Given the shifting economics of health care, it’s more important than ever for physicians to prove their value to their institutions and to become leaders in their local hospital communities while helping redesign their specialty for the future. As Salvatore Vitale, MD, director of cardiac and thoracic anesthesia at Mount Sinai Beth Israel, in New York City, and director-at-large of the Association of Anesthesia Clinical Directors, reported at the 2016 American Society of Anesthesiologists Practice Management meeting, the role of anesthesia clinical director is one such path to value.
“We need to become invaluable to our institutions so we can’t be replaced,” said Dr. Vitale. “Because of the fierce competition for anesthesiology services, I want a member of my anesthesia department as clinical director.”
The Perioperative Management Team
According to Dr. Vitale, however, being an anesthesiologist is not sufficient in and of itself. Rather, the job requires a unique and formidable set of skills.
“An anesthesia clinical director must be a leader of change and a champion of quality of care and have some business acumen,” said Dr. Vitale. “The job requires operational and strategic thinking.”
It’s also not a solitary role. Teamwork is essential in hospital management, perhaps nowhere more so than running an operating room (OR) suite. As Dr. Vitale explained, the perioperative management team typically consists of the following: a nursing director of perioperative services, an administrative director, information technology support for electronic health records, and nurse managers of the OR, PACU, and pre-op areas.
“The clinical director must bring people together and get them to collaborate,” he said. “Each team will have their own agenda, but you can’t do this alone.”
Duties and Responsibilities
Given the inherent risks of surgical procedures, the clinical director must be able to assess and prioritize risk while developing ways to minimize adverse events.
“The No. 1 goal of the OR management team is to ensure patient safety,” said Dr. Vitale. “No institution wants to be on the front page of the paper because of a mishap.”
Aside from keeping one’s organization out of the papers, the clinical director must ensure optimal outcomes while providing timely care to patients, maximizing efficiency and resources, and minimizing waste. According to Dr. Vitale, the director also should assist in the development of key performance indicators.
“Anesthesiologists make the best clinical directors because we understand what goes on to get patients ready for a procedure and how to take care of them afterwards,” said Dr. Vitale.
In addition, the clinical director must monitor and ensure compliance with federal, state and the Joint Commission regulations—all while performing the high-wire act of balancing a budget.
“Running an OR is not a cheap job,” he said, “and there are limited resources available. … The clinical director should expect to participate in utilization management in the organization.
“This is not the day and age where people can bill whatever they want for procedures,” he added. “There’s a decreasing budget, so you’re going to have to figure out how to work with the money you’re given.”
Finally, said Dr. Vitale, the clinical director must manage conflict among perioperative providers and act as a liaison between administration, nursing and the medical staff.
Regardless of one’s talents as a problem solver or communicator, according to Dr. Vitale, the No. 1 qualification for the job is a desire to lead.
“If an individual doesn’t want to do the job, they’re not going to be a very good director,” he explained. “Don’t just pick out somebody in the group and thrust them into this role. They must be willing to take the time to do it.”
As Dr. Vitale explained, the clinical director’s contract should specify performance measures by which he or she will be evaluated yearly. While this has been “efficiency” in the past—first case start and/or turnover times—in his opinion, this has not been shown be an effective metric for how well the OR is actually doing.
“These are easy to measure, so they often get used,” he said, “but if we could come up with alternative metrics, it would certainly be to our benefit.”
Cost controls, such as suite utilization and management of resources, should be considered, he suggested, as well as cancellation rate and patient satisfaction with services.
Who Should Fill the Role?
Although most qualified to assume the position, in Dr. Vitale’s opinion, it’s not a given that an anesthesiologist will be the perioperative director. Regardless of who takes on the job, however, upper management’s needs remain the same: to maximize the number of surgical cases while minimizing necessary resources related to cost.
“We’re moving from a volume-driven to a value-driven economy,” said Dr. Vitale. “We’ve heard about this for the last 10 to 20 years, but now it’s becoming a reality.
“If the job’s not done efficiently or properly, the organization suffers,” he concluded. “Whoever fills the role needs to be cost-efficient.”
Brian Parker, MD, an anesthesiologist at the Cleveland Clinic, commented that while people may witness the day-to-day role of the clinical director, they may not understand the position’s full importance or how it integrates into the rest of the hospital.
“The person who runs the OR on a daily basis has a huge fiduciary responsibility,” said Dr. Parker. “You are running that daily budget, which is pretty integral to the success of a hospital.
“I think it’s good for our specialty as a whole,” Dr. Parker concluded. “It shows what the ‘value add’ of anesthesiology is—to be able to run the daily operations of an operating room, if it’s done well.”