Author: Tony Mira
A critical aspect of any governance model is succession planning. Identifying and developing strong leadership and assuring a peaceful transition of power are items that need to be added to every group’s strategic planning agenda.
Anesthesia practices are particularly vulnerable to the challenge of succession planning. Ensuring the ongoing viability of a group practice is no small feat, especially when the knowledge, vision and leadership necessary to navigate today’s complicated medical arena is limited to a small subset of the membership. It is especially compromised when those with proven leadership skills step down or retire from the practice.
Truly democratic practices seem to be able to identify and elect a succession of qualified leaders; and, for the most part, the transitions are smooth. Typically, though, these are the exceptions rather than the rule. All too often, the key determinant in choosing a new leader rests on the group’s historic pattern of promotion. “This is how we’ve always done it.” It may be helpful at this point to provide some examples of leadership style and transition.
Leadership Style and Transition
Some rely on a long-time president or managing partner in what many observers would refer to as the Czar model. Often, these leaders become legendary for the power held over their membership. As well as the leader may run the practice, though, the question always becomes: who will replace him/her? The resulting gap in experience, authority and relationships can provide significant barriers to effective evolution into the next dynasty.
Too many groups have implemented a rotation system whereby each physician or CRNA is president for one or two terms before the next person takes over. There are several obvious problems with this approach. First, not all providers are equally qualified for the job, and so the practice may falter during their term if more qualified members do not step in. Second, such a rotation may result in an inconsistent message to the practice’s customers, especially the facility administration. Nothing is more important than the practice being able to speak with one voice so that it can effectively and consistently implement quality care and good customer service. Often, the impact of such a system is that the leadership is playing not to lose rather than playing to win.
Hindrances to Leadership
The underlying problem is that anesthesia providers have been trained to focus on what happens in the operating room and not outside of it. They understand that anesthesia is both art and science, an act of creation in which they balance the needs of the surgeon, the patient, and their own intuition. They have practiced on hundreds, if not thousands, of patients. What they have not focused on is the economics of anesthesia and the essential principles of customer service.
However complicated the administration of anesthesia, it requires the management of a very different set of variables than the interaction with the OR staff, nursing and administration. There is no better example of this than the renegotiation of a hospital contract. Providers who are used to being able to resolve critical clinical issues in a matter of seconds with the administration of “a little more of this agent or a little less of that one” often become frustrated by the business-related demands of administrators.
As many observers of anesthesia practice management have noted over the years, creating customer confidence in the service provided by an anesthesia practice requires three things: accountability, collaboration, and innovation. These are further defined below.
- Accountability involves the setting of clear standards and customer expectations and ensuring that they are consistently implemented. The essential element here is that you cannot manage what you cannot measure.
- Collaboration is more than working as a team of independent agents. It is about collaborative problem-solving and anticipating the changing needs and expectations of the surgical and OB staff.
- Innovation is essentially about value creation. How does the practice distinguish itself? What keeps administrators from thinking they might get better service from another provider group?
It is the critical role of leadership to ensure that all three of these group priorities define the experience of the customer. To accomplish this, leaders must be able to define and communicate a clear vision for the practice. They must be able to evaluate and criticize their colleagues effectively but sell and defend the practice aggressively. Many providers excel in some aspects of practice management but not all, hence the fundamental management challenge.
This is why practices must focus on succession planning. They must strive to identify and develop the skills of those new members with management potential. Education requires commitment and investment. The ASA Practice Management Conference is an excellent resource to explore the dynamic nature of anesthesia practice management. An MBA program may also prove useful to those who need to manage their financial knowledge.