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Winter 2010


Customer Service in Anesthesia Care

Jody Locke, CPC
Vice-President of Anesthesia and Pain Management Services, ABC

In the current economic environment it is not enough that anesthesia practices have consistently good outcomes from the care their practitioners provide. It is a given that today’s anesthesia providers can successfully manage any surgical patient safely, no matter how complicated the circumstances or medical history, through surgery and post-operative recovery. This is the basic service that anesthesia groups sell and that hospitals and surgi-centers buy. What matters is not just how well the anesthesia practice manages the patients’ surgical experience, but, rather how well the practice manages the broader expectations of its various customers. Anesthesia has become a critical cog in a much larger system. As such, the success or failure of the relationship depends not only on its ability to anticipate the needs of individual patients, but also on its ability to anticipate the needs of the system as a whole. This is why customer service has become one of the most important anesthesia practice management issues of the day.

Anesthesia training programs do an excellent job of preparing anesthesia providers for the exigencies of surgical and obstetric anesthesia. Most anesthetics take the provider through a familiar routine of preparation, induction, maintenance, emergence and recovery. Rare is the clinical situation that the provider has not already worked through at least a few times or where the fundamental physiological and pharmacological issues are not familiar. The operating room and the delivery suite are environments in which expectations and requirements are, for the most part, well understood and readily attainable. There is ample evidence of most providers’ ability to artfully manage the needs of patient and surgeon. Consistently reliable feedback of an array of monitors allows for timely and tactical decision-making. With experience comes confidence. Real challenge occurs when these same clinicians step outside the operating room into an environment in which they have neither the same type of reliable feedback nor the experience to consistently juggle a seemingly inconsistent and conflicting set of expectations and requirements.

Marketing consultants love to ask who is your customer and what does your customer want? Not only are these tough questions to answer in anesthesia, but no two sets of answers will be the same. Too often the default answer is “it depends,” which does not really allow for effective decision-making. If customer requirements cannot be clarified and quantified, service delivery strategies cannot be formulated and refined. While the same basic assessment and decision-making skills that make clinicians so effective in the operating room will actually serve them well in the Board room, the application of the concept is not always clear in an unfamiliar context. Anesthesia providers are trained to accept and rely on digital arrays that indicate how the patient is responding to anesthetic agents administered during the case, while the absence of such reliable monitoring tools and feedback outside the operating room makes for confusion and distrust. It may take some training, but anesthesia providers must learn to be able to read their customers like their monitors. There is no doubt that this is often more art than science, but it is not less important a skill.

Herein lies both the greatest single opportunity and quintessential test for the anesthesia provider. Anesthesia’s value to the system is that anesthesia providers do more to determine the overall quality of the patient’s surgical or obstetric experience than any other provider involved in the surgical experience. Because customer service is about perception, though, if I do not understand or appreciate how you are going to anticipate my every need and guide me safely and artfully through the potential trauma and stress of my surgery, then all your training and skill is for naught.

Surveys have shown that two areas of greatest concern to hospital administrators with regard to their anesthesia providers have to do with outlier providers and pre-operative communications. Too many groups suffer the consequences of their own inability to monitor and manage their problem providers. It is a curious phenomenon. So much is at stake and yet when it comes to monitoring how different members of the department or group interface with patients and other members of the medical staff there is an unfortunate and, sometimes, fatal tendency to turn a blind eye. There is a fine line between the competence of a clinician who can listen to and evaluate the situation of a patient effectively and in a way that the patient is left with a sense that he or she is in good and competent hands, and the arrogance of the scientist who does not appear to need or want the input of the patient. In other words, today’s patients want what they get in the salon; they want to be cared for and not just taken care of.

We all know good customer service when we experience it. Some intangible quality bonds us to certain service providers, even though we may know they are not the best providers or the cheapest option. Research suggests it is not the relationships where nothing goes wrong that are the strongest, but the ones where the commitment of the provider to find solutions and keep the relationship are evident. If your mechanic does not fix a problem with your car the first time, you may be upset but you will give him the chance to solve the problem. If the problem is resolved then your stock in him goes up but if he does not demonstrate an attitude of caring, compassion and contrition you will not go back.

The reality of today’s increasingly complicated reliance on technology is that not all solutions are evident or easily identifiable. This is especially true of medicine. A hospital is a forum for collaborative problem-solving where teams of providers and administrators work in partnership to achieve two related goals: higher quality care and stronger balance sheets. It is normally assumed that if they accomplish the first, the second will follow. Given the vagaries of the market, however, there is not always a clear connection between the two and sometimes the latter supersedes the former.

Each of the following five stakeholder’s perspectives on the surgical experience is defined by his or her own requirements, expectations and history. It is not unlike the parable of the blind men and the elephant. Each one sees the relationship only from his or her perspective. Typically, none of the participants is willing to look at the relationship through any other lens. It is easy to see why anesthesia providers become so exasperated with their interactions in the operating room suite; no one else sees what they see.

  • Patients want amnesia and the confidence that they will be pain-free and safe.
  • Surgeons want availability so that they can get their cases done in a manner that allows them to be productive.
  • Hospital administrators want affordability because they are always struggling with the bottom line.
  • The Operating Room staff and the nurses, by contrast, want affability because they have to deal with a variety of personalities and complex clinical situations.
  • Meanwhile the members of the anesthesia department or group want acknowledgement for their hard work and tireless service.

It would be easy to say that what is needed is for all the stakeholders to take a step back so they can see the whole elephant, but this is easier said than done; they are too busy trying to satisfy their own interests. It is also unlikely and unrealistic to assume that the paradigm will change from without, although occasionally hospitals do take dramatic and draconian steps to shake things up.

It would be equally naïve to assume that any of the stakeholders is willing to acknowledge the potentially pernicious impact of his or her pursuit of self-interest. No commuter leaving home at 8:30 in the morning is willing to take responsibility for the traffic jam that results when hundreds of thousands of people do the same thing so they can get to work and provide for their families. This is the nature of system problems. Our roles and responsibilities are all defined by a system over which we have little influence and no control.

Specific vulnerability of the anesthesia practice is defined by its replaceability. Contrary to popular belief, the anesthesia practice is the most readily replaceable of the five stakeholders listed above. There is no more compelling evidence of this fact than the growth of staffing companies such as Sheridan Health Care, NAPA, Sonos, Premier, etc. Many of the nation’s largest anesthesia practices have also become active players in responding to Requests for Proposal (RFPs) and in accepting contract agreements for the provision of services outside their primary catchment area.

This explains why customer service has become both a challenge and an opportunity to the typical anesthesia group practice. The challenge is survival, but the opportunity is security. Both are defined by clear evidence of and a compelling commitment to customer service. What makes so many group practices vulnerable is the perception on the part of the O.R. staff and administration that they “don’t get it about customer service.”

No service relationship is perfect and it is unrealistic to think that there will not be some disagreements or miscommunciations in the relationship between an anesthesia group and the management of the operating room. The strength of the relationship can best be measured in three areas. The first is the consistency of care provided and the perception of the medical staff. Contrary to popular opinion, superior clinical care is an essential pre-requisite. The second is the way the organization deals with its shortcomings and problems; a perception that a practice is willing to accept its shortcomings and a pro- active approach in addressing them is essential. It is never a good sign when the hospital administrator has a list of “problem” providers. The third and final factor is the management of the practice; practices that have strong leadership and which speak with one voice are always preferred over those that function as loose confederations of independent providers. A lot can be learned from the hospital administrator. Practices that do not have regular interactions with administration are generally more vulnerable than those that do.

It is these same three qualities that define the practices with the best and most secure relationships with their hospitals. A commitment to excellence in execution is essential and best practices are continually striving to anticipate clinical needs of the institution. The second quality that creates and engenders confidence is strong internal monitoring and peer review. Best practices not only do various forms of continuous quality improvement but will identify opportunities to have additional staff improve their skills or learn new techniques. There is obviously no one right way to run a hospital or its operating room suite. Because the anesthesia department inevitably has more and better data about what actually happens day to day there is an expectation that anesthesia can be a strong contributor to the ongoing improvement of operating room operations. But by far what distinguishes the strongest relationships is the way administrations interact. If leadership of the anesthesia practice has a good rapport with administration that allows for collaborative problem-solving and strategic planning, then almost nothing else matters. There is no clearer evidence of this that the level of participation in hospital committees. The practices with the tightest relationships to their hospitals are those that are willing to share data and ideas and which make it a point to offer solutions rather than to complain about problems.

It is a sad reality that those practices afraid of losing their franchise probably will. Unfortunately, there are many others that don’t even realize just how vulnerable they are. Not a week passes but that some anesthesia group president is surprised to learn that his hospital administrator has decided to send out an RFP. The lesson here is that those groups that fail to take the feedback they are getting from administration seriously are doomed to be victims of their own ignorance. Every organization can be improved and every relationship can be made stronger through communication. The fact is that those organizations that are confident they are providing the best possible care and creating value for the institution and have evidence to prove it will likely enjoy long and profitable relationships. Customer service in the world of anesthesia is all about partnership; the more you commit, the more you benefit; but it is an all or nothing proposition You either get it about customer service or you don’t.


Jody Locke, CPC, Vice Presient of Anesthesia and Pain Management Services for ABc, is responsible for the scope and focus of services pro-vided to ABC’s largest clients. He is also re-sponsible for oversight and management of the company’s pain management billing team. He will be a key executive contact for the group should it enter into a contract for services with ABC. He may be reached at Jody.Locke@anesthesiallc.com.