Stress

Embrace useful stress; eliminate the rest

 

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

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“We all have to be willing to deal with a certain amount of discomfort in order to see what we’re truly capable of.”

~David Taylor, Proctor & Gamble CEO

Stress is inherent in both our professional and personal lives.  Some types of stress are motivating and empowering whereas others are destructive and incapacitating.  Both the type of stress that you face and the way in which you respond are the determinants of the outcome.  Literature from the American Psychological Association describes the three most common categories of stress and offers insight into stress management.  Gaining awareness of the type of stress that you face and formulating a plan to address it will put you on solid ground for reducing anxiety in your life.

Acute stress

James is 12 years old and is all-in for little league baseball.  His hitting has improved, and he has mastered the skills needed for him to be successful playing second base; the coach sees him as a player with strong skills and a good sense for the game.  Today, the usual catcher is out with an injury and the coach selects James to move to a new position, one that he has never played before.  James feels the pressure.

Susan is an experienced Nurse Anesthetist and is a go-to person when her peers have questions about managing difficult cases.  Today, there is an urgent add-on open heart case and because of her strong skills, Susan is assigned to step in and provide the anesthetic.  Susan has not been in the heart room since her student days 6 years ago and she feels anxious.

Both Susan and James are experiencing acute stress (AC).  As described by the APA, AC is the most common type, it is tied to demands that are imminent or in the immediate future, and it occurs frequently.   Often, situations that create acute stress pop up unexpectedly and catch you off guard, knocking you out of your normal routine and comfort zone.

Solution

  • Retrain your brain. Move away from the fear of failure and focus on the opportunity that you are being given to develop new skills.  Enjoy the satisfaction of knowing that others respect your skills and selected you to meet the challenge…be glad, not mad.
  • Focus on personal gain. Anticipate that stressful situations will emerge frequently and welcome them as opportunities for growth rather than threats to your status quo.  Visualize a successful outcome look forward to the skills and self-confidence that you will develop from the experience.
  • Ensure that support is in place. To reduce your personal anxiety, clarify the resources, material and personnel, that will be in place to ensure your success.

 

Episodic Stress

Adam is the manager of the busy admissions area of a mid-sized community hospital.  He awakens half-rested every morning and quickly shifts into high gear, gets his boys ready for day care, scrambles to deliver them and then arrives at work on time.  Adam knows the importance of the admissions process and feels personally responsible for what happens in his office as well as for the flow of patients through the hospital.  When asked, he says yes to every request and lives his life sprinting from task to task; any unexpected challenge pushes him over the edge.

The APA describes Adam’s situation as episodic stress (ES) characterized by living a life of chaos and crisis in a rushed environment in which, if anything can go wrong, it will.  He is highly likely to become irritable and short-tempered, neither of which enhances the productivity of the team.

Solution

  • Track your stressors. Those who experience ES typically have type-A personalities and live in such a constant state of anxiety that they lose track of the source.  Keep a journal of your causes of stress and gain insight into chronic sources.  When patterns emerge, use them to anticipate your personal vulnerability and position yourself to proactively fend off the distraction before it occurs.
  • Set boundaries. Victims of episodic stress often say “yes” even if “no” is more appropriate. Think ahead and plan a response for requests of your time that transcend reason or your capability.  Acknowledging the request, state that you are too busy to accommodate and then refer the requestor to a colleague who may be able to help.
  • Allow time for recovery. You can’t be everything to everybody all the time.  To sustain your fast-paced and often over-committed lifestyle, you must embed personal recovery time into your daily schedule and it must be as important as the other things on your list.  Set aside time to read, shoot some hoops, meditate or go for a jog.  During your recovery time, push out all work-related thoughts and embrace the joi d’ vivre.

 

Chronic Stress

Betsy is a nurse in a community hospital in the small town where she lives and it provides her only professional opportunity without commuting 50 minutes to a larger city.  She dreads going to work because of the disorganized and often disorderly way in which her unit is managed.  Her sarcastic supervisor borders on being a bully and does not offer positive feedback.  Betsy’s daughter is acting like a knows-more-than-mom teenager, and as the established as the insurance expert in the community, her husband does not have the luxury of moving to another location.  Betsy is trapped in a life that is not fulfilling and she suffers from chronic stress.

Chronic stress (CS)occurs when a person does not see a way out of an intolerable situation.  Over time, the person stops expecting to resolve the situation, becomes disengaged, and accepts living with a feeling of hopelessness.

Solution

  • Change what you can. Betsy can’t change her location or her boss; however, she can assess her skills and find new ways to utilize them.  She is a nurse and has locked herself into nursing.  By finding a new application for her organizational and interpersonal skills used in nursing, Betsy may be able to find other non-nursing work in the community that will leverage her personal strengths.
  • Develop new habits. When the status quo is no longer working, identify new behavior patterns that will produce better results.  Repeating the new behavior frequently will quickly convert the behavior into a new habit.  Betsy can change the way she responds to her daughter’s sarcasm and eliminate or reduce the level of tension created by the teen-aged moments at home.
  • Create a support network. People who suffer from chronic stress feel as if they are in it alone.  Develop new friendships by participating in new activities that will give you something to look forward to such as starting a book club or volunteering to walk dogs at the local shelter.  Taking charge is empowering.

 

Stress is ingrained in the fabric of the world in which we live; however, there are ways to effectively identify and manage how it affects us personally.  In some situations, stress should be welcomed as an opportunity for personal growth.  Other forms of stress are obstructive or destructive and can be controlled or eliminated by developing awareness and implementing solutions.

 

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

 

Up your game, Leader Reader 1, Authentic lessons in leadership by Thomas Davis now available on Amazom