LoAnn VandeLeest, RN, MBA-H, CNOR, CASC, CHSP, has been the CEO of Northwest Michigan Surgery Center in Traverse City for 2 years. Frederick Campbell, MD, of Traverse Anesthesia Associates, who has worked at the center for more than a decade, is the de facto manager of the facility's anesthesia service. They have an outstanding professional bond that keeps anesthesia and administration in lock-step. We recently sat down with them to find out what makes the relationship tick.

Q: How do you ensure providers follow polices and procedures and meet the center's needs?
LV: When I arrived at the center, the anesthesia contract was up for renewal, so I took a long hard look at it and had a very frank conversation about my expectations with Dr. Campbell. It's an exclusive contract, but they had to continue to perform well if they wanted to maintain that exclusivity without risk of us searching elsewhere for service.

FC: She expects us to provide first-rate service to meet the needs of physician-shareholders, patients and the staff. We certainly feel like we do that based on feedback from patients, physicians and staff.

LV: I came in as the new CEO and he entered the meeting as someone who'd been at the center its entire 10-year existence. He knew the challenges his team faced, especially with ensuring a smooth and productive working relationship with the facility's physician-owners. We gained a lot of trust in one another in that meeting. However, I did make it clear that I'd establish reasonable expectations and hold his team accountable.

Q: So you recommend establishing a point person for the anesthesia team, someone who can keep the lines of communication open between the providers and the facility's administration?
LV: The beauty of what's occurred here is that we have one person who serves as the face of the anesthesia team. Dr. Campbell is an extremely reasonable and measured person who's a good thinker. When he gives an answer, it's typically thoughtful and fair to the needs of his group and our center.

FC: I'm certainly very approachable. I see all the perspectives, and I think that's important from both sides in any kind of business relationship. Each of us benefits by understanding the forces in which the other operates. That's extremely helpful in maintaining the relationship.

Q: What type of provider should fill that leadership role?
FC: Being relatively senior helps. I've worked 37 years in anesthesia, in a variety of environments, which has given me incredible perspective. You also have to be a good listener, but it goes beyond that. You need to stay sensitive to what's going on in the facility at all times to get a sense of the various vibrations from surgeons, staff and fellow providers. That's hugely important.

Q: How do you handle problems that inevitably arise?
LV: We ask providers to handle any issues they might have in a professional manner, meaning they report concerns directly to Dr. Campbell instead of complaining to someone on the surgical team about what they want done in the room. We have processes and polices for dealing with issues.

FC: There's got to be a personal connect. Working through problems over e-mail is not the way to approach it. I think you have to have an open line of communication, be accessible to one another and feel comfortable finding the other and saying, Hey, I need 5 minutes. Can we sit down and talk about a problem and discuss ways to address it?

LV: I'm a nurse by trade and administrator by training. I don't want to play the peer to the providers — I want their peer to do that. Dr. Campbell handles that role beautifully. He manages situations and holds his team accountable to general good practices or specific policies we have in place. He discusses issues or changes we want implemented with his team and comes back to me with further insights that we consider when making decisions about how we'll move forward. It keeps the relationship between the surgical staff and anesthesia civil and productive.

Q: How do you ensure providers will thrive when faced with the unique challenges of administering anesthesia in an ambulatory setting?
LV: Identify which providers like to work in outpatient ORs — who get ambulatory anesthesia — and have them scheduled to work at the facility. We rarely have providers who grouse the whole day. If they do, they're not accustomed to the fast pace that keeps them shuttling between rooms and pre- and post-op areas instead of having longer turnovers that allow them time in the lounge, like they're used to doing at the local hospital.

FC: Having the right group of providers is important. We have more than 40 CRNAs and anesthesiologists on staff, and not everyone is well-suited for the ambulatory setting. We try to keep those providers at other facilities where their approach is better suited. If you ask for that, it's usually something most anesthesia groups will consider as they develop staffing schemes.

LV: Dr. Campbell developed a survey for surgeons so they could let us know which providers perform well and which could use more work in meeting our facility's needs. The survey basically asked if our providers had the attitude and skill to work in our center, and gave surgeons an opportunity to speak their minds about the skills they see on a daily basis. That's a valuable tool for assessing the performance of your providers. It also helps fulfill the requirement of assessing a contracted service, as accrediting bodies and CMS both require.

Q: What value-added services do you expect and provide?
LV: The role Dr. Campbell fills is not contractually required, but the leadership he provides really does make the relationship with our providers exponentially better.

FC: Educating staff and actively participating in administrative and governance roles is important. I sit on the quality improvement and medical executive committees, and promote QA initiatives throughout the center. Anesthesia groups should also partner with administration to ensure compliance with accrediting agency standards and look for ways to control costs.

LV: We also want them on the cutting edge of care. This is what we're doing now, this is what we want to do, and here's where you fit in. Will you support us in our efforts? That keeps the anesthesia team informed, gives them time to plan, and opportunity to research and learn the latest techniques or how to use new technologies.

FC: Ensuring current care is one of anesthesia's primary responsibilities. We're fortunate to have our pick of young doctors joining us from different training centers who bring different experiences and perspectives to the table. That kind of fresh blood is helpful to a group like ours. It's very important that your providers feel a sense of responsibility to search out and learn about what's being done elsewhere and remain abreast of the literature. But it's also important to not jump on the bandwagon just because something is new and trendy or generates another revenue stream. You first want to see documented patient benefit before adding a new device or technique.