nursing team building

Kotter, for a change

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

Follow @procrnatom on Twitter

“Change is the only constant in life.”

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

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

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

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

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

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

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

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

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

Mentoring; Connect for Winning Results

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

Follow @procrnatom on twitter

“We make a living by what we get; we make a life by what we give.”

— Winston Churchill

For many healthcare workers, an ideal job includes working within an environment where individuals are valued, creative thinking is welcomed and professional development is enhanced. Effective mentoring addresses those essentials and more. This ongoing cultivation of relationships in the workplace connects less experienced workers who have a need and desire to expand their abilities with more experienced people who have knowledge and a willingness to share. Mentoring offers an opportunity for two people to connect one-on-one in a relationship that promotes personal growth for both individuals.

According to Wikipedia, an engaged employee “…is fully absorbed and enthusiastic about his/her work.” Mentoring enhances employee engagement which, in turn, increases productivity and job satisfaction. In the still highly-regarded 1996 Gallup Q12 employee engagement survey, 6 of the 12 items on the survey could be improved by an effective mentoring program. From both personal experience as a leader and a review of the small business literature, here are some of the advantages that arise from connecting people in a relationship designed to boost personal and work skills.

Promotes professional development
Connects mentee with someone who is interested in his/her advancement
Stimulates personal/professional growth
Creates a sense of accomplishment
Teaches self-discipline
Expands professional network of colleagues

The Journal of Applied Psychology (2004, Allen et al) published a report identifying additional tangible advantages that were gained by those who had a mentor in their workplace,

Greater overall career success
Increased compensation over the course of the career
More promotions than non-mentored peers
Higher job satisfaction
Greater loyalty to the organization.

Establishing a relationship that benefits both the mentee and the mentor requires preparation and commitment from both individuals. Whether you are the well-informed advisor or the neophyte learner, these two components are essential for the partnership to work.

Start with self-assessment Before entering a mentoring relation, take time for introspection and think about what you have to offer as a mentor, or what you need if you are the mentee. Are you a good match for the other person? How much time can you commit to the mentoring process? Why do you want to be a mentor? Mentoring demands sincere effort to connect with and elevate the other person; it is never a platform for self-promotion.

Establish expectations Having common expectations aligns both people in the mentoring relationship and clarifies up front what each person has to offer and what can be expected from the other. Establish and agree on the amount of time and the level of preparation needed from each person before commencing the mentoring process. To be effective, mentoring is more than casual conversation over a cup of coffee.

Make it personal In addition to sharing information, take a personal interest in the other person and include things that are important to him/her as an individual. A good mentoring relationship can produce a friend for life.

Be a thinking partner All too often, the mentor assumes the role of an authority and eagerly tells the learner how to think and do the assigned task. Avoid being an authoritarian task-master by assuming the role of thinking partner and use your experience to guide the learner to an “aha” moment.

Share your network Those in a mentoring role often hold a more elevated position in the organization than the mentee, and/or have been with the organization for a greater length of time. Introducing your mentee to those whom you trust for advice expands his/her network of connections and establishes resources for future projects. Conversely, the mentee who is lower on the chain of command has a network of trusted colleagues at the grass-roots level. Working with a mentee may give the mentor insight into frontline issues that have not yet made it upward through the power structure.

Mentoring is an opportunity to create a two-way relationship that validates the mentee and provides a sense of fulfillment to the mentor. Having someone in the workplace who cares about you as a person as well as your individual professional development is a win-win in which both parties will grow by becoming more engaged, more creative and better informed . If you are an experienced worker, share your knowledge willingly with those who will become the future leaders in your organization. If you are new to the job, seek a mentor to help you learn about the company culture and provide guidance to ensure your future success. Effective mentoring produces lasting connections and winning results.

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

Psychological Wellness at Work

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

A psychologically healthy workplace focuses importance on employee well-being, both mental and physical. The organizations that are most successful in providing psychological health for workers do so by making employees feel valued and the companies are rewarded with a highly engaged and motivated team as evidenced by increased productivity and client satisfaction. A study published in 2012 by the American Psychological Association found the following when comparing employers that value employees versus those that don’t:

Workers who feel valued are more likely to give their best effort. (93% versus 33%)
Workers who do not feel valued are more likely to seek new employment elsewhere. (50% versus 21%)
Workers who feel valued are more likely to say good things about the employer. (85% versus 19%)

It is not empowering, nor does it provide a sense of self-esteem to know that you can easily be replaced and it won’t make a difference to your team. In contrast, a worker’s self-worth is enhanced when he/she senses being an essential part of the team. As identified in the APA study, motivation, engagement and productivity are tied to a worker’s sense of being valued by the organization. Letting employees know that they are valued by both you and the organization stimulates each individual worker to put full effort into every project. Here are ways to create a psychologically healthy workplace where workers feel as if they are important members of the organization.

Recognize and showcase talent

Tie assignments to strengths and let people know why you chose them for the task. Avoid routinely dumping tasks on those who you feel most capable because it will generate a feeling of being used. Instead, discuss the objective and let the person know that he/she was chosen because you recognize particular strengths that could be showcased on the project. For example, tell the person, “Last week you did an excellent job on… and your talent is perfect for this job.” Or “you seem to have an interest in… and I think this job would provide an opportunity to further develop your skills in that area.” Making it personal while recognizing individual strengths conveys a sense of worth for the worker.

Share positive feedback from all sources

It’s great to get praise from the boss; however, it is equally important for workers to know that clients and colleagues also appreciate their work. Go beyond giving awards and recognition at a team meeting; tell how the work had a positive impact for clients or colleagues. Client surveys often generate positive comments about individual team members. Posting kudos for all to see sends the message that the work done by the individual is appreciated beyond the workplace.

Offer challenging work

Routine work keeps the wheels turning and is important for achieving the mission of the organization; however, it may not be stimulating. Mix challenging assignments with routine work to keep it stimulating and to promote professional growth. Identify ways to improve workflow and challenge a worker to develop and implement a plan to achieve it. Encourage creative thinking, provide resources and check in on a pre-planned timeline. Workers who feel ownership will put full effort into a project.

Listen to your employees

A common theme expressed by workers in low engagement environments is the perception that they are not heard; many employees say that they were never asked for their opinions. Asking for opinions, listening to understand and then following up by putting ideas into action sends the message that team members are valued. Rather than using group meetings to read announcements, introduce a topic and then spend the time listening to the comments and concerns arising from those doing the grass roots work.

Frequent two-way feedback

The annual performance review looks in the rear-view mirror rather than looking over the horizon and motivating workers to move ahead. Instead, giving frequent feedback (bi-weekly at a minimum) keeps lines of communication open, projects on track and gives tangible evidence that you recognize and value work that is currently being done. Showing real time interest in things that are important to the members of our team conveys that you each person as an individual.

Affirming the strengths of every member of the team in a manner creates a sense that he/she is a valuable member of the group produces psychological security and will pay dividends for the organization. Workers who feel secure in their role and appreciated by both their employer and their colleagues have higher morale and are more engaged in the jobs they perform. The organization reaps the benefit of improved client/customer satisfaction scores…a win/win for all.

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

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

Right player, Right position; Build a successful team

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

On January 17,2017, Patriot’s quarterback Tom Brady reached a milestone and reinforced his elite status as a team leader when he appeared on the cover of Sports Illustrated for the 20^th time. Magazines such as SI, Fortune and Forbes regularly feature the super-stars of business on their covers, filling their pages with success stories from the corporate world. What do the elite super-stars of sports have in common with successful corporate CEO’s? Both have received public accolades for combining their natural talent with their ability to effectively lead a team.

The need for teamwork on the sports field is obvious. Every quarterback in the NFL has the credentials necessary to do the job; they know the strategy of the game and have the physical talents to deliver the desired results. Yet, many fail which indicates that success involves more than the quarterback’s arm. The line must block, receivers must run the right routes and the team must work in sync to achieve victory.

Teamwork is equally essential in the business community where success involves more than the CEO’s vision. Victory in the business world requires a supporting team with each person executing his/her role in a confident and professional manner. Assigning the right person to the right role is the first step to the victory dance. Expecting a strategic thinker to balance the corporate books will be equally disappointing as asking a lineman to run the route of a wide receiver. Know your players and their strengths and then put them into the right position to showcase their skills.

Here are three essential leadership roles to play when you develop and implement an action plan for your team.

Innovator The innovator is the creative thinker who constantly sees a better way to do just about anything. Tell this person what you would like to accomplish and he/she will quickly identify several ways to complete the task. The keen insight of the innovator considers both short and long-term implications and formulates a plan to maximize success while minimizing unintended consequences. The innovator sets the course and provides the spark of energy necessary to get the project rolling. An innovator on the team introduces possibilities however, a team with only innovators becomes a think tank producing concepts but no results.

Enabler The enabler is the essential person on the team who has a network of contacts and knows where to obtain the resources necessary to transform a vision into a reality. Whether the project needs supplies or support, the enabler knows where to turn. Essential resources include not only things, but people and the enabler is a master at fostering collaborative teamwork. In short, the enabler buys into the vision, obtains the resources and motivates others to make it happen.

Implementer The implementer takes pride in actually doing the hands-on work required to give life to a project. This hard-working team member can understand the goal, capitalize on the resources provided by the enabler and do the labor necessary to achieve results. On some teams, the implementer is also referred to as a go-to person, someone who always seems to be able to do just about anything. When an implementer is charged with completing a task and given the resources to do it, the sky is the limit.

Just as sports teams need skilled players at every position, the most successful business leaders build teams where each position has a skilled player. A baseball team doesn’t recruit a generic baseball player; it recruits for a specific position, i.e. pitcher, catcher or infielder. Likewise, insightful leaders recruit innovators, enablers and implementers and then make sure that every project has people from each category on the team. Your ultimate success is dependent upon leveraging your natural abilities by creating a team that will bring reality to your vision.

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

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

Infuse the Holiday Spirit

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

Follow @procrnatom on Twitter for leadership tips

The Christmas season is a time for family and friends to gather and share the excitement of the season. With store fronts decorated, neighborhoods lit up at night and jingle bells in the shopping malls, children start squirming with excitement while adults develop a sense of kindness and generosity. For the savvy leader, the holiday season is a golden opportunity to build the team. And there’s no better place to start than by building a workplace of choice.

Think of your team as your extended family and give them a gift they will enjoy throughout the upcoming year – the workplace of choice. Make a commitment to create a preferred workplace and start today by leveraging the spirit of the holiday season. In your ideal workplace, team members will:

Feel as if they belong
Sense that they make a difference to the organization and the team
Have a spirited team spirit
Know that their work is recognized and appreciated

Exude the mood of the season then commit to carrying the new attitude into the upcoming year. Team collaboration and production will soar as your workplace gains a reputation for being the best in the organization. Here are a few ideas to make the season memorable for your team.

Make it fun and festive

A team that has worked diligently for a full year since the last holiday season has earned the right to feel good about themselves and their accomplishments. Break the monotony of business-as-usual and usher in the joyous season by changing the face and the tone of your work area. Try these ideas to lighten the mood and unite your team.

In the break room

Encourage team members to post holiday pictures of family and pets.
Post a joke of the day and encourage team members to post funny holiday stories.
Post a riddle of the day and encourage team members to work together to solve it.
Bring treats several times in the week leading up to the holidays.
Bring a nerf basketball and small hoop. Have a contest for the most buckets in 1 minute.
Set up a new challenge every day such as counting red jelly beans in a jar and provide a prize for the winner.

At your team meeting

Have a non-business meeting and encourage your team to identify ways to have fun…then follow-up.
Have a laughing contest…it’s contagious.
Create a New Year fun committee and plan quarterly events.
Ask each person to name another team member and state something that they appreciate about the person.
Discuss team accomplishments from the past year.
Finish the fun meeting with a holiday “shift exchange.”

One on one

Show an interest in each team member’s holiday plans.
Focus on positives and point out things that the person does particularly well.
Give each member of the team a hand-written holiday note and that expresses thanks for something specific that they did for the team in the past year. Deliver it in person or mail it but DO NOT leave it in their box at work.

Creating the ideal workplace takes time and commitment. Holidays are a special time of the year for each person on your team regardless of religious beliefs or family heritage. Use the season as a platform for building a team, one that everybody wants to join in an environment where people want to work. Haul out the holly and have some team-building fun.

Tom is a skilled anesthetist, author, speaker and leadership coach.

Leader Reader 1, Authentic Lessons in Leadership. “The book that goes beyond theory and provides hands-on leadership skills.”

Effective Listening

Keys to Effective Leadership: Listening

By Thomas Davis, CRNA

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

Listen to understand
Listen to emotions

Listen to Understand

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

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

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

Points:

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

Listen to emotions

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

Points:

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

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

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