Thoughts on Leadership: Lessons Learned on the Hillside

hey I’m Jamie McKelvie have you heard about our today live it’s the fun and educational conference for perioperative professionals and is coming to the Washington DC area this August though our today live offers an intimate atmosphere where you can network face to face and a more relaxed and casual environment than other larger conferences within our industry it’s also very affordable registration includes these super sessions the Welcome Reception three days of education a keynote address and access to an exhibit hall showcasing the industry’s latest technology you can get all of this and more for just 300 dollars per person for two hundred and fifty dollars per person and 2 of you registered together this is me i’m jim Stransky i work with the competency and credentialing institute in Denver Colorado and I should also tell you I’m adjunct faculty at Nova Southeastern University so I teach graduate students doctoral candidates things like healthcare finance leadership things like that so you should also know that but that leads us here you’ll notice this this looks real Texas like so there’s a connection to Texas here in a minute but this is my disclosure statement there’s anything on your CV paperwork that says did he disclose the potential conflict of interest I’m doing that now so I am the CEO of CCI our business is certification nursing education things like that the Cir cssm credential we’re business we’re nonprofit for business and we do professional development activities so I will be touching on professional development so I do need to tell you that before we begin the presentation so let’s get started here our objectives I want to talk to you about in part some of my own life journey over the last two or three years I took it to year sabbatical I did not work in the office of CCI for a period of two years which give me some time to kind of rethink what I was doing and led me to some of these thoughts about leadership so in this presentation I’ll talked about that two-year sabbatical and what I was doing contrast some of the challenges faced by the American automobile industry and then the American healthcare because there’s actually lessons to be learned here for leaders at the end of the presentation I will identify three principles for you that you can think about and apply to your daily work there are other things said less formally that are sprinkled throughout the presentation but I’m going to give you three little nuggets at the end and then finally this is a recurring theme throughout the presentation I’m going to talk about the need for a professional growth and development ongoing throughout your career for nursing leaders in my background is perioperative nursing leadership so that’s really going to be my focus and you should know that I am a period of nurse I started in the early to mid 80s in the operating room in my background my pre-licensure education is I’m a diploma nurse so I’m the last middle graduate of Toledo Hospital School of Nursing that’s where I got my start and then went on for more education so let’s get started I have a big task here I am going to make the connection for you between a project that I worked on when I lived in Texas on that sabbatical the American auto industry which is represented by this vehicle in the center of your picture and finally I’m going to tie all these things together and make a connection to surgical care American health care believe it or not there is a connection between all three and that is my job to present that to you all right this is where I started so let’s start the very first thing let’s talk about this project that I was doing so I bought a house in Austin Texas as part of this whole process and it was a brand new house didn’t know this in Texas but the house was on a hillside and I didn’t realize that the Builder had no obligation to do anything to the backyard so after we moved down there the in the wife and I

are standing on his porch so you see at the left of the picture it had been raining heavily in Austin Texas in whatever the Builder had left in the backyard for fill or grass heat or anything hidden had now gone and so I was staring at this hillside which is a bunch of limestone various scrap rock etc and my wife decided that we were going to have to do better than this because she was going to be looking at this for two years so that started the project so he probably asked him why would Jim move to Austin Texas after he’s well-established in Denver Colorado I started at CCI in 2011 and by 2014 I was a director of credentialing in education for a nice successful nonprofit that was doing very well but I was also starting to get some twinges of burnout because I had managed operating rooms for many years and then came into a very busy job at CCI in 2014 I began talking to the CEO and asked if we could think about the idea of me working remote from Austin Texas it took us a year to figure this out and because I have some great people that I work with at CCI we figured out a way to make it work and in 2015 in January I moved to Austin Texas and bought that house that you see there you so what I did I move to Austin I have one daughter or one granddaughter so the picture you see here is my only granddaughter and when I moved on since she was only a year and a half old and I didn’t know her very well in fact she didn’t know me at all hardly this is neva so she was the main reason I moved to Austin to kind of re-evaluate what I was doing in you know get some new perspective her father was doing doctoral work at the University of Texas at Austin so we moved her suburb of Austin so I could have more time with family and I was very fortunate because CCI allowed me to do that so the project that I’m talking about is was happening over two years while I lived in Austin but neva is by the main reason I moved to Austin Texas all right so started this big old project and you can see that earlier picture it’s just a bunch of rocks and stuff going down that hill and so I decided I was gonna landscape this what you’re looking at these are in Texas this is very common building material it’s six by six inch limestone blocks and they’re they’re quite heavy but it’s a building material very common in Texas used in landscaping so I had never done this kind of work before so on my off hours when I was not doing CCI business in the evening in the weekends I would do this work and eventually built up this hillside and put in all these plantings and all this but I basically learned how to do this work some trial and error talking to people in the area that a gun is kind of work before and I watched a lot of YouTube videos but learned how to do this and so that steep hillside that you saw I eventually built it up and terraced that and did all of this all of this work so this is in process and these are all the materials so the hillside you know goes down in the background of the picture but these are all the materials that I had to get down that hillside there was no way to use a or anything so it was just a lot of hard manual labor to get all this stuff from in front of the house to the back downhill and then do all this work so this is doing this kind of work gives you time to reflect and I spent a whole lot of time on his hillside you know as I’m hauling these blocks so the total I moved was ten tons so one of the blocks that you’re looking at here and and I worked with dozens of these just one of those weighs 40 to 60 pounds so that’s work that I did in surprisingly when I did this I found out that patience is a virtue in people that know me before I started this sort of stuff I was not a terribly patient sort of guy and I learned a whole lot about patience doing this work gave me a lot of time to

reflect and it also changes your perspective it’s pot so one of the things that I learned even in your mature years well well into your career it is possible to learn new things and there is value in learning new things even if it isn’t directly related to your job we know as far as maintaining your cognitive skills there are things that you can do to keep yourself sharp mentally there are things like learning a new language learning how to play musical instrument teaching yourself a new skill and that could be something like knitting carpentry work you know landscaping gardening learning these sorts of things will keep you sharp but there’s a side benefit because you get time to think and this totally took me out of my daily work with CCI and doing credentialing certification test development I’m also a realist sooner or later we all have to go back to work all right I am NOT a craftsman by any means take a look at this guy here this guy is crap this is all disappear my little brother he builds custom furniture in Toledo Ohio you can look him up on your web enabled device lookups divinsky and company in Toledo Ohio and you’ll see his website with pictures of his work so this is a table that he designed and he fabricates them from scratch you can teach yourself new skills doesn’t matter where you are in your career you can you have the capacity to learn new things you may never get to be a craftsman like this guy but just in learning new stuff there’s benefit and that’s part of what I learned in this project I will also tell you I went back to Toledo Ohio north of Toledo temperance Michigan and I met a guy there that I went to high school with I went to my 40th class reunion a few years back and there’s a guy there that had quit his career that he had G many years decades he quit I think it was in advertising or something and it became a blacksmith and he said you know what I he said I don’t miss the old job and I don’t make as much money but he said I enjoy what I’m doing and he said it’s useful to be able to make useful things so there’s a good lesson there I eventually had to go back to work and I was not going to become a landscape guy for the rest of my life but this was a good break and I learned some things here and I want to share those with you in all this time if you change your perspective and get into things like learning a new skill taking time to reflect things like this it gives you time to think of larger challenges in different things in projects challenges all right Kristin you got to help me out here so this is the first question you ready Kristin I’m ready all right so here’s our first Kristin I should have told him this earlier there’s prizes so we’re going to keep a aged you got to answer the questions you can type them in here’s our first question there’s two people in this picture I hope that you recognize the one is Bill Clinton okay he’s the one longer tie this is before I became a vegan and changes health habits and all this so this is like 1990s Bill Clinton I want to know who is the other guy in the picture in there here we will make our connection to the American Automobile Industry Kristin and let me know if anybody gets the right answer who’s the other guy in the picture because this is central to what I want to talk to you about in Kristin do we have any answers coming in wait let’s see you okay I’m gonna keep going and we’ll see if anyone comes up with the answer but I’m gonna go to the next slide so this is our connection of the American automobile industry the picture that you just saw was a guy named Lee Iacocca he is he is one of the greatest business people ever to work in the United States for those who knew who knows something about cars he is one of the guys when he was at Ford he helped to develop the Ford Mustang and he also helped to develop the Dodge Caravan he

eventually went on to lead what was then known as Chrysler Corporation but in the mid 90s 80 late 80s mid 90s his company was in trouble whenever Bill Clinton was in office they eventually got to the point quickly that Chrysler was going bankrupt he had to go to Congress to ask for bailout to keep his company going before he went to speak to Congress he went in and had an interview with Bill Clinton and at pictures from the Clinton Library of that meeting Lee Iacocca went on to write a number of books about business and leadership Claire Lee Iacocca’s still alive he’s 97 years old living in Southern California with his car collection but he has wrote some great books about business which you’re still very good and useful today in the middle of this crisis he came up with this quote we are continually faced by great opportunities brilliantly disguised is insoluble problems problems that you cannot solve it’s a great quote he used that he used these sorts of sayings to get his company through those challenges he eventually got his bailout money and they saved the company and it was a tough assignment but he pulled it off and they eventually went in to make things like k cars and stuff which room the cars that people needed and he saved his company but he did not see what he was faced with as the challenge that he couldn’t solve but rather an opportunity which really influenced how he went about solving the problem all right and Jim we did have someone that got that question right so congratulations to Tara burkas all right Tara so there’s a number of prizes today Kristin if you will type in your contact information kristin is going to send you one of our suno our prep books for certification exams which you can either use who you can share with your staff for answering that question correctly but just like late-night TV stick with us because we have bigger prizes coming though let’s now turn to American healthcare and challenges there and we’re coming back to the auto industry all right here we are an American healthcare their ascend there are hearings going on right now in the Senate today as we try to answer the basic question what is the role of government in this country in American healthcare what’s there’s a fair amount of uncertainty regarding funding who’s going to be insured who’s going to pay for insurance in there a big overriding cost concerns this brings us to the operating room we have our own challenges we’ve changed the way we do reimbursement all of this stuff about insurance and everything weighs over us and could come to affect how we do business changes in things like you know having to account for hCAP surveys has changed way surgeons can do business surgeons have lost some of their stature in American healthcare we have a very mature seasoned perioperative nursing workforce and we have some people that are now starting leaved profession we’ve difficulty attracting nurses to the o.r we have the challenge of how can we if we have to bring a lot of young our nurses in how do we train them what’s the best way to do their education what’s most effective these are all challenges for us right now so we’ve got our challenges but the single biggest thing that I think we’re faced with and this has really been going on for the last five or eight years but it continues to be refined is the Centers for medicare/medicaid services when they made the transition to value-based purchasing it used to be that we had largely a volume-based system in surgery an equation was fairly simple for those of us who managed ours for a long time basically you had to find the cases that a good reimbursement and you know what I’m talking about it’s ortho neuro the ones that had implants that you could do well on and then the idea was just push volume be efficient in your operations push volume and you know it would cover the other services like ob/gyn and you know that patient load and you could do okay even for the cases that you might lose money as long as you had the equation figured out and you could draw the right surgeons in you could do well

but that changed when CMS started to go to a value-based system and I’ll get into more of the details but the point is the old system in how we were used to doing business is forgiveness is going away in we as perioperative nurse leaders have to adjust we have now come to our second question so some of you the more seasoned members of this audience may recognize these lyrics what I’m looking for is the person most often associated with these lyrics and so if you know the answer to this go ahead and type it in the first one to get it correct I think we’ll get another CCI publication and I’ll give you a hint the name I’m looking for this guy just received a Nobel Prize for his body of work it’s Bob Dylan hopefully somebody got that right just to give you some perspective I actually this is a picture of the album cover and I actually have this on vinyl so that gives you an idea of where where I fall on the calendar but the point there’s no better phrase to describe where we’re at right now in American healthcare particularly in ELR then the times they are a-changin so for those of us and I’ve been in the ORS since the mid mid 80s early 80s it is a whole new way of doing business now which has big implications if you are a periodic nurse leader all right we’re back to the auto industry I used to work in the auto industry so I’d I I have 34 years of military service but for a few years I was an Army reservist and during that time I worked in an automobile plant in Gippsland Michigan I made transmissions I drove a little stock truck I built transmissions and they were called high dramatics and they went into journal Mulder’s carves and I worked in auto plants off and on for nine and a half years so there are lessons in business in lessons in what the American auto industry went through people like Lee Iacocca there are lessons to be learned for us in American healthcare and I want to tie it all together pretty but it recognizes this a Cadillac I think it’s a 59 or 60 Cadillac and if you can see clearly it’s got big fins on the back but the point is the American auto industry when we talk about the 40s 50s early 60s we truly were the wheel world leaders in automobiles and we were making a lot of them we’re making big cars they were beautiful beautiful cars and we were acknowledged as world leaders and that the automobile industry thrive for years and especially the boom years that followed the end of World War two were especially good for American autos which brings me to this picture this is a Willys Jeep this is the epitome of the American auto industry giving him right these who built in Toledo Ohio not far from where I lived in southeastern Michigan and the Willys Jeep plant is where my father was employed during World War Two he built Jeeps and he eventually went on to become a skilled tradesman this is some of the best work the American auto industry ever did things like the Jeep helped us to win World War two they were exported all around the world and this is some of the best work ever done by American industrious things like the Jeep so we have World War 2 the post-war years and we’re on top of the world making cars in people like my father we’re doing very well in the American auto industry there’s a large number of semi skilled workers you could if you lived in the Midwest Ohio Michigan Indiana Illinois you could get a high school education and then promptly go out and go to an auto factory you didn’t always need a high school education it helped but get a job and then stay there many years it was a unionized job good pay good benefits you had a legitimate career path and for people like my father who went from being a farmer in rural Michigan became a skilled tradesman and it was your route to the middle class and you could change the path of your family by having jobs like this then we became complacent and we eventually got

to the 1980s I believe this is a picture of a 1983 Ford LTD we went from being world’s leaders in automobile production to building cars like this which sadly we’re building when I was in the auto industry a Ford LTD this is not considered a classic car this thing got like 12 miles to the gallon and the American auto industry disassociated themselves from the needs of consumers we believe we had the best product in the world in the auto industry just kept building cars and we’ve been she gets the point we’re building cars that didn’t serve our customers well and then we hit the gas crisis so we’re building we have been over capacity to build cars like this and they get terrible gas mileage and now we have gas shortages and gas rationing and these are not the cars that people want and sadly we did not pay attention direct competition in other countries like Japan and Korea into a lesser extent Italy and Germany figured out the right Canon cars to build you name started a rapid decline for American automobile industries they did eventually recover there is a second round of bailouts which happened to the Obama administration in Chrysler had to go back again along with General Motors but they’ve recovered and now they’re making good profits all of them are stable Ford and General Motors more stable than Fiat Chrysler but there’s value during well however to move from the 1983 Ford LTD to the county cars you’re building now like Tesla’s it took a gut-wrenching change and it was horrible if you lived in the Midwest there were people who had worked in this industry for decades and they got laid off and he would never called back so it was a horrible amount of change to get them to the point where they needed to be to be competitive here’s where we come back to American healthcare we are in this sort of period of change right now for American healthcare and let me explain let’s draw a parallel from the late seventies early eighties in the American auto industry in the Ford LTD to American healthcare in 2000 this sort of change started really in the 80s when we began to DRGs but then there are some seminal events in American healthcare this is important implications for leaders this report came out at the end of 1999 we in American health care just like the automobile industry believed he we like to see this all the time we have the best health care in the world this report made us stop and think because what what this report said is there are tens of thousands of people dying needlessly do you that have experienced American healthcare because we could do this better and look at the passage that I’ve cited here in highlight high air rates with serious consequences are most likely to occur in intensive care units operating rooms and emergency departments so now we have to start to think about what are we doing and should we change it and that lettuce the things like universal protocols communication techniques sight Universal sight marquee standardizing processes lean healthcare practices this is where it began so in the 1980s the auto industry we had an indifference the quality we weren’t well connected to the consumer who very mature industry the working relationships between the management the people that own the plants and workers was poor and we had a horrible amount of excess inventory too many workers 20 plants and we’re making the wrong kind of cars big gas-guzzling cars in the time of a gas shortage not a good recipe American health care in 2000 quality is not directly tied to reimbursement it’s basically medical centered health care that works well for surgeons and medical profession but not necessarily for the consumer and it’s very much a volume based system of care there’s a lack of integration with all the components involved in and continuing with care we have horribly outdated supply chain management think back if you worked in the o.r 20-30 years ago what did your supply room look like we

kept shelves full of things like totally implants we don’t do that anymore we’re much better at supply chain but this is where we were at in 2000 we’re in a whole new financial environment and people like CMS they put in changes in reimbursement there are now financial disincentives which are based on quality if you have a poor surgical site infection rate a high rate of ventilator associated pneumonia poor hCAP scores this will affect directly your reimbursement you will get less money from CMS for the care that you render if your quality is poor and you have poor age cap scores in its direct it may be 1 or 2 percent of the revenue you could have gotten but there are very few facilities that can survive if they’re getting less over the long-term if they are getting far less than what they could you received from CMS just about everybody that does surgery has to deal with Medicare and Medicaid patients you have to be able to do those cases efficiently and you can’t afford to lose two or three interview reimbursement if you report the performer this is something else that Lee Iacocca said so when an auto industry is struggling and he’s got to go look for a bailout there was there are leadership meetings and you’re trying to figure out what to do and this and so Lee Iacocca said this so what do we do we have to do anything something we can’t just sit here if we screw it up we’re gonna start over when it try something else if we wait we’ve set it aside all the uncertainties may be too late so let’s look at American healthcare do you remember when we had to start with site marking in a universal protocol I remember going to meetings with surgeons and they we would have meetings we’d say look we have to do this protocol the Joint Commission is going to check on us we have to do it and I remember people standing up and saying you know I graduated from Harvard or Tulane or whatever and I’m gonna write a note this is stupid we’re not going to do this I don’t agree you know what we had to do it we didn’t know all of how we’re gonna solve this but we didn’t get a choice we had to do it we didn’t know all the uncertainties but just like the auto industry we had to jump in and get it done and not just the things like value-based purchasing new protocol safety procedures lean health care we have to learn this if we’re going to survive and prosper so there’s parallels to our work in perioperative nursing we’re faced with a bunch of challenges here we could kind of stand back and say you know I really don’t know how to solve this I don’t have all the answers I’m really not sure you could and you’ll probably left and wayside or you can view it as an opportunity for growth things that you can learn even if you’re very mature in your profession and how can you proceed in your career if you use these as opportunities this statement is from the IOM report on the future of Nursing this report is available to you for you can go to the National Academies press put this IOM report future nursing in and you can download the PDF copy for free you want the bound copy the softcover you got to pay for it but you’re a taxpayer it’s a government funded work and you get this report for free my company very much believes in his statement that nurses must engage lifelong learning over the span of their career you cannot rest on your past laurels especially in very turbulent times when there’s a whole lot of change in many challenges you can’t do it so we believe in this and we are trying to move to a system to provide leadership the tools to adjust to these changing times you are never too old to learn so when what I’ve told you today you’ve got a pretty good idea where I am in a life span when I applied when I came back to Denver I’ve been I moved back to Denver at the very end of 16 and I applied to become the CEO of CCI and I thought that would be the pinnacle of my profession I was well established my career well educated and I thought I was a great candidate the CCI Board of Directors did eventually hire me but they made some conditions one of those conditions is that even in my mature years I have to

go back to school they told me that you you’ve never been a CEO used to run operating rooms you’ve been a good director of credentialing you’ve never been a CEO of a non-profit so if you’re going to take this job you will have to agree to go back to school we’re gonna pay for it but you have to go back so you Nate told me what school this isn’t Houston it’s rice and they have a great program on how to become a better nonprofit leader and I found out this morning very under early in the morning after a pretty rigorous application process that I was accepted and I will begin classes at the end of August so even at this point in my career I have stuff to learn and I too have to go back to do this there’s a parallel to even if you’re well established in the operating room you know you did well as we used to do business you have opportunities yet to learn more I have a question for the audience because CCI is really darn serious about this so here’s where I need you to type stuff in if you are in the audience and you do not hold one of the CCI credentials the two big ones are seeing a wire and cssm you do not hold any of our credentials please do this in type in no CCI credential in the chat box and start doing that now and I’m gonna I’ll keep talking so we’re serious about this and we realize that we have our part in trying to help you if we go back to that iom recommendation that the credentialing organizations certification nursing schools they all have to collaborate to make sure people can access lifelong learning we’re trying to do our part and so Kristin Linda have we do we have some candidates here do you have a name let’s see here Jaime we do have a few people that answered if we’re looking for just one name first one chosen randomly would be Robin Caine okay Robin Caine so this is CCI we’re putting our money up here if you do not hold our credentials in support of your lifelong learning if you would like to take one of our certifications we will waive your certification fee if you would like to take the cssm and assuming you’re eligible if you are we will also put you in one of our I remote distance-learning cssm prep courses so if you would like to take advantage of that opportunity you’ll need to type in your contact information and Kristin will contact you to get you set up for your testing so let’s move on we’re getting close to the end here’s the three things that I want to share and just know all the other things about Lee Iacocca is a brilliant businessman and as you can still read his books choose three principles you can apply to your daily work number one the old ways of doing things may no longer suffice even the things you’ve done for years that you’re successful at may no longer be good enough and you may have to learn new things you may have to be willing to stretch your boundaries and learn stuff that maybe you weren’t all that comfortable with you may have to go back to graduate school get an MBA because that’s what’s needed now to run an operating room possible your health system II want you to do that or you may have to get better at things like financial management which may not have always been your strengths you may have been great operationally but maybe not so strong in finance you may have to stretch your boundaries and get better and develop new skill sets and finally there’s a need for lifelong learning let’s let’s just concede that and everything that we know is pointing toward that and we think at CCI there’s a role for certification etc to help you on this journey here’s a reality check this is something I learned when I was a diploma nurse this is a picture of a refrigerator there’s a term in Nursing it’s called appliance nurses these this message all this stuff that I’m telling you this is not for that kind of nurse there are people that come into nursing they work they leave the profession to

come back and it’s based on the needs of their family they need a new refrigerator they got I knew Susie needs braces and they come back in and work all this up that I’m telling you probably and I will gain no traction with people that are in nursing for that reason we need those nurses they’re valuable but this message will not resonate with them what does the future look like I I use this picture all the time here’s some of what I see in the future for us in perioperative nursing this is a picture from the Toledo Museum of Art in a Gaming Commission used this image but here’s the point we’re in turbulent times in the OU iron American healthcare real lessons that we can learn from people like the auto industry which went through this sort of period of disruptive change not all that long ago so we’re in uncharted territory but there are certain things that I know there are some things that I know that are certainties here we’re at a new financial environment we’re gonna have to learn new skills even if we’ve been in the profession for a long time we must engage in continuous professional development and lifelong learning which brings us to our credentials so for those people who hold C Noir and I must ask is there anybody in this audience that holds the cssm credential if you do please type in your name if you hold cssm if you do you know that CSS M is different CSS M is only good for three years if you hold cssm there’s only two ways to maintain a credential you can at the end of three years take that exam again and pass it or when you pass the exam we gave you a personalized professional development plan you must fulfill that plan no one can research cssm by only doing seee you cannot do it so you basically have to if you want to hold cssm you must engage in lifelong learning in fulfilling plan which addresses your the areas in which you are not strong on that exam that might be financial management could be operational management could be communications but you won’t have to address those learning needs we also have another credential called seeing a wire read so just as you have joint Commissioner Tripoli see is your accreditation body DMV someone we too are accredited the senior credential right now you could hold that pass that exam maintain that credential bite and again 125 CES every five years not terribly challenging give us a check and fill out a statement you to keep your credential CN wire will have to change based on changing accreditation standards will have to change and that’s going to happen in the next five years when we are done making this transition see a noir will look something like CSS M where you have a learning plan it will be much more prescriptive and the activities that you must do to maintain your credential well actually we will have them provide a link that we are working to improve your competency in the field that’s how we will maintain our accreditation here’s our last question so is anybody in the audience do you know who any of these three people are and if you know any of them my bet is you only know who the female is so the point in this thing about competency and developing your competency learning activities etc there’s a very sound theoretical basis for this which is why we must do it it lines up well with the Institute of Medicine everything we know about learning the fact that we must engage in lifelong learning and it’s all based on the work of people like the one lady so if you know who the lady is type her name in we have a prize for you but her name is associated with the novice to expert continue on and I will tell you Kristin I’m going to be ecstatic if somebody knows this room any luck yet looks like crystal Johnson

is the correct answer looks like it what what answer did crystal give let’s see we have Jamie I’ve sent in them over to me Gabe Patricia better that is correct I’m ecstatic I must wet it thank you note so um the Patricia Benner so she’s the nurse that brought us applied the Navis expert continuum to nursing and how we learn an acquired skill so what we are trying to do is based in part of work on work of people like Patricia Benner this is where we’re trying to help you develop as a leader the quick the question is not now do we need should we do this do we need to engage in lifelong learning I will tell you right now the train has already left the station here we just have to do this just like we argued for a while about why do we have to go to the universal protocol those people who argued about that and drugged their feet wasted your time we don’t here we’re faced with some big challenges we can’t afford to waste their time and drag our feet the trains move in we need to get on board and we need to do better and lifelong learning continuous professional development we need to do this better as a profession and I would say that it’s a leadership responsibility all going back to the beginning of the presentation I touch about all that stone and everything you may have asked yourself to how did that actually turn out it did turn out pretty well in the end this is a picture when it’s near finished in this is Texas so you have to do xeriscaping there’s a lot of stone and you know drought resistant plants but this is the other side of the hill if you remember what that looked like when I started the grass hasn’t come up yet but you can tell the landscaping everything so it did turn out pretty well and I learned a lot so let’s talk about the long run this is a picture from the city of Detroit the auto industry survived they’re making their way back cities like Detroit and Toledo are slowly recovering they got a lot of work to do but they’re making her way back so there are lessons we learned for new auto industry they went through these kind of challenges that were right in the middle of and there’s lessons to be learned the last quote from Lee Iacocca he wrote this years before the Institute of Medicine report came out and but it fits very well apply yourself get all the education you can but then by God do something don’t just stand there make it happen our nurses are very good at making things happen we’re action-oriented people so from a leadership perspective I say learn all that you can do everything you can to develop yourself and your staff and then go back to your department face up these challenges and make it happen we’re very good about doing this and I’m really confident as leaders we can rise to the challenge that concludes my presentation I will take any questions that you have in Linda and Kristin I think I got us back nearly unschedule so hey you did Jimmy got us with three minutes to spare so let’s see how many questions we can get through I do want to remind you can still submit your questions do so using the question feature on your dashboard all questions that we do not have time for we’re going to send over to Jim and his team and I know they will diligently follow up with you offline but Jim first question why is the issue of transition to value-based purchasing such a big deal so for those of us who’ve worked in the operating room for many years we truly learned about you based system that was based on close cooperation with surgeons and we did not we didn’t have to be really good about communicating outside of the ER and you know worried about the whole continuum of care under a value-based system if you if someone has surgery at your facility and let’s say they had a total joint they go to you don’t have good coordination with a long-term care rehab facility they get discharged too and they develop an infection we because of poor quality of care that surgical site

infection counts against you and affects your reimbursement so you have to learn to coordinate with all across the continuum which is new skill sets new ways of communication thinking about finance these value-based purchasing means these kinds of challenges that’s the importance of it great what do you see as the biggest effect on the work of the ER I think the biggest effect is that we have to learn new skill sets so it used to be if you were you were an authoritative source you had a good clinical background and you could basically take the end of your suite you could make it run well in the fact you know if you had a surgeon had turned a lot of bottom but he had a poor you know his infection was a little worse than average you were getting paid to clean up those cases and it just generated more volume now people like that will cost you directly in reimbursement and so we have to learn to deal with those sorts of things in eor which were never even issues before these are sorts of things that are now our challenges and we have to learn to deal with those effectively which may involve better statistical tracking applying best evidence things like that it’s it’s things that we’re not front and center thirty years ago and managing an hour alright yeah one attendee would like to know if you have any suggestions on successful recruitment of our nurses I do my contact information is up here CCI has a lot of thoughts about this and I have some superb nurse educators I would love to share their thoughts they are in provides very good guidance your membership organization on this competency-based orientations are a very nice approach we tend to get into the thing about how quickly can I treat them and get them in the oh are what we need to pay attention to is offering a high quality orientation as they learn our profession when I managed to operating in Boise Idaho we had a superb orientation course that was based on period 101 but those of you who got a very firm basis in the standards that became the basis for their practice we were able to attract candidates to Boise Idaho from all over the country that would come for this fellowship I think the future of doing this right has to do with high quality orientation which will bring you great candidates and then retain them and if you set the right nursing work environment you can do that in we can provide examples easy the other thing I will tell you is on our website we have a reference on competency assessment in eor which lays a nice framework for the work of people had done a write in Patricia Benner that is a free resource on our website and if you would like to talk more about this topic and I can bring my nurse educators into the discussion please send me an email to this address and I would love to make the connection and talk more to you because CCI actually puts out a fair amount of information and our thoughts about best practices in this area we love that to discuss them with you okay Jen due to the time I think we’re gonna get through one more question what is the take-home message from the presentation for perioperative nurse leaders today the take-home message is it doesn’t matter where you are in your career yeah yeah it should be apparent if you’re relatively new to the or but even if you’ve been in the Oh our thirty years plus like Jim there’s a need for lifelong learning and continuous professional development it can take a number of forms you may have to go back to graduate school or maybe when you go to events like our today live that maybe you have to attend to the really challenging courses on you know CMS compliance financial management

techniques etc you may have to apply yourself there but you have to pay attention your own professional development you’re keeping sharp and the skills that you need to function in this sort of environment I think that’s the take-home message how you do that there’s a lot of paths but you do have to do it if you want to remain in the profession and continue to do well great Jim thank you so much for an amazing webinar and you touched a bit on our today live attendees if you enjoyed this presentation and everything that CCI has to offer do look into attending Oh our today live surgical conference we have a special gift for everyone today there is a discount code that we have chatted out on your chat feature using 1700 our TL friend when you register for our today live you will save $50 off your registration fee and one lucky attendee today will win an Amazon gift card for completing the post webinar survey which is going to appear on your screen shortly if you have any questions about the promo code registering for the conference or if you don’t see your survey please email us at webinar at MD publishing comm you must complete this survey to obtain your certificate for more information on our next webinar which will be in September you can go to our today.com 4 slash webinars please enjoy the rest of your afternoon we’ll see you in September