Anesthesia Alert: Rethinking Struggling Anesthesia Models

Two providers — a CRNA and an MD — on surviving today’s staffing climate.

As hospitals and ASCs across the country struggle to staff their anesthesia departments, some forward-looking groups are recentering their anesthesia models and culture around the patient and creating more value for surgeons and facilities.

Here’s some insight on this development from Michael Moreau, DNAP, CRNA, and Sam Hassan, MD. Both are associate partners at Arizona Anesthesia Solutions (AzAS), which is part of Guide Anesthesia and based in Phoenix, Arizona.

Promoting autonomy, teamwork

Outpatient Surgery Magazine (OSM): Both CRNA and MD anesthesia professionals have a storied history — but they also have a well-known history of tension. As leaders at CORE Institute Specialty Hospital (CISH), a nation-leading orthopedic hospital, how do you do it differently?

Michael Moreau (MM): The team-first approach that we have separates us from many groups. We sacrifice political agendas and egos for the greater good of the team. We set an expectation for our providers from Day One to be open to sharing knowledge and skills with others, as well as to possess the humility to learn from members of the team.

Sam Hassan (SH): Historically, MDs and CRNAs were in conflict in many practices. Most recently, attitudes have changed because both professions started to realize that they benefit from one another. Cooperation and teamwork are the most effective and efficient way to cut turnover times and costs, thus improving patient outcomes. We allow independent practice where each of us can do what we do best, knowing that we can always reach out and get help from one another. Working as a team is much better than working separately with conflict.

Facility differences

OSM: Within your group, CRNAs and MDs practice both independently and collaboratively at times. When you are part of an interprofessional team, what does that look like on a daily basis? Who runs the board? How do you tackle leadership duties?

MM: When practicing in the independent setting, we still have a culture of open communication between our CRNAs and MDs. This profession is much too difficult to survive as a lone wolf. While in the collaborative setting, our CRNAs and MDs are performing their own cases. Our MD partners are available for expert consultation throughout the day. The board runner in this setting can be a CRNA or MD, based on leadership abilities and comfort with the flow of the facility. We have a shared leadership model for this orthopedic facility. The medical directorship is under an MD, and job duties such as credentialing, serving on peer-review committee, attending medical executive meetings and department oversight fall under them. The chief CRNA position manages the day-to-day operations of the facility, ensuring the daily flow of work and managing the schedule. Both leadership positions attend an anesthesia committee meeting composed of all the administration and leadership positions at the facility to solve problems as they arise. The chair of the anesthesia department is also an MD who works closely with the chief CRNA to run the preadmission testing department that deals with anesthesia clearance for the facility. Our MD and CRNA leaders work very closely to provide the best anesthesia services possible to the facility.

SH: At one facility, either an MD or CRNA can be the leader for the day. It’s not based on your degree but your leadership skills and your ability to promote efficiency within the schedule, managing patient histories and physicals, doing nerve blocks and giving breaks. And, of course, it’s also based on working with the OR team to facilitate cases.

Building a culture of excellence

OSM: What practical steps can other anesthesia groups take to build a culture of excellent services, clinical autonomy and deep teamwork?

MM: The first step is to change the culture. Once a team-first culture has been established, then everything will follow suit. With the drastic anesthesia shortages our country is facing, every team member should be able to function to the highest level of their training and capability. Our culture helps promote this self-improvement to provide the best anesthesia service possible.

SH: It’s vital to understand that each of us brings strengths into the practice. Promoting a sense of ownership and pride in the practice increases a sense of responsibility and efficiency. Coming to work and acting like this is “just a job” does the opposite.

Communication practices

OSM: “Communication is key” is a common saying. What are your best practices for communicating with your group, surgeons and administration?

MM: Excellent communication isn’t common in health care, unfortunately. High-level communication skills are often learned from those you surround yourself with. We rely on the leaders within the practice to model these effective communication skills. The most difficult conversation is often the most important one to have. Proper communication is crucial when communicating with administration, surgeons and members of the team. We prioritize excellent communication as a driving force within the group.

SH: Within our group, we send out HIPAA-secured messages throughout the day. We also have weekly and monthly conferences that deal with various aspects of the practice, such as updates and education.

As for the surgeons and hospital administrators, we try to be in as many meetings as possible weekly, monthly and quarterly to discuss all aspects of our practice and how it pertains to the hospital to improve efficiency and promote better communication in general.

Staying in sync

OSM: Every professional has their own opinion and style. How do you stay in sync with each other in “gray” areas such as patient selection or clinical policy and get buy-in from stakeholders?

MM: This is where high-level communication skills come into play. Before any communication is presented to administration or to surgeons, our team will meet and come to a consensus on what information we want relayed and in what manner.

SH: We have periodic group meetings to update members on new changes in policy or recommendations for the group. We also review questionable patients that are sent to us by the pre-op clinic so we may review the charts to decide whether the patient is appropriate for surgery at that time or needs further consultation with cardiology, pulmonary or other medical disciplines.

Value and culture

OSM: Many anesthesia departments are looking to increase their value right now, but with greater autonomy comes greater responsibility and a greater need to communicate and function as a team. How does the culture in your current environment compare to previous environments in which you’ve worked? How is your approach different from what you’ve seen elsewhere?

MM: This environment is drastically different from my previous group. This group promotes self-improvement and skill acquisition with help and guidance from other team members. I have never experienced such synergy and camaraderie within an anesthesia group. Humility is key. We promote the idea of always being open to new ideas and skill acquisition from members of the team, regardless of designation.

SH: Anesthesia is no longer about just anesthetizing patients. Hospitals want anesthesia providers to be more involved in decision-making to help improve their efficiency and lower costs.

This means that we must be on numerous hospital committees to stay in constant contact with the hospital staff and administration to let them know we are there to help with issues that arise and constantly find ways to improve patient efficiency, safety and experience. Caring for patients is a team approach, and anesthesia is a vital part of this process. OSM