In a session titled "Avoiding a Hurricane: How to Evaluate Your Anesthesia Provider and Ensure Your OR's Success" at the annual Becker's Hospital Review Conference in Chicago, Marc E. Koch, MD, president and CEO of Somnia, discussed how to tell when there is trouble brewing in the anesthesiology department.
"Take a look at these indicators and you can begin to prepare for the worst case scenario," said Dr. Koch. "If you see a problem very early on, you can sit down with leaders and work it out. That is the most prominent and good goal that can be reached. My goal is to give everyone the tools to do that before it becomes a problem."
There are several factors hospital leaders can use to predict when a "storm" might be coming, such as:
• Clinical inefficiency and ineffectiveness—this includes increased case cancellations, decreased on-time starts, issues with turnover, passive management of add-ons
• Discord and discontent—the regular visits with the c-suite executives lessen, committee involvement is less robust among the anesthesiologists, surgeons report lack of general availability of the anesthesiologists, nurses lament the lack of support and anesthesiologists regularly arrive late and leave early
• Customer dissatisfaction—there is an erosion of HCAHPS scores and case volume is shifted to competing arenas, the complaints from nurses and hospital management increase, OR scheduler and surgeon booking staff complain about the anesthesiologists, usually happy surgeons are dissatisfied
• Administrative problems—this can include frequent use of locum tenets and high turnover, increased burden on credentialing office due to high turnover, the anesthesia department case logs don't equal facility case logs, there internal complaints about failure to pay notices, there is a problem with succession planning
• Contingency planning begins—the anesthesiology group begins contingency planning for its senior surgeons, the surgeon to CRNA ratio flexes up to accommodate outside duties, incoming switchboard calls for the anesthesiologists may be recruiters wanting to know about them, queries from local hospitals and surgery centers who may employ them in the future
"If you ignore unhappy surgeons and just let the situation evolve, the surgeon will have a critical mass of being unhappy and show passive aggressive behavior and angst with the administration," says Dr. Koch. "If you start to see this trajectory, meet and talk with people. It's not just the anesthesia group; you also want to meet with the surgeons and ask them how the anesthesia group is doing and how the OR is. Meet with the nurses because they know what is going on. Have one-on-one meetings with the section heads and get a sense of the tone in the operating room."
Evaluating the operating room on a quarterly basis will give hospital leaders a good sense of where things are early on in a potential conflict. If a storm is inevitable, it's the hospital leaders' responsibility to assemble a recruitment committee and explore other options for when the anesthesiology group's contract comes due. Dr. Koch suggests beginning as early as 18 months before the contract is due if the anesthesiology group fails to make agreed upon changes and continue working to find a new group. The formal announcement of the transition should occur eight months before the group's contract is due.
Even if you are satisfied with the anesthesia services, ongoing evaluations can improve the service. "Everyone can go over the good things and what it takes to make it great," says Dr. Koch. "Deal with small issues before they mushroom into big ones."
One of the issues that may come up is the anesthesiology subsidy. "The demand for anesthesiology is significantly higher than the supply," said Dr. Koch. "Putting your head in the sand and not having that discussion isn't going to make that go away. Anesthesiologists should have an ongoing dialogue for what they are doing to improve revenue and increase efficiency with hospital leaders."
"Take a look at these indicators and you can begin to prepare for the worst case scenario," said Dr. Koch. "If you see a problem very early on, you can sit down with leaders and work it out. That is the most prominent and good goal that can be reached. My goal is to give everyone the tools to do that before it becomes a problem."
There are several factors hospital leaders can use to predict when a "storm" might be coming, such as:
• Clinical inefficiency and ineffectiveness—this includes increased case cancellations, decreased on-time starts, issues with turnover, passive management of add-ons
• Discord and discontent—the regular visits with the c-suite executives lessen, committee involvement is less robust among the anesthesiologists, surgeons report lack of general availability of the anesthesiologists, nurses lament the lack of support and anesthesiologists regularly arrive late and leave early
• Customer dissatisfaction—there is an erosion of HCAHPS scores and case volume is shifted to competing arenas, the complaints from nurses and hospital management increase, OR scheduler and surgeon booking staff complain about the anesthesiologists, usually happy surgeons are dissatisfied
• Administrative problems—this can include frequent use of locum tenets and high turnover, increased burden on credentialing office due to high turnover, the anesthesia department case logs don't equal facility case logs, there internal complaints about failure to pay notices, there is a problem with succession planning
• Contingency planning begins—the anesthesiology group begins contingency planning for its senior surgeons, the surgeon to CRNA ratio flexes up to accommodate outside duties, incoming switchboard calls for the anesthesiologists may be recruiters wanting to know about them, queries from local hospitals and surgery centers who may employ them in the future
"If you ignore unhappy surgeons and just let the situation evolve, the surgeon will have a critical mass of being unhappy and show passive aggressive behavior and angst with the administration," says Dr. Koch. "If you start to see this trajectory, meet and talk with people. It's not just the anesthesia group; you also want to meet with the surgeons and ask them how the anesthesia group is doing and how the OR is. Meet with the nurses because they know what is going on. Have one-on-one meetings with the section heads and get a sense of the tone in the operating room."
Evaluating the operating room on a quarterly basis will give hospital leaders a good sense of where things are early on in a potential conflict. If a storm is inevitable, it's the hospital leaders' responsibility to assemble a recruitment committee and explore other options for when the anesthesiology group's contract comes due. Dr. Koch suggests beginning as early as 18 months before the contract is due if the anesthesiology group fails to make agreed upon changes and continue working to find a new group. The formal announcement of the transition should occur eight months before the group's contract is due.
Even if you are satisfied with the anesthesia services, ongoing evaluations can improve the service. "Everyone can go over the good things and what it takes to make it great," says Dr. Koch. "Deal with small issues before they mushroom into big ones."
One of the issues that may come up is the anesthesiology subsidy. "The demand for anesthesiology is significantly higher than the supply," said Dr. Koch. "Putting your head in the sand and not having that discussion isn't going to make that go away. Anesthesiologists should have an ongoing dialogue for what they are doing to improve revenue and increase efficiency with hospital leaders."
More Articles on Hospital Management:
Bob Woodward: Healthcare Leaders Must Define What They Are Doing
Hospital Strategies for Surviving in a Changing Healthcare Environment
Best Practices for Strategic Communications During a Transaction