In a recent webinar, "Best Practices for Anesthesia Onboarding and Change Management," physicians from Somnia Anesthesia and California's Desert Regional Medical Center discussed the process of changing anesthesia providers at a busy hospital. The presenters, Robert Goldstein, MD, chief medical officer and executive vice president for Somnia Anesthesia, Robert Cunnah, MD, chief medical officer of Desert Regional Medical Center, and Thomas Schares, MD, chief of anesthesia at Desert Regional Medical Center, discussed essential best practices for transitioning to a new anesthesia care team model.
Partnering with anesthesia
Dr. Goldstein began the presentation by explaining that a great anesthesia provider will function as more than just a clinical service. Instead, anesthesia providers should use their status as a "perioperative caregiver" to establish efficiency in the OR, establish and support quality standards and collaborate with other OR stakeholders to improve processes.
Dr. Goldstein said the ideal anesthesia partner will be thoroughly committed to meeting shared goals for the department and facility. He outlined several "warning signs" that can mean a facility should look for a new anesthesia provider. These warning signs include a lack of collaboration between anesthesia providers and hospital leadership; inadequate coverage in the hospital OR; a negative trend in quality indications, including patient safety issues and medication errors; and increased cost.
In evaluating an anesthesia program, Dr. Goldstein recommended that hospitals consider the efficiency of the OR, how much the hospital is paying in terms of subsidy, whether the anesthesia program is meeting quality measures and whether patient and surgeon satisfaction is high. Dr. Goldstein said some hospitals may resist changing providers because the process takes time and requires a change in the organizational culture.
Case study: Desert Regional Medical Center
The webinar presented a case study of Desert Regional Medical Center in Palm Desert, Calif., a 367-bed, acute-care regional medical center fully accredited by the Joint Commission. According to chief medical officer Robert Cunnah, MD, the hospital's previous anesthesia group was hired on an exclusive contract and displayed some of the problems discussed by Dr. Goldstein. The group did not use quality initiatives to improve anesthesia provision; there was instability among the group's senior leaders; and personality differences led to dissatisfaction among surgeons and nurses.
When hospital leaders started looking for a new anesthesia provider, they decided they wanted a provider with whom they could build a long-term relationship. They decided the new provider should provide cost-effective, quality outcomes, meet the needs of the hospital's various surgical specialties and display strong, stable management that contributed to the group's reputation.
The group started the RFP process by making a joint decision between the hospital and medical staff to initiate a search. The hospital sent 50 RFPs to national and local anesthesia groups and then filtered the proposals down to groups that met their needs. The proposals were finally narrowed to seven finalists, based on recommendations and references. Fortunately for the hospital, the successful proposal won by a unanimous vote.
Dr. Cunnah said the hospital designed a 90-day timeframe to put the new anesthesia team in place at the hospital, which continued to operate as a level two trauma center throughout the transition. Somnia successfully implemented the MD/CRNA care team model at the hospital and met no resistance from the hospital's staff during the transition. Under the new model, the hospital has enjoyed a chief of anesthesia with leadership experience, extensive quality reporting and higher satisfaction scores from nurses, surgeons and patients.
Dr. Cunnah recommended that hospitals changing anesthesia providers assign an anesthesia "go-to person" onsite at the hospital to answer any questions and guide the facility through the process. He said the transition can be relatively easy with the right partner.
According to Thomas Schares, MD, chief of anesthesia at Desert Regional Medical Center, the first step to implementing a new anesthesia provider was building the OR team. This meant finding hard-working people and then identifying who was responsible and accountable for each task. Once the responsible individuals had been identified, the hospital designed a mechanism for providing feedback, so that providers could be evaluated on an ongoing basis and training could be adjusted to correct any issues.
He said the transition also involved significant effort in developing a culture of motivation, accountability and collaboration. He said providers should be encouraged to communicate about ongoing issues, and hospital leadership should facilitate post-implementation meetings to review and discuss the changes. He said hospital leaders should expect complaints, as they are an inevitable part of any major change. The key is how the leadership team reacts to those complaints and uses the feedback to make positive change within the organization.
To download slides of the presentation, click here.
Related Articles on Anesthesia:
Anesthesiologist Reaches Settlement With former Practice Over Breach of Contract
Supreme Court Declines to Hear Case Involving Death From Nurse Anesthetist Malpractice
VA Hospital Pays $925K Over Anesthetic Mistake During Cataract Surgery
Partnering with anesthesia
Dr. Goldstein began the presentation by explaining that a great anesthesia provider will function as more than just a clinical service. Instead, anesthesia providers should use their status as a "perioperative caregiver" to establish efficiency in the OR, establish and support quality standards and collaborate with other OR stakeholders to improve processes.
Dr. Goldstein said the ideal anesthesia partner will be thoroughly committed to meeting shared goals for the department and facility. He outlined several "warning signs" that can mean a facility should look for a new anesthesia provider. These warning signs include a lack of collaboration between anesthesia providers and hospital leadership; inadequate coverage in the hospital OR; a negative trend in quality indications, including patient safety issues and medication errors; and increased cost.
In evaluating an anesthesia program, Dr. Goldstein recommended that hospitals consider the efficiency of the OR, how much the hospital is paying in terms of subsidy, whether the anesthesia program is meeting quality measures and whether patient and surgeon satisfaction is high. Dr. Goldstein said some hospitals may resist changing providers because the process takes time and requires a change in the organizational culture.
Case study: Desert Regional Medical Center
The webinar presented a case study of Desert Regional Medical Center in Palm Desert, Calif., a 367-bed, acute-care regional medical center fully accredited by the Joint Commission. According to chief medical officer Robert Cunnah, MD, the hospital's previous anesthesia group was hired on an exclusive contract and displayed some of the problems discussed by Dr. Goldstein. The group did not use quality initiatives to improve anesthesia provision; there was instability among the group's senior leaders; and personality differences led to dissatisfaction among surgeons and nurses.
When hospital leaders started looking for a new anesthesia provider, they decided they wanted a provider with whom they could build a long-term relationship. They decided the new provider should provide cost-effective, quality outcomes, meet the needs of the hospital's various surgical specialties and display strong, stable management that contributed to the group's reputation.
The group started the RFP process by making a joint decision between the hospital and medical staff to initiate a search. The hospital sent 50 RFPs to national and local anesthesia groups and then filtered the proposals down to groups that met their needs. The proposals were finally narrowed to seven finalists, based on recommendations and references. Fortunately for the hospital, the successful proposal won by a unanimous vote.
Dr. Cunnah said the hospital designed a 90-day timeframe to put the new anesthesia team in place at the hospital, which continued to operate as a level two trauma center throughout the transition. Somnia successfully implemented the MD/CRNA care team model at the hospital and met no resistance from the hospital's staff during the transition. Under the new model, the hospital has enjoyed a chief of anesthesia with leadership experience, extensive quality reporting and higher satisfaction scores from nurses, surgeons and patients.
Dr. Cunnah recommended that hospitals changing anesthesia providers assign an anesthesia "go-to person" onsite at the hospital to answer any questions and guide the facility through the process. He said the transition can be relatively easy with the right partner.
According to Thomas Schares, MD, chief of anesthesia at Desert Regional Medical Center, the first step to implementing a new anesthesia provider was building the OR team. This meant finding hard-working people and then identifying who was responsible and accountable for each task. Once the responsible individuals had been identified, the hospital designed a mechanism for providing feedback, so that providers could be evaluated on an ongoing basis and training could be adjusted to correct any issues.
He said the transition also involved significant effort in developing a culture of motivation, accountability and collaboration. He said providers should be encouraged to communicate about ongoing issues, and hospital leadership should facilitate post-implementation meetings to review and discuss the changes. He said hospital leaders should expect complaints, as they are an inevitable part of any major change. The key is how the leadership team reacts to those complaints and uses the feedback to make positive change within the organization.
To download slides of the presentation, click here.
Related Articles on Anesthesia:
Anesthesiologist Reaches Settlement With former Practice Over Breach of Contract
Supreme Court Declines to Hear Case Involving Death From Nurse Anesthetist Malpractice
VA Hospital Pays $925K Over Anesthetic Mistake During Cataract Surgery