Latest / Becker’s Healthcare Podcast / What CEOs Need to Know Before Changing Anesthesia Partners

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What CEOs Need to Know Before Changing Anesthesia Partners · Becker’s Healthcare Podcast

0:00
Hello, everyone. This is Erica Spicer Mason with
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Becker's Healthcare. Thank you so much for tuning
0:04
into the Becker's Healthcare podcast series.
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So today we're going to talk about what
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CEOs need to know before changing anesthesia partners.
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And joining me for this conversation is doctor
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Josh Lumbly, the chief quality officer and senior
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vice president of physician operations at Northstar Anesthesia.
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Doctor Lumbly, so glad to have you with
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us on the podcast today. Thanks for being
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here. Yeah. Erica, thanks for having me. Yeah.
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We're so glad to have you. And before
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we get into the heart of our conversation,
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wanted to know if you could just briefly
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walk our listeners through your own professional journey
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and maybe share a little bit about the
0:39
work that you're doing right now.
0:41
Yeah. So, Erica, I'm a practicing anesthesiologist,
0:44
and I serve as the chief quality officer
0:47
for Northstar Anesthesia.
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And I think about my role as kind
0:52
of,
0:53
a
0:55
overlap of three circles, so a Venn diagram,
0:58
that typically are usually separate in health care.
1:01
So first, I'm the clinical lead on our
1:04
business development efforts. So
1:07
I am the person in the room,
1:09
with hospital administrators
1:10
when they are evaluating
1:13
anesthesia partners.
1:14
And then secondarily,
1:16
when those partnerships begin, I typically serve as
1:19
the executive clinical sponsor helping to stabilize the
1:23
practice
1:24
during
1:25
the startup and transition period.
1:27
And then thirdly, I oversee our office of
1:30
clinical quality. So I focus on patient safety,
1:33
performance improvement,
1:34
and supporting clinicians across
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our
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multiple hundreds of clinical locations, both ASCs and
1:41
acute care hospitals.
1:43
And so what's really interesting is that those
1:45
first two experiences
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seemingly very disparate being in the room during
1:50
a hospital evaluation and being present during the
1:53
early months of a new partnership,
1:55
those directly inform how I think about
1:58
quality and operational stability. So from my standpoint,
2:02
you know, we're talking today about anesthesia transitions,
2:06
and I think about those not really just
2:09
as contracts, but more so
2:11
complex clinical systems
2:13
that have to work reliably
2:15
starting from day one.
2:19
That's so well said, doctor Lumley. And I
2:21
think your perspective coming from, you know, it
2:24
sounds like you have your your hand in
2:25
a lot of business operations, clinical operations. You
2:28
have a really well rounded perspective that you're
2:30
bringing to partnerships
2:32
and to this podcast episode today. So I'm
2:34
excited to dig in and learn a little
2:35
bit more about,
2:37
what these partnerships
2:38
should look like when they're effective.
2:41
And and we know that anesthesia right now
2:43
is an area of care delivery that is
2:45
certainly facing a lot of strain from a
2:47
workforce standpoint
2:48
and in other areas. So I think it's
2:51
important to start
2:52
high level here and just maybe start at
2:54
the beginning, and that's selecting a new anesthesia
2:57
partner.
2:58
I think executives probably assume that maybe the
3:00
hardest decision is selecting
3:02
the right partner, but I'd love to know
3:04
how that compares to what you're observing in
3:06
the field. You know, does that selection process,
3:08
does that ring true for you as the
3:09
most difficult part or does the real challenge
3:11
start somewhere else?
3:13
Yeah. It's a great point. So, of course,
3:17
when you if you as a hospital administrator
3:20
have gotten to the point where you are
3:23
considering
3:23
transitioning anesthesia services,
3:26
you have really
3:28
focused on a really complex difficult problem, so
3:31
maybe you're lacking in leadership.
3:33
Maybe you're lacking
3:35
in confidence in your existing partner being able
3:38
to scale and grow with you as an
3:40
organization.
3:41
Maybe the group that you've got,
3:44
has some clinical deficiencies
3:46
or,
3:47
maybe, frankly,
3:48
you feel like they,
3:51
are lacking in,
3:53
you know, the leadership and the operational
3:55
sort of savviness that you need in a
3:57
good partner.
3:59
And, yes, wrestling with that decision making process
4:02
does feel very complex, and you may feel
4:04
like that's the hardest decision.
4:06
But in reality, it's
4:08
really the first step of a multistep
4:12
complex
4:13
problem that you've gotta solve. So the real
4:15
test really begins
4:17
the day the transition starts. So the day
4:19
you announce, we are going in a new
4:21
direction with our anesthesia services because
4:24
anesthesia touches
4:26
nearly every surgical case in the hospital, every
4:29
procedural case in the hospital.
4:31
And if your confidence in the staffing model,
4:35
the leadership structure, the recruiting pipeline, if those
4:38
aren't already in place,
4:41
then you can start to see, really, even
4:43
before the transition has taken place,
4:45
some challenges and friction around OR staffing
4:49
and meeting
4:50
the
4:51
procedural volume needs that currently exist with your
4:55
with your existing footprint.
4:57
So, really,
4:58
the best transitions
5:00
are the ones that
5:03
are
5:04
the the quietest, the ones where you really
5:07
don't have a whole lot of hand wringing
5:08
and teeth gnashing in the Operating Room.
5:11
Surgeons and proceduralists, they've seen the same level
5:14
of coverage. Their cases continue to start on
5:17
time.
5:17
Clinical teams, the ancillary
5:20
perioperative team, they feel supportive.
5:23
And I guess, ultimately,
5:25
that doesn't happen by accident. You gotta have
5:28
months of preparation,
5:30
dedicated preparation,
5:32
a a good,
5:34
mechanism for communicating with your partner,
5:37
recruitment that's already underway, retention that's already underway,
5:41
leadership on the ground early,
5:43
and a pretty clear operational plan to all
5:46
the salient stakeholders.
5:48
So when I am communicating with hospital leaders,
5:51
I'll tell them, you know, look. The the
5:53
the contract,
5:54
what we are agreeing upon, that's the decision
5:56
point, but the operational stability is ultimately
6:00
gonna be what's gonna define the success of
6:02
this transition.
6:05
Really helpful points about transitions, Doctor. Lumley. It
6:08
sounds like if I'm following, it sounds like
6:11
a lot of complexity and preparation and intention
6:14
goes into the transition, but the best transitions,
6:18
I think you put it, they happen quietly
6:20
and they don't feel like big transitions. Do
6:22
I have that right? Yeah. Yeah, exactly.
6:25
Yeah. Well, let's let's go a little further
6:27
there. You know, when CEOs and COOs are
6:30
looking at anesthesia groups, what questions do you
6:33
think reveal whether a group can actually deliver
6:36
that stable, quiet transition
6:38
rather than just making a strong pitch?
6:41
So I think there's four
6:43
themes, I would say, that need to be
6:45
explored,
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to
6:47
that'll really
6:48
clarify
6:49
and reveal a lot about what a transition
6:52
with a prospective partner, what that's gonna look
6:55
like. So the first is,
6:56
who on your team is gonna be responsible
6:59
for the transition,
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and when are they going to be here?
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Is this a person who's gonna be here,
7:06
you know,
7:07
a smattering of days after announcement and then,
7:10
you know, say, hey. I think we're good.
7:12
I'm gonna handle interviews from my home office
7:15
in another state, and then you'll see me
7:18
on the transition date.
7:20
And,
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if that leader is someone who's going to
7:25
do that, that's a that's a warning sign.
7:27
There needs to be a leader,
7:30
an operational and a clinical leader,
7:33
that is part of your
7:35
part of the team on the with the
7:38
new partner,
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who's gonna be the point person and is
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gonna be a face that is seen with
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great regularity
7:45
leading up to the transition and post transition.
7:48
The second one is,
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do you have a recruitment pipeline
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that you feel like that you feel confident
7:54
in in this market?
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No one's going to have just a pipeline
8:00
of providers that aren't doing clinical anesthesia that
8:02
they can say, hey. You know, ninety days
8:05
from now, I'll have you a full team
8:07
that's ready to go.
8:08
But, really, you should feel some confidence
8:11
in your prospective partner's capacity to be able
8:14
to staff your operating rooms and recruit
8:17
in a market
8:18
no matter how difficult or challenging that market
8:20
is.
8:21
Thirdly,
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ask them point blank what is the fur
8:24
what is the transition and what does the
8:26
first ninety days look like,
8:28
operationally
8:29
and from a clinical you know, meeting the
8:31
clinical
8:32
needs and,
8:33
the contracted
8:35
points of service that your department of anesthesia
8:37
should cover. So,
8:39
that's gonna look like what what is contingency
8:42
staffing? Are you dependent on ten ninety nine,
8:45
PRNs, full timers, etcetera?
8:48
Do you will you have a schedule made
8:50
up that our,
8:52
perioperative staff
8:54
can look at and feel confident and that
8:56
the names that are listed on this schedule
8:58
are in fact gonna be the people that
8:59
show up on on those days, and how
9:02
are you going to communicate
9:03
stability
9:04
with our,
9:06
proceduralists and our surgeons.
9:09
And then,
9:10
and then the last one is
9:13
retention, retention, retention. How are you going to,
9:18
gain trust
9:19
with our existing department of anesthesia,
9:23
such that you are retaining,
9:25
a good portion of the anesthesiologist
9:27
and nurse anesthetist
9:29
at that location. So, obviously, you wanna instill
9:31
confidence or you wanna have confidence as a
9:34
hospital executive
9:35
in the group's capacity to recruit, but you
9:39
also wanna have confidence in their capacity,
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to,
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to retain existing clinicians and hold on to
9:47
clinicians that they bring on board. Because ultimately,
9:50
the success long term of the department,
9:53
revolves around your new partner's capacity
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to focus on building a stable clinical culture
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so that day in and day out, the
10:01
anesthesiologist,
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the nurse anesthetist, the AAs that you have
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staffing your Operating Rooms are the same people
10:07
day in and day out.
10:10
Really, really helpful questions that you've shared here,
10:13
doctor Lumley. So questions around whether leadership is
10:16
present, what the pipeline looks like, clarity around
10:19
the first first ninety days, and then retention
10:22
as you've underscored,
10:23
really important questions for leaders to keep in
10:25
mind.
10:26
And I kind of want to flip that
10:28
question on the other side and talk about,
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you know, based on what you've seen, what
10:34
are early warning signs that any anesthesia transition
10:37
is not going well and that it's maybe
10:39
putting OR stability at risk? And if and
10:41
when you've seen that happen,
10:43
what actions do you recommend that leaders take
10:45
when those signs appear?
10:47
So I think,
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the the first and the most obvious red
10:52
flag is you're talking to your new partner
10:54
and saying, how are things going? And they
10:56
say, it's perfect.
10:58
No problems at all. None. There there's not
11:01
been any challenges, no missteps,
11:04
no,
11:05
unexpected things that have happened. And that is
11:08
that that sort of
11:10
that just does not exist. That's a panacea.
11:13
There are always going to be unexpected things
11:17
that happen
11:18
during a transition of anesthesia services. I really
11:21
think that the the key is is how
11:23
does the group and your how does your
11:24
partner adapt to those unknown unknowns
11:28
that occur during a transition of anesthesia services.
11:30
So at a high level, if you have
11:32
a partner that says, it's perfect. No problems
11:35
whatsoever.
11:36
That's a red flag because there are undoubtedly
11:39
things that are not gonna go according to
11:41
plan during a transition. It is how your
11:44
partner handles
11:45
those,
11:47
sort of challenges that sort of elucidates
11:51
their skill set and being able to successfully
11:53
make that transition. So having said that, I
11:55
think that
11:57
the earliest warning signs tend to be around
12:00
operations
12:01
rather than clinical.
12:03
So this is going to be
12:05
increased open shifts,
12:08
last minute schedule changes in
12:11
with great frequency.
12:13
That indicates
12:15
a heavy dependence on locum tenants,
12:18
ten ninety nine labor, non full time staff,
12:21
and really
12:23
any sort of tension or vibe shift that
12:26
you're picking up in the Operating Room indicating
12:28
some friction between the department of anesthesia,
12:31
perioperative staff, and surgeons
12:34
and their capacity to get cases booked. So
12:37
sometimes that's gonna be delayed first time starts.
12:40
Sometimes that's gonna be Operating Rooms shutting down
12:43
earlier than expected and
12:46
stacking cases one after the other after the
12:49
other, indicating some
12:52
decreased capacity,
12:54
for you to get your cases done or
12:56
your surgeons to get their cases done at
12:58
the end of the day.
12:59
Ultimately, that is a,
13:02
early warning sign that there's a staffing strain
13:04
that's existing there. And when
13:07
you, as an administrator,
13:09
see that,
13:10
you should expect transparency from your partner.
13:14
That is not to say that when you
13:16
see it, that's a sign that things have
13:17
gone sideways and you've made the wrong decision,
13:20
because as I said, you know, there are
13:22
unknown unknowns as it relates to to staffing
13:25
anytime there's a transition.
13:27
But what you should expect from your partner
13:30
is transparency.
13:32
And so that should be
13:34
your partner
13:35
proactively
13:36
communicating to you challenges that are arising
13:39
or certainly,
13:42
when pressed,
13:43
your partner,
13:45
being clear eyed and honest
13:47
with some of the challenges that that they
13:49
are having in the operating room as it
13:52
relates to staffing. So that person should be
13:55
sharing staffing data,
13:57
recruitment progress,
13:58
retention progress,
13:59
and any of the mitigation plans that might
14:02
be, that they have
14:04
for solving the the current state staffing,
14:07
plans. So, ultimately, what I'm saying is
14:10
staffing transitions
14:12
are they are gonna be these trans sorts
14:14
of transitions
14:15
are very challenging,
14:17
and,
14:19
and challenges and unexpected events will occur. But,
14:22
really, what is going to distinguish a partner
14:24
that's gonna be with you for the long
14:25
time
14:26
is how quickly they surface those problems, how
14:29
they communicate those problems to you, and how,
14:32
as a good partner, they address those problems
14:34
in coordination
14:36
with you and your perioperative
14:38
staff.
14:40
Yeah. Doctor. Lumley, it sounds like transparency is
14:42
such a foundational
14:44
piece of this relationship. You know, acknowledging that
14:47
realistically,
14:47
this is going to be a complex and
14:49
challenging transition, but
14:51
data transparency, accountability sounds like,
14:54
those are the things that can help
14:56
ameliorate the effects of those potential red flags
14:59
or at least to feel reassured that your
15:01
partner is able to address them. Exactly.
15:04
Yeah.
15:05
Well, let's go ahead and shift gears just
15:07
a little bit here. I want to talk
15:08
a little bit more about recruitment and retention.
15:10
I know that we touched on earlier in
15:12
the episode that
15:14
staffing in general and anesthesia right now is
15:16
quite strained.
15:17
What do you think CEOs should understand about
15:20
the anesthesia labor market right now? And how
15:22
can they tell whether a prospective partner really
15:25
does have a credible staffing strategy versus just
15:28
a hopeful one?
15:30
Yeah. It's it's a great point.
15:33
And,
15:34
there is
15:36
really no secret sauce to, you know, fixing
15:40
the labor market challenges that exist. Ultimately,
15:44
it's not as white hot as it was
15:46
in, say, '21, '22, and '23, but you
15:50
still have an exquisitely tight labor market,
15:53
for anesthesiologists
15:54
and nurse anesthetists
15:56
with
15:57
increasing demands for their services both at
16:00
the hospital based business as well as the
16:03
ASC based business. So, of course,
16:06
recruiting is critical, but I would argue that
16:10
that as a good partner, we should be
16:13
doubling down and focusing
16:15
on retention as well. So, yes, there's the
16:18
first r, which is recruiting, but there's also
16:21
a second really important r, which is retention.
16:24
And both of those need to be addressed
16:27
satisfactorily,
16:29
with your prospective anesthesia partner. So
16:33
that is going to mean
16:35
how do you
16:37
bring folks to the door? And once you
16:39
get them through the door, how do you
16:40
hold on to them? So that's gonna be,
16:43
are we establishing,
16:45
a strong leader in place
16:47
that,
16:48
really leads the department
16:50
in a strong fashion,
16:52
distributes
16:53
call, distributes schedules
16:55
equitably,
16:56
is developing
16:58
other leaders under them,
17:00
and is your partner one that can depend
17:03
on sort of a national base as it
17:05
relates to recruiting?
17:07
Certainly, you wanna be able to call upon
17:09
clinicians from all across the country.
17:11
But, also, do they have a great deal
17:14
of knowledge in your specific market for bringing
17:17
new people through the door? And then what
17:19
is their
17:21
across their footprint, what does their retention number
17:24
look like?
17:25
It's not just bringing people through the door.
17:28
As I said, it's holding on to them.
17:29
And are the people that they're bringing through
17:31
the through the through the door, are these
17:33
temporary
17:34
partial FTEs,
17:36
locum tenants, clinicians that, of course, are gonna
17:38
get the cases done, but may not be
17:40
contributing to the overall culture in the department
17:44
so that you have a stable department with
17:46
the same faces day in and day out.
17:48
And so I think
17:50
so much focus can be,
17:53
dedicated towards
17:55
recruiting and filling empty spots,
17:58
but a good partner should be able to
18:00
articulate
18:01
the their capacity to once they get people
18:04
through the door, we hold on to them.
18:07
We invest in their careers as leaders. We
18:09
invest in their careers clinically and operationally
18:12
so that, you know, they're growing their careers.
18:14
They they have some career progression,
18:17
and they are stable in seat. And so
18:19
you're seeing them day in and day out
18:21
in your department.
18:22
Mhmm.
18:24
Doctor Lumley, you've given us such
18:27
fantastic insights, ones that are really tangible as
18:30
well. So I just wanna say I appreciate
18:31
how specific you're being in all of these
18:34
considerations that leaders should be looking at when
18:36
they're looking at anesthesia partners or perhaps in
18:38
the early stages of the partnership and the
18:40
transition.
18:42
To round us out, I wanted to just
18:43
end on something that we already kind of
18:46
addressed and that's the concept of accountability because
18:48
I think that can kind of tie together
18:50
everything that you've shared with our audience today.
18:53
In in practical terms, what are the commitments,
18:56
reporting structures, or leadership behaviors that really do
18:59
show that an anesthesia group has, so to
19:02
speak, skin in the game?
19:05
Yeah. I mean, this relationship cannot be transactional.
19:08
It has to be consultative and a true
19:11
partnership.
19:11
So it's gotta show up in leadership structure,
19:15
and it has to show up in on
19:16
the ground behavior.
19:18
And sometimes when you hear skin in the
19:20
game, you think, well, what is the what
19:22
are the financial risks that my partner is
19:24
taking? And I like to turn that on
19:26
its head and say,
19:28
what are the investments that your partner is
19:31
making above and beyond
19:33
the contract to make sure that this contract
19:35
is sticky, and they are true
19:38
partners
19:39
in helping you grow your surgical volume. So
19:41
the first one is, what does leadership look
19:43
like? Is there leadership on the ground from
19:45
the organization
19:47
in the transition?
19:48
And is there leadership investment in terms of
19:50
growing
19:51
leaders at the local level so that you've
19:53
got a strong medical director, a strong chief
19:56
CRNA,
19:57
and a strong operations leader that's gonna be
19:59
engaged with you and with your surgical teams
20:02
as you try to grow surgical volume.
20:04
Secondarily
20:05
is, are they transparent? Are they transparent financially,
20:08
and are they transparent,
20:11
operationally,
20:12
staffing,
20:13
giving quality metrics, what the performance looks like
20:16
in the department? Is it a black box
20:17
that you really I I don't really know,
20:19
what staffing looks like there. I don't really
20:21
know what their quality metrics look like. I
20:23
don't really know what their revenue cycle looks
20:25
like. That cannot be the case. It has
20:27
to be open book, transparent reporting,
20:31
as a true partner. And then I think,
20:33
last but not least,
20:35
are they partners?
20:37
Are they truly invested in your medical staff
20:40
and aligned with you
20:42
and your hospital success. So that's gotta be,
20:45
you know, number one, of course, recruiting. It's
20:47
gotta be leadership development. It's gotta be retention,
20:50
and it's gotta be aligning around, like, system
20:53
based quality initiatives
20:55
so that we collectively
20:57
are accountable,
20:58
when there are challenges that arise. And we
21:01
collectively
21:02
are both, you know,
21:04
rowing in the same direction,
21:06
as the department of anesthesia
21:08
with the hospital department of surgery perioperative.
21:11
So, ultimately,
21:13
your partner should not look like a vendor.
21:15
The best relationships are gonna be true integrated
21:18
clinical partnerships.
21:21
Such a fantastic insight. Doctor Lumley, before we
21:24
close, is there any final piece of advice
21:27
or insight that you'd want our leadership audience
21:29
to hear, especially if they're considering an anesthesia
21:32
change in the next year?
21:34
Yeah. I think,
21:35
great question. And if I can leave with
21:37
any bit of insight, it would be
21:39
focus as much attention on the transition plan
21:42
as you do the actual
21:44
contract
21:45
itself
21:46
and the evaluation period of your perspective
21:50
anesthesia vendor, anesthesia partner. So questions about recruiting,
21:54
questions about leadership presence, questions about leadership development,
21:58
OR stability,
21:59
etcetera.
22:00
What do things look like not on just
22:02
announcement day or
22:05
transition day, but what do things look like
22:07
six months from now? Because the goal is
22:09
not just to select a partner. It's to
22:12
make sure that that transition is invisible, is
22:15
quiet,
22:16
as I said earlier, to your surgeons, to
22:18
your patients. Because when that happens,
22:21
it usually
22:22
occurs because
22:23
the hospital
22:24
and your anesthesia partner
22:27
have,
22:28
aligned
22:29
for a long term partnership view, not just
22:31
a we're gonna make the first through the
22:33
first ninety days and there's not gonna be
22:35
any hiccups in the Operating Room. We are
22:36
aligned collectively for a long term partnership in
22:40
mind, and we're making decisions
22:42
with that long term mentality in place.
22:46
Doctor Lumley, I wanna thank you for all
22:48
of your thought leadership today and the fantastic
22:50
insights that you've shared with our audience. I
22:52
know they have a lot to think about
22:53
here as we close the episode and just
22:56
wanna thank you for all the practical advice
22:58
and the wisdom.
22:59
Well, fabulous. Thank you so much for hosting.
23:01
It was a great time.
23:02
Oh, likewise. And of course, we'd also like
23:04
to thank today's podcast sponsor, Northstar Anesthesia.
23:08
Listeners, be sure to tune into more podcasts
23:10
from Becker's Healthcare by visiting our podcast page
23:13
at beckershospitalreview.com.