Leadership Spotlight: Trauma (“I’m fine!”)

Have you ever had someone ask you “How are you doing?” You might imagine yourself often responding with the phrase, “I’m fine.” But the reality might be quite different. Lyn Ketelsen MBA, RN, a 40-year health care veteran recently led a session on The Gratitude Group  about the trauma we as leaders and providers experience in our professional lives and how we have been culturized to suppress it.

The experiences amassed throughout our time as leaders in health care become inherently part of who we are as individuals and professionals. These experiences become our “war stories,” perhaps our badges of honor. We share our stories as a way to decompress and connect with one another. Ketelsen shares that these collected career stories are representative of our skills, our fears, and even valor, for all the things we have been through. They are badges or tokens perceived as won for handling things “other people cannot.”

Some of our experiences leave lasting marks on us as leaders. Our years of travel, those clients and employees you “deal with”, challenging projects that you work on, even unexpected external variables (COVID-19). Ketelsen characterized our time as leaders as periods where we are essentially running flat out on a treadmill. Then one day, you might choose to step off the treadmill. You might take a break you might try to retire. And in that moment, “you might not know how to breath while standing still.”

Our experiences as leaders that encompass our “war stories” can be in some ways likened to trauma. She goes on to note that typically when we think of trauma in health care we race to the worst cases imaginable. But, those stories and circumstances we recall and share with such great detail and vivid emotions- we remember them because these moments are imprinted on us. They have become part of our DNA and unless recognized for the emotionally charged moments they are, can scar us.

Many of us over the last year have experienced real trauma as a result of the pandemic- the type one kind.  According to Ketelsen, it’s the secondary trauma, the kind we may not recognize we are experiencing, that is the kind that can eat away at us over time from the inside out. Type 2 can be found in people who experience trauma as a result of their job and likely to experience it repeatedly. This kind of trauma has two possible outcomes:

  1. Compassion Satisfaction: fulfillment as a result of helping others who are experiencing type one trauma- where our calling is with our patients, families, employees we serve
  2. Compassion fatigue: emotional exhaustion, suppressing our own emotions while supporting others which leads to burnout, involves work stress, reduced capacity for empathy and lack of personal fulfillment.

Ketelsen shared those personal impacts from compassion fatigue can be physical health issues, lower quality of life, social isolation. Stress and trauma can also impact development of brain, nervous system, and immune system.

However personal strength can be found in weathering this type of trauma through acknowledgment and acceptance. We can find out strength by stepping back as leaders and remembering to care for ourselves during these challenging times. Elements of strength that can help us as we try and stand strong- lend to our well-being:

Think about where you put your focus? As humans we need  and crave balance across all 5 elements of strength, but we often ignore our spiritual and emotional elements

At the end of her sessions, Ketelsen shared a quote from Nelson Mandela “Our human compassion binds us with one to the other- not in pity, but as human beings who have learned how to turn our common suffering into HOPE for the future.”

As we reflect on the last year and half,  we have all experienced unprecedented human suffering, stress, and trauma whether it be personal or professional in nature- However, it is the beauty of the human condition that we can  rally around one another and support one another as we forge a path into the future. As leaders we must remember to care for ourselves to be able to continue to care for others.

Want to hear more from Lyn Ketelsen MBA, RN or other leaders in healthcare? Visit The Gratitude Group  to access recordings and resources.

Focus on Leadership: “What’s on your dashboard?”

Organizations in private duty home care are increasingly embracing the use of data dashboards to measure and manage performance and  benchmarking is becoming commonplace. The goal of course is for these dashboards to help us make well-informed business decisions and understand how we perform overall in relation to our strategic priorities and goals. They should be geared towards learning rather than judgement. However, this all starts with the premise that we already know as leaders what kind of information we need and what we should include on these dashboards.

A recent session from The Studer Group’s Gratitude Symposium presented by Robert Lloyd, Ph.D., Vice President of the Institute for Healthcare Improvement, focused in on organizational dashboards and why some of us might not be creating in our dashboards in a way that can be the most beneficial. His session entitled: So, What’s on Your Dashboard? Focused on the things that leaders should consider when constructing as well as utilizing these important tools in the best and most valuable way possible.

Start by Choosing Data Over Information:

Lloyd noted that for some, there can be a tendency to confuse data and information when beginning their journey on organizational dashboard creation. “Data refers to raw facts and figures…versus information which is defined as data that has been processed and analyzed in a way making the results directly useful (Austin, 1983).” Many organizations create dashboards that are only about outcomes rather than the processes and cultural elements that drive them and its important to remember to choose data that incorporates the elements of Structures+ Processes+ Culture and then Yield Outcomes.

Then, Assess Your System

Does your organizational dashboard have a balanced, cascading system of measurement with related and connected metrics and are they balanced?

Not every role in an organization needs the same kind of information. However, what information that is presented should be simplistic, meaningful, and actionable.

Think about this scenario- Patient/Client Experience Scores. The organization wants to improve these scores- but how does this happen for each role through a dashboard? What does each role need to know in order to have the best chance of success?

Senior leaders need information at the Macro level- they might need a dashboard that shows performance on the Likelihood to recommend question.

Middle managers or emerging leaders need information presented at the Meso level- they might need information about a specific key driver of the likelihood to recommend question- like timeliness of service or promptness of care deliver as their dashboard metric.

Line level staff need information presented at the Micro level- metrics that might have to do with the tasks they conduct with each patient and family.

Now, think about how long your metrics/information stay in place on your dashboard?

Dashboards are living, breathing, documents. They should be constantly evolving based on your organization’s goals and strategic plans.  You want the most meaningful information, not just what you have always had on hand because internal and external variables will impact what you need and what is most important.

Your metrics should be reviewed and evaluated at a minimum on annual basis. However, it shouldn’t just be about what we need to add from a metric standpoint as part of the review it should also be about what you should be removing measures when they are no longer useful or valuable based on business goals. As a best practice-measures should never be carved into stone.

Finally, how are you presenting this information?

A cascading, balanced, dashboard will be less about rating and rank which can lead to judgement (Scorecard Approach), and more about where we are and also how we can go in the future “in real time” which brings us into the learning sphere.

“The instrument panel or dashboard has an entirely different aura than that of the report card. It has vitality, timeliness, and a clear-cut utility that is absent from report card thinking. A key feature is providing critical, real-time information to the user to prompt wise decisions and, if need me, make rapid midcourse corrections.” Eugene Nelson

Your dashboard should ideally have only the essential indicators. There are a lot of things that can be interesting to know, but on a dashboard, you should choose those indicators that can be not only interesting but impactful and tied to your strategic objectives. Always ask yourself- WHY is this useful? (Sometimes more is not better when it comes to dashboards- its just more noise)

How do you display the data you selected?
Lots of people like red/yellow/green graphics. We especially like them in healthcare for some reason. However, Lloyd reminds us that the “stoplight” method often only works if you are looking at data for judgment. If you want data for learning and improvement you are going to need to create something else. He recommends looking at data overtime and sharing it in a way where you can still see things at a glance. This will help you not only make a judgement, but also make informed decisions. He highly recommends choosing a statistical process control chart in order to see true improvement and normal common cause, variation. This type of presentation of the information will also be able to help you make causal connections.

Benchmarking Illuminated

Ok, so now you have a fully-evaluated dashboard. Lloyd explains that today the most popular question now is- What about benchmarking?

In healthcare people often look at benchmarking as a NOUN– a number that we received from somewhere- targets and goals that become benchmarks. These are often from a national source or report and for an organization seem like the “holy grail” of performance. But these types of indicators are not leading you to learning, they tend to only lead you to more judgement.

“Occasionally there is some confusion over the correct use of the term “benchmark.” A benchmark is a measure of best performance against which an organization’s performance is compared. A benchmark, however, should never be derived from average or aggregate performance, or a lagging indicator. Because it represents the BEST, a benchmark must refer to the performance of only one organization.”- The Mihalik Group, 2003

Benchmarking should really be a- VERB- concerned with Identifying best practices, creating a new culture, focusing on the processes that produce excellence. Benchmarking is a beginning not an end, all about the journey. Lloyd explains that rather than looking at national “benchmarks,” choose to instead look at an organization you aspire to be like. Look their performance and their metrics and decided to use that performance as your rue benchmark for success on your dashboard. This is not about the aggregate of performance but more about choosing ONE guiding star for achievement.

For example- in the hospitality world, people often choose to look at The Ritz-Carlton performance as their benchmark- not the whole industry or the industry in the aggregate- but one organization to serve as measurement for success.


Overall, dashboards and information/metrics can be very valuable tools for an organization when they are utilized in a way that supports informed decision-making and learning rather than judgement.  What’s on your dashboard?

Focus on Leadership: Employee Well-Being and the Anxiety Epidemic

At the recent month long The Gratitude Symposium  Chester Elton, and Adrian Gostick Founders and Authors of FindMojo focused in on what may be characterized as an epidemic of employee anxiety brewing in the workplace and what we as leaders can do to help combat this phenomenon and help to cultivate employee well-being.

Their session entitled- “The Anxiety Solution: 8 Strategies to Help Teams Build Resilience, Handle Uncertainty, and get Stuff Done,” began with Elton and Gostick sharing some sobering statistics:

  • #1 issue in the workplace today is anxiety
  • In 2018- 15% of workers living with an anxiety disorder
  • In 2020 30% of people had an anxiety disorder
  • 50% of millennials and 75% of Gen Z say they have quit a job for mental health reasons
  • Only 10% of employees feel like they would feel safe speaking to their boss about their anxiety.

With employee anxiety at an all-time high, and the need to retain employees a priority in the home care industry- the question becomes, how can leaders address the anxiety while continuing to motivate their employees to stay engaged?

Elton and Gostick share that it is important for leaders to help employees by preparing them, by setting the right expectations and leading with positivity instead of fear. This can be accomplished by:

They also stressed during their session ways in which as leaders we can work to “spot anxiety”:

While Elton and Gostick shared 8 ways in which leaders can work towards building a culture that enhances mental safety and resilience (You can listen in to their session for free HERE or any of the other sessions from the symposium’s 45 speakers and though leaders), one of their biggest takeaways unsurprisingly centered around the idea of embracing gratitude as a way to combat anxiety.

The speakers shared “Anxiety can make talented people feel like frauds, their external validation is not matching up with what they feel internally- Imposter Syndrome.”  It may seem like too much gratitude can be a bad thing, but the reality is that showing gratitude and recognition for their contributions can be a powerful positive motivator, because “let’s be honest, no one has ever gone home and said that they got too much recognition.” But its not just about the act of showing gratitude and recognition, the efforts should be done “now, often, with specificity, and with sincerity.”

Take for example the “The Ten Penny Story”:

A general manager from Avis rental cars explained that he places ten pennies in the one pocket of his pants every morning. Over the course of the day, he actively seeks out moments where his employees are demonstrating the company “values in action.” When he sees an employee caught doing something great, stops and shows gratitude and recognition for their actions, in the moment, with specific and sincere praise. He might offer them a small token of appreciation etc. But, for each moment he does this, each action he finds, he moves a penny from one pocket to the other, ensuring that all ten have moved by the end of the day. This is how one leader embraces gratitude in the moment, with frequency, specificity, and sincerity working towards combatting employee anxiety but also gives himself a salient, tangible, reminder to practice gratitude in a meaningful way.

As we work as a community to address our workforce challenges, I encourage you to think about your organizations and what you can do as a leader to identify anxiety, practice gratitude, and positively impact well-being.

Focus on Leadership

Throughout the month of May, the Studer Group is hosting a free Gratitude Symposium The Gratitude Symposium by Quint Studer (heysummit.com) featuring forty-five well-known experts banding together to present a series of lectures geared towards thanking, teaching, and inspiring those in working in healthcare. 

As we continue to strengthen our service line efforts in Private Duty Home Care at NAHC around Leadership, I wanted to take the time to share with you not only this symposium, but also highlight a specific presentation from Linda Deering Dean, RN, MSN. 

Linda is a national coach and executive speaker, but also a nurse by trade and at heart. Her presentation entitled, “Outstanding Leadership is a Choice” was a really timely conversation as we reflect on the future of the private duty home care industry and how we need to attract and cultivate not only more caregivers but also new leadership talent to support the future expansion of care and services in the home.

In her 21 minute video lecture, Linda spoke fondly of her career as a nurse, but mentioned that as a leader she “would never have had a great career if I didn’t have great leaders who helped me long the way. Leadership makes all the difference.” And she went on to share a very relevant quote from Robert Cooper, “Outstanding leadership- is the ability to accomplish results through people.” For me some of the most important key take-aways from her presentation focused on our responsibility as leaders.

In home care leaders are responsible for so many things. There are core business outcomes and key performance indicators to stay abreast of. But we are also responsible for building the future, for cultivating future bench-strength and the talent that may one day be running the home care agencies that are providing care to us.  We are as leaders “owners of all aspects of the organizational culture- the sociology, the results, the relationships, the trust, the engagement, and most importantly the love.” We are there to help our employees and future leaders thrive. 

Linda outlined three important key actions leaders should work towards honing their skills at in order to create a culture that engages and grows our employees:

  • Talk about what is going well- takes a lot of skill and practice to sense and share the good first, rather than the critical- complimented behavior gets replicated and repeated
  • Compliment and praise- not just a thank you- you must share the details, what and how
  • Own your own role modeling- careful what you emit, careful with your actions, what you do and say is what others will start to emulate and model

While her key actions may seem simplistic sometimes as leaders who must remember to lead with the good rather than focus on the more critical. However, the biggest key take-away today for me was the notion that “No one becomes a great leader overnight…it’s a lifelong journey.”

How are you as a leader working to build the next generation of leaders in home care? How are you leading with gratitude in your roles as we work towards building the future of home care together?