We're certainly off to a great start. Now we'll start looking at some of the cases for discussion. And remember, we'd like to hear from you, your questions and your experiences. Before we jump in, I see a question from the audience, but I also wanted to ask Sian and Lisa, what their thoughts are about doing 360 degree feedback evaluations for team leaders and members. Do you think those are useful or harmful? I must say I think they're very useful. It's very important when we do a 360 that we hear from everyone. So it really doesn't matter if they're your supervisor or someone that you manage, but you get to have opinions from everyone that you interact with. And of course, it's confidential, so they can really give you feedback. And we talked about the idea of how do we learn as a leader? We learn from feedback so we can say, what am I doing right? What can I improve on? I totally agree. I have had these over the years. They have helped me grow as a leader. They've given me great insight on areas that I need to focus on. We're not born, we're not all born as these great leaders. We have to evolve, we have to grow, and we have to take feedback from our staff on how to be better and how to make them better. Great. So I don't know how many of you have had a 360 degree feedback evaluation. Sometimes it can be a little bit disheartening when you see some negative reviews, but those are actually opportunities to improve. So hopefully you will have a chance at some point in your career to have one of those because I do think they're valuable. We do have one question from our audience. It asks, are there any ideas about generational differences and best ideas for engagement? I wonder if this is something that's related to the differences between GENs X, Y, and Z. Perhaps, Lisa, do you want to give us some input into this? Absolutely. So as the manager in the ENDO unit, we had staff from all generations. There's the folks that have been there for a long time. I was one of them. I grew up in a very structured unit and followed the task and task-driven. So I had to take that and put it aside for my newer generational nurses and realize what drives them was different than what drove nurses such as myself that have been around and knowing what is important to them. And I found that for them, time off, work-life balance, having opportunities to be involved in decision-making, getting involvement, these are all things that take into consideration. So what drives one group may not necessarily drive another. That is a terrific answer. And I think that a lot of those generational differences apply to differences in how people were raised, what kind of environments we were used to. I think that if you use the nuts and bolts that Sian had actually talked about in her talk, it could lead to a lot of open conversations about things that are important to that particular person and making sure that people are heard. Sian, what do you think? Yeah, I agree. I think really communication is the key. People from different generations, different experiences, different obstacles come in with a different point of view and looking at the exact same issue or struggle that you're having in your endoscopy unit and allowing people to have an open forum to discuss how they see it, where they see the problems are, allows you to find out where they are to kind of bring people together and create a solution together. So I agree with you completely, Gerard. So hopefully, Pam, that answered your question. Hopefully you've gotten some ideas about handling that situation. I think we could go into our first case discussion. And I again encourage everyone in the audience to participate. Raise your hand if you'd like to engage in this discussion. Oh, boy. So one of the other questions that came up is, how do we get our physicians engaged with staff? And I do think that it's this process of building team culture. The leaders within the endoscopy units really need to bring together everybody on the team so that everyone's voice is heard. Issues that come up are sorted out. Those principles of high-performing teams are followed. Again, I'd point you to that slide to take back to your team. I think that's how you can get your physicians engaged, knowing that if staff are leaving or there's a high turnover rate in your unit and it's because of physicians within your unit, that needs to be addressed. So using those nuts and bolts that we talked about are ways to get everyone on the team on the same page, having that team-based agreement. Lisa and Cyan, do you have any other comments about that question? Yeah. I think it's really important that in terms of just practical tips, that the physician lead, the nursing lead, and the administrative lead have small touch points where they sit down and say, over the course of the next six months, what are the issues that our endoscopy unit is facing? And we can talk about issues that are operational, but then also we should talk about morale and team building. And collectively, they should sit down and say, okay, I want to make sure that we engage in these various activities by the end of the year. They also have to engage the physician leader to be a part of the larger meetings with the staff, because the physician has to be present to really understand what the issues are going on. And then they can take that to their other physicians and colleagues to essentially champion the efforts that are going on. So these are the times that we can use our small little triad groups to set very serious goals and metrics for everyone on the team to achieve, including the physician, so that they can be the champion within the endoscopy seat with their other physicians to really bolster engagement and say, hey guys, this is what we're doing. You may not understand, but morale is down. I need you to really help. You're in the endoscopy room. You're a little gruff with the other people in the room. We got to give feedback, those kinds of things. But this is where sitting down and aligning with goals and really coming up with tangible things we need to do is important. Yeah. So this gets right on point to our first case discussion, because a lot of things that we've been talking about kind of address some of the issues that come up with this. So this is a senior level nurse. She's become somewhat passive aggressive in the unit in terms of her assignments. It's reached to the point where physicians start requesting other nurses to work with them. They've noticed that when she's in the room and she's pushed to move faster because the physicians are feeling the pressures of getting things done, she tends to move a little bit slower and the day winds up being one to two hours longer than with other nurses. So when confronted by the nurse manager about expected times to complete tasks, she says that if her job assignment gets changed again or she's feeling the threat of being fired, she's going to sue for racial discrimination. So how do we handle this situation, Lisa? Okay. Sorry to put you on the point. No, this is true to life, right? This has happened over the years. This is a true to life scenario. And so how I handled it in my unit on more than one occasion is, you know, connecting with that nurse, right? Finding out what is going on, what is really going on with them. Hopefully you've built a relationship with this employee over the years and they trust you. Getting to the heart of the matter. In one instance, this employee had some personal issues going on in her personal life that was then translating into the work environment and that it was coming out in this manner, slowing down, taking her time. You know, my role was to support nurses and support safe practice, right? And then, so finding out what was happening with this nurse, offering up some assistance, the hospital, our system offers like an employee assistance program, referring her to that route, seeing if maybe the employee needed to take some time off away from work to take care of the issues that were happening outside of the workplace and just having an open dialogue and getting to the heart of the matter. And then once things came out and I worked with the employee, they turned around on a different path and they really rose to the occasion, but you got to get to the heart of the matter of what is really happening with them. Because obviously this person's been there 15 years, they are probably a great employee or you wouldn't have had them in your unit that long and just getting to the heart of the matter. Those are great suggestions. If people in the audience want to propose their own solutions for this, go ahead and put that in or raise your hand. We'd love to hear from your perspective as well. Maybe we'll go on to the second case. So this is case two at a hospital endoscopy unit. At a hospital endoscopy unit, the nurse manager realizes that many of her long-time staff are becoming more and more dissatisfied, morale is declining. You can think about this during the COVID pandemic. She finds out from one of her nurses that one of the reasons is that they have seen several travel nurses in their unit who are making more money, but they're not working as hard as the employed nurses. As you would expect, some of these employed nurses have started to look for other jobs. How do you handle this situation? Right. This is another true to life scenario. We're probably all dealing with it. And, you know, we lost a couple people during COVID. So we had to bring in travel nurses, which, you know, is was something quite new to our unit. And they are right to feel that way. So some of the things that the strategies that I employed were talking to the team. And fortunately, work life balance is very important to them. So some of the options that we discussed war were, well, there are incentive programs for folks that want to pick up a dollar incentive programs that want to pick up more time. So there's options of that. Or we could bring in travelers. And the staff that I oversaw, their work life balance was very important to them. And their time off was very important to them. So they voted for the option to bring in travel nurses. I talking to leadership there, we put in other incentives in place. I know dollar incentives aren't always realistic in today's environment. But our organization, they listened. And I was able to get on call pay dollar incentives, because the travel nurses did not do call yet the working staff did. And this helped with increase their morale, because they were taking a lot of call. Just talking as a group on how this is going to be a temporary situation, hopefully, and trying to recruit up which we have to help alleviate some of the travel nurse positions that we had. But I mean, this is a real issue. And I like to hear how other units, maybe across the region or the country are handling this. But just being connected to your teams, seeing what drives them and advocating for them on all levels. Yeah, I think I think that's a terrific way of approaching this problem. Signe, you had your mic on. Did you want to add to that? Yeah, I must say the thing that I love that Lisa stressed is the idea of acknowledgement. A lot of times they feel as leaders, when our team's coming to us, we have to pretend like that's really not a pop, you know, problem, put a positive spin. But I think you discussed the idea of acknowledging the problem saying that, yes, we're in a critical time where we don't have enough staffing. And I acknowledge that this is an issue with the travelers, I acknowledge that they're getting higher pay. I am thankful for my team and what you do. And I value and appreciate you. And my goal is to retain you and grow. And then Lisa talked about giving them options, right? Having that shared decision making on how do we move forward? Do we want travelers? Or do I want to advocate for you in other areas to get some additional overtime? And having that shared decision making process allows people to be a part of it. And then, of course, as Lisa said, giving them updates, what are the plans that we're moving to, to have permanent hires and build our staffing so we can use less travelers. But I love that, you know, acknowledgement, really presenting offers, your options, having everyone engaged in the solution, and then also advocating for your team. Amazing, Lisa. Yeah, all great ideas. And I think those also apply to some of the things that some of the people in our audience have been asking while this case was being presented. So there's one on, you know, the ASC environment typically has no call, no weekend shifts. And it's changed to where now weekends, I'm assuming Saturday, is starting to be a requirement in some of the ASCs. And how do you keep people there? And then the other question was that in the hospital endoscopy unit, those high performing staff members on your team are moving over to the ASC and presumably it's because of either better pay, better work hours, better whatever. And all these strategies that Lisa talked about, those are things that you need to talk with the people who are contemplating those decisions and seeing, you know, what would work for them to get them to stay. Lisa, I'm sorry to put you on the spot again, but these are questions that seem to be right up your alley. Absolutely. And so if they are, we talked about opening Saturdays here, like in our hospital outpatient endo unit, first, everybody's disgruntled. Oh, no, we're not doing that. Oh, no, this is going to impact. Oh, I'm so used to a Monday through Friday. But pulling the team in, we didn't end up going that route. But there were discussions and offering the staff the change in the hours, going to longer days or a day off during the week was very favorable to if somebody had to then if we had to shift scheduling out to the Saturday and staff seemed to like that because not having time during the week is also impactful in your work-life balance. Because as we all know, everybody's out on the weekends doing their grocery shopping, doing their banking, and it's a busy time. But having that time during the week, the staff did bring that up and they liked that. So just shifting the hours to a longer day, having a rotation, letting them sign up. These were all things that we discussed if we had to go to a Saturday workday operation. So hopefully our audience members got some good ideas about how to handle that particular situation. I don't know, we have time to move on to the third case? Yeah, we have four minutes. Let's do it. So this case, this is a nurse manager who's getting feedback about the long hours associated with inpatient add-on cases. And there are more and more nurses that are leaving because of this attrition rate due to travel assignments. And she recognizes the increased workload and the longer hours, the staffing. So again, I think we talked a little bit about some of the steps that the nurse manager can take to help staff feel supported. Are there any other recommendations or steps that you would recommend in this situation? So one of the things that we did in our unit, because the same thing would happen, add-ons would just come and come and come. And people were scheduled till 4 or 4.30, they want to go home. And it was always the call team that was, I don't want to use the word stuck, but okay, I will. We had to finish up the day. So we employed a scheduling strategic plan where folks are scheduled in an eight-week block, because that's what the system uses, an electronic schedule, eight-week blocks. And they would sign up for a, they would have their shift, but then they would sign up for like a late shift, meaning that they would get paid a call stipend from, so we would say a four-hour call from four to eight. And that would be to finish up the day. And we would have, so we'd have the on-call team overnight separate from this late call team four to eight to finish up the day. And guess what? They were scheduled. They knew they could plan their life ahead. Oh, I'm late. I could possibly have to finish out the day. And then they were getting paid call pay. So this helped alleviate a lot of that as things were planned and it was worked into the daily schedule. Yeah. So another suggestion would be to look at what's impeding the ability to get some of these add-on cases done during the regular hours. Is it a problem associated with anesthesia? Is it a problem associated with turnover times between the rooms? Is it because you don't have enough physicians doing these cases? Can another physician be recruited to help out with some of these inpatient cases? So if the inpatient attending is taking care of this patient, can they assist in providing some of the staffing for this? Can we move some of the tech hours to a later point in the day so that there's enough techs to handle some of the later hours and give them the freedom of having that sleeping in in the morning, so to speak? Those are some of the things that could potentially be used to solve this situation. Obviously, asking your team. Sometimes you'd be surprised that a biomedical engineer is watching this from the sidelines and he'll come up with a great idea about ways to improve the process and operational process through the unit. So listening to your team members is really important. Any other suggestions, Cyan? I was also trying to think if data might help, because when you're trying to understand the problem, taking some time to understand and better understand the issue behind it. How many days a week are we running late? Is it a Monday? Is it a Tuesday? Is that a Friday? Also allowing the team members, because I think sometimes we can feel like every day is running long. But when we actually look at the data, we can say, well, we've actually identified that it's just three days out of the week. And allowing us to focus on those days to come up with various solutions or interventions. Like you said, can we pull another endoscopist? Because it's not only it's everyone's responsibility to help create a solution. So if it is just adding on another physician that might be doing outpatient cases to help with the inpatient cases on these particular days, or to make some changes in the scheduling, that's important. But then also using that data to show improvement. Sometimes it might not show improvement, but that's okay too. But the idea to say, okay, now that we've come together and said we're going to do these three interventions, let's now in three months take a look back and see if our interventions are working. So it really is kind of that balance where data might be able to help you find out what's the real issue. It can help alleviate people's anxiety and say, listen, not every day are we staying late. The data shows this. And then you can use that data to show improvement. And hopefully they'll say, you know what? Yeah, I agree. I think it is getting better.

leadership

team management

communication

feedback

generational differences

team culture