Want to work on changing things? Want to learn about your team and listen better? Interested in a pretty good pathway to do that?



Appreciative Inquiry is process of:




Discovering what’s working well



Dreaming about what could be



Designing for future change & success



Realizing the Destiny that this process will bring about




In this podcast, we’re gonna walk through Appreciative Inquiry and Theory U and how these 2 organizational development processes meld together to create a powerful tool for listening to and helping to improve the work your team does. It’s so good!



Our CRNA team at Maine Medical Center worked through this process – really, we’re still working through it – this spring. The full story is in the podcast.



I made a video for this podcast but I haven’t been able to get it loaded to YouTube yet and apparently, it’s too big for this website. In the meantime, you can see the core show notes to the podcast in the PDF below. There’s photos of the Theory U and our list of 10-questions we developed as our Appreciative Inquiry survey we used at Maine Medical Center.



I hope this episode gives you some very practical tools for how to engage with your team better. I’ve found appreciative inquiry to be a great way to have a conversation with groups and find a new way forward. Let me know how it goes for you!



#120 – Appreciative InquiryDownload



References



Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. John Wiley & Sons. 



Hollnagel, E. (2020). Synesis: the unification of productivity, quality, safety and reliability. Routledge. 



Scharmer, O. (2016). Theory U: Leading from the future as it emerges. Berrett-Koehler Publishers.



Scharmer, O. (2025). Theory U process of co-sensing and co-creating.  Presencing Institute. https://www.presencing.org



Whitney, D., & Cooperrider, D. (2005). Appreciative inquiry: A positive revolution in change. Berret-Koehler Publishers.

Yo yo! Today, we close out our 3-part series on systems thinking with this episode on psychological safety & just culture.



Part 1 (Episode 117) introduced systems thinking & high reliability organizations.



Part 2 (Episode 118) walked through resilience engineering, safety differently and synesis.



Part 3 (this episode) threads these topics together with psychological safety & just culture.



This three part series invites you to think about your home team and professional practice.



How does your team handle errors & mistakes? Are you safe to fail and be honest about mistakes & near misses? Are mistakes and mishaps talked about?



Do you usually take feedback well and look for ways to grow or get defensive and think it’s always someone else’s fault? What about the other folks on your team?



Psychological safety is about the freedom to speak up without fear of embarrassment or punishment. Psychological safety doesn’t just happen. Organizational leaders need to talk about it and normalize it – truly, make it part of your team norms. Psychological safety doesn’t skirt accountability. Accountability is a key part of a psychologically safe culture. We’ll talk more about it in the show.



Just culture extends the idea of psychological safety to the organizational environment and the team’s approach to errors and mistakes. Just culture encourages teams to look at systems factors for why things break down. People don’t make mistakes willfully. Willful harm with malicious intent is recklessness or sabotage. That’s not a mistake. Mistakes are always unintentional because people don’t show up to work planning how they’re going to accidentally drop the ball and screw things up. Just culture looks at mistakes from the standpoint that perhaps the system is broken and sets frontline staff up for failure. A systems fix is like a rising tide that lifts all boats. Just culture sees the systems as the usual point of failure, not the frontline worker. Front line workers are often the source of resilience and capacity within systems.



We talk about these things and more in the podcast as we thread all three parts of this series together.



As a reminder, I’ll be in Hilton Head, SC next month teaching with Encore Symposiums and back at the Cliff House in Maine this October with Encore. Come check us out if you’re looking for a great continuing education conference!




Your values build your system, your system creates your culture, your culture generates your results.








References



Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com



Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202



Dekker, S. (2016). Just culture: Balancing safety and accountability. crc Press. 



Dekker, S. W.,

This is Part 2 of a 3 part series on organizational development – how we work and live together as teams in healthcare so we can do our best work, master our craft, take amazing care of patients and actually enjoy the work we do. (no big deal)



In the first part (Episode 117), we talked about systems thinking and patterns of high reliability organizations (HROs). Systems thinking helps us zoom out to consider the complexity of situations and the various levers that influence outcomes. High reliability organizations adopt specific systems thinking practices to achieve consistent success in safety-critical, complex environments.



Resilience engineering builds on systems thinking and HRO theory by teaching us how to develop adaptive capacity, build for success (not just avoiding error) and bounce back when things don’t go well. Safety differently is about seeing safety as not the absence of mistakes and errors but the capacity for the right thing to happen. It also recasts the worker not as the weak link in a complex system (the point of failure), but as the source of resilience and capacity. Front-line healthcare workers – you and me – are often the ones who find the workarounds and get the job done despite suboptimal conditions.



No one shows up to their job with the intention to make mistakes, get hurt or put patients at risk. Mistakes are always unintentional. Willful acts of harm are something totally different. Blaming and shaming workers (forms of punishment & embarrassment) are counterproductive and stem from leaders who do not understand what’s actually going on or the best ways to run their organizations and build thriving teams.



Synesis, which sounds like a scary word, stems from the same Greek word that system and synergy come from and is actually kind of a cool idea. It’s the way we balance the often competing interests of productivity, safety, reliability and quality. We need to figure out how to do all of these things concurrently in healthcare. I’ll share some stories and examples of how to do that as an anesthesia provider in this episode.



So that’s where we’re headed with this podcast!



In Part 3, we’ll come back and talk about psychological safety and just culture, which thread all three episodes in this little mini-series together.



As a reminder, I’m teaching with Encore Symposiums next month in Hilton Head, South Carolina and back at the Cliff House in Maine this October. If you’re looking for a continuing education conference where we’ll talk more about all of this – or if you’re a resident or graduate student looking to check off one of your state/national meetings, come check us out! I’d love to see you there!



As always, you can come work with us at MaineHealth – Maine Medical Center. We have a phenomenal team of CRNAs, physician anesthesiologists, surgeons, OR nurses & CSTs, anesthesia techs and admin specialists. If you want to be part of a growing team of providers doing world class work at a level 1 trauma center in a spectacular city, check us out!







References



Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com

Yo! This episode introduces the concepts of systems thinking and high reliability organizations. It’s the first part in a 3 part series. Part 2 is gonna dive into resilience engineering and safety differently. Part 3 is all about psychological safety and just culture.



These 3 shows unpack crucial intel for front-line providers, equipping them to understand their roles and how to develop their clinical impact. It’s also for organizational leaders and practice managers and will help you think about how to design better systems and support your team so they can thrive.



Systems thinking is the process of zooming out beyond simple cause-and-effect understanding (i.e. linear causality models) of how errors happen. It encourages people to consider the complexity of their environments and the power of leveraging changes in your processes and systems.



In this episode we cover:




Learning organizations and their 5 characteristics:

Personal mastery



Mental models



Shared vision



Team learning



Systems thinking





High reliability organizations and their characteristics

Preoccupation with failure



Reluctance to simplify



Sensitivity to operations



Commitment to resilience



Deference to expertise





How these ideas link to resilience engineering and safety differently




“Every organization is perfectly designed to get the results it gets” (Batalden, 2015).



If you don’t like the results you’re seeing, you need to change the system. Whether this is your anesthesia team, hospital/OR or your personal life. If the outcomes are not what you desire, you need to adopt a systems thinking approach to change. This episode will walk you through how to do that.



The values you embrace shape your culture. Your culture builds your systems. Your systems generate your results.



Quick reminder: I’m teaching at Encore Symposium’s Hilton Head conference May 19-22 and then again with their fall conference at the Cliff House here in Maine that runs October 20-23, 2025. I love seeing y’all in person at these conferences. If you come because you heard about it here on the show or are just there and have checked the show out before, come holler at me! I’d love to chat with you about what you’re up to and what your practice is like.



Be sure to check out Part 2 and 3 of this series and I’ll see you there!



References



Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com



Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202



Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303. 



Hollnagel, E. (2020).

On the corner of Skyland Drive and 23 in a little town called Sylva in Western North Carolina, sit’s PJ’s gas station. One hot summer day back in 2005, I was filling up the tank in a convalescent transport van on my very first day as an EMT-Basic. That’s the most basic, entry-level certification of working as an Emergency Medical Technician or EMT.  My convalescent transport van had a wheelchair ramp and my role as an EMT-B was not to do 911 calls, but to drive this glorified shuttle bus. My role was to transport people to and from their doctor’s appointments. Maybe to help them get home after being discharged from the hospital. If you were too sick for a taxi but not quite sick enough for an ambulance, I was your guy.



The guy training me that day, a senior paramedic, was actually a good friend of mine and happened to also be my boss at a local outdoor education company. Everyone affectionally called him “the Padj,” a shortened third-person version of his last name, Padgett. The Padj ran Landmark Learning, which offers wilderness medicine educational courses for outdoor guides and enthusiasts and eventually became the Southeast training center for NOLS Wilderness Medicine. Pretty much everyone who taught for NOLS Wilderness Medicine had a part time gig working in EMS and so that became my path too and this was my first day on the job.



I felt supremely important because of two things: as part of my standard issue uniform, on my thick polyester blue shirt, I was wearing a chrome name badge that said “J. Lowrance, Since 2005” and I had a big, heavy, professional walkie talkie. We had no more checked out the van and driven a mile down the road from base to fill up with gas at PJs when the tones went off on the walkie talkie, indicating a serious 911 call had just been dispatched. As I was pumping gas and the Padj was relaxing in the passenger seat, the radio crackled with the call: there was an unresponsive patient about a half mile down the road from where we were. We looked at each other and shrugged, knowing that even though we were essentially in a shuttle bus with next to no medical supplies, we wanted to see if we could help. We hurriedly paid for the gas, jumped in the van and ended up beating the ambulance to the house where the 911 call came from.



We were met by a distraught woman in her 60’s who told us she couldn’t wake her husband up. We went in the house through the side door, immediately finding ourselves in her kitchen. The bedroom was just off the kitchen and walking in, I remember the time on the bedside clock – one of those little rectangular digital clocks with red numbers: the time was 10:10 in the morning.







Photo credit: OpenAI (2025). ChatGPT 4o version. [Large language model]. https://chatgpt.com. 



The man was large, heavy and not moving. He looked like he was still asleep except he was a deep shade of purple… not quite blue yet, but definitely not alive-looking. 



The Padj called out to him and checked a pulse. Nothing. My heart, however, was racing. 



As my palms began to sweat, the Padj looked at me serious, which he never did, and said quietly out of respect for the man’s wife, standing in the doorway, “dead on arrival or do you wanna run the code?”



I could hear the sirens of the ambulance approaching the house.



“Let’s do it.” 



We heaved the man onto the floor… he was heavier than I thought he would be. It dawned on me that dead people don’t try to help you like ...

Hey y’all! First of all: thank you to those of you who have subscribed to the website and get these posts right to your email inbox. That’s all that happens: the podcast is free and subscription to the show just means you get the content straight to you as soon as it’s live. I never sell or use your contact info for any other means. I’m just simply thrilled to have your support and interest in the show as the whole thing is geared to support you and help you thrive in your career as an anesthesia provider. Thank you!



This podcast covers a run down on the NBCRNA’s Maintaining Anesthesia Certification (MAC) Program. The MAC Program is how CRNAs maintain and rectify their license with the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA).



The MAC Program launched in 2024 as a revamped version of the old CPC (Continued Professional Certification) Program. There are some substantial changes that CRNAs should be aware of. First off, you need to know if you’re in the MAC Program yet. Most CRNAs (new grads and those who’ve re-licensed after 2024) ARE in the new MAC Program.



This show will coach you on how you can log into NBCRNA’s website to see where you’re at and what you need to know about MAC Ed (Class A) & MAC Dev (Class B) credits and the quarterly MAC Check exam questions that you can take on an app on your phone.



All the details are in the show! For the truth of what’s up with the MAC Program and your license, as always, check with NBCRNA! Things change over time. Be sure NBCRNA has an updated email for you. 30% of the emails they send to CRNAs bounce back as invalid addresses. That’s insane! Updatechur email!



You can follow along with the podcast by checking out the attached PDF that outlines the show with lots of helpful graphs and more info than what I spoke about in the podcast.



Two last points:



First: Overall, I think the MAC Program is a really healthy and needed evolution to the CPC Program. NBCRNA has listened to CRNAs and made needed adjustments to the continuing education/relicensure program. We have to have a continuing education/certification program for the CRNA license to have meaning and value. The current iteration is the best it’s been, so there’s that.



Second: Remember that your STATE Board of Nursing may require additional steps for you to re-license as a CRNA. For instance, NBCRNA does NOT require pharmacology-specific continuing education credits (MAC-Ed/Class A); however, the State of Maine (where I’m at) does!



For example, Maine CRNAs must obtain 60 MAC-Ed/Class A and 40 MAC-Dev/Class B credits for recertification with NBCRNA every 4 years but we have to have 50 credits every 2 years, 15 of which (every 2 years) must be pharmacology credits, to re-license as CRNA in the State of Maine. So the requirements to re-license as a CRNA in the State of Maine are slightly more stringent (and more frequent) than to maintain the national license with NBCRNA.



Follow along with the powerpoint for more details:



MAC Program Overview – Anesthesia GuidebookDownload

This podcast is for leaders, clinicians, residents & students who need to get wildly important things done. It’s about how to prioritize when so much of your work seems important. How to find balance when so much seems to be coming at you. How to get started at achieving your biggest goals.



This episode will walk you through the 4 Disciplines of Execution by Chris McChesney, Sean Covey & Jim Huling. 



I have no financial relationship with these folks, the book or their publishers. It’s just a great concept that will help you get organized, identify your wildly important goal and figure out the work you actually need to do and CAN do to accomplish your goals.



The 4 Disciplines of Execution (4DX) model will ask you to identify your wildly important goal. You’ll then create several lag measures (subgoals) and several lead measures (objectives) for each lag measure. These lead and lag measures are where the real work is. The wildly important goal may seem out of reach. Even the lag measures (which lag behind the work you’ll do in the lead measures) may seem a bit ambitious. That’s ok. The lead measures should be the specific actions you will take on a daily or weekly basis that will chip away at the lag measures. As you put the work in on the lead measures, your lag measures will come into sight and slowly be realized. As you stack up achieving the lag measures, your wildly important goal will become within reach.



The next components of the 4DX model is the scoreboard where you track your progress on each lead & lag measure. This can be any relevant metric on any kind of progress tracker: a list on a whiteboard, a data point in an Excel file, the pounds on the scale, dollars in the investment account or left on the loan. Whatever.



Lastly, is the cadence of accountability. You need to either personally set up a check in on your progress with yourself or you need to set this up with your team, mentor or coach. The authors of the 4DX model recommend this be a short weekly meeting where you review progress from the last week and plan actions for the coming week. Accountability is about follow through, taking steps (as small as they might be) and slowly, setting up the cadence of consistency.



I was on the Peloton last night and heard Matt Wilpers say that the order of priorities in exercise is developing consistency, then duration, then load. You can’t go out hard all of a sudden and expect big results. Develop consistency. Show up a little bit each day or each week. Then put the time in. Build the duration of your investment towards your goals. Then you’ll know when to put the extra effort in.



Check out the show and if you want to dig deeper, definitely check out the 4 Disciplines of Execution.



McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution: Achieving your wildly important goals. Simon and Schuster.




What’s your Wildly Important Goal?

Matt & Alison Moody took a year off of working as CRNAs to live and travel in Spain with their then 4-year old daughter.



This is part of that story.



Matt & Alison Moody in Granada, Spain



The two were living and working as CRNAs in Asheville, North Carolina when they caught the idea to take a year off of work and live in Spain. Their journey to Spain went from the fall of 2023 to the fall of 2024 and over the last few months, they’ve been re-integrating back to the United States and Western North Carolina and back to their careers as CRNAs. Part of their inspiration to take a year off work came from listening to the episode I did with Kyle & Jen Steen on their decision to sell everything, build out a sprinter van and hit the road. That story is in episode 73. Side note: Kyle & Jen took about 18 months off from work before Kyle returned to his career in anesthesia through locum assignments. They’re still in the van full time and still crossing off new places to live & explore. I hope to have them back on the show soon!



Matt & Alison wanted to head to Spain to work on their Spanish language skills and take time to connect with each other as a family. What they discovered along the way may surprise you. In this conversation with Matt, he walks us through what they set out to do and how that changed over time – from before they left through how their experience evolved while they were over in Spain.



I think you’ll enjoy this story and hopefully find some inspiration for yourself to think outside of the box and consider what might be possible in your own life. It doesn’t have to be taking a sabbatical or selling everything and hoping in a custom built Sprinter van. It might be about re-prioritizing your work-life balance in other ways. It might be going back to school or picking up pottery like my wife, Kristin. It might be about moving to that area of the country you’ve always wanted to live in or finding a new way to explore your passions. Finding a way to prioritize your own story, dreams and aspirations along the way is possible and I loved chatting with Matt to hear how he & Alison arranged their life to pursue their goals.



Matt grew up in coastal North Carolina; went to college and nursing school at UNC Chapel Hill; and then received his CRNA degree at Wake Forest. His heart and soul have always belonged in the Pacific Northwest, so after graduate school he moved west and started his career at the University of Washington Medical Center in Seattle, WA. Eventually, the pull of family brought him back to NC, and he has called Asheville home since 2017. Thus far in his career, Matt has had the fortune to gain experience in many practice areas – from major trauma hospitals to small surgery centers – and has experience in many subspecialties of anesthesia.



In his free time, Matt loves to spend time being active outdoors, but he’s especially passionate about rock climbing and skiing. Lately, he and his wife, Alison, have been experiencing the joys (and frustrations!) of introducing their 5 year-old daughter to these activities.



While in Spain, Alison created an Instagram page that they invite you to follow. It’s @ La Moody Aventura. @lamoodyaventura Matt also offers his email to anyone who might have questions about how they did what they did. In the show, he talks about how they felt like they were the only ones crazy enough to do something like this but then actually met several folks abroad – including another CRNA family from the States –...

What’s up y’all! This is Jon Lowrance and this is episode 112 – How to Transition from Clinician to Chief CRNA.



Y’all are going to love this conversation.



So… I almost don’t know where to begin cause there’s so much to talk about…



This is an episode about chief CRNAs but so much more. It’s like when you watch one of those food documentaries about the best pizza kitchens in the world and you’re like: oh, a documentary about pizza, but then it’s really about the experience of chefs, small business owners, friendship and passion. This episode is like that.



It’s about chief CRNAs. And we have a couple of guests that are going to talk with us about an article they published on the research they did into the professional experience of chief CRNAs. But this story is really about the transition that most healthcare providers take when they take the step from expert provider to clinician-leader, practice manager or owner. You’re going to see this through the lens of what these 2 researchers saw when they did a qualitative analysis of chief CRNAs across the state of North Carolina. But you might take something away from this about the physician who leads your team or the CMO or health system president that runs the show where you’re at.



If you work in healthcare, cause you probably do – again, unless you’re my mom, who listens to all these podcasts – hey Gail! But for the rest of you, if you’re in healthcare, this episode will likely help you understand your clinical leaders better.



I never set out to be a chief CRNA or practice manager. I wanted to be the best clinician I could. I wanted to stand in the gap between the chaos and the outcome. I wanted to master my craft as an anesthesia provider and take the best care of patients possible.



Literally, like 6 months before our chief CRNA announced that he was going to step down after 8 years in his role, I had the opportunity to become a daily shift supervisor – like a board runner in the OR. I was like: I’m never going to do that. It seems way too hard. Then our chief stepped down and his role opened up and I was like… wellllllllll…



This episode hopefully will be relevant to any clinician who, like me, has stepped into a role or is thinking about taking on a clinical practice leadership role that maybe they’re not totally ready for. You’re not alone.



So we’re going to talk with Austin Cole and Robert Whitehurst, co-authors of an article about the competencies & professional development needs of chief CRNAs that was published in April 2024 in the AANA Journal.



Austin framed his doctoral project at Duke University around this study. Austin Cole, DNP, CRNA began his career after graduating from the school of nursing at UNC-Chapel Hill. Following graduation, he spent two years as a Registered Nurse in a cardiothoracic critical care unit. He received his DNP and nurse anesthesiology training at Duke University and currently practices as a CRNA at Duke Regional Hospital in Durham, NC.



Robert Whitehurst is the President of Advanced Anesthesia Solutions, a CRNA practice providing anesthesia services to a variety of outpatient practices. He graduated in 1997 from East Carolina University School of Nursing with his Bachelor of Science in Nursing and in 2004 from Duke University School of Nursing with his Master of Science in Nursing. Bob Whitehurst is also the Chairperson for the North Carolina Association of Nurse Anesthetist’s Political Action Committee and he’s passionate about patient access to high quality anes...

What’s up yall! This is Jon Lowrance and this is episode 111 – How to Prepare for Medical Mission Trips with Stacey Such, MSN, CRNA. (Stacey pronounces her last name, Such, like “Suke/Duke.”)



Before we get to this show, I’d like to give a quick shout out to the CRNAs, SRNAs & physician anesthesiologists who made it to Encore’s conference in Bar Harbor back in October as well as the Maine and Arizona State Association of Nurse Anesthesiology conferences, which were also in October. I had the privilege of speaking at all three of these conferences and really loved getting to see some of you out there. We had 2 SRNAs in Bar Harbor from different programs who came to that conference because they heard about it right here on the podcast, which is awesome! Somebody else in Bar Harbor let me know that after they listened to the episode on how ondansetron prevents spinal induced hypotension – which I recorded way back in 2021 with Jenny Li in episode 16, this guy went and did his own deep dive on the topic, ended up presenting on it at his group and they changed their whole practice as a group in managing c-sections. That’s amazing. I have so much respect for yall out there on the front lines, working to master your craft and make a difference for your patients. So, it’s always a blast to get to hang out with you in person at these conferences.



On that note, for 2025, I’ll be back with Encore Symposiums down in Hilton Head, South Carolina in May and back at the Cliff House in October. That’s May 19-22 at Hilton Head Island in South Carolina and October 20-23 at the Cliff House Resort in Cape Neddick, Maine and those are with Encore Symposiums.



All right, in this episode, Stacey gives us a run down on how healthcare providers can prepare for short term medical mission work. Stacey has been a CRNA since 2012 when she completed her Master of Science at Middle Tennessee School of Anesthesia. She worked as a CRNA for just over 10 years prior to returning to graduate school to complete her Doctorate in Nurse Anesthesia Practice at Virginia Commonwealth University. She framed her doctoral project around short term medical mission trips, their impact on global health and how healthcare providers can prepare to engage in this work.



In this show, you’ll hear what motivate Stacey to engage with this work following a deeply personal tragedy. You’ll hear stories about her time serving with Mercy Ships, Samaritan’s Purse and the World Health Organization. Stacey walks listeners through her 8-step guide for how to prepare for medical mission work. This is an excellent introduction to short term mission work and will hopefully inspire you to get involved in serving others in new ways and give you a guide for where to start.



Stacey included her 1-page guide to preparing for medical mission work in the show notes to this episode. She’s titled this Global Anesthesia Outreach: A Comprehensive guide To Preparing for Medical Mission Work.







Global Anesthesia Outreach: A Comprehensive guide To Preparing for Medical Mission WorkShow more...