Tag: Thomas Davis CRNA

Take charge of change

change management

By Thomas Davis, CRNA, MAE, DNAP candidate

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

 

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

~Charles Kettering

 

 

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

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

 

 

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

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

 

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

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

 

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

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

 

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

 

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

 

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

Who wants to be a millionaire leader?

Who wants to be a millionaire leader?

By Thomas Davis, CRNA

Keep up to date with healthcare leadership topics,

 

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

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

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

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

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

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

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

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

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

The Value of Vision

By Thomas Davis, CRNA

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

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

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

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

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

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

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

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

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

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

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

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

Flight Path to Patient Safety

By Thomas Davis, CRNA

Flight Path to Patient Safety

747With reimbursement and therefore job security tied to patient safety, it is incumbent on healthcare workers to become actively involved with the process of making healthcare safe for our patients.   Since the publication of “To Err is Human” in 1999, much attention has been given to patient safety, however, statistics still show that your luggage is safer in the airline system than your grandmother is in your local hospital. What can we learn from the Airline industry?

The 1970s were a particularly tragic time for commercial aviation.  In 1977 the collision of two 747 airliners on the runway in Tenerife killing 583 people followed by the famous airline crash in Portland in 1978, both due to poor communication, triggered a change in the way that the airlines conduct their business.   Mandatory training and implementation of Crew Resource Management changed the way flight crew employees interact with one another and ushered the way to a 5 year period with zero adverse incidents.   How did they do it?

Crew Resource Management is a set of training procedures for use in environments where human error can potentially have devastating effects. The focus of CRM is on interpersonal communication, leadership and decision making.   Our patients deserve the same focus on healthcare safety that they would receive as passengers on an airline. Here are some recommendations for taking CRM from the cockpit to the hospital.

All humans are fallible and susceptible to error…period. The greatest disservice that we can do to our patients is to believe that because we have special knowledge or skills, we are infallible and cannot make mistakes.   The airline crashes of the 1970s confirmed that the senior pilot did not have all the answers. Not only can we make mistakes but others around us can do the same.   It is only when we acknowledge our fallibility, and engage with our team in vigilance, that patient safety can be ensured. Regardless of your position on the team, know that you can make a mistake, and also know that you can fend off the consequences of mistakes that others are about to make.

All potential problems must be openly communicated in a positive manner that supports our coworkers.  In an environment focused on patient safety, sharing your concern with other team members should be welcomed and encouraged.   In addition, you must welcome and solicit the concerns and observations of others.   As healthcare professionals, we tend to get defensive when a co-worker points out a lapse in our delivery of a treatment.   With a focus on collaboration, we set the stage for patient safety as we reply, “Thank you,” rather than feeling threatened. Your reply sets a tone for other team members to welcome feedback.

All team members must be respected and heard.   Your knowledge and skills are respected. Your eyes and ears are open and your judgment is solid. Even so, remember that magicians make a living based on creating false perceptions.     What you see and believe may not be true. The TV program “Who wants to be a Millionaire” offers the contestants lifelines when they do not know the answer.   When statistics are reviewed “poll the audience” has the highest percentage of correct answers whereas “ask an expert” lags far behind in accuracy.   When the goal is patient safety, the collective wisdom of the group is more likely to be correct than the opinion of the expert.   Openly solicit and welcome the opinions of others regardless of their position on the team. Often, we can learn as much from people with lower status as we can from the recognized team leaders.

Problems must be anticipated and contingency plans must be in place. In his book Why Hospitals should fly: The Ultimate Flight Plan to Patient Safety and Quality, author John Nance recommends that healthcare workers view every patient as having a 50:50 chance of being harmed.   With a team committed to anticipating, detecting and preventing harm, the patient is best protected.   The team time out prior to a procedure is an opportunity for each member of the team to identify potential risk and offer a plan to prevent harm.   All too often the time out is not given the respect that it deserves and potential risk is not adequately discussed among the team members. As a patient advocate, use the time out as an opportunity to focus the team on patient safety.

Reduce distractions at critical times. Regulating the airline industry, the FAA requires the observation of “sterile cockpit” during the critical times surrounding takeoff and landing.   During this time, pilots must refrain from non-essential activities and conversation so that they can focus on the critical task at hand.   Stories of lapses in communication among distracted healthcare workers abound.   Distraction by idle conversation or use of social media during high risk times of patient care increases the risk of patient harm.   In the hospital setting it is not unusual for side bar conversations to take place while checklists are being read or timeouts are being done. As patient advocates, we must all share responsibility for the focus of the team to be on the patient at all times.

Value every member of the team.   On a recent flight, our boarding was delayed by an hour awaiting the arrival of a crew of flight attendants. Once we were on board, the pilot made an announcement. He apologized for the hour delay and said that we would be delayed a few more minutes…collective groan. He went on to say that the flight crew would be greater than 8 hours without food by the time we arrived at our destination.   He announced that he had ordered dinner for the flight crew and that we would be under way once the food arrived…collective cheer from the passengers. By looking out for the crew, the pilots believed that the passengers would be better served.   The lesson here is obvious. All too often we focus on our own needs and are not sensitive to the needs of others on our team.

As healthcare workers, our best opportunity for ensuring safety for our patients is to follow the example set by the airline industry and focus on communication and collaboration.   Hospitals across the nation hire experts to provide training on patient safety and yet the statistics often do not improve. When training is an academic exercise, nothing changes. It is only by applying the knowledge that improvement is made.   Use the lessons borrowed from the airline industry to ensure that your patients are safer your luggage.

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

Getting the Right Match


By Thomas Davis, CRNA

“What counts in making a happy marriage is not so much how compatible you are but how you deal with incompatibility.”  ― Leo Tolstoy

Neil Clark Warren is a name that you may not know, however, when you see his face and hear his voice you will say, “Oh yeah, that guy.” Mr. Warren is a clinical psychologist, Christian Theologian, seminary professor and CEO of eHarmony.com. Most likely you know him fromeharmony over a decade of TV commercials.   As a marriage counselor, Neil worked with couples who, despite their love for one another, had compatibility issues.   The eHarmony.com web site was designed to assess the basic character and values of each person and then match them with a partner based on compatibility. The success of this online dating plan has been impressive.   Compatibility is foundational to every good relationship, including work relationships.

Compatibility is just as important in the workplace as it is to your personal life.   Being in the wrong job is like being married to the wrong person…lots of work and not much fun. All too often production pressure influences a manager to hire a person primarily to get them on the job and working quickly.   After months or years of frustration, the manager realizes that the employee is not compatible with his leadership style or the institution’s values. Both are unhappy and neither is as productive as each could be.

As healthcare managers, Chief CRNAs have a vested interest in ensuring that employees are fully engaged in their work.   Engaged employees provide consistent, high levels of productivity. They are your problem solvers and proactively identify ways to streamline workflow and improve patient satisfaction. They embrace the vision and values of the organization and are on board with your management style.

In contrast, disengaged employees are actively or passively against just about everything. They believe that they are right and everybody else is wrong and would rather hold on tightly to the problem than fix it. Most people reading this article can name both engaged and disengaged co-workers.   As a manager, you seek to increase the number of workers carrying the load and to reduce the number of those who put a drag on the system. Your goal is to have a fully engaged workgroup, and employee engagement starts with the hiring process.

As my mother used to say, “It’s easier to avoid getting into a bad relationship than it is to get out of one.”   As a manager building a team, the Chief CRNA must assess compatibility of every applicant and stay out of bad relationships. Always remember, there are highly qualified, fully capable applicants who have the work experience that you seek but still may be a terrible fit on your team. Compatibility is as important as capability when assembling your team.   Building compatibility into your team begins with the application/interview process.

Competence and capability are foundational for any employee to become a valued member of your staff. Competence is evident by the applicant’s having the education and skills required in the job description, however, capability relates to the willingness to work and the quest for professional growth. When interviewed, an engaged applicant will ask about your expectations and will also ask about taking on more responsibility.   The person will want to know how you define and reward excellence.   When you follow up with calls to references, ask about work ethic and ask for examples of when the applicant went above and beyond the basic requirements of the job.   If all the person does is show up, earn a pay check and go home, don’t expect to see an attitude change after becoming your employee.

An applicant’s Commitment to the mission, vision and values of the larger organization aligns them with others in the workgroup and provides a stable platform for future interaction. When you interview, ask the applicant why they want to work with your group. Are they committed to the group values and are they committed to a long term work relationship or are they passing through until a better option arises? Before the interview ends, get a verbal commitment that the applicant supports the values of the group. Regardless of their competence, if the applicant cannot commit to the values of the group, the person is not a good fit.

Compassion and caring about the welfare of patients and co-workers are signs of emotional health.   Having a sense of happiness and a good sense of humor will elevate the mood of the entire group and make your hospital a preferred workplace. Build your team with people who appear happy, who support one another and have a desire to connect socially.   The interview is your opportunity for a conversation with the applicant that is relaxed and easy.   If the interview is stressful or there is not a free flow of thoughts, the applicant is not a good fit.

Compensation to include both pay and benefits is important to the institution and to the applicant. The offer should be competitive with the local market and the applicant should be satisfied with the offer. Employees who feel that your offer is too low will feel under-appreciated and may quickly become under productive. Not only do they become a drag on your system, they drag others down with them and create discord on your team. Don’t apologize for your offer. If the applicant does not gladly accept it, they will not fit in and will jump ship at the first opportunity.

Communicate with people who know the applicant and their work ethic. The applicant will provide a list of people who can be relied upon to give a glowing testimony.   When you interview, ask the applicant for names and contact information for current employers/supervisors. Follow up with a phone call to validate the things told to you during the interview.

Just as Neil Clark Warren uses eHarmony to assess values and characteristics of people to increase the likelihood of compatibility, the Chief CRNA must have a working knowledge of the values of the institution, conduct a focused interview, and follow-up to assure that the applicant is a good match. A happy, healthy and engaged workgroup is founded on a compatible partnership.

Remember, it is easier to teach technical skills to the right person than it is to change the basic personality of a highly skilled but wrong person. For eHarmony in your workgroup, do your diligence and make a good match.

 

 

Tom is an experienced leader, educator, author and speaker with a passion for team building.      Contact tom@procrna.com

Chief CRNAs are Team Builders


Chief CRNAs are Team Builders

By Thomas Davis, CRNA

“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”  ― Margaret Mead

As CRNAs we live and work in a rapidly changing healthcare environment.   The mandate to provide more care for more people at a lower cost combined with increased Federal regulations has introduced both stress and uncertainty into the healthcare industry. New challenges have emerged in the healthcare workplace.     Value based reimbursement, systems team-buildingintegration, and regulatory changes are but a few of the issues that are stressing the status quo.   Now more than ever, having a staff of fully engaged, cost effective workers is essential to the survival of the organization.

CRNA leadership on the local level is more important now than at any time in history as hospitals adjust to the new reality of regulation and reimbursement.   With safety and outcome metrics being publicly reported and reimbursement being tied to patient safety and satisfaction, it is essential to have the right people providing patient care.   As highly skilled, cost effective front line providers of anesthesia, CRNAs are regarded as leaders in the operating room.   We are in a unique position to make a difference on a daily basis not only with patient outcomes but also with the overall success of the institution.

Chief CRNAs across the country play an important role at the intersection of the operating room and the larger institution.      CRNA leaders are challenged with putting together a team that will provide a positive experience for the patient within the financial limitations of the Hospital.   Selecting the right people and having them fully engaged is an ongoing challenge for managers. As Chief CRNAs, we must look beyond the fact that a person has a license and wants to work. We must carefully select the right people who will be fully engaged in their work and raise the bar on patient safety and satisfaction.   The following are tips for selecting the right people to join your team:

Set a greater goal for your group.   Have a meeting with your current CRNA group and discuss the mission, vision, and core values of the larger organization.   Share your personal vision and values with your group and then listen carefully as you discuss your vision with them.   Take the initiative to develop a written vision statement for your CRNA group with a list of core values.   The vision and values that you share must become the foundation when interviewing applicants for a new position.   Develop interview questions to determine the applicant’s alignment with your vision and values.   The person may be an accomplished anesthetist however if they do not align with your vision and values they are not a good match for your group.

Describe your leadership style and how it aligns with organizational leadership.   Literature from business management states that the traditional top down “captain of the ship” leadership style blocks creativity and engagement.   In healthcare as in the private sector, shared governance “serving leader” style of management promotes creativity and engagement.   Take the initiative to learn about serving leadership and develop a one on one relationship with each member of your group. A sincere desire to promote the career of each person will lead to CRNA engagement which translates into improved patient safety and satisfaction. An applicant who views you as a serving leader and a person who will promote his/her individual career will be eager to share your vision and will give 100% on the job.

Discuss all of the positives and negatives related to the job.   It is unfair to both you and the new employee for surprises to emerge after they start working.   The applicant should walk away from the interview with a clear knowledge of your expectations. If there are less desirable assignments or shifts, the applicant should know before they agree to join your group.

Communication is essential.   In this era of instant messaging and 24/7 access to texting, email and internet, it is possible to avoid basic one on one communication.   As a manager, you need open and honest, face to face, two way dialogue with each employee. If you have problems communicating with the applicant at interview, you will also have problems later.   Patient satisfaction is founded on connecting with healthcare providers. Your new employee must have the communication skills needed to connect with each and every patient.   In addition, conflict is inherent within any healthcare team.   It is equally important that your new hire have the skills to have constructive conversations with difficult physicians.   At interview, ask the applicant about times when they have connected with patients as well as times that they have disagreed with physicians.   If they can not have positive interactions in difficult situations, they may not be a match for your group.

Not every skilled CRNA is a good match for your team.   When you have a clear vision of your goals, have an empowering leadership style, and clearly communicate your expectations, you will be able to determine the right candidate for your position.   At the end of the interview, the applicant will know your expectations and will be able to commit to your vision before accepting the position. When both the manager and the new hire agree on the greater goal up front, the road to success has been paved.

 

Let me help you excel as a Chief CRNA.  Consultation service available related to team building and serving leadership.    Contact tom@procrna.com