How to build a winning surgeon-anesthesiologist partnership: Q&A with NAPA CEO Dr. John Di Capua

The surgeon-anesthesiologist relationship is vital for high-quality patient care as well as efficiency in the operating room. A strong professional working relationship between the two helps keep the OR team on track and improve the patient experience.

John Di Capua, MD, CEO of North American Partners in Anesthesia, headquartered in Melville, N.Y., and founding chair of the anesthesiology department at the Hofstra Di Capua, John GNorthwell School of Medicine in Hempstead, N.Y., discusses the importance of this relationship as well as the benefits for patients and healthcare facilities.

Question: Why is the surgeon-anesthesiologist partnership in the OR important?

JD: The relationship is important on a number of different levels. The primary purpose is always offering the best possible patient care. When patients undergo surgery it is a major event in their lives. So it is critically important that the surgeon and anesthesiologist work together to ensure the quality of the patient experience, which first and foremost focuses on safety, as well as collaborating on  a number of efficiency initiatives in the OR. They have to keep things running on time. Patients can get anxious if we are delayed. Also, the OR is an expensive resource. The surgeon and anesthesiologist have to work together to plan out the day and make sure that resource is being used efficiently and appropriately. Communication is critical.  

Q: What are some of the benefits of collaboration between surgeons and anesthesiologists for patient care?

JD: The biggest benefit is achieving the goal of providing the highest quality of patient care at the lowest cost. The physicians must provide value without sacrificing quality.

We also want patients to have a great experience. We want to make them feel good about the care team. We want to convey professionalism and confidence, which only happens when the surgeon and anesthesiologist work together. We have to be thinking of customer expectations before, during and after surgery.  

We are very focused on the importance of creating a patient-centric experience and an environment that encourages the surgeon and anesthesiologist to talk to each other -- and, of course, to the patient. It requires that we carefully explain to patients what to expect.

Another benefit is timeliness. Anesthesiologists and surgeons can work to make sure there is high utilization of the expensive OR space.  

Q: In terms of efficient workflow in a facility, how does a strong surgeon-anesthesiologist partnership help?

JD: First, we should expand how we define the relationship. For NAPA, our patients are our customers and so are the surgeons with whom we work. Surgeons can choose where to perform surgery and so we, as anesthesiologists, need to think about providing a good experience for the surgeons as well. For example, we have to make sure that the turnover time isn't too long. We don't want to do that for the sake of both the surgeons and the patients.

At NAPA, we provide our anesthesiologists with professional training to ensure the highest level of customer service to our customers. We want everyone to feel that we are doing the best for them.

We also have to think about what's important for surgeons — namely, patient outcomes. So we have set rules about credentials and certifications for our anesthesiologists. We require the highest professional standards. We monitor outcomes for all of our providers so we can make sure that our patients are doing really well.

To minimize wasted time, we take responsibility for turnover time. NAPA invested in a remote video auditing solution that we call NAPA Peak Performance2. This technology allows outside auditors to collect data on OR efficiency. It also helps us ensure that we and others in the OR are adhering to safety and quality guidelines.

Using this technology, we learned that having an outside individual watching the room via remote cameras can help the OR run more efficiently. They can point out and communicate things that others may not notice or be able to communicate to all stakeholders. For example, they can make sure the cleaning crew reaches the OR as soon as the procedure is over and the next surgeon is ready to go. The technology helps align all the professionals who take part in what is a  complicated dance in the OR.  

When results began to come in, we were astonished at how effective remote video auditing was. The technology blurs everyone's face so privacy concerns are maintained and just the relevant information is used to make the environment safer and more efficient.

A NAPA Peak Performance2 pilot study showed that the technology allowed OR staff to save 25 to 50 minutes per room per day. There are so many benefits that come from looking at the OR in a different way. The hospitals love it because we are using that expensive space and resource in a more efficient way.

Q: What effect does a close partnership between surgeons and anesthesiologists have on a facility's bottom line?

JD: The OR is responsible for 60 percent of most hospital profit margins. Imagine the scale of that. Thus, it is absolutely critical for a hospital's survival today to make sure the OR is efficient so we can bring in more cases and care for those patients in a timely manner. Every hospital wants to make their OR a destination for surgeons. Bringing in more surgeons also benefits a facility's bottom line. There are multiple financial advantages to creating an efficient and high quality operating room, including the fact that if the OR is running on time, the hospital doesn't have to pay overtime.

Q: What are some ways surgeons and anesthesiologists can foster a strong professional relationship?

JD: One of the beautiful things that came out of collecting performance data is a stronger professional relationship between the anesthesiologist and surgeon. In the past, when we collected OR data, it was an abstract or a sample collected by someone who would go to the OR and just watch. Sometimes, staff members would start to doubt the information.

NAPA Peak Performance2 is unbiased because it looks at 100 percent of cases. We can look at the data weekly, which encourages surgeons, anesthesiologists and nurses to sit down and think about how to improve. They start to make leadership changes and a wonderful bonding occurs between anesthesiologists and surgeons.

An editorial, published in BMJ Quality & Safety, noted that the feedback from remote video auditing increased compliance and reduced OR turnaround times by 14 percent at the Hofstra Northwell School of Medicine.

The technology helps give surgeons and anesthesiologists the chance to make a change, which can sometimes be difficult in the OR. Allow your OR leadership team to make changes and everyone benefits.

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