Theresa Palicki, administrator of Eastside Surgery Center in Columbus, Ohio, offers five ways for your ASC to develop good working relationships with your anesthesiologists and achieve improved clinical quality outcomes.
1. Involve annual clinical quality outcomes in your anesthesia group's contract. If your anesthesia group is accountable to a set of quality outcomes — transfer rates and infection rates, for example — they will likely work harder to improve patient safety. Ms. Palicki's center sets annual expectations for its anesthesia group. If the group falls below the threshold in their benchmarks, the group's contract could be terminated for the following year. Incentivizing your anesthesiologists to provide quality care can help your center and tangibly reward your anesthesiologists when they do good work.
2. Choose a group who feels true ownership of the patient. When selecting an anesthesia group to work with, choose a group that feels responsible for each patient they care for. "[A poor anesthesiologist] would think it was appropriate, as soon as the patient was in PACU, to think their job was done and they could go home," she says. "From the time the patient is put on the schedule, [a good anesthesiologist] will be looking at the chart, looking at the pre-op history and doing evaluations. They'll be right there in the PACU looking at the files — not just the nurse, but the anesthesiologist." She describes an anesthesiologist at Eastside Surgery Center who stood by a patient's car while she sat in it, talking on her cell phone after surgery, to ensure she was safe until she left the parking lot.
While you want to work with committed anesthesiologists, it can be difficult to tell them apart during the interview process. Ms. Palicki recommends asking each group questions about the relationship between the surgeon and the anesthesiologist to get a sense of how they view their role. "We asked, 'If there is a disagreement between you and the surgeon regarding whether the patient can handle the procedure, what would you do?' Most say [they would defer to the surgeon], and we throw them out," she says. "If the patient is at risk, we want someone who will piss off the surgeon as long as it saves a life."
3. Choose an anesthesia group with ASC experience. Anesthesia functions differently in a hospital than in an ASC, and it helps to have an anesthesia group that understands the day-to-day processes of a surgery center, Ms. Palicki says. During the interview process, she asks about the other organizations the group has worked in. "If a group has only done hospitals, they might be used to having all hands on deck. If something goes wrong, they can press a button and go to code blue and the whole team comes in," she says. "At an ASC, it's a few people who have to be responsible when [something unexpected happens]."
4. Recruit a nursing staff that will keep your anesthesiologists happy. Ms. Palicki says anesthesiologist satisfaction often depends on the working relationship between the anesthesiologists and the nursing staff. "You don't want nurses that are too pedantic," she says. "You want nurses that follow the rules, but you also want them to look more at what's best for the patient than at the minute details of the policy."
5. Appoint a strong medical director. If your medical director is a respected presence, you can guarantee a strong ally. Ms. Palicki says ASCs can make the mistake of appointing a "low man on the totem pole" who is brand new to the group as director. Instead, you want a medical director who has been an integral part of the group for a few years and has clinical experience that other anesthesiologists respect. "If things need to be changed in the anesthesia group and you have to send someone inexperienced to talk to the anesthesiologists, they won't listen," she says. Eastside Surgery Center's current medical director is president of the entire anesthesia group. Because he has a lot of sway and connections to the community, he fights for the ASC by reaching out to surgeons and convincing them to joint the center.
Read more about Eastside Surgery Center.
1. Involve annual clinical quality outcomes in your anesthesia group's contract. If your anesthesia group is accountable to a set of quality outcomes — transfer rates and infection rates, for example — they will likely work harder to improve patient safety. Ms. Palicki's center sets annual expectations for its anesthesia group. If the group falls below the threshold in their benchmarks, the group's contract could be terminated for the following year. Incentivizing your anesthesiologists to provide quality care can help your center and tangibly reward your anesthesiologists when they do good work.
2. Choose a group who feels true ownership of the patient. When selecting an anesthesia group to work with, choose a group that feels responsible for each patient they care for. "[A poor anesthesiologist] would think it was appropriate, as soon as the patient was in PACU, to think their job was done and they could go home," she says. "From the time the patient is put on the schedule, [a good anesthesiologist] will be looking at the chart, looking at the pre-op history and doing evaluations. They'll be right there in the PACU looking at the files — not just the nurse, but the anesthesiologist." She describes an anesthesiologist at Eastside Surgery Center who stood by a patient's car while she sat in it, talking on her cell phone after surgery, to ensure she was safe until she left the parking lot.
While you want to work with committed anesthesiologists, it can be difficult to tell them apart during the interview process. Ms. Palicki recommends asking each group questions about the relationship between the surgeon and the anesthesiologist to get a sense of how they view their role. "We asked, 'If there is a disagreement between you and the surgeon regarding whether the patient can handle the procedure, what would you do?' Most say [they would defer to the surgeon], and we throw them out," she says. "If the patient is at risk, we want someone who will piss off the surgeon as long as it saves a life."
3. Choose an anesthesia group with ASC experience. Anesthesia functions differently in a hospital than in an ASC, and it helps to have an anesthesia group that understands the day-to-day processes of a surgery center, Ms. Palicki says. During the interview process, she asks about the other organizations the group has worked in. "If a group has only done hospitals, they might be used to having all hands on deck. If something goes wrong, they can press a button and go to code blue and the whole team comes in," she says. "At an ASC, it's a few people who have to be responsible when [something unexpected happens]."
4. Recruit a nursing staff that will keep your anesthesiologists happy. Ms. Palicki says anesthesiologist satisfaction often depends on the working relationship between the anesthesiologists and the nursing staff. "You don't want nurses that are too pedantic," she says. "You want nurses that follow the rules, but you also want them to look more at what's best for the patient than at the minute details of the policy."
5. Appoint a strong medical director. If your medical director is a respected presence, you can guarantee a strong ally. Ms. Palicki says ASCs can make the mistake of appointing a "low man on the totem pole" who is brand new to the group as director. Instead, you want a medical director who has been an integral part of the group for a few years and has clinical experience that other anesthesiologists respect. "If things need to be changed in the anesthesia group and you have to send someone inexperienced to talk to the anesthesiologists, they won't listen," she says. Eastside Surgery Center's current medical director is president of the entire anesthesia group. Because he has a lot of sway and connections to the community, he fights for the ASC by reaching out to surgeons and convincing them to joint the center.
Read more about Eastside Surgery Center.