Strategies to Maintain Group CohesivenessFriday, May 6, 2005

8:30 – 9:00 AM

James English, M.D.President

Anaesthesia Associates of Massachusetts

How Do We Do it?

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Culture

“The set of shared attitudes, values, goals andpractices that characterizes a group”

Webster’s Dictionary

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Culture

•Patient safety •Excellent efficacious service•Anesthesia care team•Good citizenship at facilities•Strong work ethic•Equality in workload and compensation

How to Perpetuate Culture and Maintain Cohesiveness

•Everybody does (almost) everything•Equal pay for all•The call team•The anesthesiologist who practices pain management•Monitoring the troops

Everybody Does (Almost) Everything

Flexibilityhttp://www.funnypart.com/funny_pictures/flexibility.shtml

“Everything”

•Straightforward pediatrics•Obstetric anesthesia•Regional anesthesia•Vascular, thoracic, trauma, neurosurgery•Rotate to at least three facilities•In-house call•Call team•MD/CRNA anesthesia care team

Rotating

•Necessary for members to absorb culture•All MD’s and CRNA’s•At least three facilities•Practice with familiar personnel/(friends) in different settings•Core vs. rotating personnel•Employment vs. deployment (deep bench)

MD/CRNA Anesthesia Care Team

•AAM’s predominant form of (private) practice•Mutual respect•Collaboration on anesthetic plan•Shared workload•Camaraderie and loyalty

Niches

•Cardiac (TEE)•Pain management•Complex pediatrics•Critical care

Niche anesthesiologists also do “everything”

The Key

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Equal Pay

•Shareholder status after three years•Equal base draw•Overtime incentives available to all•Equal distributions

Differential Compensation for Extra Clinical Endeavors

•A work in progress•Reward and incentivize group members who contribute more•Preserve the culture of equality•Time, money, titles, privileges

Extra Clinical Endeavors

•Duties of officers, chiefs, residency directors•Research initiatives•Consulting opportunities•New ventures to benefit the group

Before Call Team

•4 first calls out of house•6 back up calls•Facility dedicated•Potential for unequal work and time•Non call MD’s “trapped” late•Four post call MD’s daily

Call Team

•Three high teammates•Combined privileges cover all facilities and niches•Seven low teammates•Cover ten out of house call positions

Call Team Advantages

•Deeper coverage with the same (or less) number of people•Fairer distribution of workload•Less late days for non-call people•More post-call MD’s available for assignments

Call Team Coordinator

•1 of 3 high team MD’s•Dispatcher and practitioner•Receives all bookings, floor calls, pain calls, ICU/ER calls•Coordinates location, credentials, expertise

AAM Daily Call Team Schedule/Call Team Coordinator Worksheet

Call Team Pitfalls

• Missed page/CTC incommunicado

• Credentialed M.D. occupied elsewhere

• Emergency OB when in house MD occupied

• Inclement weather

• Backup CTC• Avoid dead spots• No alpha pagers• No relayed messages – obtain

confirmation• Anticipate thin coverage• Low call team• In-house• Expanded CRNA coverage• Early notification of in-house cases• Location of backup based on time of day,

traffic, distance• Facility dedicated MD• Consider in-house or hotel• Four wheel drive vehicles

Problem Solution

The Anesthesiologist who Practices Pain Management

Anesthesiologists Practicing Pain Management

•9 doctors to cover 6 sites•Practice 50 to 80 percent•Rotate to pain clinics and OR’s

Pain Specialists Practicing Anesthesia

•Call coverage•OR coverage early and/or late•In-house emergency back-up•Teaching•Expertise to the call team

Pain Chief

•A peer to facility chiefs•Liaison to hospital administration•Business and clinical issues

Monitoring the Troops

“You can observe a lot by watching”

Yogi Berra

Corollary: You can hear a lot by listening

Communicate, Communicate, Communicate

•Facility Departmental•Board of Directors•Steering Committee•Chief’s Clinical Management Committee•Shareholders•Future Shareholders

Meetings

Other Communication Strategies

Reaching outCRNA site managersAAM websiteStandardization committeeSocial functions

Issues Identified through Vigilance

•Morale and burnout•Safety•Drug seeking behavior•Depression•Alcoholism•Debilitating illness