Andrew Greenfield, MD, Senior Vice President of the Anesthesiology Division of Sheridan Healthcare, discusses anesthesia leadership in hospitals and where he sees the biggest challenges and opportunities for anesthesiologists going forward.
Expectations
Sheridan has a well-developed job description for its department chiefs to perform and interact with hospital executives and physicians. The responsibilities include:
• Build and maintain a team of anesthesiologists and allied health professionals
• Conduct evaluations of team members and goals
• Meet the hospital's needs for availability in the OR
• Achieve high quality outcomes
"We also look for our anesthesia leaders to be involved in all areas of the hospital where anesthesia is utilized because anesthesiologists are uniquely positioned for leadership," says Dr. Greenfield. As physicians and trusted colleagues, anesthesiologist can work with surgeons and other proceduralists to champion hospital initiatives to enhance patient safety or quality of care. Most often the goals of the anesthesia department and the hospital are aligned 100 percent, making the role of champion a natural fit for the anesthesia leader.
Top qualities
The best person to take on the chief leadership role among anesthesiologists has several key qualities that allow him or her to execute the job well. Good chiefs of anesthesiology are politically astute and understand the various constituencies they work with.
"The anesthesia chief serves as the eyes and ears for the hospital administration," says Dr. Greenfield. "The surgeons can share their concerns with the anesthesiologists and then the anesthesiologists are positioned to listen to suggestions for improvement and take them to the administration. That way these issues are addressed in a forum outside of the OR."
One of the biggest issues for hospitals today is electronic medical record implementation. EHRs can be a huge source of physician dissatisfaction, but if anesthesiologists are able to champion the EHR integration, they can bring other physicians on board.
OR efficiency
Anesthesiologists are poised to make a significant impact on operating room efficiency, which typically generates around 60 percent margin for most hospitals. Running an efficient OR can have a big impact on clinical care, physician satisfaction, patient satisfaction and the economics of the hospital.
"The anesthesiologist is well positioned to focus on efficiencies and implement best practices in the OR," says Dr. Greenfield. "Being able to run an OR in the most efficient, cost-effective manner that drives the best outcomes is the goal in accountable care organizations."
Anesthesiologists can also help to ensure patients have the right screening before surgery to avoid same day cancellations as well as minimize unnecessary screening. They can work with operating room personnel to schedule cases in an efficient manner and track data to determine how well their efforts work.
"Perioperative care can also impact the length of stay at the hospital, which opens up space at the hospital for additional patients and decreases overall costs," says Dr. Greenfield. "Patient satisfaction is becoming an area of intense focus with the introduction of value-based purchasing. Anesthesia groups must find a way to track customer satisfaction and develop a customer service mentality amongst their department members."
Improving patient satisfaction
Anesthesiologists also play an important role in patient satisfaction throughout the perioperative period, from pre-op screenings to postoperative pain management. "Preoperative screening should be initiated prior to the patient's arrival at the hospital on the day of surgery," says Dr. Greenfield. "And find out everything you can beforehand. Patients don't want to take off work and bring in family for surgery and then have it cancelled due to something that could have been identified sooner."
Anesthesiologists may impact patient satisfaction in the following areas:
• Reduce painful IV insertions
• Reduce unnecessary IV insertions in children
• Reduce postoperative nausea and vomiting
• Help patients recover faster and feel less pain postoperatively
Incoming challenges
Anesthesia leaders are now busy with their clinical and administrative responsibilities, but there are several challenges they can begin to prepare for in the future. Chiefly, anesthesia departments who are receiving subsidies may not receive them in the future. Payment models are changing and anesthesiologists need to be prepared to respond accordingly.
"They need to be armed with the information to respond to hospital requests for bundled payments along with how they can add value in that model," says Dr. Greenfield. "This could make the difference in whether or not they are invited to the table to discuss bundled payments along with the other physicians involved in the patient's care. It's important to be seen as physicians who can add value and drive better patient care to be included in that conversation."
Another challenge is data collection; like other specialists, anesthesiologists are beginning to collect, analyze and manage quality data. “Metrics-driven healthcare is here to stay,” says Dr. Greenfield. “If you aren't collecting the data, someone else will and come to you with issues and concerns.”
Opportunities for the future
Dr. Greenfield sees many opportunities in the future for anesthesia leaders to work collaboratively in the hospital environment with physicians and hospital staff to deliver high quality care. Respected anesthesia leaders will be called upon to help develop clinical pathways for best practices and promote evidence-based medicine from the point of contact in the surgeon's office to the recovery room.
"Leaders working together to deliver the best outcome is where we're moving with a population health model of care," says Dr. Greenfield. "We are taking medicine to a level that focuses the delivery of care on best outcomes for patients."
Anesthesiologists who are part of larger organizations also have the opportunity to collaborate and interact with other anesthesia professionals. "These organizations bring to bear the resources and infrastructure necessary to really meet the demands of bundled payments models, quality improvement, and the ability to implement best practices. In a rapidly changing healthcare environment, it is hard for just one person to keep up."
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