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Your greatest value is your ability to solve problems

As a healthcare professional you may face problems that require problem solving at the least and the generation of creative solutions ideally. How do you hone your creativity?

The results revealed that leadership clarity is associated with clear team objectives, high levels of participation, commitment to excellence, and support for innovation. Team processes consistently predicted team innovation across all three samples. Team leadership predicted innovation in the latter two samples, and there was some evidence that team processes partly mediated this relationship. The results imply the need for theory that incorporates clarity and not just style of leadership. For health care teams in particular, and teams in general, the results suggest a need to ensure leadership is clear in teams when innovation is a desirable team performance outcome. West et al

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What did you expect yesterday?

As you walked through the front doors at work yesterday what were your expectations? Were you hoping:

  1. To serve to the best of your ability
  2. To learn something new
  3. To enjoy good company doing something meaningful
  4. To make a difference to someone
  5. To earn a big pay cheque
  6. To pass the time before home time
  7. Something else?

Which was it? How did you feel at the end of the day? How do you think those who interacted with you felt at the end of the day?

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Do you see how that happened?

You may face may challenges or have an unexpected outcome following your interaction with your customer, client or patient. As a healthcare professional these are opportunities to reflect on how an event unfolded, how you were feeling at the time and how you are feeling afterwards. Consider then how those emotions play out through the course of the day. Given that most  outcomes in healthcare are moderated by an interaction with a health professional it is important to ensure that the health professional is attuned to their inner world. We can’t change many things as providers of health services but we can look within.

Know what causes your negative emotions, and which types of feelings you face most often. When those emotions begin to appear, immediately start your strategy to interrupt the cycle. The longer you wait, the harder it will be to pull yourself away from negative thinking. Mindtools

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What do you notice?

Before making any changes that might improve outcomes where you work you have to notice things that don’t look quite right or that hint at a solution. I know someone who notices the tiniest details even when she is out shopping. She generates a huge number of ideas about how things could be improved sometimes with the smallest tweaks. Here’s an example. As a result she is the most successful person I know. You’d be lucky to have her on your side. I know I am. What did you notice about your office, clinic, shop or hospital today?

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Does parking stop doctoring

Imagine you have back pain. Your doctor suggests you need special scan. You have to travel an hour across town to get to the hospital where you have an appointment at 9 am. You take the morning off but hope you might get to work in the afternoon. It’s peak hour traffic as you arrive at the hospital. The queue to get into the car park stretches down the street. You join the line of cars and realise it’s now 8.45am. The X-ray department is a long walk from the car park. Just as you get to the entrance to the parking lot the attendant indicates that it is full and you have to try and get a spot on a side street. The chap in the car behind you is getting frustrated- are you waiting in the queue or trying to back out? It’s a one way street you can’t turn the car here. It’s now 9 am you are going to be late- not sure how late. You toy with the idea of just going home.

In November 2011, an editorial in the Canadian Medical Association Journal called hospital parking fees a barrier to health care, saying the charges amount to “parking-centred health care,” and recommended hospitals stop charging patients for parking. The editorial stirred up a debate in the media. The Ontario Nurses’ Association, for one, agreed with the recommendation and noted that many of its members could tell stories about patients who had avoided seeking care or had cut appointments because of high parking costs. Canadian Nurse

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Mobile phones aren’t allowed in the operating room.

Before a surgeon gets anywhere near a patient in the operating theatre he must wash his hands, put on a gown and gloves. He then drapes the patient and cleans the skin. As he makes his first incision there is no mobile phone on the table, he banishes all distractions and appreciates that the job isn’t over until he has sutured the wound. Whatever you do for a living how do you approach the job? If you adopted rituals would you perform better? Bacteria can destroy a surgeons work. What contaminates your work and how does that manifest in your results?

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How do you enjoy musac?

It’s Friday evening. Your customer, client or patient needs something. You’ve been trying to arrange it or get the necessary authorisation over the phone and now you’ve been put on hold listening to musac. You had advised this person in all good faith that what they need to make a decision will be here today. The minutes tick by and then the phone goes dead. The queue of people waiting is growing longer. A tired child is screaming somewhere nearby and you are already running late.

Over 54% of physicians report a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. The number is up 10% from just three years ago. Who is to blame? If you ask many physicians, the fault lies among leaders involved in healthcare finance, policy and clinical administration. Sachin Jain

You can choose your reaction to the trial by phone on Friday evening. This scenario is not uncommon and as a doctor it won’t be the first or last time you will experience it. Yet each time it happens it may evoke the same negative emotions until you choose otherwise.

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Is this something for today?

How your customer, client or patient responds to your advice, offer or recommendation will depend on factors that may have nothing to do with how these are presented to them.

Susan sat bolt upright glancing at her watch. Although she had only been waiting for ten minutes she was becoming irritated as she was keen to get away as soon as possible. It would be a long day ahead. The staff meeting was likely to be challenging. There was talk of redundancies. She wasn’t sure if her department would survive the purge. It had been a bad start to the year, the sales figures were down at least thirty percent and the company had appointed an external consultant to determine what should be done urgently. She was interviewed last week and she wasn’t sure if the consultant would recommend keeping her section open. Over the past six months she had been drinking more, the glass of wine with dinner was now two glasses. She was also snacking more during the day and the doughnut on the way home which had been a Friday afternoon treat were a daily habit. She was aware that her weight was becoming a problem but right now she just wanted to get through this nightmare. She didn’t come to the doctor often but she needed a script. She had argued with the pharmacist but he was adamant that he would not supply the steroid inhaler without a prescription. Finally the doctor summoned her through and noted that she was much heavier than he remembered. 

What happened next ……your call.

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Let’s do it my way this time

Occasionally your customer, client or patient will come with their mind made up. Nothing you will say will make a difference to what they feel they need. In healthcare if what they want is going to harm them you will be duty bound to refuse just as you might refuse to serve alcohol to a drunk. But occasionally it may be difficult to argue.

Just one other thing, doctor, I need this wart burnt off.

Her doctor noticed the simple wart on her finger.

How about we try something that might be just as good? How about you try taping banana peel on this every night for a week. It will be far less uncomfortable and you might be surprised that the wart will just fall off.

Sure doctor. But today can we just burn it off and then if it comes back we might try the banana?

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What is your approach when you know you can’t cure?

The upper respiratory tract infection or common cold is the commonest reason people  see a doctor. There is no ‘cure’. The symptoms last three to ten days and eventually resolve. Some symptoms take longer to resolve than others. Those with a cold have to bear with the discomfort for a few days or even weeks.

Placebo treatment has been reported to improve subjective and objective measures of disease in up to 30–40% of patients with a wide range of clinical conditions. A review of 8 clinical trials on the effects of antitussive medicines on cough associated with acute upper respiratory tract infection shows that 85% of the reduction in cough is related to treatment with placebo, and only 15% attributable to the active ingredient. R Eccles

Twenty-seven patients were randomized to placebo treatment and 27 to the no-treatment group (mean age 22.6 years). The median difference between post- and pretreatment CF was −3 in the no-treatment group and −18 in the placebo group (p = .0003). There was a significant increase in CST in the placebo group compared with no treatment (p = .027). Lee et al

However is it ethical to recommend treatment which is not proven to have any pharmacological effect?

OTC cough medicines do not appear more effective than placebo in relieving symptoms of acute cough. Even if statistically significant, effect sizes were small and of doubtful clinical relevance. The number of trials in each category was small, and the results of this systematic review have to be interpreted with caution. Based on the available evidence from a small number of studies, we cannot recommend OTC cough medicines as a first line treatment for children with acute cough. Schroder and Fahey

Experts are still pondering. Meantime what will you do today when you see that person with a cold who is still coughing a week later?
It has traditionally been assumed that deception is an indispensible component of successful placebo use. Therefore, placebos have been attacked because they are deceptive, and defended on the grounds that the deception is illusory or that the beneficent intentions of the physician justify the deception. However, a proper understanding of the placebo effect shows that deception need play no essential role in eliciting this powerful therapeutic modality; physicians can use nondeceptive means to promote a positive placebo response in their patients. Brody

Although the available evidence is incomplete and confusing at times there can be little doubt that the prevalence of placebo use outside of clinical trials is not negligible and that views and attitudes on placebos use differ considerably among individuals, both health care professionals and patients. Further research is needed to clarify these issues. Fassler et al

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