5TH ANNUAL SOUTHERN CALIFORNIA PERIOPERATIVE NURSING SYMPOSIUM A Game Plan for Work & Life Presented in Partnership by Patient Care Services, Regional Perioperative Services and UNAC September 15, 2012 - The Disneyland Hotel

OPENING REMARKS 

Marie Paulson, RN, BSN, MS, CNOR Perioperative Director, Southern California Region

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James DeFontes, M.D. Asst. Executive Medical Director SCPMG Administration Perioperative Services

2012 PERIOPERATIVE NURSING SYMPOSIUM 

Acknowledgements  

UNAC Steering Committee: 

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Administrative Assistances 

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Books for purchase from morning break through 3:00 pm today

Book Signing 

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Amily Valencia

Barnes & Noble 

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Tamica Lewis, Lynne Fuller, Anjai Shields, Cheryl Widmer

Kathleen Pagana will be available for book signing at the end of the symposium

Housekeeping  

Cell phones – please place on vibrate Break/Lunch (Lunch upstairs in the Magic Kingdom Ballroom West)

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Engagement

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Evaluations – please place in box in the Foyer near CEU tables

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CEUs – available in the Foyer at the end of the symposium Please engage & enjoy…

Leading From Where You Stand

James DeFontes, MD Assistant Executive Medical Director, SCPMG Administration Regional Perioperative Services

REGIONAL PERIOP SERVICES: VALUE EQUATION “to be the safest place to have your surgery.”

S SAFETY CULTURE

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Patient & FamilyCentered Care

P PERFORMANCE

QUALITY

C COST

=

V

VALUE

S

The safest place to have your surgery.

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SAFETY CULTURE

Q

QUALITY

Safety Highly Reliable Teams (HRT) Human Factors Training (HFT) Critical Event Team Training (CETT) Periop Internship Program Simulations

Quality Serious & Reportable Events Core Measures Surgical Quality Improvement Compliance

Patient & Family-Centered Care Focus Groups Surgery Scheduling Education Satisfaction

Cost Affordability Revenue Cycle Procurement & Supplies Fee for Service

Patient & FamilyCentered Care

C

P

PERFORMANCE

COST

Performance Process Improvement Central Supply / SPD Accreditation, Regulation and Licensing (AR&L) Integrated Information & Analysis

=

V

VALUE

SOUTHERN CALIFORNIA REGIONAL LEADERSHIP

SOUTHERN CALIFORNIA REGIONAL LEADERSHIP 

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Benjamin Chu, M.D., MPH, MACP President, Southern California Region, Group President, Southern California and Hawaii Edward Ellison, M.D. Executive Medical Director/Chairman of the Board, SCPMG Patti Harvey, RN, MPH, CPHQ Senior Vice President, Quality and Risk Management Patient Care Services, Clinical Operations Support KFHP/KFH Southern California Jerry Spicer, MPA, RN, NEA-BC, FACHE Vice President, Regional Patient Care Services KFH Southern California

Presented by:

Kathleen Kohut, RN, MS, CIC, CNOR System Director of Infection Prevention Cone Health, Greensboro, NC

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3M

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AMN Healthcare

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The Compass Group

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BE Smith Consulting

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Johns Hopkins Hospital

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NCH Healthcare System

1.

Name one state/national initiative that is influencing SSI prevention strategies

2.

List the 3 areas of focus with the Joint Commission NPSG for SSI Prevention

3.

Describe the five basics of SSI prevention

4.

Discuss two opportunities for practice improvement

44,000-98,000 deaths due to medical errors annually $17-20 billion dollars per year Patient Costs: of

Lost income, household productivity, disability, lack trust in Healthcare System

Healthcare Industry: frustration

Patient satisfaction, HCP morale & increased

Societal Costs:

Lost worker productivity ($$$), school attendance, overall population health status

Called for a 50% reduction in medical errors.

To Err is Human-To Delay is Deadly Published by the Consumers Union Conclusions:  Lack of data  Est. 1,000,000 more lives lost  Billions of more dollars wasted  No nationally coordinated effort

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National Healthcare Quality Report (2009)  Perhaps worse rather than better  1 in 7 Medicare pts experiences one or more adverse events  Thousands of CLABSIs each year AHRQ Annual Performance Report, FY 2008. February 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annrpt08

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Increase in demand for:  Quality care from consumers  Accountability from the legislators  Quality care from payors (CMS)

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Resulting in an increase in demand for data  State Collaboratives, SOWs, State HAI Plans, Legislation, CMS

public reporting

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The catalyst:  American Recovery and Reinvestment Act of 2009. (2009).

Available via U.S. Government. http://www. gpo.gov/fdsys/pkg/PLAW-111publ5/content-detail.html.

Current National SSI Initiatives include: The Joint Commission National Patient Safety Goal NPSG.07.05.01 included in 2009 CMS Public reporting requirements for SSIs  2012 - Colon Resections and Abd Hysterectomies ▪ Nationally

Main Concepts: 1. Educate ▪ Yourself ▪ All Surgery Personnel (upon hire and annually) ▪ Patients and Families 2. Measure ▪ Conduct risk assessments with the OR to determine process and outcome measurements 3. Communicate http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/

Senate Bill 739 - HSC 1288.9  Develop and report compliance with measures for prevention of SSI (SCIP) Senate Bill 1058 - HSC 1288.55  Reporting MRSA/VRE BSI, C. diff infections SSI from ”deep and organ/space surgical sites, cardiac, orthopedic, and gastrointestinal” surgical procedures (28 procedures) http://www.cdph.ca.gov/programs/hai/Documents/Slide-Set-17-Regulations.pdf

SSI is an unfortunate possibility (it says so right on the consent form) Challenge-change the culture of tolerance to one of intolerance to SSI

The Business Case- maximization of OR volume to increase revenue

Challenge- improve efficiencies without compromising infection prevention

Tradition

Challenge- re-examine practices from a fresh perspective to find new opportunities

Lack of research

Challenge- conduct research and publish to create a solid body of evidence

Five Focus Areas: 1. 2. 3. 4. 5.

Aseptic Technique Sterilization ABX Prophylaxis Hair Removal Skin Antisepsis

Principles were developed to reduce the risk of wound contamination.

Risk of SSI =

Dose of Bacterial Contamination X Virulence Resistance of Host (patient)

Berry & Kohn’s, Operating Room Technique, 11th ed., p. 254

Exogenous sources

1. 

Cleanliness of environment, lack of proper airflow, shedding by the Surgical Team

Endogenous sources

2.  

Patient’s own skin/hair Infection at a remote site

People = Shedding 4000-10,000 particles per minute (Berry & Kohn’s, Operating Room Technique, 11th ed., p. 252)

Carried by wind currents to the sterile field which results in wound contamination. 1. 2. 3. 4. 5. 6.

Patient Surgical Team Ancillary Personnel Sales Reps Students Passersby

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Requires the control of:  Amount of Traffic  Traffic Patterns

Sherertz, et al. “Cloud” HCWs. Emerging Infect Dis. 2001;7(2): 241-44. Edmiston, et al. Airborne Particulates in the OR Environment. AORN 1999; 69(6): 1169-1183.

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Essential personnel only

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One foot (min) perimeter around sterile field

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Sterile fields should be a destination, not a thoroughfare

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Limit students and observers  The right of the student to learn vs. the right of the patient to receive safe patient care

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Utilize alternative methods of communication

People + Wind + (-) Aseptic Technique > ABX + Skin Prep = Wound Contamination = SSI

Patient/Family Teaching Opportunities 

Lose weight, control diabetes, quit smoking Pre-op showering program -At least 2 showers with CHG

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Hat and clean gown/linen for patient transport Hair removal only when necessary

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Nasal Decolonization

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 Clippers, not in the OR

Association of periOperative Registered Nurses (AORN). Recommended Practices for Perioperative Nursing: Skin Antisepsis. Perioperative Standards and Recommended Practices 2008 ed., pp537-555. Webster, J, Osborne, S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systemic Reviews 2007

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Between 25-30% of all patients are colonized at any given time

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Another 60% carry it intermittently.

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Carriers are at higher risk

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S. aureus causes 25-35% of all HAIs

Perl, TM, et al. Intranasal Mupirocin to Prevent Postoperative Staphylococcus Aureus Infections. N Engl J Med 2002; 346(24): 1871-7.

20% of all surgical pts acquire some type of HAI during their postoperative course  85% of S. aureus infections were endogenous in SSI study populations  MRSA SSI rates decreased from .23% to .09% (5,094 pts) with MRSA eradication program 

Van Rijen, et al. Intranasal Mupirocin for reduction of S. aureus in surgical patients with nasal carriage. J Anti Chemotherapy 2008; 61:254-261. Pofahl, WE, et al. Active Surveillance Screening of MRSA and Eradication of the Carrier State Decreases Surgical-Site Infections Caused by MRSA. J Am Coll Surg 2009;208:981-988.

Surgical Team  Hand Hygiene  Nocardia farcinica (Wenger, et al. J Infect Dis. Nov 1998)  Proper aseptic technique  Properly worn hats, masks, clean OR scrubs,

jackets, minimal jewelry (AORN scrub attire)

If it takes 17 years to adopt new technology, our time is up! Dineen, P, Drusin, L. Epidemics of Postoperative Wound Infections Associated with Hair Carriers. Lancet 1973; (Nov) 1157-59. Institute of Medicine (IOM). (2001). Crossing the quality chasm. Crossing the quality chasm: A newhealth system for the 21st century. Washington: National Academy Press.

THE JACKSON LABORATORY BIOTECHNOLOGY COMPANY

COSTCO

Room Requirements • Ventilation System

▪ (min 15- recommended- 20-25/hr, 3 fresh) ▪ Positive pressure

• Temperature (68-73° F) • Humidity (20-60%)

Room Cleaning • Between cases • Terminal cleaning • Types of construction materials • Clutter AORN, Recommended Practices for Perioperative Nursing: Patient & Worker Safety. (2011 ed., p 219-221)

Proper Management of Sterile Processing Departments    

Instruments- do you have enough? Technology- old equipment? Workflow - dirty to clean Staff certification makes a difference

www.jointcommission.org

A focus area for The Joint Commission • • • • •

IUS rates 10 minutes were randomly assigned to the parent present group (n = 150) or parent absent group (n = 150) in the PACU Anesthesia technique was similar Reunification occurred once children's eyes had opened for the parent present group. In the PACU, crying was scored each minute after eye opening using a 5-point scale. Negative behavior change 2 weeks after discharge was determined using the Post Hospitalization Behavior Questionnaire

Parental Presence in the PACU 

For fit healthy children undergoing outpatient surgery, parental presence in the PACU decreases negative behavior change at 2 weeks postoperatively but makes no difference in crying in the PACU (Lardner, 2009)

Parents and Home Care 

Parents should be given better information to manage their child’s pain after surgery

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One study showed that only 20% are given adequate instructions at time of discharge

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The more knowledgeable they are about their child's condition, the better they will be able to manage their care

SmartTots 

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A multi-year project aimed at making anesthesia safer for the millions of infants and young children who undergo anesthesia each year To study existing anesthetic drugs and how they are used with children, including the dosage amounts and number of exposures Information from these research studies will help determine if there are hazards to children It will also help to improve the anesthetics currently in use or under development and develop new anesthetic drugs

Effects of Anesthesia on Long-term Behavior 

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In multiple research studies, all of the anesthetics and sedatives commonly used in infants and children caused widespread loss of nerve cells and/or later abnormal behavior when administered during rapid brain growth in rodents One study showed harmful effects to the nervous system in newborn monkeys given a commonly-used anesthetic (Slikker W et al. 2007)

Effects of Stress on Neurodegeneration 

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Many studies have shown that exposure to ANY stress at a very young age such as pain may affect behavioral problems in adult life: Two Proposed Mechanisms: 

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(a) excessive neonatal stimulation resulting from perinatal trauma or other insults causes NMDA-mediated excitotoxicity in multiple areas of the developing brain, and (b) lack of appropriate sensory stimulation in the neonatal period serves to enhance the normal occurrence of developmental apoptosis in the neonatal brain

What About Humans? 

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One study describes learning disabilities after multiple anesthetics administered in infants and children prior to four years of age, but not from a single anesthetic (Wilder RT et al. 2009) In that study, the researchers found that two exposures to anesthetics before age four increased the likelihood of future learning disabilities in reading, writing, and math by 50% Three or more exposures created even greater risk for learning problems Exposure times under two hours did not appear to be linked to learning difficulties

What About Harm to Infants and Young Children? 

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Dangers to infants and children from a any single anesthetic are unproven at this point There is no direct evidence that anesthetics are unsafe for children Necessary surgeries should NOT be postponed until after age four Waiting may create far more health risks later in life Parents of children requiring surgery should consult an anesthesiologist or other qualified physician for advice about an individual child’s situation

So… 

Preclinical evidence indicates anesthetic exposure in neonatal animals leads to neurotoxicity and neurobehavioral deficits

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Available clinical studies related to anesthetic neurotoxicity are retrospective and inconclusive

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Two multicenter clinical studies are currently underway to address anesthetic neurotoxicity in children

Future Studies 

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Children’s Hospital, Harvard University (Boston, MA), is conducting a longterm study of neurodevelopment outcomes in pediatric patients administered regional or general anesthesia as neonates or infants. Arkansas Children’s Hospital Research Institute (Little Rock, AR) is researching the pharmacokinetics, pharmacodynamics, and neurotoxic effects of an anesthetic agent in infants undergoing various surgical procedures. Columbia University (New York, NY) is evaluating the effects of anesthetic exposure on neurocognitive, emotional and behavioral outcomes in pediatric patients. Mayo Clinic (Rochester, MN) is studying long-term cognitive development following exposure to general anesthetic agents during infancy. The NCTR is conducting non-clinical studies in non-human primates to assess the decline in mental function when young animals are exposed to anesthesia. The NCTR is researching the development of noninvasive ways of using imaging to measure structural changes in the human brain.

Putting It All Together 

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Identify and recognize perioperative anxiety and take measures to alleviate them Define, distinguish premedication, and understand its importance and timing Demonstrate an understanding of emergence delirium and behavior changes of the pediatric population in the perioperative period Communicate and clarify parental presence immediately after surgery in postop period because it is beneficial Clearly communicate postop care to parents Be well-versed with the issues surrounding the effects of anesthesia on the developing brain of young children

LUNCH: OPEN/NETWORKING 11:30 AM TO 12:30 PM LOCATION: THE MAGIC KINGDOM BALLROOM, 2ND FLOOR

Kaiser Permanente

Secure Document Alliance Goodwill Industries The Benefits of Waste Management: Our Environment, Our Work, Our Communities

Tim Eng, Kaiser Permanente Lori Yalem, Goodwill Industries Southern California

Overview: Kaiser Permanente  37 Hospitals  568 Medical Office    

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Buildings 336 Administrative locations Over 56 million square feet of real estate 9 million members 173,300 technical, administrative, and clerical employees and caregivers, 16,658 physicians representing all specialties

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Overview: Kaiser Permanente Southern California

 70,000 technical and clerical employees and caregivers  5,700 SCPMG physicians  3.5 million members  14 medical centers  198 medical offices.  Los Angeles County's largest private employer.

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Founded on our Commitment to our Communities

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We recognize our environmental responsibility Kaiser Permanente has been working for years to curb its environmental impact and improve the health of the communities it serves by: •safer chemicals, •building greener hospitals, •reducing waste •using less energy. •The organization is also taking the initiative to “green” the health care industry by leveraging its purchasing power.

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We started in 2007 with electronic waste

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E-waste Posters

Let’s Keep E-Waste From Contaminating Our Local Landfills Once e-waste hits our local landfills, it’s too late! E-waste contaminates our soil, air, and water, and is hazardous to human health. Recycle it right!

Bring your personal e-waste from home to the KP-Goodwill Collection Event

April 22, 2008: 393 E. Walnut St., Pasadena, CA Upper Atrium; 7:30 a.m. – 1:00 p.m. E-waste includes: Old, broken or unusable electronics, or, anything that has a plug or uses batteries. • Computers • Monitors • Televisions • Stereos • Radios • Copiers • Fax machines

• Cell and conventional phones • Clocks • VCR, CD, and DVD players • Answering machines • Networking equipment • Digital devices of all kinds • Vacuums, fans, lamps, microwaves

Kaiser Permanente and Goodwill. Partnering to make lives– and the planet–better.

For further information: Tim Eng (626) 405-5152 [email protected]

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We expanded the effort to the community

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Medical Center Participation

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Sustainability Activities 

2007 • Pilot site

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2008 • 13 Medical Center & Reg. Bldg. Operations electronic waste collected 87,177 lbs • Confidential Document destruction & recycling initiated

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2009 • 12 Medical Centers & Reg. Building Operations collected 37,078 electronic waste collected. • Sterile blue wrap and saline bottle recycling initiated at South Bay and West Los Angeles. • Secure document destruction and recycling roll-out completed at all Southern California KP locations.

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2010 • 13 Medical Centers & Reg. Building Operations participated in 2010 Earth Day eWaste collections – 62,594 lbs. collected. • Sterile blue wrap and saline bottle recycling targeted for remaining sites.

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2011 • National Waste Reduction policy in effect • Continued eWaste events at all medical centers • Capacity for blue wrap recycling in all medical center areas developed.

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2012 • Upcoming……. 118

Our Partnership is Mutually Beneficial: Mission Statements

Kaiser Permanente exists to provide affordable, highquality health care services to improve the health of our members and the communities we serve. Secure Document Alliance: To increase employment opportunity for people with disabilities by expanding commercial document management and recycling services at a national, regional, and local level. Goodwill Industries International enhances the dignity and quality of life of individuals, families and communities by eliminating barriers to opportunity and helping people in need reach their fullest potential through the power of work. 119

Our Partnership

•Provides and create new green jobs •Create jobs for individuals who may otherwise not be able to work. •Enhances information security •Promotes sustainability through improved logistics. 120

Community Benefit by working with another non-profit on Environmental Stewardship Kaiser Permanente's Mission KP exists to provide affordable, high-quality health care services to improve the health of our members and the communities we serve.

Community Benefit

Environmental Stewardship

KPSC Operations

SDA/Goodwill Industries

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The Secure Document Alliance

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Coverage for the Southern California Area Secure facilities NAID certification Competitive Price Point Community Benefit • Employment for persons with disabilities • Got Your 6 – National Veterans Reintegration Program • Supports programs for disadvantaged communities

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Recycling Program Option available • Cardboard • Plastic bottles and cans • Sterile Blue Wrap & Saline Bottles 122

Secure Document Alliance & Goodwill Southern California

About SDA

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SDA Formed in 2005 Represents over 75 individual nonprofit members Members provide document destruction services in every state in the U.S. Many partners 35 - 95 years in business Actively involved in the local community Document Destruction E-Waste Recycling Scanning & Imaging

Winning Partnerships

We’ve created numerous “win-win” partnerships with our clients. Let us repeat our successes with your organization.

Security Overview

SDA & Kaiser Permanente Partnership Opportunities 

Process Improvement • Pharmacy Guidelines and Program

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Additional Cost Savings for Kaiser Permanente • Program monitoring – Right-sizing containers, frequency, service; shared solutions; reducing waste pickups & landfill items. • Improved Logistics: - Centralized destruction service; Reduced truck time at the dock.

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Current and Potential Recycling Program for • • • • • •

Aluminum & Plastics Electronic Waste Sterile Blue Wrap/saline bottles Publications, Public Documents E-Media (CDs, DVDs, tapes, etc). Other waste streams 127

Accomplishments 

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441 Facilities serviced 23,000,000 lbs of documents shredded & recycled annually Avg. +50,000 lbs. of blue wrap and saline bottles recycled Standardized confidential handling process Over 120+ Persons with Disabilities employed Positive working partnership – developing solutions together

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Increased HIPAA / PHI compliance / lower risks Support Community Programs: • WorkSource • Got Your 6

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Next Steps: Cardboard & Plastics

Here’s the Situation…

2011 KPSC Regional Waste Profile Costs $9,000,000 $8,000,000 $7,000,000 $6,000,000 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $-

Category $3,500,000.00

8,133,942

7,890,044

$3,000,000.00 $2,500,000.00 $2,000,000.00 $1,500,000.00

2010

$1,000,000.00

2011

$500,000.00 2010

$-

2011

Solid Waste (78650)

Diversion Rate 45% 40% 35% 30% 25% 20% 15% 10% 5% 0%

Medical Waste (78660)

Document Hazardous Waste destruction & (78665) recycling (78655)

Weight 70,000,000

30%

32%

2015 Diversion Goal 40%

60,000,000 50,000,000 40,000,000

2010 (lbs)

30,000,000

2011 (lbs)

20,000,000 10,000,000 2010

2011

2012

2013

2014

2015

0 Solid Waste

Recyclables

Medical Waste Hazardous Waste

Waste Characterization

Study conducted by the City of Los Angeles: Services: Medical / Health •Other Organic – 37.8% •Paper – 27.8% •Plastic – 24.3 •Metal – 9.4%

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Reducing our Impact

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Blue Wrap Recycling for 2011 2011 Total 2011 lbs % 2011 lbs lbs % Oct-Dec recycled Recycled purchased recycled Recycled

Sterilization wrap KAISER PERMANENTE HOSPITAL

442 N LAKEVIEW AVE

ANAHEIM

KAISER FOUNDATION HOSPITAL

9334 IMPERIAL HWY

KAISER PERMANENTE HOSPITAL

2434

1897

78%

10440

6100

58%

DOWNEY

4518

1565

35%

18090

8528

47%

10801 MAGNOLIA AVE

RIVERSIDE

5040

3875

77%

20538

7706

38%

KAISER PERMANENTE

1012 BALDWIN PARK BLVD

BALDWIN PARK

4014

1719

43%

16560

5899

36%

KAISER PERMANENTE

25826 VERMONT AVE

HARBOR CITY

2484

677

27%

10206

3621

35%

KAISER FOUNDATION HEALTH PLAN

6671 ALTON PKWY

IRVINE

6462

1605

25%

24588

8025

33%

SO CAL PERMANENTE MED GRP

9401 ROSECRANS AVE

BELLFLOWER

2484

738

30%

10224

2801

27%

KAISER PERMANENTE HOSP

5602 DE SOTO AVE

WOODLAND HILLS

4302

1009

23%

17100

2971

17%

KAISER PERMANENTE

4868 W SUNSET BLVD

LOS ANGELES

5544

389

7%

11934

1176

10%

KAISER PERMANENTE PANORAMA CITY 8002 VENTURA CANYON AVE PANORAMA CITY

3114

83

3%

13266

1169

9%

KAISER LOS ANGELES MEDICAL CENTER 1551 N EDGEMONT ST

LOS ANGELES

2790

22

1%

24408

686

3%

KAISER PERMANENTE HOSPITAL

9962 SIERRA AVE

FONTANA

5976

294

5%

27720

468

2%

KAISER FOUNDATION HOSPITAL

4648 ZION AVE

SAN DIEGO

4914

205

4%

18108

205

1%

KAISER PERMANENTE HOSPITAL

2296 S VINEYARD AVE, STE A ONTARIO

5292

0

0%

21222

0

0%

59368

14078

24%

244404

49355

20%

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What can you do? Connect with other service areas which have a robust blue wrap recycling program. Look for an area to set aside unused blue wrap Discuss with EVS on how to move the wrap to the dock Work with your local Green Team, Product Support to identify opportunities.

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Summary & Questions & Quiz

Other Programs & Contact Information

http://www.gotyour6.org/partners/ [email protected]

[email protected] 138

Quiz

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By percentage, who recycles the most blue wrap?

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Anaheim

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By weight, who recycles the most blue wrap?

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Downey

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When was Goodwill Southern California founded?

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1916

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QUESTIONS

BREAK – 15 MIN

SELF CARE Christine M. Evans, PhD, RN Medical Psychologist SCPMG Assistant Medical Group Administrator Riverside Medical Center

Reinvesting in your Potential: A game plan for life & work

Kathleen D. Pagana, PhD, RN 5th Annual Perioperative Nursing Symposium Kaiser Permanente 9/15/12

The Day of the Jackal The Odessa File No Comebacks The Fist of God The Veteran The Devil’s Alternative The Fourth Protocol The Afghan

Fred Forsyth

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“If the young Talib bodyguard had known that making the cell phone call would kill him, he would not have done it. But he did not know, so he did, so it did.” The Afghan

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If the shy high school student and aspiring science teacher had known that the hospital tour would change her career path, she never would have believed it. But, it did and she became a nurse.

[email protected] 146

Developing a Game Plan

10 Strategies 147

1. Strengthening your Power Base

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“You be the young doctor fresh out of medical school, ….” 149

2. Sowing Seeds

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3. Enhancing your Leadership Role

L l

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4. Positioning for Tomorrow

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5. Raising the Accountability Bar

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ABOVE THE LINE: STEPS TO ACCOUNTABILITY DO IT SOLVE IT OWN IT SEE IT

-----THE LINE-----THE LINE ---FINGER POINTING

WAIT AND SEE

IGNORE / DENY

COVER YOUR TAIL

IT’S NOT MY JOB

BELOW THE LINE: THE BLAME GAME 154

The OZ Principle

6. Building a Success Team

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7. Dealing with Procrastination

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Accountability colleagues

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8. Failing Forward

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9. Saving Lives; Having a Life

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Save a piece of the pie for yourself.

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Take time for yourself!

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Daily life strategy checklist Exercise ___ Nutritious diet ___ Prayer/ bible study ___ Tending to immediate family ___ Tending to extended family ___ Controlling commitments ___ Protecting creative time ___ Responsibility for professional growth ___ Playing/ relaxing/ reading ___ 162

10. Putting Your Best Foot Forward

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Question #1

You are judged by the quality of your handshake. True/ False

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Handshake • Extend hand at 90 degrees with thumb up. • Connect hands web to web with firm grip. • Pump 2 to 3 times and drop hands. 165

Question #2

Place your nametag on the left side of your chest. True/ False

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Nametag Location

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Question #3

There is nothing small about “small talk.” True/False

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OAR: Conversation Starters • Observe • Ask Question • Reveal

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Question #4

Always be prepared to leave a voice mail message. True/ False

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Voice Mail Tips • • • • • •

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Jot down key points Be concise Avoid confidential info Repeat numbers Repeat name Don’t be a coward

Question #5

Your e-mail is a reflection of your professionalism or lack of it. True/ False

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E-mail tips • Nothing confidential • Subject line • Greeting and close • Recipient check • Signature block • Business tone • Concise • Add attachments 173

Sample e-mail To: Jocelyn Gall From: Mary Clark Subject: Business lunch with new VP Hello, Jocelyn! I have scheduled the welcome luncheon for Monday, October 22nd, 2012 at Embers Inn at noon. Thanks, Mary Mary Clark, RN Director, Staff Development Susquehanna Health 777 Rural Ave, Williamsport, PA 17701 570-321-4000 [email protected] 174

Question #6

Your bread plate is located to the right of your entrée plate. True/ False

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Where is your bread plate?

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Use these tips to Put Your Best Foot Forward

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The builder

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Develop and Follow your Game Plan

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Best wishes to all! • www.KathleenPagana.com Free newsletter Free tips Free articles 180

CLOSING THOUGHTS..... Ending 

Acknowledgements

Housekeeping 

Pick up your CEU Certificates 

INPUT LOCATION!!!!

Evaluations Thank you for coming and have a safe drive home!