Archive for October, 2009

The Stress of Leadership by Guest Author Sharyn Mosca

Wednesday, October 28th, 2009

Stress- When you are at the end of a frayed rope

Stress- When you at the end of a frayed rope

As the demands placed upon leaders increase, so does the level of stress. Researchers agree that a certain amount of stress is necessary to maintain vitality and a zest for life. However, too much stress can cause health problems, impair performance and curtail your creativity. It is important to step back and take stock of the stressors in your life and reevaluate how you might tackle them. It is the intent of this article to broaden your awareness of commonly shared work place stressors and ways to better diagnose your particular needs.

The Center for Creative Leadership in Greensboro, North Carolina (CCL) did several interesting surveys recently. * They sought out to find if particular issues or people were causing the most stress for leaders at work. Here is what they found:

Causes- the “What”
The number 1 cause of stress, according to the leaders surveyed, is trying to do more with fewer resources and do it faster. Other stress-contributing factors included;

• Developing people
• Managing limited resources
• Physical demands from travel, working hours and the work environment
• Motivating employees and providing feedback
• Making decisions
• Increased job responsibilities

Interestingly, interpersonal demands of leadership such as establishing and maintaining relationships were also cited as somewhat stressful. Managing difficult interpersonal issues such as difficult personalities, political maneuvering or conflict… not surprisingly, contributed highly as well.

Causes-the “Who”
CCL’s research also sought to uncover if there was a particular person(s) within working relationships that was a primary stressor? Was the boss usually the cause of stress? Their results showed that there was no one group to blame. That is, leaders reported experiencing stress equally from their bosses, peers, direct reports, and customers. However, while no one group caused more stress than any other group, the reasons for the stress differed.

Stress from the boss usually tended to emerge when people felt a lack of support or respect. Management style differences were also cited as a key factor for provoking stress. From peers, being overly competitive and demonstrating no inclination toward teamwork were the primary sources of stress. From direct reports, poor performance was the primary stress factor, and from customers, experiencing unreasonable demands or unreasonable expectations.

How Can I Become Better at Managing my Stress?

Probably, a good place to start would be to assess your current level of stress, more methodically and objectively. Responses to stress are very unique to the individual, and complex. We “feel” stress, but often do not have a good handle on our current stress managing “strengths” and stress-managing weaknesses or vulnerabilities, i.e. “my needs, my temperament, my way of looking at the world”. There are several good assessment tools available that can really help people really figure out all the factors involved, and target specific steps to remedy them.

“Stress is not what happens to us. It’s our response TO what happens. And RESPONSE is something we can choose.” Maureen Killoran

What Would Such an Assessment Uncover?

• A closer examination of your current environment, discerning the unique changes, pressures and satisfactions that are a part of your everyday world. An opportunity to see the whole of professional and personal issues and how they manifest as stress.
• Your current coping responses and their effectiveness.
• Insights into your current proficiency with basic skills that really help you manage under stressful situations. Skills such as; how to seek support, becoming more adaptable or learning how to manage your time more effectively.
• More discoveries into your inner world of thoughts and feelings. Behaviors such as having a positive outlook, connecting to others, expression and compassion are huge components in successful stress management.

What then?
When you uncover the full range of factors, more intelligent choices can be made for improving. Some examples;

• Basic time management techniques can be easily learned, but an unattended behavior of procrastination or avoidance will thwart any time management technique.
• Or, consider the person who has long forgotten how to give feedback, or receive feedback in a positive way. Rediscovering the importance of expressing yourself can be most effective when coupled with proper feedback techniques.
• Knowing how and when to seek support and confide in others is hugely important in managing stress, but happens only when people trust. Exploring your current trust “radius” may provide you with more information.

An honest assessment of cause and effect will put you in a place to choose more authentically, where and who you want to be.

“If you are distressed by anything external, the pain is not due to the thing itself but to your own estimate of it; and this you have the power to revoke at any moment.” Marcus Aurelius

__________________________
Source
* Leading Effectively e-Newsletter. Center for Creative Leadership; June 2007

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The J Curve of Change by Pat Iyer

Monday, October 26th, 2009

The J Curve of Change

The J Curve of Change

You know those eureka moments when you hear a concept that immediately makes sense? Yesterday I was listening to an audio CD from the 2009 National Speakers Association when I learned about the J curve. A management principle from the field of economics is well-suited to explain the resistance to change. Understanding this principle helps to make sense of what happens when you embark on a change. Think of the short leg of the J as the entry point for making a change.

1. As an attorney or legal nurse consultant, you decide to purchase new software to upgrade your office.
2. As an attorney or legal nurse consultant, you advise the staff that cross training is needed in order to achieve maximum productivity and customer support.
3. As a nurse, you take a legal nurse consulting course and decide to open a business.

You enter the J curve and expect that your hard work and effort will result in an upward growth or positive change. Despite your preparation and expectations, things go wrong.

1. The software is not intuitively obvious and you feel inadequate.
2. Your staff don’t want to change what they know how to do in order to learn new skills.
3. You find customers are not flocking to your doors to take advantage of your new business.

Things get worse. You have entered the valley of despair.
1. You find that it takes twice as long to do something in the new software as in the prior version.
2. The staff reluctantly takes on the new responsibilities and makes mistakes. Clients complain. The staff loses interest in the change.
3. You find yourself unable to keep up with marketing to get new clients and your current day job.

Many change efforts die in the valley of despair. You don’t know if you have hit rock bottom; this is only clear as you ascend the bottom of the valley. At any point in time, you don’t know if things are getting better or they will continue worsening. Can you tough it out?

Take home lessons:
A. Remember that none of the hoped for improvements will occur if you give up too soon.
B. Remember that performance will dropdown before it will improve above the old standard.
C. Remember that you can make adjustments to achieve the outcome you desire.
D. Keep your confidence that the changes you are making are necessary and right.

Give us feedback. Tell us when you went through a J curve.

Also see Managing the Stress of Change
On Determination and On Being Trapped

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Properly Using Leverage Increases Your Negotiation Strength by Guest Author Greg Williams, modified by Pat Iyer

Wednesday, October 21st, 2009

Careful use of leverage gives you power

Careful use of leverage gives you power

During a negotiation, applying leverage right, at the right time, can lead to the right outcome. Leverage increases one’s ability to accomplish sought after outcomes, but applying leverage inaccurately can lead to unforeseen problems. As an example …

1. A legal nurse consultant and an attorney are negotiating over the phone about the hourly rate of an expert witness; both negotiators have equal negotiation skills.
2. The attorney, Negotiator A, is negotiating on behalf of his client. He needs the expert witness’ expertise to prove liability related to an obscure point of medicine. The other negotiator is the legal nurse consultant, who bills for the services of the expert, Negotiator B.
3. The two negotiators reach a point in the negotiation where price becomes an issue that can’t be bridged. They try to build rapport on other points, but when they get back to price, once again they find themselves at an impasse.
4. Negotiator A, partially due to frustration exclaimed, “If you can’t meet my offer on price, we have nothing else to discuss. I’ll inform my client I will have to seek another expert. This is my final offer, take it or leave it.” (He delivered the offer with a sense of venom, and rude forcefulness.)
5. Negotiator B stated, “That being the case, the offer to supply the expert to your client is withdrawn and this negotiation has concluded.” Both negotiators slammed the phones into their cradles.
6. Several days passed. Negotiator A had no luck finding another expert with this particular knowledge base. Finally Negotiator A called Negotiator B, in an apologetic state, and informed him that he would like to use the services of the expert at the price Negotiator B had requested from the outset of the negotiation.
7. Negotiator B accepted the apology of Negotiator A, and they consummated the deal that day.
In the above example, Negotiator A tried to apply the leverage of “taking away” the deal to get Negotiator B to acquiesce to his desires. Had he done so in a manner that was not fraught with male injected testosterone and a “take it or leave it” attitude, his offer would have been viewed in a different light. By making the offer in the manner that he did, he almost cost his client weeks of delay and possibly blowing of discovery deadlines.

Sometimes you have to bend in the direction in which power pulls, in order to achieve the outcome you seek. When it comes to using leverage, make sure you understand the possible outcome of that which you seek to influence … and everything will be right with the world.

The Negotiation Tips Are …
• Be it negotiating, or other aspects of your life, always seek to apply the right amount of leverage. Too much leverage can be as bad as too little.
• Leverage is like any other tool at your disposal when negotiating. Learn to use it wisely and you enhance its effectiveness.
• One form of leverage is a lack of resistance. Determine when it’s wise not to resist in a negotiation.

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The Fifth Element of a Medical Malpractice Case by Pat Iyer

Monday, October 19th, 2009
A near fatal overdose of Insulin

A near fatal overdose of Insulin

Linda (name changed) was admitted to an inner city hospital due to leg pain. She wandered through the hospital, searching for something. When she came upon an unlocked medication cart sitting in the hallway, she found it. She took a syringe, a bottle of Insulin, and a bottle of Lasix (reduces swelling) and injected herself with the contents of both bottles. Linda was a substance abuser, but it remains a mystery to this day why she injected herself with these medications. Within hours her blood sugar plummeted and she had a seizure.

After Linda’s acute care was over, it was clear that she suffered brain damage as a result of the drop in blood sugar. Her attorney filed suit against the hospital; his expert (me) opined that it was a deviation from the standard of care to not provide closer monitoring of this young woman. It was a deviation from the standard of care and against hospital policy to leave a medication cart unlocked.

Selecting a jury was tough. The jurors were asked this question: “Do you believe that a person with substance abuse is entitled to the same quality of care as someone who is not abusing drugs?” It took two days to find eight people who could say “yes”. I spent an entire day on the witness stand as each of the defendant’s attorneys cross examined me.  I was told by my client that I did well.  During one of the breaks, I met Linda in the ladies room. She was having trouble getting her clothes adjusted and tried to put her underpants on over her skirt. As a result of her brain damage, her mother had to care for Linda and her daughter; Linda had become easier to control and was on a Methadone program.

The jury came back with a verdict on behalf of the defendants. The plaintiff’s attorney concluded that the jury could not bring themselves to place money in the hands of a substance abuser. They may have also blamed her for what occurred. (Jurors are not allowed to be interviewed after trial in this state so it remains unclear why they came to that decision.)

I’ve recently learned this was the first and last medical malpractice case this attorney tried. Would a more experienced attorney have taken the case?

In order to successfully win a medical malpractice case, a plaintiff has to prove four elements.  (The plaintiff may be in the patient if he or she is alive and capable of filing suit, if not, the plaintiff might be a family member or other entity.)

1. The healthcare provider had a duty to give care to the patient (Duty)
2. The provider did not deliver care according to what the reasonably prudent person would have done in the same situation. (Breach)
3. There were damages or injuries to the patient. (Damages)
4. The failure to deliver care according to the standards of care was the direct cause of the damages (Causation)

The quality of the patient is the unofficial fifth element in a medical malpractice case. I have heard attorneys describe the ideal plaintiff as a person you would enjoy sitting next to in an airplane on a cross country flight. “She’s a church organist”, I’ve been told by an attorney who described a wonderful person. “He and his wife are really nice people”, another attorney said. Conversely, attorneys are hesitant to take a case involving someone who is in prison*, has an intravenous substance abuse history, or in some significant way radically deviates from the norm. The harder it will be for the jury to empathize with the plaintiff, the harder it will be for them to award money. Savvy plaintiff’s attorneys carefully evaluate the background, demeanor, personality and habits of potential plaintiffs. It is better to put the plaintiff on trial before the jury does.

* An exception may be made for people jailed for minor offenses who are the victims of neglect in jail
.
For more on this topic, see Cultural Competence and Attorneys and How is the Economy Affecting Jurors.

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On Participating in a Webinar by Pat Iyer

Wednesday, October 14th, 2009
Woman watching webinar

Woman watching webinar

As much as 50% of programs that would have in the past been presented in a classroom are now being offered through webinars, I recently learned at the National Speakers Association annual meeting in Phoenix in July. Webinars are convenient ways to share information with geographically diverse groups. A variety of formats may be used to deliver the material, and varying levels of audience participation may occur.

Within the last month, I participated in two webinars directed to attorneys.  The experiences were remarkably different. In the first program, presented by the Aletheia Institute, I was a speaker presenting concepts related to pain assessment. The program was being broadcast by a live video feed, with speakers in four locations across the US. I was supposed to go to a local videoconferencing site located at a court reporter’s office.  The arrival time was set for 2:15 PM for a 3 PM program. The 45 minutes was to have been spent learning and rehearsing how to use the technology. Unfortunately, there was a communication mix up regarding who was to supply the laptop computer to use for the program. When I realized I needed to bring my computer, I raced home to retrieve it. My car’s GPS did not recognize the address of the court reporter, and I lost more minutes getting directions from yahoomaps. The court reporter’s office was farther than I expected and traffic was maddeningly slow.

When I arrived at the court reporter’s office at 2:55 PM, I was rattled. In a space of 10 minutes, I had to learn how to use the technology with a less than intuitive remote device, figure out where to place my notes, get a clock set up, and try to calm down. The wisdom of having plenty of time to get used to the equipment was painfully evident to me, but hopefully not to the audience.

My second experience took place in my office. The New Jersey Institute for Continuing Legal Education webinar consisted of me moderating a program on liability issues affecting the emergency department. I reformatted, edited, and illustrated the Powerpoint presentations prepared by the speakers. We had a dry run a week before the program to learn how to handle the technology. There was no video component to the program.  The three speakers and I talked over the phone to the listeners/viewers. Each speaker controlled the advance of the Powerpoint slides. We could communicate with a chat panel so I could advise each speaker of the remaining time left to keep them on track.
Two webinars and two different presentation formats made these two very different experiences. My advice to people who have the opportunity to participate in, moderate or put on a webinar, is to be allow time to become very familiar with the technology. Practice, practice, practice, and have another person to act as an assistant. The video component of a live program can be a powerful enhancement to learning, but also captures all of the foibles of a less than perfect presentation. Learn as much as you can about webinars, how to make the most out of them, and how your participation can be enhanced. Two resources I recommend are:

Great Webinars: How to create interactive learning that is captivating, informative and fun by Cindy Clay
6 Weeks To A Great Webinar: Generate Leads And Tell Your Story To The World (Paperback) by W. Wayne Turmel
I heard W. Wayne Turmel speak at the National Speakers Association; he was outstanding.

And most of all, recognize the staying power of this type of education and take advantage of the programs that are of interest to you.

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Reduce Draining Mental Stress by Guest Author Natalie Gahrmann

Monday, October 12th, 2009
Stress will drain your ability to remember

Stress will drain your ability to remember

Chances are that if you are reading this blog, you have too much on your plate. Your ‘to-do’ list is likely several pages long and your plate is overflowing with activities and responsibilities, many that you didn’t even put there yourself. Often, you may feel like your mind is going to explode because you have so many things stored in it that you must remember.

When I meet with clients who are feeling this way, they tell me that they feel like they can’t get anything done even though they’re trying their best. They express feelings of inadequacy, overwhelm, stress and frustration. They feel scattered!

Although these clients usually have a to-do list, they also keep a running list of all the things they have to do in their minds. This is the primary cause of mental stress! My clients expend a lot of energy worrying about these things, even though 87% of what we worry about either never happens or is totally out of our control anyway!

Studies indicate that when we pay attention to a piece of information, it enters our short-term memory. Typically we can only hold 5-9 pieces of simple information in our short-term memory. If this information is not acted on or encoded it goes away. Therefore, to keep information available we need to get it into our working memory. Working memory is like a vehicle that transports information from short-term into long-term memory. Working memory will transport something that fits into an existing memory, much like a filing cabinet storing data.

Once you get information into your long-term memory, you’ve made progress, but then you have to get it out. Working memory files information into long-term memory. These files are not easily accessed—-we often need reminders. And it’s easier and more efficient to recognize something than to try to recall it from scratch.

The important key to reducing the stress of forgetting things or not being able to recall them is to have a system for organizing material as it comes at you and then being able to take action. Neither system will operate effectively if left in your head though. You need to get this out of your head and into easily accessible files on your computer or in a series of reminders for action in your daily management system (e.g., MS Outlook). You can reduce mental draining stress by de-cluttering your mind.

Read more about stress at Harmony at Work.

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Boost Sales by Guest Author Caryn Kopp

Wednesday, October 7th, 2009

Call your A prospects to get more business

Call your A prospects to get more business

Do you need to drum up new business? Here are three top tips for doing so.

1. Add 20 new “A” level prospects to your list and call them. An “A” level prospect is the person you most want to do business with. He/she buys the right amount, at the right price, in the right time frame. Criteria for an “A” level prospect can include industry, size of company, department, level of decision-maker and geography. To determine the makeup of your “A” level prospects, look at the makeup of your “A” level customers. Then, using the criteria, replicate the recipe. Block out a minimum of 1 hour twice a week with your phone off, email closed, Blackberry off, cell phone off and hammer away at the prospect list. You may even need to hang a “Do Not Disturb” sign on your office door!

2. Catch up with your current clients, and upsell by offering incremental programs and add-on services. Capture “Sweep-up Dollars” from the “use it or lose it by year end” client budget. One Sales Director in the media industry called one of his clients and said, “We have a really interesting program, and if you have any budget available for this year, I’d like to discuss the benefits of the program with you.” That simple call resulted in a $100K sale. That’s why I call it “sweep up dollars”. The money is lying around and you sweep it up!

3. While you’re talking with your current clients, ask for referrals to other departments, divisions, parent companies, sister companies, and subsidiaries who have a bucket of money to spend on what you have to sell. Surprisingly, this low lying fruit is often overlooked. Leveraging your relationships to capture all sales within any one company will quickly increase your earnings as well as solidify your position with your customers. When you are on the phone with your client, ask him/her to transfer your call to one of the referrals. Whose name is on the caller ID? Not yours! Your call is more likely to be picked up if it shows up as an internal call.

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Use of Technology to Save Time by Pat Iyer

Monday, October 5th, 2009

analog devices

analog devices

Consider how much technology has changed our personal lives. Would we go out without a cell phone? Would we use a travel agent to make flight arrangements? Would we go to the bank to transfer money when we could do so on line? I realized just how much technology affects us when I described the usefulness of OneNote, a Microsoft program, to one of my 26-year-old son’s friends. OneNote enables you to set up sections of notebooks and collect the stray bits of information that drift into your life. My son’s friend was grateful to know there was a digital solution for collecting and organizing data. He said, with a look of horror, that before I told him about One Note, he had been considering “going analog”. It took me a few seconds to realize he was discussing what was to him the most archaic of practices- writing something with a pen.

Nurses are relying increasingly on mobile applications as patient safety and productivity tools, a recent survey showed. “Nurses can quickly look up clinical information on their mobile device right at the patient’s bedside, which helps reduce medication errors and save precious time,” Snyder said. Pam Davis, RN, program director for Centennial Medical Center’s bariatric surgery product line, agreed. She has been using Epocrates for the past four years, initially as a case manager. In her current position, she provides educational information for her patients. This program can be downloaded for free onto Blackberrys, Iphones, Palm Pilots and Windows Mobile devices.

Instead of hauling out the hefty paper drug reference, Davis can search for updated medication information “at her fingertips,” she said. Davis is not alone. More than half of the survey respondents noted they look up drug or disease information on their mobile devices during patient consultations. “Technology makes the processes more efficient,” Davis said. “It makes encounters with patients more effective.” Forty-eight percent of respondents said they have saved more than 30 minutes per day using Epocrates’ drug formulary and reference. Using a mobile application has reduced the time spent on labor-intensive paper charting, Davis said. Davis said that Nashville-based Centennial Medical Center has felt the constraints of the nursing shortage, although the health system has not had to lay off any nurses because of the economic recession. Having health IT has helped nurses do more with less, she said. If nurses are fully trained and the technology is utilized appropriately, mobile device applications are “definitely a time saver,” she said.

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