John Di Capua, MD, is deputy CEO and chief medical officer of North American Partners in Anesthesia Corp.; vice president of anesthesia services of North Shore-Long Island Jewish Health System; and chairman and the Peter Walker Professor of Anesthesiology in the department of anesthesiology of Hofstra University-North Shore LIJ School of Medicine. Dr. Di Capua previously discussed "Hospital OR Turnover Challenges and Solutions" and "Best Practices to Improve Surgical Prep and Patient Draping Time."
Q: How can anesthesia help to enact change in all the other hospital departments that touch the operating room suite (e.g., housekeeping, transporters, bed assignments, etc.)? Without system-wide coordination, wouldn't the throughput improvement/quality be lost?
Dr. John Di Capua: One of the reasons why larger anesthesia management companies excel at this is it requires the dedication of leadership time. We consider the anesthesia chief to be our representative to understand the goals of a given institution. They are there to help provide leadership and implement necessary changes in accordance with the hospital's goals to ensure its success. Our philosophy embodies leadership as having responsibilities not just in the OR but everywhere in a hospital, while creating a culture that thrives on change and improvements.
The OR impacts every part of an institution. When a patient arrives to the OR, they come from either a patient floor, registration area or from the ED. When they have to make their exit from the OR, they have to go to any number of places. That means you're interfacing with just about every thing a hospital has to deal with.
The traditional anesthesia paradigm is to consider their departmental responsibility as limited to the "four walls" of the OR. The reality of the situation is that the chief of anesthesia and their support team need to think about things like pre-surgical testing, OR equipment standardization, etc. For example, they need to work with nursing in the ICU, because if we can make nurses in the ICU comfortable recovering fresh post-op patients — and it's certainly doable — then maybe we can bypass the PACU and go right to the ICU.
The trick is in having a leader who is empowered to manage his or her department and is provided enough non-clinical time to focus on the goal of helping the entire institution prosper. I've never seen, and I don't think I will ever see, a department of anesthesia that does well in a hospital that isn't doing well; the two go hand in hand. The goals and the incentives align.
If you believe in that alignment, it means the anesthesiology department has to make sure the entire institution does well. If that's your focus as a leader, you have to get out of the OR. You have to go to numerous hospital-wide committees to: 1) improve quality and improve brand and reputation; 2) increase volume; and 3) save money on expenditures. To do that requires a lot of time and resources to interact with multiple areas that aren't the traditional responsibility of a department of anesthesia.
Once you become known within the institution as someone who cares about the hospital as a whole, then sitting down at the table to do things such as improve turnover time, which impacts maintenance, nursing and transport, all of a sudden the organization starts to understand that your interests lay beyond just the anesthesia department. Once you break down those traditional barriers, you can start to really work with people to improve the hospital-wide issues.
It comes down to your core philosophy; if your focus is limited to your world in the OR, then you won't fix anything. You need to align with people in other parts of the hospital to make sure you're meeting the needs of the entire hospital.
Learn more about North American Partners in Anesthesia.
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