Theodore Hanley, MD, is the chief of anesthesia for St. Barnabas Hospital in Bronx, N.Y. He received his bachelor's degree from City of University of New York and graduated from medical school at SUNY Downstate Medical Center in Brooklyn in 1989. Dr. Hanley spent his residency program in anesthesia at Downstate's Kings County Hospital. Since completing his residency, Dr. Hanley has held leadership positions in anesthesia at SUNY Downstate, the former Catholic Medical Center of Brooklyn and Queens, and North General Hospital in New York.
He was serving as chief of anesthesiology for North General Hospital, where he had been elected president of the medical staff twice and expected to finish his career, until the hospital closed in July 2010. He spent the next six months working in a private practice in office-based anesthesia and continued his pain practice when was asked by Somnia Anesthesia Services to consider the open chief of anesthesiology position at St. Barnabas, a role which became available in November 2010. He accepted the position in December.
Dr. Hanley discusses the experience of assembling, transitioning and integrating a new anesthesia team at St. Barnabas and his objectives for the hospital's anesthesiology department.
Q: Describe the experience of putting together your team for St. Barnabas.
Dr. Theodore Hanley: I probably had 3-4 weeks to actually put the team together as our start date was January 10 at midnight. I was very successful in putting the team together very quickly. As recruiting goes in the New York area, sometimes it's rather difficult to have people go into areas like the Bronx. My experience in Manhattan, and in Harlem, was actually pretty difficult also.
Q: Who is on your anesthesia team and what is your relationship to them?
TH: The team is 11 anesthesiologists including myself and three CRNAs of varying backgrounds, from a new graduate to two older seasoned anesthesiologists who had been here with the previous team. The experience levels ranged from one end to the next including a couple of people I had either trained at Downstate when they were residents or people I had trained with at Downstate.
Q: What are some of the biggest challenges you have faced since taking on the chief of anesthesiology position
TH: Understanding the background about St. Barnabas is helpful to understanding the challenges. This is a 500-bed hospital. It's pretty much a community hospital in the middle of the Bronx that provides all services. They are in discussion with some neighboring hospitals about forming an accountable care organization. St. Barnabas serves an indigent and working class population. It's level one in terms of the perioperative services it offers. It has a level one trauma center and it has obstetrics.
Some of the team — myself included — had not done trauma recently, and had not done OB recently. So coming and bringing a team together that had the training but who were now faced with, day one, dealing with a high-level, high-acuity hospital was a significant challenge. During the first week we were here, we did 35 cases in the OR plus another 20-25 cases in endoscopy. The number of cases increased all week, as if they were testing us.
I think it was a banner two weeks in terms of the number of cases that were done as we came on. We were told later that this was the first time they had ever done so many cases.
In addition to that, through almost the whole month of January, there were snowstorms every week and patients still showed up and my team, now I called them a team, they came together. They showed up early, they stayed without any complaints that I heard. They were on the money. By the end of the first month, I was proud of how we handled the large volume of patients and how they brought their skills together to handle the first month of being here.
Q: As you and your team continue to settle into your new roles at St. Barnabas, what are some adjustments you plan to make?
TH: As we move forward, there will be a lot of tweaking in terms of what people's real clinical skills are, what they really like to do, and developing anesthesia subspecialty teams. In the very beginning I did ask them and encouraged them to tell me what they would like to do and what is their expertise.
As for myself, I have been tackling the administrative challenges, getting to know all of the new chiefs, new attendings and the new executives that usually come when you're transitioning. It's been a good transition so far and my leadership has been enhanced by the quality of the people that I was able to help recruit.
Q: What are some of the plans you have for your department?
TH: One of the first steps I've taken and one of the themes going forward is that I'm looking for champions. I'm looking for people who can be in leadership roles so that we can actually start to build not just a department of anesthesiology but sections within the department of anesthesiology.
So obstetrics is a major area we have to cover here and it is a high-risk area for patients who are morbidly obese or maybe diabetic or hypertensive. What I'd like to do is have a leader who can actually be an [obstetrics] expert here at St. Barnabas in our department who can lead us as we go through this transition. We have other areas that I would like to do the same: neuroanesthesia, vascular, we have a big trauma segment and we also have a fair number of medical students who rotate from the osteopathic school of medicine here. We certainly would like to continue to provide an academic base for them.
We also have a fair number of dental anesthesia residents who rotate through the anesthesia department, so certainly we would like to provide an educational base for them as well.
I also want to make sure I have somebody I can depend on as a second. I've already put that into place. My associate chief is Dr. Roy Winston, whose interesting clinical experience includes service in the Navy Reserve and with NASA. He has an excellent background; he's someone who can be excellent clinical director. I look at myself as the big vision and I need someone I can go to and make sure that person feels comfortable in carrying out the clinical decisions and can make good clinical decisions in respect to the rest of the team.
Q: What are some of your long-term goals for the department?
TH: My long-term goal for here is that we're not just a fill-in anesthesia group. I want us to be an anesthesia group with longevity that provides quality surgical care to this population with the expertise necessary to do that.
My other long-term goal is retention. I want to make sure people who come here know this is a quality department on par with any quality anesthesiology department in New York. I want to make sure we are at the same class, same level they are, providing the same type of service.
I also want to make sure there is a quality of life for the team. I believe that to ensure a long tenure in your practice, you also have to be happy when you come to work and that the things that are important to you, even though you're working, are being taken care of on the outside. I want to make this a department where people feel that it is home and that their quality of life is taken care of, where they can do the things they want to do with their families and the other hobbies they have, that they will have time to live and at the same time provide a quality service.
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