When you're looking to hire staff, you can screen candidates for skill sets. You can orient new employees on facility-specific details. But you can't teach someone to have the right attitude. That's why it's critical that the people you hire have it on the way in the door.

"The right attitude" isn't always an easy quality to discern, but I've learned it can help to spend part of the interview asking a candidate behavioral-based questions. Even if they're expecting these sorts of questions, the fact that there's no "right answer" means you'll get a clear and honest view of who's sitting across the desk from you.

Asking them to "Describe a conflict you had with a peer and how it was resolved," for instance, lets you see whether they take any ownership of what happened and its eventual solution. Likewise with "What are some things that frustrate you about your job?" Do they play a role in problem solving, or do they wait for someone else to take care of it?

I won't soon forget the time I asked a business office candidate how she'd respond if I asked her, in a pinch, to help out with the laundry. "That's a girls-in-the-back job," she said. Not exactly a team-player answer, especially at an ASC where we each wear many hats. And the question, "If you pursued a dream job or another career, what would it be?" might open a window on a person's hidden strengths and talents.

You want to hire winners, people who are positive, confident, proactive and professional enough to make the decisions you do. Questions that tap into their working personality will help you identify people who'll improve your patient care, and that will impact the way that patients see your team and your facility.

Tracy Hoeft-Hoffman, RN, MSN, MBA, CASC
Administrator
Hastings Surgical Center
Hastings, Neb.
[email protected]

Intubation With a (Clockwise) Twist
While anesthesiologists have great techniques for evaluating a patient's airway during the pre-op examination, the picture often changes when the patient is lying down on the table, ready for intubation. As challenges arise, different techniques can help assist in smooth intubation. For example, when the endotracheal tube butts up against cartilage or the vocal cords and can't seem to pass through, giving the tube a clockwise twist often helps. When you hold the tube as you would a pencil and give it a slow twist, the elliptical shape of the stylet helps part the vocal cords and lets you advance the tube. In addition, using a video laryngoscope can also be helpful because it lets the anesthesia provider see how much twist is needed to pass the cords.

Vibhuti Kowluru, BA and Daniel K. O'Neill, MD
Department of Anesthesiology
New York University School
of Medicine
New York, N.Y.
[email protected]

Let Your Staff Evaluate Their Colleagues
A few weeks before we hold our annual end-of-the-year employee evaluations, I send a letter to each member of our nursing staff that lists each of their names and includes space for writing below them. One year the letter asked, "What's the nicest thing you can say about each of these co-workers?" Another year it asked what qualities they valued in each person. It's a way for them to express appreciation for their teammates in a way they might not remember or be able to during the daily workflow.

Once I've collected all the letters, I'll include the positive comments about each person anonymously in their evaluation review notes. For example, "Your teammates say you're always willing to lend a hand, always smile when interacting with patients," and so on. It lets them know how their co-workers feel about them and shows them that they're valued here.

Dori Nelms-Ossman, RN, MBA, BSN, CNAA, CBN
Vice President of Clinical Services
Barix Clinics of Ohio
Groveport, Ohio
[email protected]

Highlight Code Cart Drug Expiration Dates
Running a yellow highlighter over the expiration dates of your code cart and anesthesia drugs helps ensure that people will check the dates every time they pick up a vial.

Billie Carney, RN
Fairfield Surgery Center
Fairfield, Conn.
[email protected]

Make "Please Call For Your Arrival Time" Work
When we schedule patients for surgery, we give them a date but not a time and ask them to telephone our hospital's call center the night before to find out their assigned arrival time on the day of surgery. I'll admit this isn't always a crowd-pleaser as far as patient satisfaction is concerned — people want to control the day of surgery, make concrete arrangements with family members, know exactly when they'll be home — but the efficiency it gives us benefits them in the long run.

Each business day at 5 p.m., our anesthesia provider and charge nurse meet to plot out the next day's cases. Many things happen between the initial, tentative scheduling and the day of surgery: cases get canceled, blocks might be consolidated, staffing can be rearranged, rooms can be flipped. Taking these factors into account, the anesthesia provider and charge nurse build a schedule for efficient case flow and turnovers. Then the schedule is made available to the next day's patients through the call-in line.

This planning helps patients to arrive at the best time and to move through the surgical process smoothly and without delay. Otherwise, we might be calling them more than once before the day of surgery to reschedule their arrival time. The call-in method requires a little extra effort on their part, but it will make the day of their surgery that much more convenient for them.

Kathie Wheeler, RN, BHA, CNOR
Director of Surgical Services
Cape Fear Hospital
Wilmington, N.C.
[email protected]

3 Simple Ways to Motivate Staff
Here are 3 ways to reward staff when they go above and beyond the call of duty.

"Wow" Awards. Three small toys sit on a shelf in my office, each symbolizing a different character trait: a statue of a cheerleader (a positive attitude), a teddy bear with a heart (a random act of kindness) and a bobblehead puppy climbing a ladder (a show of improvement or excellence). These items, or "totems" as I call them, are bestowed upon employees by their peers. When I first explained the idea to the staff I called it the "Wow" Awards — when somebody does something that makes you say "wow," you can come into my office, find the appropriate totem and give it to the person as a sign of your appreciation. This encourages staff to look for the good in each other instead of focusing on the negative.

Find the Pint. Purchase some gift cards to a local store or restaurant (I use coupons for a free beer tasting at the microbrewery located down the street from our center) and hide them in places your employees fear to tread, such as the dishwasher's soap dispenser or underneath the full bag of the paper shredder. This transforms mundane tasks like running the dishwasher into a game (we call it "Find the Pint") that rewards those who lend a helping hand.

Eeyore & Tigger. I use small stuffed toys depicting these 2 "Winnie the Pooh" characters as behavioral modification tools for people who aren't having the best of days. When I deliver Eeyore or Tigger to a surgeon, nurse or staff member, they know exactly what it means — either your gloomy, negative outlook or your too-hyper, unfocused behavior is affecting your work. At the end of the person's shift, the toy comes back to me, and usually the recipient has gotten the message.

Kris Sabo, ADN
Executive Director
Pend Oreille Surgery Center
Ponderay, Idaho
[email protected]