May 1, 2023

Too many anesthesia practices are experiencing a less than collaborative relationship with the administration of the facility where they provide services. Given what an important role anesthesia plays in the management of the operating rooms, this can be a particularly troubling state of affairs. Anesthesia services bring such value to the facility.  The anesthesia provider does more to enhance the patient’s overall surgical experience than the surgeon, leading many to wonder why the relationship is not more compatible. Obviously, part of the explanation is historical. In many facilities the anesthesia providers were the masked men about whom little was known. More recently, many in the administration see them as the annoying providers who are always asking for a bigger subsidy or other forms of financial support.

Clearly, it does not help when the only interactions between the anesthesia department and the hospital administration occur at the time of a contract renewal. Some might even argue that the lack of a productive and meaningful dialogue is by design: it is part of a strategy to enhance the administration’s power over the group. An arm’s length relationship makes it easier to hold the anesthesia providers accountable. While such relationships may have been the norm in the past, most observers would now agree this status quo is no longer appropriate in today’s highly competitive healthcare environment. The anesthesia challenge is how to change the paradigm.

Administration Perspective

Certainly, we all need to be understanding of the challenges faced by hospital administrators in the current environment. If the anesthesia practice is experiencing revenue challenges, we can be sure that the hospital is experiencing them as well. If the anesthesia practice wants to discuss additional financial support, it is safe to assume that it is not the only specialty engaged in such efforts. It should not come as any surprise that administrative staff is being challenged on many levels. This makes it especially difficult to get their attention and establish a working dialogue.

Anesthesia’s Strategy

Best practices are notable in medicine. Some anesthesia practices pride themselves on their close working relationship with administration. Key members have regular meetings with hospital leadership and are in the loop in critical decision-making affecting the management of the operating rooms. Some even have members on the hospital board of directors. The question is, to what do we attribute such administrative success? What strategies have these practices pursued to ensure they have an optimal working relationship with their customers?

As is true of so many things, success is a function of focus and commitment. The group must be committed to a close working relationship with administration. It does no good to simply view the CEO as a tough customer. He must be seen as a business partner. Collaborative problem-solving must be the goal. Regular and consistent communication is essential. This seems so logical and such common sense; why is it not the norm? For one thing, everyone’s time is valuable and scarce. Anesthesia concerns are not often at the top of the list of hospital executives who are typically more focused on developing new lines of business and revenue opportunities. There is often a perception that administration is most happy when they don’t have to deal with any anesthesia issues. Most anesthesia providers are happiest when they have the freedom and flexibility to do their cases as they see fit. Regulatory requirements and administrative responsibilities are nothing more than an unnecessary annoyance to most.

Clearly, the anesthesia provider’s perspective is conditioned by the nature of anesthesia practice where the objective is to get patients comfortably and safely through the trauma of surgery. Anesthesia tends to have the shortest decision cycle in medicine. Critical clinical issues rarely require more than a matter of seconds to resolve. When they need something from administration, like a bigger subsidy, they approach it with the same level of impatience they approach clinical care. Unfortunately, this is not how business people think or act. More often than not, the implicit objective of management decision-making is maintenance of the status quo. Herein lies a fundamental disconnect. Administrators want and need data to analyze and assess options. This is what anesthesia providers often perceive as paralysis by analysis. What many groups have come to understand is that this is an opportunity for education. They need to have the patience and commitment to educate the administration.

One anesthesia chairman developed an operating room utilization report that compared coverage hours by billable anesthesia hours by anesthetizing location. Each month he dropped off a copy of the report for the COO. At first the COO did not take the information seriously, but over time he came to see its value. Eventually, the chairman was able to convince the hospital not to open any location that would not generate 45 ASA units. The process took a number of months, but eventually the administration understood its relevance.

A good strategy that has worked for many practices is to be seen as a problem solver. Identify challenges and issues that need to be addressed and provide workable solutions. With each problem or issue that the practice addresses and solves, the group buys credibility. Eventually, it becomes a go-to source for solutions.

Ultimately, a practice must be seen as a good business partner. Strong leadership is critical. It is essential that the practice speaks with one voice and that all providers act accordingly. Disunity can easily be the fatal flaw that causes administration to lose faith in the practice and consider other options. If you have questions, feel free to contact your account executive.

With best wishes,

Rita Astani,
President—Anesthesia