2015 Fall Leadership & Management Section Bulletin

Fall 2015 Leadership & Management Bulletin

Roger L. Berg, PhD, DSc, RRT-NPS
RT Instructor
American Career College
Ontario, CA
Cheryl Hoerr, MBA, RRT, FAARC
Director, Respiratory Therapy
Phelps County Regional Medical Center
1000 W. Tenth Street
Rolla, MO 65401
Past Chair
Bill D. Cohagen, MSHCA, RRT, FAARC

Specialty Practitioner of the Year: Garry Kauffman, MPA, RRT, FACHE, FAARC

Our section is pleased to present its 2015 Specialty Practitioner of the Year Award to Garry Kauffman, MPA, RRT, FAARC, during the Awards Ceremony at AARC Congress 2015 in Tampa.

Garry has 20+ years of experience as a manager and has worked in that capacity in both acute care and subacute care facilities. Before becoming a consultant in the areas of training, strategic and operational planning, and performance improvement earlier this year, he served as the administrative director of respiratory care at Wake Forest Baptist Medical Center in Winston-Salem, NC, where his staff credited him with making many positive changes aimed at improving the financial and clinical performance of the department and the facility.

Over the past several years, Garry has also worked as a member of the AARC Program Committee, putting together the majority of the manager content for the AARC’s Summer Forum. Colleagues say he possesses an extremely advanced knowledge of management concepts and is literally on the cutting edge of health care in 2015. The management program topics and speakers at this year’s Summer Forum certainly reflect that level of expertise.

He’s been a regular contributor to this Bulletin as well, as the article you’ll see in this issue can attest.

Finally, Garry is known far and wide for the passion he exudes for the respiratory care profession. He literally eats, sleeps, and drinks respiratory care and travels throughout the country helping state societies work through their business plans to improve their situation. You’ll often find him on the section discussion list as well, asking and answering questions and networking with managers from across the country.

Congratulations, Garry, on your receipt of this prestigious award.

How Identifying Strengths in Your Staff Can Foster Engagement

Mary Lou Guy, MBA, RRT, CHT, Manager, St. Luke’s Northland Hospital, Kansas City, MO

My grandson has had a ball of some kind in his hands since I can remember. He is a natural with basketballs, footballs, and juggling balls, but his focus is baseball.

As soon as he could run, he would sprint from the entry hallway into the family room and end with a slide across the carpet. I so feared he would slice open his head on the bricks of the raised fireplace that I attached foam to the corners and front to lessen the imagined injury. (Strengths: courage, enthusiasm)

At the age of two, he would squat to play catcher while Grandpa threw a ball to him. Then he would have Grandpa squat to catch his pitches. Grandpa had to do it just right. If Grandpa did not put his free hand behind his back, my grandson would coach him, saying, “Not like this, like this,” and demonstrate keeping the free hand safe from getting injured with an errant pitch. (Strengths: leading, common sense, developing others)

At four, he played on a T-ball team. While others just stood still at home plate or ran to third base or all over the field — to the amusement of some and the horror of their parents — he knew the rules. First base, then to second, then to third, and home was the route he would take. (Strength: decisiveness)

As he grew older, he continued to run from the entry into the family room to catch “fly” balls thrown by Grandpa, leaping over the couch arm to fall on the cushions, snatching the ball out of the air in a heroic finish — all while “calling” the game until a team won. (Strengths: results focused, resilience)

Even now at 13, the activities surrounding baseball energize him. I believe this is so because his strengths are ones needed by a baseball player. By playing baseball, he practices skills which, when done well, create the enjoyment needed to keep him in the game.

Strengths and drainers

The challenge for managers is to keep employees energized so they are in the “game” of work.

After all, energized people are more engaged and provide better patient care. Isn’t that the outcome we all are focused on today?

One thing managers can do to energize staff members is to focus on each individual’s strengths and drainers. Begin by recognizing that one strength is not necessarily better than another strength in creating an engaged employee. As a matter of fact, it is important to have different strengths within a team.

Let’s start with a possible list of strengths: strategic minded, self-improvement, efficiency, decisiveness, results focused, collaboration, courage, optimism, enthusiasm, flexibility, self-confidence, critical thinking, leading, resilience, creativity, emotional control, detail oriented, developing others, persuasiveness, common sense, empathy, compassion, relationship building. initiative. By identifying a time when an individual performed at his best — when he was totally absorbed and feeling energized — you can identify which strengths led to the outcome. You can do this at the interview or with current employees.

You can also create Strength Cards (each card has an individual strength on it) that you can use to incorporate tasks into the individual’s daily work that will energize her. For example, if someone likes to develop others, that individual may be a great person to orient the new therapist. The efficient, critical thinker might be best at process management. Identifying strengths for each employee will take some effort, but it will be well worth it in the long run.

But what about those things that drain the individual? We can work on those also, if the individual is willing to do something about them. Consider the following alternatives —

STOP! Just stop doing it.

Not an option? Then . . .


Not an option? Then . . .


Not an option? Then . . .


Still not an option? Then . . .


Game of failures

I recently heard an announcer call baseball a “game of failures” and I agree that this is true. The pitcher is hoping to throw well enough to get the batter out. The fielders hope to make a play to create an out. The batter wants to hit the ball out of the park or well enough to advance the runner. Each play results in failure by someone.

Luckily, one of my grandson’s strengths is resilience. However, a drainer for him is that he has not developed good emotional control. He sometimes gets mad at himself if he is involved in one of the many incidents when a “failure” happens. Unfortunately, at these times his body language reveals to others that he has become discouraged or has given up — shoulders droop/facial features sag. HALT takes over. (When you are hungry, angry, lonely, or tired your brain has a harder time working.)

But he can’t just stop the game. The game goes on until the last play. He doesn’t want to outsource his spot to another player. He wouldn’t be playing. He may not be able to re-frame it. The umpire is in charge of the calls. He can learn better skills and practice longer, but in the end, he has to own the fact that he isn’t perfect. He will make mistakes. Others sometimes control the outcome. Showing he is upset creates power in others and depresses his own team.

I experienced a huge ray of hope during the last game of this season. He was pitching and he remained calm and in emotional control even when his team got behind. He owned it for that day.

As managers, we can learn how to use the strengths of those we work with and create ways to deal with the drainers. It will take work and a focus on the process. Will we have engaged or disengaged employees? It is up to us to OWN it.

12 Things Successful Leaders Never Tolerate

Garry W. Kauffman, MPA, RRT, FACHE, FAARC, Consultant: Education, Training, Strategic and Operational Planning, Performance Improvement, Walnut Cove, NC 

The following list of 12 behaviors is liberally adapted from “12 Things That Successful Leaders Never Tolerate.” I remember reading this a few years ago and ran across it again while surfing Al Gore’s Internet looking to learn something from a recent professional engagement.

I’ve kept the “12 Things” intact and have added some personal thoughts that may be useful to RT leaders and RTs pursuing a career in leadership. I’d appreciate feedback on this list — perhaps we can revise it and use these concepts to guide us to be successful leaders.

  1. Dishonesty. Dishonesty places a false reality on your life and is an easy way to bring down success. I remember reading a quote about honesty and it went something like this: “Only tell the truth. That way, you only have one story to remember.”
  1. Boredom. Successful people are usually exploring something new, not because they know everything about the status quo, but rather because they want to continuously learn and improve. If you’re still leaning on the 2nd edition of Egan for your clinical knowledge, you just might want to purchase the 3rd edition of Respiratory Care: Principles and Practice (and no, I don’t get paid to mention this).
  1. Mediocrity. Settling for less is a huge temptation, particularly if you’re pushing 70 hour weeks and just don’t have much left in the tank. However, “settling” is what will get us and our services replaced by a lower common denominator. We can’t take that risk.
  1. Negativity. Every negative thought we have detracts from our reputation, and in my opinion, even having the negative thought while not expressing it eats away at us. I think it parallels former president Jimmy Carter, who felt that he was disloyal to his wife because of having a thought. (For those under the age of 40 who don’t remember the quote, Google it.)
  1. Toxicity. I think I have heard every health care professional I know use the phrase: “S/He is toxic.” Why do we keep toxic people on the team? What can we do as RT leaders to fix or jettison toxic RTs? Perhaps we could add “No Toxicity Tolerated Here” in the job description, so that we advance our image and our caring for patients.
  1. Disorganization. I am the poster boy for this trait and I’ve just made a 100% commitment to changing this two weeks ago. I remember using the following phrase when welcoming folks into my office: “Please excuse the mess. It usually doesn’t look this bad.” Well, that was just an excuse so that I didn’t have to address the issue and is certainly not a leadership characteristic that I want to be identified with.
  1. Unhealthiness. As with #6 above, you’re reading from the poster boy on this one. My most recent administrative assistant repeatedly (and politely) said: “Is that what you’re eating?” I’m not saying that we have to replace our McBurgers with tofu and lettuce wedges, but I know down deep that healthiness starts with eating properly and getting exercise. The other side of this coin is dealing with the time commitments of our positions that seem to continue to grow at an unhealthy pace. Whether it’s the monthly financial report, the quarterly QA report, or the seemingly endless meetings and other essential activities of our jobs, we really do need to look in a mirror and reflect (pun definitely intended) on whether this is the image we want our executive team, our colleagues, and others to identify us with as health care professionals.
  1. Regret. In exploring events surrounding a recent employment, I racked my brain for weeks in an attempt to figure out what the heck happened. I created a list of mistakes, dumb decisions, and poor word choices, and cemented my anguish with a list of regrets on more pages of paper than we have Republican candidates for president (at least at the time I am composing this diatribe). My new motto is to learn from it and then leave it behind.
  1. Disrespect. Disrespect, no matter the form or who it may be directed toward, is one of the most destructive forces we can harbor. I hope that I adhere to the Golden Rule: Treat others how you would want to be treated. I heard an amplification of the Golden Rule called the Platinum Rule: Treat others as they wish to be treated. I think the Platinum Rule encourages us to listen to and learn about others from their perspective first, and then we can create the best relationship.
  1. Distrust. We’ve all heard the phrase: You have to earn their trust. I think that is certainly true, but I believe we need to avoid earning their distrust as well by focusing on growing our integrity and surrounding ourselves with others who do the same.
  1. Anger. This may sound like a cop-out, but I don’t think we can avoid being angry. However, holding onto it paralyzes us from making changes to fix the issue. We must learn to direct anger toward problems rather than people if we are to be successful leaders.
  1. Control. There are some things we as RT leaders will never be able to control. (Does “productivity percentile targets” ring a bell?) In fact, most of the processes in health care are totally out of our personal control. What we need to do as RT leaders is to focus our time and energy on what we can control, or at least influence, and let the rest go.

I hope that I’ve stimulated some thoughts, both among today’s leaders within our AARC Management Section and those not currently in a leadership position who want to read what we’re reading, what we’re saying, and what we do in our offices.

As the AARC Program Committee liaison to the Management Section and our section chair, Cheryl Hoerr, I’m also interested in receiving tons of great topics and speakers for our 2016 AARC Summer Forum and 2016 AARC Congress. Perhaps this column may inspire someone to create a new leadership presentation to share at the Summer Forum or Congress next year. (Deadline for RFPs, Jan. 8, 2016!)

Management in the Land of Plenty

John S. Rinck, MM, RRT-NPS, CPFT, Adjunct Faculty, Graduate and Professional Studies, Spring Arbor University, Traverse City, MI 

Respiratory managers belong to that hectic specialty wherein knowledge, skill, and endurance mix with business and clinical understanding to form a career that demands continual 360 degree surveillance; surveillance of internal and external environmental changes that require vigilance and forward thinking. Stretched between diverse and often competing demands on their time (regulations, budgets, patient satisfaction, staffing), they are asked as members of the health care team to take up administrative “arms” in the ongoing war against disease and illness.

And as if that is not enough, there is also the need to function as counselor, coach, disciplinarian, critic, and cheerleader for the staff members whom they lead. Managers are caught needing to be all things to all people. Life at work is rarely their own; they live to serve others.

However, there is an oasis in the midst of the daily emergencies, obligations, and responsibilities where personal growth, replenishment, and discovery can take place for managers who recognize and inventory the resources surrounding them; a place where job-related obligations are turned into opportunity.

The road to research and publication

By nature of their dual careers in health science and business, managers are surrounded by access to resources that would be coveted by those in other careers. For example, many are the specialists in health care who work alongside the respiratory manager in fields like pharmacy, medicine, nursing, infection control, information technology, and manufacturing — not to mention specialties within each of these broad categories (e.g., adult, pediatric, infant, critical care, general care, engineering, and maintenance). Each of these specialties comes into contact with the respiratory manager on a daily basis, exposing the manager to abundant resources and knowledge that can be tapped into.

Managers whose eyes are open and focused to recognize the abundant resources surrounding them can capitalize on the opportunities close by. At the junction where management responsibilities meet with the available resources, the focal point of scientific (clinical) or business (management) interests are formed that can be leveraged into original research with far reaching effects on management of the immediate department, the workplace, or the field of respiratory care. It is at this focal point where daily responsibilities and resources meet that the inquisitive manager is driven to ask, “Why, what if, or how?”

I think my personal experience is constructive and worth sharing. I have found that much of what is discovered within a department or service line can easily be refined or tailored into a publication, an abstract, or an article with shared value and benefit to other health care professionals. Working within the focal point of management job duties and available resources, the opportunity to leverage certain challenging situations took shape for me in the following investigations, publications, and original research:

  • Poster Presentation: Expanding operating hours in outpatient pulmonary rehab. (Purpose: Alleviate overcrowding and optimize patient-staff ratios during exercise hours.)
  • Spring Bulletin, AARC Diagnostics Section: Alpha-1 antitrypsin deficiency screening and pulmonary function testing in the PFT laboratory: partners in diagnosing pulmonary disease. 2013.
  • Respiratory Care, Abstract #1415665: Development and implementation of a process improvement plan for alpha-1 antitrypsin targeted screening. October 2012.
  • American College of Clinical Pharmacy, Abstract Publication #25355: Using non-bronchoscopic bronchoalveolar lavage-obtained respiratory cultures to guide antimicrobial therapy in patients with suspected pneumonia. June 2011.
  • Academy of Pediatrics, 2006, Vol. 118, Supplement 2: Evaluation and development of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants. Vermont Oxford Network, November 2006.
  • AARC Times: Important considerations to make prior to purchasing a transport ventilator. March 2000.
  • American Pediatric Society, Poster Presentation: Effect of postnatal prophylactic dexamethasone treatment for prevention of BPD on sequential pulmonary function tests. 1996.
  • American Pediatric Society, Abstract: Effect of endotracheal tube (ET) size on static pulmonary resistance. 1996.

Overcoming barriers

As the respiratory therapy profession continues to grow in skill and knowledge, corresponding investigation, observation, and experimentation are needed from engaged managers. Respiratory managers are a vital, essential element of this growth in that they are experienced in a wide variety of clinical skill sets and business knowledge. With respect to capturing management experience in published form, the need now is for managers who can:

  1. Inventory surrounding internal and external resources.
  2. Identify the need by asking “Why, what if, how?”
  3. Develop a collegial network with those who are like-minded.
  4. Collaborate with those who can make a difference.
  5. Organize and plan the investigation, research, and follow up presentation.
  6. Hone writing and statistical skills.
  7. Lead by example.

The biggest objection to direct involvement in the additional responsibility to investigate and publish is TIME. Fortunately, that is what managers are trained and educated to be skilled at — managing our time, priorities, to-do lists, appointments, phone calls, texts, and email. Add to this a project or a research paper incorporating individuals who are knowledgeable, skilled, and interested (resources), and the project becomes a self-imposed daily expectation. Those who are so motivated, and are creative enough to incorporate such endeavors into their daily management workload, are rewarded with a hedge against the mundane repetition of role familiarity that often culminates in mid-career burnout.

The other objection frequently voiced by busy managers is that they do not know WHAT to address, investigate, or write about. This is easily solved by taking a close-up inventory of the normal activities they are involved in and the other health professionals with whom they work. What interests them will most likely interest other managers in similar situations. Managers are problem solvers as well as team members with access to individuals and resources within their organizations that they frequently rely on for assistance. Writing about the problem solving process, the results, the team integration, or a new idea is simply putting on paper what has already been achieved by operating from the daily to-do list. From personal experience, this may include physicians, nurses, suppliers, or even staff members, who help solve many of the issues managers face.

The stage is set

A successful management research project results in self-respect and a sense of professional pride. Those managers aggressive and motivated enough to have earned their bachelor’s and master’s degrees hold those titles not only for the rights and privileges endowed by higher education, but also to meet higher expectations as professionals. More than this though, is the knowledge that emerges to benefit the respiratory profession.

One of the governing rules of management is: Complexity of the job (duties and responsibilities) brings opportunity (abundant access to resources), and opportunity opens the door to inquisitive creativity; when summarized results are shared in print, inquisitive creativity results in increased knowledge.

Clinical and business aptitudes are at the heart of respiratory managers as professionals. Add access to other individuals, and the stage is set for the manager to leverage his or her duties and responsibilities into an expanded, satisfying role in publication that will help to determine the growth of the knowledge base in respiratory care. This is management within the land of plenty.

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