Latest / Becker’s Healthcare Podcast / The Case for Anesthesia-First Leadership

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The Case for Anesthesia-First Leadership · Becker’s Healthcare Podcast

• 0:01
  - In health care today, anesthesia can sometimes be
• 0:03
  - treated like a box to check, a logistical
• 0:06
  - requirement for surgery instead of a critical clinical
• 0:08
  - discipline that affects safety outcomes and patient experience.
• 0:13
  - Today, we're going to be talking about the
• 0:14
  - difference between being part of a company where
• 0:17
  - anesthesia is just another service line versus being
• 0:20
  - part of an organization where anesthesia is the
• 0:22
  - entire mission. This is a conversation about focus,
• 0:25
  - about respect, and about what happens when clinicians
• 0:28
  - are supported by leadership that truly understands what
• 0:31
  - they do.
• 0:34
  - Welcome to Unmasked, the CCI anesthesia podcast, the
• 0:37
  - show where we dive deep into the world
• 0:39
  - of anesthesia practice improvement, all the enhancement, and
• 0:42
  - the evolving landscape of health care. I'm Doug
• 0:45
  - Simpler, your guide on this journey as we
• 0:47
  - explore the strategies,
• 0:48
  - innovations, and stories that shape the future of
• 0:51
  - anesthesia care. Get ready to be enlightened,
• 0:53
  - inspired, and most importantly, unmasked as we unravel
• 0:57
  - the many layers of the current state of
• 0:59
  - anesthesia.
• 1:00
  - This is Unmasked.
• 1:02
  - Joining us today is Sean Bitts, certified registered
• 1:04
  - nurse anesthetist and vice president of clinical affairs
• 1:08
  - at CCI Anesthesia.
• 1:10
  - Sean has served for eight years at Union
• 1:12
  - Health, including four as chief CRNA and is
• 1:15
  - widely respected for his collaborative leadership style and
• 1:18
  - innovative approach to patient care.
• 1:21
  - Sean also serves on the board of directors
• 1:23
  - for the Indiana Association of Nurse Anesthetists,
• 1:26
  - actively shaping the future of the profession
• 1:29
  - in his state.
• 1:30
  - We're thrilled to have his voice and perspective
• 1:33
  - with us today. Welcome, Sean. Thanks, Chuck. Happy
• 1:35
  - to be here. We're also joined by Alex
• 1:37
  - Gorecki, president of CCI Anesthesia. Alex brings over
• 1:41
  - twenty five years of senior level experience in
• 1:43
  - health care leadership,
• 1:45
  - organizational development, and performance improvement.
• 1:48
  - Throughout his career, he has supported leadership teams
• 1:50
  - across more than 300 hospitals nationwide
• 1:53
  - with a focus on strategic growth, clinician engagement,
• 1:57
  - and operational excellence. We're fortunate to have his
• 1:59
  - strategic viewpoint in this discussion. Welcome, Alex. Thanks,
• 2:03
  - Doug. Appreciate you having me here. So let's
• 2:05
  - set the stage for this conversation today. Alex,
• 2:07
  - what happens when anesthesia is not a priority
• 2:10
  - in a health care system?
• 2:11
  - So anesthesia is critical
• 2:13
  - to the OR operations, and Sean will talk
• 2:16
  - about the clinical aspect of that in more
• 2:17
  - detail. But you have to keep in mind,
• 2:19
  - you know, whether it's a health system or
• 2:21
  - a multispecialty group that feels like they can
• 2:23
  - kinda be all things to all people, and
• 2:25
  - you end up with this dilution of your
• 2:27
  - resources and your focus.
• 2:29
  - It is a definite clinical service line in
• 2:31
  - and of itself. You can't have an ER
• 2:33
  - doc go up and do anesthesia. That's that's
• 2:35
  - not how they do. It's why they go
• 2:36
  - to medical school. That's why they specialize in
• 2:38
  - things.
• 2:39
  - And so there was a time when you
• 2:41
  - could blend a lot of these together, within
• 2:43
  - the system and and then have multiple services
• 2:46
  - under one umbrella. But it... Especially with the
• 2:48
  - big multi specialty groups, it attracted private equity
• 2:51
  - investors.
• 2:52
  - It helped them to maybe do one service
• 2:55
  - line as a lost leader a little bit.
• 2:57
  - Maybe in the ER, they made a a
• 2:59
  - huge margin, but in the,
• 3:01
  - in the anesthesia, it was, you know, more
• 3:03
  - subsidized.
• 3:04
  - The payers now have kinda ratchet down on
• 3:06
  - reimbursement, and there's new legislation out there now
• 3:08
  - on surprise billing and all that that that
• 3:11
  - makes it a lot less attractive to to
• 3:13
  - do that kind of model. Even in our
• 3:15
  - company,
• 3:16
  - when we recruit
• 3:17
  - new people to come in to be part
• 3:18
  - of our practice management team, if they came
• 3:21
  - out of, an ER group or hospital medicine
• 3:23
  - group, it takes them a few months to
• 3:24
  - learn,
• 3:25
  - how our how our business works, how anesthesia
• 3:28
  - works,
• 3:29
  - because it doesn't always translate over like people
• 3:31
  - assume that it does.
• 3:32
  - And so, it is a critical line service
• 3:35
  - line in and of itself,
• 3:37
  - and, and hospitals have to recognize that. Well,
• 3:39
  - it all boils down to taking care of
• 3:41
  - patients. And so
• 3:44
  - anesthesia is a specialized field, and so the
• 3:46
  - management
• 3:47
  - should be specialized as well. It takes specific
• 3:51
  - quality measures. It takes very specific training
• 3:55
  - and a specific subset of people to match
• 3:59
  - with, that clinical approach as well.
• 4:02
  - So
• 4:02
  - when we have operational,
• 4:05
  - assistance
• 4:06
  - within,
• 4:08
  - anesthesia management companies, they become very familiar with
• 4:12
  - the practice of anesthesia
• 4:14
  - and the support that it takes in order
• 4:16
  - for anesthesia to be efficient and take care
• 4:21
  - of the evolving changes of the OR.
• 4:23
  - When anesthesia is undervalued, Sean, how does it
• 4:25
  - affect morale performance
• 4:27
  - and retention?
• 4:28
  - So we want our providers to stay with
• 4:31
  - us. We want
• 4:32
  - to promote retention and hold on to these
• 4:35
  - high quality people
• 4:37
  - as long as we can.
• 4:39
  - And so culture and morale play into that,
• 4:42
  - and CCI
• 4:44
  - specifically is is very focused on culture and
• 4:47
  - and maintaining
• 4:49
  - high cultures within all of our practices,
• 4:53
  - to support that retention.
• 4:55
  - So we've established that
• 4:57
  - a a focus in anesthesia can have a
• 4:59
  - major impact.
• 5:00
  - Alex, why does CCI choose to remain anesthesia
• 5:03
  - only?
• 5:04
  - Well, it's because
• 5:06
  - a lot of the things, Sean has alluded
• 5:08
  - to, whether you're talking about the quality management
• 5:10
  - piece, whether you're talking about recruiting,
• 5:13
  - whether you're talking about,
• 5:14
  - operational efficiency and how you structure models,
• 5:17
  - you have to really have a clear understanding
• 5:19
  - of how that works, how you utilize a
• 5:22
  - team model, anesthesiologists and CRNAs effectively within the
• 5:25
  - model, How you handle,
• 5:27
  - callback or late late rooms, whether you have
• 5:30
  - post call day off, how you handle weekends,
• 5:32
  - how you handle high OB volumes.
• 5:34
  - These are not kind of cookie cutter ways
• 5:37
  - of doing this. Every place is unique in
• 5:39
  - in how it operates. And so you have
• 5:41
  - to really have a a firm grasp of
• 5:43
  - that. And that that comes from both
• 5:45
  - the the business side, but primarily from the
• 5:47
  - clinical side. And so you have to bring
• 5:49
  - those two together to say, okay. Clinically, in
• 5:51
  - an ideal world, we would have this.
• 5:53
  - Financially, the hospital can't do it that way,
• 5:55
  - so let's figure out,
• 5:57
  - in a more efficient way that kind of
• 5:58
  - finds a common ground between both of those
• 6:00
  - areas.
• 6:01
  - And then in the mix of all that,
• 6:02
  - you have surgeon preference, which throws a big
• 6:04
  - wrench in the works because you're like, oh,
• 6:06
  - we've got the perfect model, and this surgeon's
• 6:08
  - like, I'm not gonna do my cases at
• 6:10
  - that time. I'm gonna do them on this
• 6:12
  - time. And so you have to balance a
• 6:14
  - lot of aspects of that, keeping patient safety
• 6:17
  - the primary focus the entire time. And so,
• 6:19
  - you know, anesthesia runs the full gamut of
• 6:21
  - the case all the way from preopting well
• 6:24
  - in advance that patient coming in all the
• 6:26
  - way the all the way the PACU on
• 6:27
  - the back end to make sure the person's
• 6:29
  - coming out of the anesthesia okay. And so
• 6:32
  - it's important
• 6:33
  - that anesthesia
• 6:34
  - be focused and and the people running anesthesia
• 6:37
  - know what the heck they're doing because otherwise,
• 6:39
  - it's just gonna be like a free for
• 6:40
  - all, and that kills efficiency. It kills,
• 6:43
  - patient patient care,
• 6:45
  - and it upsets the surgeons when they can't
• 6:47
  - get the the coverage that they need throughout
• 6:49
  - the day and get the the OR time
• 6:50
  - that they need.
• 6:51
  - That uniqueness of each individual site
• 6:54
  - highlights the importance of our clinical leadership as
• 6:57
  - well,
• 6:58
  - having,
• 6:59
  - strong chiefs on-site to facilitate
• 7:01
  - what's right for the patient and what's right
• 7:04
  - for the anesthesia,
• 7:05
  - what's right for the OR as a whole.
• 7:07
  - And so we
• 7:09
  - try to focus heavily on,
• 7:12
  - on getting that strong
• 7:14
  - clinical
• 7:15
  - leadership in place so that, we can optimize
• 7:18
  - efficiency.
• 7:19
  - I'm a big fan of
• 7:22
  - modeling the OR as a whole after anesthesia.
• 7:25
  - And so
• 7:26
  - with that mindset,
• 7:28
  - we take the first strong step forward, and
• 7:31
  - then
• 7:32
  - the OR as a whole can can fall
• 7:34
  - in place in terms of how many rooms
• 7:36
  - are we running.
• 7:38
  - We can dive in and
• 7:40
  - analyze case times and,
• 7:43
  - the needs of surgeons, the needs of our
• 7:45
  - patients,
• 7:46
  - and then
• 7:48
  - model our staffing
• 7:50
  - after those needs,
• 7:51
  - make it... Make sense for the providers,
• 7:54
  - for the patients, as I mentioned,
• 7:56
  - as a... And as a system as a
• 7:58
  - whole.
• 7:59
  - And then the nurses and the techs of
• 8:01
  - the OR, that can be modeled after the
• 8:04
  - anesthesia, and that's just one piece of
• 8:06
  - really solidifying that efficiency.
• 8:09
  - Many places
• 8:11
  - seem to
• 8:12
  - not have that style of communication of,
• 8:16
  - modeling the staffing
• 8:18
  - with anesthesia
• 8:19
  - or the nurses and techs,
• 8:21
  - in whatever flavor that, you know, looks like
• 8:23
  - at the specific facility.
• 8:25
  - It's important to look into that and know
• 8:29
  - how can we move forward in
• 8:31
  - matching the two respects so that we can
• 8:34
  - ultimately promote
• 8:37
  - a,
• 8:38
  - well oiled machine.
• 8:39
  - When it's critical to to provide a retention
• 8:41
  - to having
• 8:43
  - a clear understanding of how to build these
• 8:44
  - models because I... I've seen ER groups try
• 8:47
  - to get an anesthesia, and they'll build twelve
• 8:49
  - hour and twenty four hour shifts just like
• 8:50
  - they would in the ER. Well, that doesn't
• 8:52
  - work in the OR. It's it's too cumbersome.
• 8:55
  - And then I've seen other ones that the
• 8:57
  - hospital will do it, and they'll treat the
• 8:59
  - CRNAs as as nurses. And they'll say, well,
• 9:02
  - they didn't get their forty hours in this
• 9:03
  - week, and, they only work thirty five. And
• 9:05
  - so should we cut their pay five hours
• 9:07
  - this week? And I'm like, no. You're missing
• 9:09
  - the point. If they if they were five
• 9:10
  - hours short, that means your ORs weren't running
• 9:12
  - like they were supposed to. You missed five
• 9:14
  - hours of billable revenue in your OR. You
• 9:16
  - need to go talk to the surgeons and
• 9:17
  - get those five hours up because you wanna
• 9:20
  - do forty forty five, fifty hours if you
• 9:22
  - can for each of your providers. If you're
• 9:24
  - underutilizing
• 9:26
  - them, then then you're you're costing your your
• 9:28
  - hospital money. If you're overworking them because
• 9:31
  - you're using an ER group model for an...
• 9:33
  - For a anesthesia model, then you're gonna have
• 9:35
  - turnover, you know, burnout and turnover. And so
• 9:37
  - getting it bright for the from the provider
• 9:39
  - perspective is critical as well.
• 9:41
  - And that five hours that that,
• 9:44
  - Alex is mentioning, you know, in a... On
• 9:46
  - the flip side of that, in a truly
• 9:48
  - efficient model,
• 9:49
  - we want the five extra hours. That means
• 9:51
  - we're doing higher volume cases
• 9:54
  - in less amount of time. That's higher efficiency,
• 9:56
  - and so it expands our capacity
• 9:59
  - to add more cases in. Once you're once
• 10:01
  - you're flowing efficiently and,
• 10:04
  - the OR is is matching with anesthesia,
• 10:07
  - you can get way more done. Surgeons are
• 10:09
  - more satisfied.
• 10:10
  - They're not sitting in between cases waiting on
• 10:13
  - things to get going.
• 10:15
  - Nobody wants that. Nobody wants that. We want
• 10:18
  - patients to be taken care of to the
• 10:20
  - top tier. Of course, that's always number one.
• 10:22
  - But number two, let's do it in
• 10:25
  - a way that makes sense for everybody,
• 10:27
  - and then we can all get home to
• 10:28
  - our families.
• 10:30
  - What is the impact to patient care when
• 10:32
  - you have a more singular focus like this?
• 10:34
  - We've talked a lot about the operational impact,
• 10:36
  - but we haven't talked a lot about the
• 10:38
  - patients. So let's let's talk a little bit
• 10:40
  - about the impact of patient care. Yeah. So
• 10:42
  - that's that's why we're all here. You know,
• 10:43
  - we wanna take care of patients to the
• 10:45
  - absolute best ability that we can.
• 10:48
  - And so having a
• 10:50
  - dedicated
• 10:51
  - anesthesia service that that isn't focused on funneling
• 10:55
  - resources to every other specialty,
• 10:58
  - all resources can go
• 11:00
  - directly
• 11:01
  - to the anesthesia from the anesthesia management company.
• 11:05
  - One way to build that out is having
• 11:07
  - clinical leaders.
• 11:08
  - So having someone on-site,
• 11:11
  - overseeing
• 11:12
  - exactly how the OR
• 11:14
  - operates,
• 11:14
  - how
• 11:16
  - the anesthesia providers are performing
• 11:19
  - in terms of quality and and efficiency.
• 11:21
  - It makes a huge difference to patients,
• 11:25
  - to ensure that their outcomes are are, optimized.
• 11:29
  - I I would say too,
• 11:30
  - you know, it's having a
• 11:33
  - a fine tuned machine, well oiled machine working,
• 11:36
  - not only helps the surgeons have a happier
• 11:38
  - day with moving patients through, but it helps
• 11:39
  - the patients move through quicker too. They've they've
• 11:41
  - done all this prep work to come there.
• 11:43
  - Their family's waiting in the OR or waiting
• 11:45
  - outside the OR for them to get in.
• 11:47
  - You don't want a, a one hour procedure
• 11:49
  - to take two or three hours because people
• 11:51
  - didn't have their act together.
• 11:52
  - And then also talking about patient outcomes,
• 11:56
  - you know, if you have a, a good
• 11:58
  - team model
• 11:59
  - where maybe it's orthopedic cases and you have
• 12:01
  - the anesthesiologist
• 12:02
  - doing blocks, regional blocks, and prep for those
• 12:04
  - cases, then you have the CRNA actually doing
• 12:07
  - the case in the in the room with
• 12:08
  - the, with the surgeon.
• 12:10
  - It makes things work a lot better. The
• 12:12
  - patient... Because they got a regional block instead
• 12:14
  - of being fully sedated heavily for a case
• 12:16
  - that they didn't need that much that much
• 12:18
  - sedation for.
• 12:20
  - They they come out of the anesthesia better
• 12:22
  - in the PACU. They feel better in the
• 12:24
  - day. It's good for the hospital because their
• 12:26
  - patient satisfaction scores look good because I'm a
• 12:28
  - happy patient. I'm not groggy all day, and
• 12:31
  - I don't have any pain because that block
• 12:32
  - is still set for the next three days
• 12:34
  - or however long it lasts. So,
• 12:36
  - it's good good for the patient from that
• 12:38
  - perspective too. That hits the nail on the
• 12:40
  - head, you know, with with patient outcomes and
• 12:42
  - experience.
• 12:43
  - You
• 12:44
  - could see so many,
• 12:47
  - practices that might not be optimizing
• 12:50
  - regional blocks. And the question is why? Well,
• 12:52
  - they're...
• 12:53
  - That can be multifaceted. Maybe they're not familiar.
• 12:56
  - Maybe they don't have the time to learn
• 12:58
  - it.
• 12:59
  - Maybe they're not
• 13:00
  - comfortable or have the resources available to... That
• 13:03
  - they feel to do that safely. And so
• 13:06
  - focusing on those specific anesthesia
• 13:09
  - modalities and techniques,
• 13:12
  - allows us to
• 13:14
  - essentially enhance the patient experience.
• 13:17
  - As Alex said, you know, they wake up
• 13:19
  - more comfortable,
• 13:21
  - ready to go home. It enhances recovery and
• 13:23
  - and healing, encompasses
• 13:25
  - the full patient into the the process. Sean,
• 13:27
  - what does it feel like clinically when leadership
• 13:30
  - truly understands anesthesia?
• 13:32
  - Yeah. It makes all the difference for morale.
• 13:34
  - Essentially,
• 13:36
  - if we need support, we, as clinical providers
• 13:39
  - and leaders, we we talk to the full
• 13:41
  - team and,
• 13:42
  - we find a way to make it happen.
• 13:44
  - It's really not even a question. If it's
• 13:46
  - a proven way to make us better for
• 13:49
  - our patients and for our communities,
• 13:51
  - we're gonna do it. And,
• 13:53
  - so that's that's... Makes all the difference to
• 13:55
  - know that
• 13:57
  - what we're doing is important.
• 13:58
  - They highlight that by by understanding our role
• 14:02
  - and by supporting it.
• 14:04
  - And we are their advocate with administration. I
• 14:06
  - mean, we're there. The hospital's the customer, the
• 14:09
  - client, but the the providers are customer too
• 14:11
  - when we're doing this. And so when they
• 14:12
  - come to us and say, look. We're we're
• 14:14
  - having burnout. This is... We're getting called back
• 14:16
  - a lot at night,
• 14:18
  - and the next morning is tough to come
• 14:19
  - back in. If you've had to come in
• 14:21
  - at 2AM, then you're there till 4AM, and
• 14:23
  - then you're supposed to be back there at
• 14:24
  - 7AM,
• 14:25
  - it's too much. And so we'll say, okay.
• 14:27
  - Let's build in a, for example, post call
• 14:29
  - day off to give people a chance to
• 14:31
  - decompress.
• 14:32
  - And and we'll look at those hours, and
• 14:33
  - and we'll say, look. You know, we have
• 14:35
  - a surgeon that's routinely starting late in the
• 14:37
  - day. We're all here at seven in the
• 14:39
  - morning. This guy's rolling in at at ten
• 14:42
  - in the morning and go until six or
• 14:43
  - seven at night when everybody else is wrapping
• 14:45
  - up at three. And so we'll gather that
• 14:48
  - data. We'll gather, you know, how many hours
• 14:50
  - people are working, and we'll go to administration
• 14:52
  - with that and say, look. This is what's
• 14:54
  - happening. So if you wanna keep accommodating the
• 14:56
  - surgeon, that's fine, but we're gonna need a
• 14:58
  - late shift, or we're gonna need a post
• 14:59
  - call day off, or we're gonna need these
• 15:00
  - different things. We use data. We use,
• 15:03
  - our our business negotiations with administration to kind
• 15:06
  - of advocate on behalf of the providers
• 15:08
  - to to create a a a better model
• 15:10
  - for them that's more sustainable. Not that it's
• 15:13
  - it's easier.
• 15:14
  - It's just appropriate and sustainable to to prevent
• 15:17
  - that burnout long
• 15:18
  - term. A lot of time, these multiservice
• 15:21
  - groups are also backed by private equity. Alex,
• 15:24
  - what's lost in a multiservice,
• 15:27
  - pea owned model?
• 15:29
  - Well, you end up spreading your resources too
• 15:31
  - thin. You have,
• 15:33
  - a lot of times they think, okay. If
• 15:34
  - I...
• 15:35
  - If this group over here manages a a
• 15:38
  - hospitalist program somewhere, then they can do anesthesia
• 15:40
  - too. It's it's clinical. It's doctors. What's the
• 15:43
  - difference?
• 15:44
  - And it's certainly not the same.
• 15:46
  - And so you end up,
• 15:47
  - diluting your your focus on those areas, diluting
• 15:50
  - your expertise in those areas.
• 15:52
  - And,
• 15:53
  - and then you eventually figure out,
• 15:55
  - I don't know what I'm doing here, and
• 15:56
  - the whole thing falls apart. And meanwhile, patients
• 15:58
  - are suffering because because of it. The, the
• 16:01
  - surgeons are unhappy.
• 16:02
  - And at that point, it's too late and
• 16:04
  - and the damage is done. And now you're
• 16:05
  - trying to mop things up because whether it's,
• 16:08
  - clinical quality, whether it's drug diversion,
• 16:12
  - whether it's just certain... Just, operational efficiency
• 16:16
  - starting on time in the mornings. Because, I
• 16:18
  - mean, they have to look... It's not like...
• 16:20
  - Okay. From the ER example, patients are just
• 16:22
  - coming in all day. They're coming in. You're
• 16:23
  - reacting. You're reacting. You're dealing with those things.
• 16:25
  - In the OR, we have a schedule. Right?
• 16:28
  - And if anesthesia
• 16:29
  - is routinely
• 16:31
  - late, starting the day, it throws the whole
• 16:32
  - day off. Meanwhile, you've got patients, like I
• 16:34
  - said earlier, they're,
• 16:36
  - they prepped for that. Their families are waiting
• 16:38
  - for them. And now,
• 16:39
  - okay, my my 10AM procedure
• 16:42
  - procedure is now
• 16:43
  - gonna
• 16:44
  - happen at 01:00 in the afternoon because the
• 16:45
  - whole morning got off because something didn't go
• 16:46
  - right with the anesthesia.
• 16:48
  - And when the OR director picks up the
• 16:50
  - phone to call a practice manager
• 16:52
  - that's over that group, the person don't know
• 16:54
  - what to do because they don't understand why
• 16:56
  - they were late either, what happened there. And
• 16:57
  - sometimes it's the surgeon. Sometimes it's a variety
• 17:00
  - of fact. Maybe the patient wasn't ready. But
• 17:02
  - if you don't understand that environment,
• 17:04
  - you don't know how to deal with that
• 17:05
  - and resolve that so it doesn't happen again.
• 17:07
  - And so they they end up
• 17:09
  - being masters of nothing at that point because
• 17:12
  - they're just trying to to appeal to private
• 17:15
  - equity groups that'll say, okay. And you do
• 17:18
  - ER, hospitalists,
• 17:19
  - radiology,
• 17:20
  - anesthesia.
• 17:21
  - You're doing all... OBGYN.
• 17:23
  - You're doing everything.
• 17:25
  - I'm gonna buy that group because we can
• 17:27
  - take that whole model and bring it to
• 17:28
  - a hospital and be everything for that hospital.
• 17:31
  - Well, it sounds good academically, but it's it's
• 17:33
  - not there anymore,
• 17:35
  - especially on the reimbursement side.
• 17:37
  - They've ratchet down so much, the payers have
• 17:39
  - on on reimbursement.
• 17:41
  - The surprise billing legislation,
• 17:44
  - stopped a lot of the revenue that the
• 17:46
  - the private equity pack groups were getting.
• 17:48
  - I mean, they were they were dropping huge
• 17:49
  - bills to these patients, and the patient, you
• 17:52
  - know, was threatened with going to collections if
• 17:54
  - they don't pay up this money.
• 17:56
  - And, it put people in a difficult position.
• 17:58
  - And so that's all stopped. And so a
• 18:00
  - lot of the money they had coming in
• 18:02
  - has dried up. And so it's less appealing
• 18:04
  - for the private equity guys at this point
• 18:06
  - to be in into those most multi specialty
• 18:08
  - groups, which makes it less appealing
• 18:10
  - for a company to be multi specialty at
• 18:12
  - this point. You know, and from a provider
• 18:14
  - standpoint of that, it's not always easy to
• 18:17
  - to
• 18:18
  - jump out of bed in the middle of
• 18:19
  - the night and and go in for a
• 18:21
  - case. And,
• 18:22
  - there's always the aspect of, oh, does this
• 18:24
  - really need done right now? And and all
• 18:26
  - of that set aside, we take care of
• 18:28
  - patients. You know? We do that first. And
• 18:29
  - then if we need to look retrospectively
• 18:32
  - of does it need to be... Or did
• 18:34
  - it need to be
• 18:35
  - done, we can look at that retrospectively
• 18:37
  - and and analyze that and then work with
• 18:39
  - the team to, come up with a plan
• 18:42
  - going forward for those scenarios. But, you know,
• 18:44
  - in the middle of the night, you
• 18:46
  - you might have that thought like, oh, I'm
• 18:48
  - I'm waking up in the middle of the
• 18:49
  - night, and then there's these private equity,
• 18:52
  - investors that, you know, who are paying for
• 18:54
  - their beach house in Malibu. You know, it's
• 18:56
  - not a not a great feeling. And, so
• 18:58
  - ultimately,
• 19:00
  - it kinda can burn out your morale if
• 19:02
  - if that's the case. How does focus translate
• 19:05
  - into clinical autonomy?
• 19:07
  - Well, it's important to have,
• 19:09
  - a management company that will
• 19:11
  - highlight the importance of autonomy.
• 19:14
  - And with that comes
• 19:16
  - an expectation as well for the providers.
• 19:19
  - We can we can demand
• 19:21
  - autonomy from a provider standpoint, but we have
• 19:24
  - to be able to deliver that, not just
• 19:26
  - ask for it. But then when we get
• 19:28
  - it, what do we do with it? Right?
• 19:30
  - It's empowering
• 19:31
  - to have the autonomy to be able to
• 19:34
  - take care of a patient in a full
• 19:36
  - in
• 19:37
  - a in a full arena of of the
• 19:39
  - anesthetic and be able to do the nerve
• 19:41
  - blocks, be able to do
• 19:43
  - the,
• 19:44
  - higher risk type lines,
• 19:47
  - and,
• 19:48
  - the high risk cases.
• 19:50
  - So as a provider, it's empowering to be
• 19:52
  - able to take care of people
• 19:55
  - in a complete way.
• 19:57
  - I would say to the... You know, the
• 19:59
  - surgeon has a relationship with the patient, obviously.
• 20:01
  - And so,
• 20:03
  - sometimes anesthesia is viewed purely as a support
• 20:06
  - role for that that case that they're gonna
• 20:07
  - do. And they they are in a support
• 20:09
  - role, frankly, with the the surgeon being the
• 20:11
  - lead on on taking care of that patient
• 20:13
  - right there surgically.
• 20:15
  - But
• 20:15
  - it is a true team effort at that
• 20:17
  - point. Anesthesia
• 20:19
  - is its own specialty just like that surgeon
• 20:21
  - is their own specialty, whether they're cardiac or
• 20:23
  - or orthopedic or whatever. And so if we
• 20:26
  - see,
• 20:27
  - that dynamic not playing out properly,
• 20:29
  - we as the management group need to step
• 20:31
  - in with the, chief of surgery or with
• 20:33
  - that surgeon directly and be like, hey. You
• 20:35
  - know,
• 20:36
  - this anesthesia person doesn't work for you. Right?
• 20:38
  - You can't boss them around and tell them
• 20:40
  - what to do. They are your partner with
• 20:41
  - this case. They're they're a clinical professional as
• 20:44
  - well. They've got specific things they need to
• 20:46
  - to check off to make sure this patient
• 20:48
  - is safe,
• 20:49
  - before surgery, and they've got things they need
• 20:51
  - to take care of during the case to
• 20:52
  - make sure that patient moves through the case
• 20:55
  - safely as well and has a good recovery.
• 20:57
  - And so sometimes you have, you know, a
• 20:59
  - boastful surgeon that's gonna say, well, this is
• 21:01
  - my OR, and this is the way it's
• 21:02
  - gonna be.
• 21:03
  - But that's not really how the real world
• 21:05
  - operates at this point. Anesthesia
• 21:07
  - truly is, its own, standalone service line that
• 21:10
  - works in conjunction
• 21:11
  - with surgical services.
• 21:13
  - If your organization wants an anesthesia partner that's
• 21:16
  - fully dedicated to one thing, anesthesia, CCI offers
• 21:20
  - a singular specialized focus
• 21:22
  - that larger multiservice groups simply can't match. We
• 21:25
  - don't dilute our attention across radiology,
• 21:28
  - urgent care, emergency medicine, hospitalists, or dozens of
• 21:31
  - other service lines. We specialize
• 21:34
  - exclusively in anesthesia
• 21:36
  - with on-site leadership, transparent reporting,
• 21:38
  - and collaborative approach that hospitals trust. To learn
• 21:42
  - how anesthesia first partnership can support your surgeons,
• 21:46
  - your scheduling efficiency,
• 21:47
  - and your bottom line, visit ccianesthesia.com
• 21:51
  - or connect with our leadership team for a
• 21:53
  - discussion.
• 21:56
  - How does specialization
• 21:58
  - attract stronger clinicians?
• 22:00
  - It comes down to building the right model,
• 22:02
  - the right team models for anesthesia, or it
• 22:05
  - can be an all CRNA model as well,
• 22:07
  - And and giving them the opportunity to work
• 22:09
  - at the top of their skill set. I
• 22:10
  - mean, you understand the anesthesia providers, they're not,
• 22:13
  - like, people out there filling potholes in the
• 22:15
  - street, watching the clock, trying to eat up
• 22:17
  - the clock for the day. They want to
• 22:19
  - be busy. They got into this to take
• 22:20
  - care of patients. They wanna be challenged.
• 22:23
  - They want to have opportunities
• 22:24
  - to to really,
• 22:26
  - push themselves throughout the day. And so having
• 22:29
  - a good, a good model that keeps them
• 22:31
  - busy,
• 22:32
  - having a good case mix too is helpful
• 22:34
  - because it helps them feel feel fulfilled. I
• 22:35
  - mean, these are very bright people. Right? They...
• 22:38
  - They're well educated,
• 22:40
  - and they love what they do. And so
• 22:42
  - building a model
• 22:43
  - that allows them to to function that way
• 22:45
  - is a huge retention tool for them.
• 22:48
  - And then having good leadership is critical as
• 22:50
  - well. If you have a great leader
• 22:52
  - that's advocating for you, a great chief that's
• 22:54
  - that's got your back and that's helping you
• 22:56
  - develop professionally as well clinically
• 22:58
  - and professionally,
• 23:00
  - you feel like, okay. I love this team.
• 23:02
  - I love my leader.
• 23:03
  - And and we have a great culture of
• 23:05
  - a team here. And so there's a lot
• 23:07
  - of components that go into that retention to
• 23:09
  - make sure that that everyone feels valued
• 23:11
  - and that they feel like they can really
• 23:13
  - stretch themselves throughout the day and and work
• 23:15
  - hard. There's gonna be days that are tough,
• 23:17
  - and there's days that are easier. You get
• 23:18
  - to go home, and and they balance out
• 23:20
  - if you have a short day.
• 23:22
  - But overall feeling like... And I I really
• 23:25
  - did some good stuff today. I I took
• 23:26
  - care of patients,
• 23:28
  - and and I have a great team to
• 23:30
  - to lean on when I need help with
• 23:31
  - things. That makes a huge difference on retention
• 23:33
  - and morale.
• 23:34
  - Yeah. And having,
• 23:36
  - a k... A good case mix is is
• 23:38
  - very important. I always try to think of,
• 23:40
  - you know, if I'm on call, for example,
• 23:43
  - anything can walk into that ER. And and
• 23:46
  - depending on whether you're utilized a lot in
• 23:48
  - the ER or not,
• 23:50
  - at your specific practice,
• 23:52
  - you could be. You could be called for
• 23:55
  - whatever shows up. And so having that,
• 23:58
  - familiarity
• 23:59
  - with whatever case type it might be, whether
• 24:02
  - a pediatric or
• 24:04
  - a trauma
• 24:06
  - or, you know, whatever it might be.
• 24:08
  - Maintaining that familiarity and how to care for
• 24:10
  - these people that might land on your doorstep
• 24:13
  - is just imperative.
• 24:15
  - How does operational
• 24:16
  - support change when anesthesia is the only focus?
• 24:20
  - Well, you you make sure you've got the,
• 24:22
  - clinical leadership
• 24:24
  - in one regard.
• 24:25
  - That's a big piece of it, because
• 24:28
  - when there are challenges in the o r...
• 24:29
  - I mean, in... Yeah. In the OR with
• 24:31
  - the anesthesia services there, we need someone who
• 24:34
  - has been there, has done it, or is
• 24:35
  - currently doing it. Like, Sean is VP of
• 24:37
  - clinical affairs, but he's he's a practicing clinician.
• 24:40
  - And so having those resources,
• 24:43
  - specialized in that area helps you tremendously. Instead
• 24:47
  - of having,
• 24:48
  - a radiologist, for example, trying to chime in
• 24:50
  - on how to fix
• 24:51
  - a clinical anesthesia issue, it it doesn't make
• 24:54
  - sense to do it that way.
• 24:56
  - And then also having,
• 24:57
  - the the,
• 24:59
  - recruiting resources
• 25:00
  - because
• 25:01
  - turnover happens sometimes, and you wanna get perms
• 25:04
  - in there as quick as possible. Having a
• 25:06
  - professional team that can not only get the
• 25:07
  - perms in, but can help get locums in
• 25:10
  - as well that are qualified locums that are
• 25:12
  - not gonna drag down the whole team because
• 25:13
  - they're a bad provider.
• 25:15
  - Having those resources
• 25:16
  - where people really understand
• 25:18
  - the the caliber provider that needs to be
• 25:20
  - in there makes a huge difference.
• 25:21
  - And from a facility perspective to,
• 25:25
  - the generalist,
• 25:26
  - management team,
• 25:28
  - they may not be perfectly in tune with
• 25:30
  - every single market that they're serving. So, you
• 25:33
  - know,
• 25:34
  - having
• 25:35
  - a finger on the pulse of anesthesia,
• 25:37
  - how do we recruit? How do we retain?
• 25:40
  - What's the appropriate compensation for this region?
• 25:43
  - How many weeks off do we need to
• 25:45
  - offer to
• 25:47
  - draw people in,
• 25:49
  - it can make a huge difference in promoting
• 25:52
  - those perms to come on board.
• 25:54
  - Can you share an example of where
• 25:57
  - anesthesia only focus
• 25:58
  - really changed a struggling practice?
• 26:02
  - Yeah. I mean, we've we've seen... For instance,
• 26:04
  - there's... There was one practice where
• 26:06
  - they were technically a group, but everybody was
• 26:09
  - independent within that group independent contractors. They weren't
• 26:11
  - really organized under one group. It was more
• 26:13
  - of a conglomerate, I guess, you could call
• 26:15
  - it, of individuals.
• 26:16
  - And so we went in because there was
• 26:18
  - no no teamwork in that regard. No one
• 26:21
  - had each other's back. They're all just trying
• 26:22
  - to get out as quick as they could
• 26:24
  - or take the best case because they were
• 26:26
  - billing individually for their cases.
• 26:28
  - And so what we came in and did
• 26:30
  - was we, and it was an all anesthesiologist
• 26:32
  - model. Until we put in a team model,
• 26:35
  - it made it operate a lot more efficiently
• 26:37
  - and cost effectively
• 26:38
  - and then, allowed everyone to to function more
• 26:41
  - seamlessly throughout the day.
• 26:43
  - Surgeons
• 26:44
  - didn't have to worry who was gonna be
• 26:45
  - in the OR for them. They weren't... Because
• 26:47
  - they were having to pick certain people. Like,
• 26:48
  - I don't like this guy, but this guy's
• 26:50
  - okay or whatever. We we kinda raised the
• 26:52
  - bar and level set across the across the
• 26:54
  - board as to what the,
• 26:56
  - the expectations were in terms of patient care,
• 26:59
  - in terms of quality of provider.
• 27:01
  - And so,
• 27:02
  - surgeons could just show up and do their
• 27:03
  - cases at that point. They didn't have to
• 27:04
  - worry about who was... Which anesthesia was provide...
• 27:07
  - Provider was available.
• 27:08
  - And so it made things a lot, better
• 27:10
  - for the surgeons, better for the patients.
• 27:13
  - And, and then we had true leadership at
• 27:15
  - that point. They had a rotation. Like, it
• 27:17
  - was,
• 27:18
  - you know, they do it six months, and
• 27:19
  - now it's your turn to be the chief
• 27:21
  - now. And now six months later, it's your
• 27:22
  - turn. And, like, no one was really invested
• 27:24
  - in being the leader at that point. And
• 27:25
  - so we we recruited a true leader
• 27:28
  - that that had the skill set to do
• 27:30
  - it and then embraced the the leadership responsibilities
• 27:33
  - and made it more successful.
• 27:35
  - It sounds so obvious, but consistency is key.
• 27:38
  - So
• 27:39
  - many practices across the country
• 27:41
  - may may have varying
• 27:43
  - numbers of anesthesia providers
• 27:45
  - from week to week. And so they have
• 27:47
  - to work with the
• 27:49
  - scheduling
• 27:50
  - of the operating room to,
• 27:53
  - know how many rooms that they can run.
• 27:55
  - Well, as you can imagine, that's a huge
• 27:57
  - dissatisfier
• 27:57
  - to
• 27:58
  - surgeons trying to get cases on, patients that
• 28:00
  - have to wait, you know, wait in line
• 28:02
  - essentially for cases.
• 28:04
  - And so having that consistent number of anesthesia
• 28:08
  - anesthesia providers
• 28:09
  - is key to have the
• 28:12
  - to having the operating room run efficiently. How
• 28:15
  - many nurses do we need to staff?
• 28:17
  - Block scheduling of the of the surgeons will
• 28:21
  - add into that consistency,
• 28:23
  - and then everybody can have a mindset of
• 28:26
  - knowing
• 28:27
  - what their work week will look like.
• 28:29
  - What should clinicians look for when choosing a
• 28:32
  - practice?
• 28:33
  - Well, there's there's location, there's pay, there's case
• 28:36
  - types, autonomy.
• 28:38
  - All of those things are important, and and
• 28:41
  - individuals have
• 28:43
  - their keys that are are more important to
• 28:45
  - them. I would challenge the provider to
• 28:49
  - seek what is most important to them, because
• 28:51
  - if they're fulfilled in their personal life and
• 28:54
  - what's important to them, then they're more likely
• 28:56
  - to be fulfilled in the workplace. And so
• 28:59
  - that's that's imperative for for a high functioning
• 29:02
  - team.
• 29:03
  - If there's one thing you wanted listeners to
• 29:05
  - take away from today, what would it be?
• 29:08
  - Make sure that
• 29:09
  - you have a a, anesthesia group that truly
• 29:12
  - is a partner for you. The... A lot
• 29:14
  - of people put partner and partnership in their
• 29:16
  - marketing materials and all that kind of stuff.
• 29:18
  - But are they really a partner? Are they
• 29:20
  - really
• 29:21
  - keeping you informed as to what's going on,
• 29:23
  - both the good and the bad? There shouldn't
• 29:25
  - be any surprises,
• 29:27
  - in administration.
• 29:28
  - And so if you have a a group
• 29:30
  - that's really working in partnership, they're
• 29:32
  - they're they're navigating those challenges,
• 29:34
  - and then they're working proactively with you as
• 29:36
  - well. If they
• 29:38
  - if they know two new orthopedic surgeons are
• 29:40
  - coming, they should be coming to you ahead
• 29:42
  - of time to say, okay. Here's what we're
• 29:44
  - gonna do to to make sure you can
• 29:45
  - do all those cases.
• 29:46
  - They shouldn't be reacting all the time to
• 29:48
  - things. They should be working proactively with you.
• 29:51
  - That... That's what a partnership is at that
• 29:53
  - point.
• 29:54
  - And then if
• 29:55
  - maybe you've you've lost a surgeon or cases
• 29:57
  - are down, then they're gonna come to you
• 29:59
  - and say, look. You don't need all these
• 30:00
  - ORs throughout the day, or,
• 30:02
  - you're not operating efficiently throughout the day. You've
• 30:05
  - you've got 10 starts every morning.
• 30:07
  - You really only need eight because you're... So
• 30:09
  - many guys are cutting out early, and they're
• 30:11
  - just using the afternoon for clinic. And so
• 30:14
  - you could probably run this with eight ORs
• 30:15
  - if you wanted to. Most groups are not
• 30:17
  - gonna do that because the bigger... The the
• 30:19
  - more ORs they had they had, the more
• 30:21
  - they can charge you for that coverage.
• 30:23
  - For us, you know, we wanna be their
• 30:25
  - their their partner and say, look. You don't
• 30:27
  - really need this much, coverage in your in
• 30:29
  - your OR. And so that's... Being being an
• 30:32
  - honest and, and and informed partner makes a
• 30:35
  - big difference for a hospital. Yeah. I think
• 30:37
  - it's important for anesthesia providers to just find
• 30:39
  - a anesthesia group that allows them to practice
• 30:43
  - to the absolute best of their ability. Take
• 30:45
  - care of patients
• 30:46
  - in, in the best way possible, and you
• 30:49
  - fulfilled the mission.
• 30:51
  - Alex and Sean, thank you for sharing your
• 30:53
  - insight and your conviction.
• 30:55
  - When anesthesia is the priority instead of the...
• 30:57
  - An afterthought,
• 30:58
  - clinicians feel supported,
• 31:00
  - patients feel safe, workflows function smoothly, and the
• 31:03
  - OR becomes a more collaborative environment.
• 31:05
  - Anesthesia
• 31:06
  - deserves specialized leadership because it's a specialized discipline.
• 31:11
  - Thank you for listening to Unmasked.
• 31:13
  - I'm Doug Simpler, and we'll see you next
• 31:15
  - time. Unmasked is brought to you by CCI
• 31:18
  - Anesthesia, leaders in anesthesia services for over twenty
• 31:21
  - years. Subscribe to Unmask, the CCI Anesthesia podcast
• 31:24
  - today so you never miss an episode.
• 31:27
  - For more resources and information, visit the CCI
• 31:30
  - Anesthesia website at ccianesthesia.com.
• 31:33
  - We look forward to having you with us
• 31:35
  - next time as we continue to unveil the
• 31:37
  - remarkable stories and innovations
• 31:39
  - shaping the future of anesthesia care. Until then,
• 31:42
  - stay curious, stay safe, stay informed,
• 31:45
  - and we'll see you next time.