March 6, 2017

While many anesthesia practices are struggling to survive, others are thriving as they embrace the new challenges facing the specialty.  The American Society of Anesthesiologists’ Conference on Practice Management offered an excellent forum for the discussion of new ideas in this regard.  Today’s eAlert comes from the presentation by Daniel Cole, MD, immediate past president of the ASA.

Anesthesia leaders can guide their practices through the tumult of healthcare’s shift from fee-for-service to value-based payment—and evolve successfully from Blockbuster to Netflix along with the rest of medicine—by thinking like Wayne Gretzky, Dr. Cole said. 

In a session on leadership for anesthesiologists, Dr. Cole, who is professor of clinical anesthesiology and vice chair for professional development at the David Geffen School of Medicine, University of California, Los Angeles, quoted the legendary hockey player to illustrate a leadership fundamental:  “I skate to where the puck is going to be, not where it has been.”

Healthcare’s current unpredictability requires anesthesia leaders to think in terms of “innovation and where that play is going next,” he said, noting that “more has changed in the past two or three years and will change in the next three years than in the previous 30 years of my anesthesia career.  This is really nothing more than a classic transformation that occurs in all kinds of other industries.  I’m optimistic about anesthesiology, because I see a lot of innovation; we’re leading the way in a lot of respects.”

Dr. Cole pointed to the ASA’s leadership role in shaping a proactive response to the MACRA legislation and recent creation of an Ad Hoc Committee on Health Reform as two examples at the national level, but he said anesthesiologists are innovating locally as well.

With the rise of healthcare’s focus on population health management, including an emphasis on prevention and chronic disease management, “episodes of care are not going to go away, but the incentives of population health are to prevent the episodes of care, so we need to rethink our strategy,” he said.

For the specialty, and for anesthesia leaders, these changes call for innovation based on helping health systems achieve new efficiencies with such value-based methods as reducing pharmacy costs, cutting waste and shortening hospital length of stay with pre-habilitation (e.g., smoking cessation and nutritional counseling).

Perioperative medicine—participation in coordinated, integrated care that extends the anesthesiology department’s participation in care episodes outside the OR—provides the strategy, while the perioperative surgical home (PSH), enhanced recovery after surgery (ERAS) and population health management offer some of the possible tactics through which anesthesia can extend its influence, he said.

“Value-based care is just going to happen, so partner with your organization to look for system performance improvements,” said Dr. Cole.  “That is where shared savings is going to occur.  Have data to back up your value, because cost will be the primary driver of change.  And make sure you have a seat at the table for the advanced APMs [alternative payment models].”

In his presentation, Dr. Cole shared a variety of other insights acquired during his years as a leader in anesthesiology to help anesthesiologists lead their practices and the profession through the current period of seismic change.  We summarize selected highlights from Dr. Cole’s presentation here.

Do not get locked into one leadership style.  Understand the kind of leader you are and recognize when you need to use a different leadership style.  Dr. Cole said he tends to be a coaching, strategic, facilitative, visionary and transformational leader, but that some situations require him to make autocratic decisions.  “Otherwise, the mission does not go forward,” he said. 

Understand the differences between leadership and management.  Leaders tend to be visionaries who like to think strategically and be proactive, and who are focused more on people and less on processes and activities.  They like to influence and inspire, appeal to the heart and are more charismatic.  They are willing to take risks to achieve a mission and are deeply engaged in change management.

Managers are focused on policies and procedures, react to how things happen, are very task-focused, like to have power and control, prefer a stable environment, appeal to the head rather than the heart and are risk averse.

Leaders set goals and managers mobilize resources.  Both are needed to fulfill a mission.  And their circles of responsibility sometimes overlap.  If you are a leader, you have to be engaged in management because the best idea falls flat unless it is executed well.  Sometimes you can do it yourself, but if you find yourself doing the executing and mobilizing much of the time, your job is probably more management than leadership.

Know your own ego.  Ego needs to be set aside when you have a team that is trying to accomplish a mission.  It clouds the way you plan and execute projects, and stands in the way of your ability to absorb valuable feedback on how well you’re doing.  “In my experience, the most difficult ego to manage is my own,” Dr. Cole said. 

Focus on trust, vision and communication—the three most important ingredients of effective leadership, according to Dr. Cole.  “If I’m a leader, you have to trust that I have competency in what I’m doing; otherwise, you’re not going to follow me.  There has to be a connection between the two of us.  Hopefully, I am likeable and friendly, so there is a human connection.  And I have to be authentic,” which means a willingness to walk the talk, he said. 

As a leader, you can rarely over-communicate, so communicate 10 times more than you need to, then do it 10 times more after that.  And remember that part of communication is listening.  “People trust you a lot more if you’re not just hearing them, but really listening,” he said.

Communication also involves influencing, and “unless you are in the military, rarely does a dictatorial style work,” he said.  “What I’m trying to do is communicate to affect change, to change people’s vision and mindset.  Most of the time, communication is about persuasion.”

On the importance of vision, Dr. Cole quoted Yogi Berra, who said, “If you don’t know where you’re going, you might not get there.” 

Create a sense of urgency.  “Leadership is about affecting change,” said Dr. Cole, but many change management initiatives spike within the first two or three months and then fade.  Empower the individuals on the front lines to make the changes you’re trying to accomplish.  And use short-term wins to build momentum regarding the “burning platform.”

Watch out for rabbit holes.  Focus only on the projects and priorities that align with your purpose.  “There are only a certain number of things that you can do and do well.  Delegate the things that are important to other people.”

Develop a good relationship with the “deciders.”  What are your goals, and how do you influence them?  You will rarely get 100 percent of what you want.  Try to negotiate around shared interests and mutual gain.

Separate the people from the problem.  Sometimes, you have to be the adult in the room.  Focus on the issues rather than the personalities involved.

Never lose sight of your purpose or mission.  The infinite purpose of anesthesiology is the specialty’s contract with society to improve health and relieve pain and suffering.  “If we stay true to our purpose, all of the other things will tend to fall into place,” Dr. Cole said.

Finite changes within healthcare, such as APMs, fit within the infinite purpose of anesthesiology.  Anesthesia leaders should focus on helping people feel intrinsically motivated to “get better, to retool, to have a more excellent fit within society,” he said.

Medicine and anesthesiology are in a ‘Blockbuster-Netflix moment,’ said Dr. Cole, and “if we are willing to take some chances, innovate and adapt to what’s going on, we have the opportunity to become the next Netflix.”

With best wishes,

Tony Mira
President and CEO