Tag: leadership

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Business/Finances Leadership & Practice Management Preparing for Grad School/Residency

#114 – Leadership: how to get stuff done

This podcast is for leaders, clinicians, residents & students who need to get wildly important things done. It’s about how to prioritize when so much of your work seems important. How to find balance when so much seems to be coming at you. How to get started at achieving your biggest goals.

This episode will walk you through the 4 Disciplines of Execution by Chris McChesney, Sean Covey & Jim Huling. 

I have no financial relationship with these folks, the book or their publishers. It’s just a great concept that will help you get organized, identify your wildly important goal and figure out the work you actually need to do and CAN do to accomplish your goals.

The 4 Disciplines of Execution (4DX) model will ask you to identify your wildly important goal. You’ll then create several lag measures (subgoals) and several lead measures (objectives) for each lag measure. These lead and lag measures are where the real work is. The wildly important goal may seem out of reach. Even the lag measures (which lag behind the work you’ll do in the lead measures) may seem a bit ambitious. That’s ok. The lead measures should be the specific actions you will take on a daily or weekly basis that will chip away at the lag measures. As you put the work in on the lead measures, your lag measures will come into sight and slowly be realized. As you stack up achieving the lag measures, your wildly important goal will become within reach.

The next components of the 4DX model is the scoreboard where you track your progress on each lead & lag measure. This can be any relevant metric on any kind of progress tracker: a list on a whiteboard, a data point in an Excel file, the pounds on the scale, dollars in the investment account or left on the loan. Whatever.

Lastly, is the cadence of accountability. You need to either personally set up a check in on your progress with yourself or you need to set this up with your team, mentor or coach. The authors of the 4DX model recommend this be a short weekly meeting where you review progress from the last week and plan actions for the coming week. Accountability is about follow through, taking steps (as small as they might be) and slowly, setting up the cadence of consistency.

I was on the Peloton last night and heard Matt Wilpers say that the order of priorities in exercise is developing consistency, then duration, then load. You can’t go out hard all of a sudden and expect big results. Develop consistency. Show up a little bit each day or each week. Then put the time in. Build the duration of your investment towards your goals. Then you’ll know when to put the extra effort in.

Check out the show and if you want to dig deeper, definitely check out the 4 Disciplines of Execution.

McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution: Achieving your wildly important goals. Simon and Schuster.

What’s your Wildly Important Goal?

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Anesthesia Education Business/Finances Leadership & Practice Management

#112 – How to Transition from Clinician to Chief CRNA

What’s up y’all! This is Jon Lowrance and this is episode 112 – How to Transition from Clinician to Chief CRNA.

Y’all are going to love this conversation.

So… I almost don’t know where to begin cause there’s so much to talk about…

This is an episode about chief CRNAs but so much more. It’s like when you watch one of those food documentaries about the best pizza kitchens in the world and you’re like: oh, a documentary about pizza, but then it’s really about the experience of chefs, small business owners, friendship and passion. This episode is like that.

It’s about chief CRNAs. And we have a couple of guests that are going to talk with us about an article they published on the research they did into the professional experience of chief CRNAs. But this story is really about the transition that most healthcare providers take when they take the step from expert provider to clinician-leader, practice manager or owner. You’re going to see this through the lens of what these 2 researchers saw when they did a qualitative analysis of chief CRNAs across the state of North Carolina. But you might take something away from this about the physician who leads your team or the CMO or health system president that runs the show where you’re at.

If you work in healthcare, cause you probably do – again, unless you’re my mom, who listens to all these podcasts – hey Gail! But for the rest of you, if you’re in healthcare, this episode will likely help you understand your clinical leaders better.

I never set out to be a chief CRNA or practice manager. I wanted to be the best clinician I could. I wanted to stand in the gap between the chaos and the outcome. I wanted to master my craft as an anesthesia provider and take the best care of patients possible.

Literally, like 6 months before our chief CRNA announced that he was going to step down after 8 years in his role, I had the opportunity to become a daily shift supervisor – like a board runner in the OR. I was like: I’m never going to do that. It seems way too hard. Then our chief stepped down and his role opened up and I was like… wellllllllll…

This episode hopefully will be relevant to any clinician who, like me, has stepped into a role or is thinking about taking on a clinical practice leadership role that maybe they’re not totally ready for. You’re not alone.

So we’re going to talk with Austin Cole and Robert Whitehurst, co-authors of an article about the competencies & professional development needs of chief CRNAs that was published in April 2024 in the AANA Journal.

Austin framed his doctoral project at Duke University around this study. Austin Cole, DNP, CRNA began his career after graduating from the school of nursing at UNC-Chapel Hill. Following graduation, he spent two years as a Registered Nurse in a cardiothoracic critical care unit. He received his DNP and nurse anesthesiology training at Duke University and currently practices as a CRNA at Duke Regional Hospital in Durham, NC.

Robert Whitehurst is the President of Advanced Anesthesia Solutions, a CRNA practice providing anesthesia services to a variety of outpatient practices. He graduated in 1997 from East Carolina University School of Nursing with his Bachelor of Science in Nursing and in 2004 from Duke University School of Nursing with his Master of Science in Nursing. Bob Whitehurst is also the Chairperson for the North Carolina Association of Nurse Anesthetist’s Political Action Committee and he’s passionate about patient access to high quality anesthesia care. He’s happily married to Amy Whitehurst; they have 4 children and in his spare time he enjoys hanging out with his family and playing tennis with friends.

Austin & Bob’s paper is titled “A mixed-methods exploration of competencies and professional development needs among chief Certified Registered Nurse Anesthetists.” For the study, the authors contacted 85 chief CRNAs across North Carolina and conducted structured interviews and qualitative analysis with 10 of them. They set out to understand the competencies and professional development needs of chief CRNAs.

I gotta say, when I read their article, so much of it resonated with me as a chief CRNA. The path for so many practice managers – including physician anesthesiologists and other Advanced Practice Providers, like PAs & NPs, is that a senior clinician with several years of clinical experience often steps into a practice management & leadership role that’s been vacated and their learning curve in leadership happens through on the job training.

That’s kinda suboptimal.

Yet it’s pretty rare for groups or hospitals to have dedicated mentorship and professional development programs established and to encourage clinicians to develop as practice leaders. It’s even more rare for clinicians to have formal leadership & management training prior to stepping into leadership roles. In the show, we hit on 2 important concepts – the double loss phenomenon and the halo effect. The double loss phenomenon is where the group looses a senior clinician when they step into a leadership role since they’re not doing clinical work as much and they gain an inexperienced leader & manager… someone with little to no experience in that kind of role.

No bueno.

The halo effect is the cognitive bias where people believe that because they’re really good at doing one thing – like being an expert anesthesia provider – they’ll automatically be really good at another – like being a practice leader. Competency in your clinical practice does NOT translate to competency in leadership & management. They’re two wildly different skill sets and you need to train, study and work hard at leadership & management just like you trained, studied and worked hard to become an expert clinician.

So I think you’re going to enjoy this show. Regardless of your clinical background – whether you’re a CRNA, a med student or resident, physician anesthesiologist or some other Advanced Practice Provider. Even though we’re talking about chief CRNAs here, we’re really talking about the phenomenon of clinicians transitioning into leadership & practice management roles. I’m a big believer that if healthcare is going to change for the better… become more effective, efficient, safer and just better for both patients and the people providing the care, we will need expert clinician-leaders. We need these clinician-leaders to learn the art & science of practice management. We need clinicians to develop the key competencies to become expert leaders. That transition and development is not a given. It doesn’t just happen with on the job experience. You can be a very experienced practice leader and be terrible at your job.

This episode is a great place to start for new and future clinician-leaders. I hope you enjoy it as much as I did! I’ve got links in the show notes to the article that Austin & Bob published.

And with that, let’s get to the show!

Cole, A. L., Simmons, V. C., Turner, B. S., Whitehurst, R., & Tola, D. H. (2024). A Mixed-Methods Exploration of Competencies and Professional Development Needs Among Chief Certified Registered Nurse Anesthetists. AANA journal, 92(2), 105–113.

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Anesthesia Education Business/Finances Preparing for Grad School/Residency

#110 – How we do interviews with Alison Kent & April Bourgoin

What up yall. This is Jon Lowrance with Anesthesia Guidebook. This is episode #110 – How we do interviews with Alison Kent, MSN, CRNA & April Bourgoin, DNAP, CRNA.

In this episode, April, Alison & I talk about how we conduct CRNA interviews as a leadership team with our Department of Anesthesiology at MaineHealth – Maine Medical Center. Maine Med is the only level 1 trauma center in the state of Maine with 700-licensed beds. We run around 60 anesthesia sites of service a day with a staff of just over 130 CRNAs, 50 physician anesthesiologists, a physician residency & fellowship program and have clinical affiliations with 4 different nurse anesthesiology training programs.

Alison Kent is the Manager of CRNA Services at Maine Medical Center and completed her Master of Nursing in anesthesia at the University of New England in 2006. She’s been at Maine Medical Center as a CRNA for nearly 20 years and has served in the Manager role since 2017.

April Bourgoin is one of two Supervisors of CRNA Services at Maine Medical Center and completed her Master of Science and Doctor of Nurse Anesthesia Practice degrees at Virginia Commonwealth University in 2017.  Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army as flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major.

April joined me on episode 93 of Anesthesia Guidebook where we talked about OR fires and this is Alison’s first, but certainly not last, appearance on the show!

These 2 folks are part of the core CRNA leadership team at Maine Medical Center. Together, they truly make the world go round for our team and are like the glue that holds everything together. It’s an absolute privilege to get to work closely with these folks on a daily basis and I couldn’t be more thrilled to have pulled them in on this podcast about how we do interviews.

So, let’s tee this up a bit.

In today’s anesthesia market, you can go anywhere and make a great money and do interesting cases but the thing that will differentiate your experience with a group is the culture of the team. And your experience of that culture begins with your interview. It actually begins a little earlier than that, even, with how the reputation of the team reaches you – maybe through things like this podcast, or when you reach out to inquire about a group or talk with friends & colleagues who may work or have worked with a particular group.

But a really important deep dive into the culture of the team will come on interview day. You should meet some core folks on the team – CRNAs, physicians, trainees, administrative specialists. You should get in the operating rooms and actually see the staff do the work that you’re looking to join them in. You should leave the interview with a very clear idea of what you’re potentially getting yourself into, both in terms of culture and with a thorough run down of the benefits and compensation package.

If you’re listening to this and you’re a practice manager or thinking about getting into a role in which you support your team as a leader, hopefully you find this podcast super helpful.

Alison, April & I talk through our process & structure for interviews, what kinds of questions we ask, what we look for in candidates and how we work to both recruit folks and protect our culture by making sure we’re bringing in people who are a good fit for the team.

A few years ago another chief CRNA asked me if I had any tips on how to conduct interviews. When we talked then, I of course knew that I wanted to get around to doing a podcast on the topic to share the same advice with you. And here it is!

Oh, by the way, what we describe is our process as a leadership team. Our opinions expressed here are our views and do not necessarily represent the views or opinions of our employer. Seth Godin has this great definition of culture where he says, “people like us do things like this.” This is how we do interviews as a leadership team.

We hope you enjoy our story.

If you’d like to apply to work with our team as a CRNA, please reach out to chat or drop your application here: https://www.careersatmainehealth.org/jobs/search

Search for the CRNA roles at Maine Medical Center in Portland, Maine.

And with that, let’s get to the show.

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Anesthesia Education Business/Finances Leadership in Emergencies Preparing for Grad School/Residency

#109 – Leadership 101 – Why it Matters

What’s up yall! This episode dives into fundamental concepts related to leadership and casts a message for why it matters to all of us.

Whether you’re primarily a clinical CRNA/physician anesthesiologist, resident/SRNA, a practice leader/manager, business owner, educator, researcher or policy advocate, leadership has a fundamental role in your day to day life.

In this episode, we talk about:

  • The art & science of leadership
  • Position, power, influence
  • Leadership & management 
  • Leadership & followership
  • Culture, and how we influence it 
  • The Servant Leadership Model 
  • Jocko’s leadership principles

I’m pulling from my time as an instructor with Landmark Learning and NOLS (National Outdoor Leadership School), both outdoor education schools that thread leadership principles through their risk management and wilderness medicine programs. I’m also pulling from my experience as the chief CRNA at Maine Medical Center, a level 1 trauma center with over 200 staff in the anesthesia department. And some of the content is coming from the work I’m doing as I pursue a PhD in organizational leadership with a research focus on how high performance teams operate in emergencies.

Hopefully you’ll find something you can hang your hat on here.

Leadership is the art and science of influencing others to achieve shared goals.

There’s a ton of different leadership styles & theories out there and I’ll touch on some in the podcast. My personal approach is the Servant Leadership Model, which flips the traditional organizational chart – a pyramidal/triangular structure – on its head and puts the leader at the bottom of the triangle and the most important staff up at the top. The most important folks in any organization are those who are doing the front line work to deliver on the mission and vision of the organization. In the Servant Leadership Model, these folks are the top and the leaders and managers are positioned below them. The job of leaders and managers is to support and empower the folks above them to do their best work in robust and resilient environments where the capacity for the right thing to happen flourishes.

No big deal right? To find out more, check out the podcast!

Servant Leadership ModelDownload

Leadership Tactics

By Jocko Willink

  1. Be humble 
  2. Don’t act like you know everything 
  3. Listen, ask for advice & heed it
  4. Treat people with respect 
  5. Take ownership of failures
  6. Pass credit for success up & down the chain of command
  7. Work hard 
  8. Have integrity – do what you say, say what you do
  9. Be balanced – avoid extreme actions/opinions
  10. Be decisive 
  11. Build relationships = this is the main goal of a leader
  12. Get the job done

Willink, J. (2023). Leadership strategy and tactics: field manual expanded edition. St. Martin’s Press.

Thank you to everyone who subscribes to the website & podcast… wherever you do that! YOU are the reason Anesthesia Guidebook is here. Take care and have fun out there!

Jon Lowrance

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Anesthesia Education Business/Finances Personal Finances Preparing for Grad School/Residency

#82 – How Change Management can Build Value with Randy Moore & Desirée Chappell

Randy Moore, DNP, MBA, CRNA and Desirée Chappell, MSNA, CRNA join me to talk about change management in healthcare. They are both on the leadership team with NorthStar Anesthesia, which provides perioperative services at over 200 facilities across 20 states.

This conversation focuses on how leaders can navigate change, develop culture and build successful anesthesia practices. We discuss the challenges facing anesthesia providers right now after 2 years of the COVID-19 pandemic and what market forces are at play including provider shortages, pressure from reduced reimbursement rates and lower surgical volumes. This episode will be relevant for any anesthesia provider who’s looking to build value in their career and especially relevant for those practice managers, owners, leaders & entrepreneurs who want – and need – to know how to navigate change, find sustainable & deliberate growth and develop cultures where providers want to invest their careers.

Desirée Chappell, MSNA, CRNA is the Vice President of Clinical Quality at NorthStar Anesthesia. Desirée has an extensive background in education and quality improvement in anesthesia. She is the managing editor & lead anchor of TopMedTalk, a podcast on anesthesia, critical care & perioperative medicine with nearly 1600 episodes. She is also adjunct faculty for the Acute Pain Management Fellowship at Middle Tennessee School of Anesthesia and serves on the board of directors for the American Society for Enhanced Recovery. Desirée received her Master of Science in Nurse Anesthesia from Texas Wesleyan University.

Desirée Chappell, MSN, CRNA, VP of Clinical Quality at NorthStar Anesthesia

Dr Randy Moore, DNP, CRNA, MBA is the Chief Anesthetist Officer at NorthStar Anesthesia. He recently left his role as the Chief Executive Officer of the American Association of Nurse Anesthesiology and has a long background in organizational leadership. He retired as a Major in the United States Army after 22 years where he served as an active duty CRNA with tours in Afghanistan at Forward Surgical Bases. His doctorate of nursing practice is from the University of Alabama, his MBA from Southern Illinois University and Master of Science in Nursing anesthesia from Bradley University.

Randy Moore, DNP, CRNA, MBA, Chief Anesthetist Officer at NorthStar Anesthesia

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Anesthesia Education Clinical Tips Preparing for Grad School/Residency Wellness

#57 – Incivility in the Workplace – Joshua Lea, DNP, MBA, CRNA & Kelly Gallant, PhD, CRNA

Josh Lea, DNP, MBA, CRNA and Kelly Gallant, PhD, MSN, CRNA join me to discuss workplace incivility in anesthesia training. We discuss the role of precepting SRNAs and anesthesia residents, root causes and implications of incivility and processes for improving healthy work environments. 

Josh Lea, DNP, MBA, CRNA is a professor of anesthesia at Northeastern University’s Nurse Anesthesia Program and staff CRNA at Massachusetts General Hospital in Boston.  He serves on the board of the Anesthesia Patient Safety Foundation and focuses on burnout & creating healthy work environments as his area of research and publication. He has spoken extensively on the topics both nationally and internationally through his work with the Anesthesia Patient Safety Foundation and as a member of the American Association of Nurse Anesthetists (AANA) Health and Wellness Committee. 

Kelly Gallant, PhD, SRNA completed her anesthesia training at Northeastern University in Boston. She received her Bachelor’s degree from Northeastern in 2010 and spent 8 years working in the surgical intensive care unit as a Registered Nurse while researching pediatric pulmonary hypertension and caregiver reactions as part of her PhD, which she completed at Northeastern in 2017. Kelly then returned to school to study anesthesia completing her Master of Science at Northeastern in May 2020. Kelly was the fiscal year 2019 SRNA Representative to the AANA Health & Wellness Committee. and also contributed to episode #52 – SRNA Wellness in COVID-19 of Anesthesia Guidebook.

References:

Elmblad, R., Kodjebacheva, G., & Lebeck, L. (2014). Workplace Incivility Affecting CRNAs: A Study of Prevalence, Severity, and Consequences With Proposed Interventions. AANA Journal, 82(6), 437–445.

Katz, D., Blasius, K., Isaak, R., Lipps, J., Kushelev, M., Goldberg, A., Fastman, J., Marsh, B., & DeMaria, S. (2019). Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Quality & Safety, 28(9), 750–757.

Neft, M., Hartgkidek, A., & Lea, J. (2017). Wellness milestone: The road to wellness: Paving the way toward a healthy work environment. AANA NewsBulletin.

Mahoney, C. B., Lea, J., Schumann, P., & Jillson, I. (2020). Turnover, burnout, and job satisfaction of certified registered nurse anesthetists in the United States: Role of job characteristics and personality. AANA Journal, 88(1), 39-48.

Mahoney, C. B., Lea, J., Jillson, I., & Meeusen, V. (2014). Turnover of nurse anesthetists: The similarities and differences between countries. BioMed Central Ltd. 14(2).

Other Resources:

Do you want to learn from APSF about patient safety? Easy. Just subscribe to the APSF Newsletter for FREE and connect with APSF on Twitter, Facebook, and LinkedIn.

AANA Promoting a Culture of Safety and Healthy Work Environment: Practice Considerations PDF

AANA Webpage on Bullying, Disruptive Behavior and Workplace Incivility

AANA SRNA Wellness

Need Help? Not sure? Check out AANA Ask For Help website.


AANA Nurse Anesthesia Leadership Survival Guide PDF

Do you have more questions about workplace incivility? Feel free and contact Joshua Lea, DNP, MBA, CRNA at lea.joshua@gmail.com, Kelly Gallant, PhD, MSN, CRNA at gallant.k@husky.neu.edu or wellness@aana.com.  For concerns related to alcohol or other drugs, call the AANA Helpline at 1-800-654-5167 for 24/7 live confidential help.

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Anesthesia Education Clinical Tips Leadership in Emergencies Preparing for Grad School/Residency

#31 – Expertise in Anesthesia with Denham Ward, MD, PhD

This episode originally released on From the Head of the Bed in February of 2017.

Denham Ward, MD, PhD joined me to talk about expertise in anesthesia. At the time of this recording, Dr Ward was the director of the Academy at Maine Medical Center Institute for Teaching Excellence and professor of anesthesiology at Tufts University School of Medicine. He is Emeritus Professor and Chair of Anesthesiology and Emeritus Professor of Biomedical Engineering at the University of Rochester.

This podcast focuses on developing and maintaining expertise over a career in anesthesia.  Highlights range from defining expertise, specialization in anesthesia, types of problem solving and clinical decision making, deliberate practice, grit and how to teach and coach the development of expertise in trainees as well as experienced clinicians. We touch on Ericsson’s ideas on deliberate practice and the 10,000 hour rule for expertise, Dreyfus’ conceptions of skill acquisition from novice-advanced beginner-competent-proficient-expert, Kahneman’s System 1 and System 2 ways of thinking, Moulton’s “when to slow down,” Gawande’s ideas on the benefit of getting coached to improve our performance even well into our careers and more.

“The difference between medicine and music is… musicians practice, practice, practice and then they go to Carnegie Hall for one evening…  We’re essentially at Carnegie Hall every day.”  Denham Ward, MD, PhD

“Most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers.” Anders Ericsson

References:

Benner, P. (1982). From novice to expert.  The American Journal of Nursing, Vol. 82.  Retrieved from http://www.healthsystem.virginia.edu/pub/therapy-services/3%20-%20Benner%20-%20Novice%20to%20Expert-1.pdf.

Dreyfus HL, Dreyfus SE. (2005).  Expertise in Real World Contexts. Organization Studies, (26)5: 779-792. Retrieved from https://www.pdx.edu/sites/www.pdx.edu.unst/files/UNSTArticleDreyfus.pdf

Duckworth, A. (2016). Grit: The power of passion and perseverance (Vol. 124). New York, NY: Scribner.  Retrieved from http://www.simonandschuster.com/books/Grit/Angela-Duckworth/9781501111105. Screen shot by author.

Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. Screen shot by author.

Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.

Gawande, A. (2011). Personal best. The New Yorker, (30). 44.  Retrieved from http://www.newyorker.com/magazine/2011/10/03/personal-best.

Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.

Kaminski, J. (Fall, 2010). Theory applied to informatics – Novice to Expert. CJNI: Canadian Journal of Nursing Informatics, 5 (4), Editorial. Retrieved from http://cjni.net/journal/?p=967.

Moulton, C. E., Regehr, G., Mylopoulos, M., & MacRae, H. M. (2007). Slowing down when you should: a new model of expert judgment. Academic Medicine: Journal Of The Association Of American Medical Colleges, 82(10 Suppl), S109-S116.

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Anesthesia Education Clinical Tips Leadership in Emergencies

#7 – Leadership in Emergencies – how to master the art & science of resuscitation

Leadership in emergencies is about leadership outside of emergencies. The art and science of resuscitation involves understanding and mastering both the systems design and human factors at play in emergencies. In this episode, I unpack research by Weinger, et. al. (2017) to help us see the potential for improvement in our response to emergencies as anesthesia providers. This is the tip of the iceberg and in future shows, we’ll explore concepts related to cognitive biases, leadership & followership, communication, flow, stress inoculation training and more.

Resources:

Weinger, M. B., Banerjee, A., Burden, A. R., McIvor, W. R., Boulet, J., Cooper, J. B., … & Torsher, L. (2017). Simulation-based assessment of the management of critical events by board-certified anesthesiologists. Anesthesiology: The Journal of the American Society of Anesthesiologists, 127(3), 475-489.

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