Developing leaders with a strong background in quality is essential for the optimal functioning of an anesthesiology department, perioperative services, hospitals, and health care systems. Anesthesiologists are uniquely positioned to instill and guide a culture of patient safety and quality in a health care system. Such a culture improves patient care and outcomes, enhances the patient experience, strengthens the reputation of the anesthesiology department, and provides value to the institution as a whole. Anesthesiologists collaborate and interact not only with physicians of virtually every specialty, but also with stakeholders in nursing, pharmacy, accreditation, risk management, biomedical engineering, and operations, to name a few. Moreover, health care systems will benefit from anesthesiologists’ comprehensive medical knowledge, long history as patient safety advocates, and operational expertise in perioperative management by having an anesthesiologist serve in hospital-wide leadership roles. These positions could include chief quality officer, chief medical officer, chief operating officer, president of the medical staff, or president/CEO of the health care system. Developing effective interpersonal and interprofessional communication skills, creating a patient safety culture, error analysis and prevention, and establishing and implementing reliable systems demonstrate the value of anesthesiologists to the hospital system as leaders in the areas of patient safety, quality improvement, and risk management.
The physician leading the department’s quality program should not only have knowledge of patient safety and quality concepts, but also must understand the breadth of the programs and reportable metrics generally accepted as under the purview of “quality.” Compliance with guidelines from the Centers for Medicare & Medicaid Services (e.g., oversight of moderate sedation) and Joint Commission standards are almost universally accepted as the responsibility of the quality leadership. Health care-associated injury metrics (i.e. CAUTI, CLABSI, DVT/VTE), clinical protocols such as enhanced recovery protocols and clinical pathways, measures of patient experience, and patient-reported outcomes also typically fall under the purview of quality. Hospitals and departments will need to demonstrate that access to care, treatment protocols, and outcomes are equitable across race and socioeconomic status.
Quality management efforts are essential to the financial well-being of anesthesiology departments and health systems in general as reimbursement depends on value-based payment programs such as MIPS and MACRA (described in earlier articles within this issue) Since physician wellness is known to impact patient safety, in many departments the wellness champions report to the quality leader as well. Finally, the quality leader should be a proponent of “just culture” and ensure that peer support is provided after significant patient events. Of course, rigorous assessment of “near-miss” and “significant” events form the backbone of a patient safety program. The anesthesiology quality leader must engage in collaborative, honest assessments of such events, develop appropriate corrective action plans, and ensure implementation of those plans throughout the department and the hospital/system. To effectively accomplish this, the quality leader should be granted the resources and authority necessary to review the data for the above-mentioned metrics, leveraging the electronic health record and the institution’s quality event reporting system. To ensure that the anesthesiology quality leader can engage effectively with other leaders within and beyond the institution, financially supported nonclinical time and administrative assistance should be provided.
“An anesthesiologist, as a senior health care system administrator, has a greater voice in educating and promoting fellow anesthesiologists’ roles in overall hospital quality and safety, not only in the OR but also in many other locations, including the catheterization lab, endoscopy suite, obstetrical suite, emergency department, radiology, and intensive care units.”
Particularly in a rapidly changing health care system, identifying and developing anesthesiology quality leadership is critical for the success of the department and the mission of the institution. The department must identify a quality leader who is engaged, patient-focused, empathetic, and seeks to serve their colleagues, patients, and institution. Leadership theory is complex and includes the study of different types of leadership styles, each of which may be more suitable for certain roles. Emerging leadership, authentic leadership, strategic leadership, and transformational leadership are just some of the leadership styles that may be effective in quality management.
While leadership strengths and weaknesses are innate to some degree, many traits can be learned or improved through reading, education, mentorship, and experience. Just as the candidate for a quality leadership position may need training in quality metrics, patient safety protocols, and value-based payment systems, so too might that individual benefit from leadership training programs. Training in both quality and leadership is widely available on all platforms, including in ASA educational programs.
The anesthesiology quality leader must be engaged institutionally in “high-value care,” delivering high-quality care in an efficient manner, and in working to develop actionable solutions to institutional challenges. Having anesthesiologist leaders involved at the group, facility, state, and national levels is critically important to delivering the safest and most cost-effective care.
Leadership roles not only enhance an individual’s personal satisfaction but also have more impactful benefits to the profession of anesthesiology:
- Hospital administration and senior leadership often do not have a clear understanding of the key role anesthesiologists play in overall hospital operations and, ultimately, quality and safety. They more often view anesthesiologists and other anesthesia providers as a cost center, a necessary expense to keep the ORs fully functional. An anesthesiologist, as a senior health care system administrator, has a greater voice in educating and promoting fellow anesthesiologists’ roles in overall hospital quality and safety, not only in the OR but also in many other locations, including the catheterization lab, endoscopy suite, obstetrical suite, emergency department, radiology, and intensive care units. Anesthesiologists offer oversight and standards of safe airway management, lead and provide oversight for rapid-response and resuscitation teams, and bring more focus to pain management with multimodal strategies in all patient care areas. Not only does the administration come to appreciate our expertise and influence on high-quality patient care, but also this translates into greater respect and appreciation for the anesthesiologist and willingness to financially partner with nonemployed anesthesia groups.
- When an anesthesiologist serves as chief medical and/or quality officer (CMO/CQO), they can play a significant role within the organized medical staff in setting policies and procedures that advance overall patient care. This can include privileges specific to other specialties, such as the example of a physical medicine and rehabilitation (PM&R) physician applying for interventional pain privileges. A CMO/CQO with anesthesia training is in a great position to recommend minimum standards of core competencies and training such that PM&R physicians are held to the same high standards in competencies and quality of interventional pain as an anesthesiologist pain physician. In the same vein, when considering a hospital-wide policy regarding required competencies to practice moderate and deep sedation, a knowledgeable anesthesiologist serving as CMO or president of the medical staff can navigate the predictable resistance from other departments. In the November 2022 ASA Monitor, Drs. Abdelmalak, Martin, and Arnold, described what a well-executed anesthesiology oversight program for procedural sedation would look like, leading to a great number of benefits in advancing patient care and safety, efficiency, and economic benefits to the community, hospital, and health care system in general.
Regardless of how demanding or important the leadership position undertaken, an anesthesiologist should maintain a clinical presence. This is extremely important and advantageous on many fronts:
- Remaining clinically active allows the anesthesiologist leader to have a direct connection to the clinical side of quality and safety, including frontline challenges and required behaviors.
- Anesthesiologists continue to appreciate the great professional satisfaction and thrill of helping patients through their surgical or other complex procedures, and this is not easy to give up!
- Staying in touch with the complexities and challenges of daily clinical life on the ground leads to a more effective and credible leader.
- A clinical presence allows for a clear understanding of the impact of the C-suite-level decisions on clinical practice and the implementation success/barriers.
- It facilitates maintaining relationships with many different clinical and nonclinical teams in the hospital.
- Physicians who become administrators can appreciate the safety net of the option to return to full clinical practice if they have a change in their professional goals, i.e., no longer wish to serve in an administrative role
- Nonphysician administrative roles can change or even be eliminated, but as talented and highly trained physicians, our clinical services and talents will always be in demand. As such, it is wise to maintain a medical license and clinical skills.
In conclusion, we hope that we inspired you as we have attempted to share with you the qualifications that anesthesiologists possess that make them great candidates for different roles in hospital leadership, particularly those related to quality, patient safety, clinical care, and clinical operations. It behooves us to prepare our anesthesiologists and pursue these opportunities to benefit not only our patients and specialty but also our hospital systems and communities as a whole. As we do so, we should not lose sight of our education and training and our first love of anesthesiology and continue to maintain clinical activity as appropriate.