Building Alliances with the C-Suite

Part of the reason anesthesiologists may be so naturally aligned with the C-suite is their intimate knowledge of the scheduling nuances that take place throughout health care systems. Scheduling in perioperative services may span beyond a single hospital and across all operating and nonoperating room locations. Surgeons and proceduralists may not always see the big picture of the perioperative demands for anesthesia and procedural sedation care and often have insufficient expertise in how to efficiently deploy anesthesia resources.

“We (anesthesiologists) can better direct the management of both NORA and OR cases,” explained Dr. Harter. “Instead of acting for our own individual scheduling convenience, anesthesiologists can see what’s best for the overall schedule to accommodate our surgeons in getting cases done in the shortest amount of time possible with as little operating room downtime, or rooms sitting empty while juggling multiple proceduralists, as possible.”

In ambulatory surgical centers, anesthesiologists bring an additional strength to the table in the eyes of the C-suite: guiding proper patient and case selection. In a hospital OR, it’s easy enough for a patient with multiple comorbidities to be admitted overnight after a procedure. It’s much riskier and more expensive, and can become a reportable event, when a patient must be transferred to the hospital for an overnight stay after surgery at an outpatient facility. “The final decision on whether a patient should be scheduled for surgery at an ambulatory center requires significant input from an anesthesiologist familiar with the case. The anesthesiologist can determine if it’s really an operation that can be safely performed on that specific patient at an ambulatory facility,” said Dr. Harter.

Sonya Pease, MD, MBA, CPXP, FASA, an anesthesiologist with Cleveland Clinic Florida, instructed audiences at last winter’s ASA ADVANCE conference that the value equation within health systems has changed and anesthesiologists need to be proficient in “C-Suite language” to improve the anesthesia group’s partnership and “stickiness” within their facilities.

“It’s important for anesthesia groups to understand their hospitals’ objectives and key result (OKR) priorities. As Dr. Harter stated, typically what benefits our hospital efficiencies will also improve the anesthesia groups’ efficiencies, and this goes a long way toward maintaining financial stability and demonstrating value,” she explained. “When one of our hospitals is working with an outsourced anesthesiology group, there has to be both quality and efficiency advantages driven by local anesthesia leaders. These large independent groups have to provide value beyond just economies of scale, or we will have to make some hard decisions to achieve OKR goals.”

Aligning with your organization’s OKRs can improve practice and patient outcomes and build new capabilities that are mutually beneficial. Some examples of OKR goals that are an organic fit with anesthesiology include coding and documentation. Documenting conditions that are present on admission, the severity of illness (sepsis versus severe sepsis), and comorbidities that establish the risk of mortality greatly impacts the coding for an episode of care. This documentation supports efficiency metrics like length of stay, episode cost, and readmission risk. “Alignment” is a skill that today’s anesthesiologists need to master, much as “ability, availability, and affability” were the top attributes of anesthesiology practices in the 1990s, said Dr. Pease.

Though there are dozens of key metrics that Dr. Pease considers a perfect match for anesthesiologist alignment, she said elimination of catheter-associated urinary tract infections and central line-associated blood stream infections are excellent starting points.

“The key driver tactic may be to have all Foleys out of surgical patients within 24 hours, so anesthesia would ensure the hospital’s enhanced recovery after surgery program targets not placing Foleys intraoperatively whenever possible, removing Foleys in the PACU when possible, and authorizing nurse-driven protocols to remove Foleys as soon as possible. When anesthesia supports best practices that ensure high-quality care, it’s a win-win-win; our patients get high-quality care with fewer postop complications, hospitals’ quality OKRs are supported, and the anesthesia group ensures contract stability by providing enhanced value to their hospital and patient outcomes,” summarized Dr. Pease.

Establishing aligned OKR goals requires meaningful conversations and review of current performance to determine exactly how the anesthesia team and hospital team are going to engage in performance improvement work together. This begins by identifying and tracking SMART (Specific/Measurable/Achievable/Relevant, and Time-Based) goals:

• What is the specific problem we need to solve?
• How are we going to measure progress or milestones in achieving that goal?
• What else or who else is needed to ensure the goal is achievable?
• Is the goal relevant for all patients or caregivers or subsets of each?
• When can we expect to see results?

“Having a very clear understanding of what and how we are going to align around key results is where the rubber meets the road,” she said. “It is our front-line leaders and caregivers that drive all quality, safety, and patient experience work, so when we work together to define how we are going to achieve results, this allows our teams to work together more strategically to achieve results. I don’t expect my anesthesiology leaders to dedicate bottomless time to this work – just their knowledge, expertise, and leadership support so our quality and safety and continuous improvement folks can come alongside to support them in these activities. It’s typically a one plus one equals three synergy when we work together to achieve OKR results.”

It’s expected that anesthesiology leaders will collaborate with leadership on issues beyond serious safety events. Dr. Pease pointed out that building a safety culture in an environment that has experienced significant turnover since the pandemic is a major pain point for all C-suite executives right now. In fact, a 2022 survey by the American College of Healthcare Executives called staffing the number-one challenge for health care CEOs (asamonitor.pub/468MaAQ). Anesthesiologists have led the way in safety and quality, so this is a natural avenue to align with executives.

“When staffing was at more reasonable levels, there was some latitude with anesthesia coverage,” said Dr. Harter. “Now, if our anesthesia blocks are only going to have, say, 50% utilization, we may have to close some ORs on some days to better flex staff for busier days.”

Regardless of the issue being addressed, both Drs. Pease and Harter agree that joining committees – especially quality councils, credentialing, or pharmacy and therapeutic committees – is a necessary step in demonstrating leadership in improving patient care and hospital operations. In fact, regulatory agencies require anesthesiologists to participate in several key hospital quality assurance committees. “The more you are engaged in medical staff activities and make connections outside your department, the more that creates opportunities for additional collaboration and a seat at the table when decisions are getting made,” Dr. Harter reasoned.