Managing with Style:

Effective Management Approaches

Effective managers know that certain situations call for certain management styles. For example, some situations require a personal, people-oriented approach, while others require a manager to solely focus on a project or product. Managing without a specific style can hinder your efforts and even lead to costly mistakes. Get your people to do their best work by using one or more of the following effective management styles:

Delegation
Delegation can prove a powerful management style for two primary reasons. First, it allows you to hand off several tasks, enabling you to better concentrate on your main priorities. Second, delegating tasks will empower and motivate your employees.

With delegation, it is critical that the individual knows and understands his/her part as it relates to the entire project or task. When people on your team know where they fit in the big picture, they're more likely to be motivated to complete the task. So, take the time to explain the details and why their role is important. This will give them a sense of value, and hopefully encourage them to take ownership of their piece of the project.

Direction
Sometimes a situation calls for a direct style of management. Perhaps you’ve been given a tight deadline, or a certain project involves numerous employees and requires more of a top-down management approach. In this situation, let employees know what they need to do, how they’re going to do it, and when they must be finished. Moreover, don’t be afraid to set specific standards and expectations. You need to set clear, short-term goals like, “Your goal is to work each shift as scheduled, for a week.”

This style may seem cold and impersonal, but you still have an opportunity to be a motivating and accessible manager. For example, when you assign roles and responsibilities, provide helpful tips or share experiences you encountered with a similar project. Make sure, as well, to reward and recognize jobs well done.

Collaboration
Some projects or tasks require the ideas and input of your entire team. Often, teams can tackle problems more quickly than what you can accomplish on your own. Furthermore, when you motivate people to pool their knowledge, the results may exceed your expectations.

Remember that successful teamwork depends on coordinated efforts among the staff, as well as solid communication skills. Everyone must know what they’re responsible for, and when their tasks must be completed. Probably most important, however, is your willingness to credit the team for its success and independence, rather than your savvy management skills. Indeed, when you get around to employee evaluations, remember to recognize those who were able to collaborate and maintain a team spirit, especially under pressure.

The management style(s) you select ultimately depends on your staff’s skill set, the available resources, the desired results, and, of course, the task before you. Once you have evaluated these items, you can then choose the management style that will best lead you to success.

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

—John Quincy Adams:

Personal Problems:
How to Keep Them Off the Job
Plain and simple, no one’s personal life is perfect. At some point, problems are sure to arise. And when they do, it’s very difficult to just forget about them once we get to work. However, as we all know, allowing your personal problems to affect your work will only add to your stress. It’s a predicament that can throw even the most level-headed, hard-working healthcare professional off their “game.”

So what’s a person to do? The strategies below can help you keep your personal problems off the job.

Connect with the community. You can avoid taking your personal problems to work by getting involved in a community work or support group. Getting involved allows you to vent and to problem solve, so you're not taking your negative mindset to work. Being with other people who have similar problems also provides an opportunity to share experiences and ideas, and keeps you from feeling isolated. Check with your local chamber of commerce for a list of organizations and volunteer opportunities.

Concentrate on what you can change. Dwelling on events that have already occurred and other items you can’t change will only bring you down. You need to determine which changes you can make in your personal life. Where can you add more predictability and structure? With whom do you need to set limits? Can you either divide up the household chores or hire someone to help with the cleaning, laundry and cooking?

Make “me” time. Schedule time for yourself. Make sure you're eating properly, exercising, getting enough sleep, and relaxing every day. Each week, do at least one activity you enjoy. At work, use part of your lunch hour to listen to music, go for a walk, or read an inspirational book.

Get social. Work consumes the majority of your day—so you may as well get to know the people with whom you spend so much time with. Invite a different co-worker to lunch as often as you can. These one-on-one lunches will help you get to know your peers on a more personal level. Once you have established a trusting relationship, you may feel comfortable enough to share some of your problems; sometimes all we need to feel better is a friend who will listen.

Get in touch with management. You’ll most likely need to talk with management if your personal problem(s) is having a significant impact at both home and work. Make your supervisor aware of any major problems. He or she may have more compassion and offer possible solutions. Also check to see if your company has an Employee Assistance Program or will pay for outside counseling.

By using these strategies, you'll be better-equipped to focus at work in spite of personal problems. Better yet, you may soon discover your work has become a safe haven from the chaos you experience at home.

“The greatest part of our happiness depends on our dispositions, not our circumstances.”

—Martha Washington

Pressure Ulcers Redefined

The National Pressure Ulcer Advisory Panel has redefined the definition of a pressure ulcer as well as the stages of pressure ulcers. This work is the culmination of more than five years of work beginning with the identification of deep tissue injury in 2001.

Why the Change?

The original definitions were confusing to many clinicians and often led to inaccurate staging of ulcers. Previously, a pressure ulcer was defined as, “an area of localized tissue destruction caused by the compression of soft tissue over a bony prominence and an external surface for a prolonged period of time.”

Now, a pressure ulcer is defined as:

A localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

This new definition states that underlying tissue (such as muscle tissue), not just epidermis and dermis, can be affected by the forces that contribute to pressure ulcer development. It also incorporates the other mechanical forces (shear and friction) that can contribute to pressure ulcer development. The new definition also states that many variables are associated with pressure ulcer development, and we may not yet be able to identify all of them or know the significance of each variable as it relates to each pressure ulcer.

The definitions of the stages were also revised in important ways:

Stage I Pressure Ulcer
Old definition:
An observable, pressure-related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following: skin temperature, tissue consistency, and/or sensation.

New definition:
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

This new stage I definition reinforces that the epidermis remains intact, but there is some alteration in the appearance of the skin.

Stage II Pressure Ulcer
Old definition:
Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

New definition:
Partial thickness loss of dermis presenting as a shallow open ulcer with a red/pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

In the new definition for stage II, “shallow crater” has been replaced with “shallow open ulcer.” This definition clarifies that a stage II ulcer cannot have any slough in the wound base. It also clarifies that a blister, whether ruptured or still closed, is a stage II ulcer, as well.

Stage III Pressure Ulcer
Old definition:
Full thickness skin loss involving damage to, or necrosis of, subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

New definition:
Full thickness skin loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

This new definition specifies that a stage III pressure ulcer is full thickness, so it goes through the epidermis and dermis and into, but not through, the subcutaneous tissue. Dead space, in the form of undermining or tunneling, may be present with this type of pressure ulcer.

Stage IV Pressure Ulcer
Old definition:
Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule).

New definition:
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

The new stage IV definition clarifies that underlying structures, such as bone or muscle, are present in the base of the full thickness stage IV pressure ulcer. It reiterates that dead space, in the form of undermining or tunneling, is often present.

Unstageable Pressure Ulcers
There is also an expanded definition for unstageable pressure ulcers. The new definition defines an unstageable pressure ulcer as:

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

This new definition for unstageable pressure ulcers describes both forms of nonviable (dead) tissue—slough and eschar.

Deep Tissue Injury
The NPUAP has developed a definition for suspected deep tissue injury and included it with other pressure ulcer definitions. Suspected deep tissue injury is defined as:

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

The new definitions developed by the NPUAP will ultimately better enable caregivers to correctly document pressure ulcer assessment. For more information, visit http://www.npuap.org/.

Favorite Patients

Five surgeons are discussing who makes the best patient to operate on. The first surgeon says, "I like to see accountants on my operating table, because when you open them up everything inside is numbered."

The second responds, "Yeah, but you should try electricians! Everything inside them is color coded."

The third surgeon says, "No, I really think librarians are the best; everything inside them is in alphabetical order."

The fourth surgeon chimes in, "You know, I like construction workers...those guys always understand when you have a few parts left over at the end, and when the job takes longer than you said it would."

But the fifth surgeon shuts them all up when he observes, "You're all wrong. Politicians are the easiest to operate on. There are no guts, no heart, and no spine, and their head and rear end are interchangeable, too."