Evaluating Your Anesthesia Services — How to Assess Your Anesthesia Team
In a webinar on May 8, Syed Ishaq, vice president of client development for Somnia Anesthesia; David Perlstein, MD, MBA, medical director at St. Barnabas Hospital in the Bronx (N.Y.); and Thomas Dean, chief administrative officer at San Juan Regional Medical Center in Farmington, N.M., discussed how to evaluate an anesthesia department's performance and the importance of doing so.
Mr. Ishaq began the webinar by explaining the importance of evaluating a hospital's anesthesia department. He explained that 70 percent of a hospital's revenue is tied to its operating room or other surgical services. As a result, the anesthesia group oversees one of the most critical departments in a hospital. While each facility, of course, has OR managers and other staff to manage the day-to-day operations of the department, Mr. Ishaq believes anesthesiologists play a major role in OR operations as they can greatly impact delays, cancelations and surgical quality.
He pointed to a recent study by researchers at Tulane University that uncovered delays and cancelations at the university's medical center cost nearly $1 million in 2009. With reduced reimbursements a rising concern for all hospitals, improving OR efficiency can have a huge impact. "Declining volume and revenue demands tighter efficiency," said Mr. Ishaq.
Because of the impact anesthesia departments can have, it is very important hospitals regularly evaluate their anesthesia group, said Mr. Ishaq. He recommended evaluating the groups in four main areas:
• Leadership: Is the group aligned with the hospital's mission and goals? Is there an anesthesia leader that serves as the "face" of the department? Are anesthesiologists involved in the hospital's overall strategy through committee involvement?
• Quality: Does the group measure quality and identify areas for improvement? Is it regularly collecting and tracking data? Is there a formal quality improvement program in place? Are there standard operating procedures based on evidence-based practices?
• Finance: What are the current revenue and expenses of the department? Is there an anesthesia subsidy paid? If so, why? What is the group's ability to bill and collect? What staffing model is used? Is it the most efficient?
• Clinical: Are the anesthesiologists running the OR clinically competent? Do they offer the newest types of services? Are they partnering effectively with OR management and nurses?
Mr. Ishaq then directed listeners to a new, first-of-its-kind app developed by Somnia Anesthesia to help hospital leaders evaluate their anesthesia services. To access the app, using your smart phone or tablet, click here.
He recommended leaders use this to guide the initial evaluation of their current services and use the information gained from it to develop objectives for improvement either by working with the current anesthesia provider or by selecting a new provider with capabilities in these four areas.
Next, Dr. Perlstein shared how St. Barnabas Hospital's evaluation of its anesthesia department led it to seek a new anesthesia group. Specifically, the previous anesthesia leadership was not aligned with the hospital, and quality was somewhat inconsistent. "We felt we really had no partnership [with the group]," he said. Efforts to improve did not meet desired objectives, so the hospital released a request for proposal for a new provider. The RFP included objective and subjective criteria upon which to evaluate potential new providers. "We looked for extensive management experience; we wanted dedicated physician leadership, onsite management and access to quality data," he said. The hospital eventually selected Somnia Anesthesia.
Dr. Perlstein reported that the anesthesia department's onsite leadership and overall OR efficiency has markedly improved since working with the new group. He recommended other facilities that are considering a new anesthesia group involve as many key stakeholders — from OR staff to surgeons — as possible in the selection process and attempt to include someone with anesthesia expertise on the evaluation committee.
Finally, Mr. Dean shared his experiences surrounding San Juan Regional's decision to replace its anesthesia department last year. He pointed to inadequate presence of leadership, inefficient OR scheduling, subsidy increases and quality concerns as the key reasons the hospital sought to open the RFP process up beyond its incumbent provider.
"We were going to have to be measuring ourselves against national standards and norms," he said, explaining that the hospital, while small and in a rural area, had to begin benchmarking itself against other providers, especially given the advent of value-based purchasing.
San Juan's selection committee based its decision on two key factors: leadership and quality. The wanted a "pit-crew" model as opposed to "cowboys," he explained. Critically important was "the ability to get objective data, think about evidence-based practices…and have leadership responsible for having necessary changes," he said.
Just a few months after selecting Somnia Anesthesia, Mr. Dean reported that the anesthesia group has become more aligned with the hospital while creating greater efficiencies. He also advocated for involving key stakeholders beyond hospital administrators in the selection processes. Specifically, he recommended involving surgeons and members of the department of surgery as well as board members in the process.
View or download the Webinar by clicking here.
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