September 11, 2023

As anesthesia practices evolve and diversify, it becomes increasingly difficult to maintain a consistent level of customer service. While the quality of the anesthesia care provided may be exceptional for most patients, there is much more to an optimum relationship with administration than just good clinical outcomes. In the current environment, quality of care is often taken for granted; and it used to be that what happened in the operating room was all that really mattered, but times have changed. The anesthesia department has become a critical business partner.

Clinical Skills, People Skills

Administrations need their anesthesia providers to be exemplary members of the medical staff who work collaboratively with surgeons, nurses and the OR staff. They must ensure that every patient receives not only a comfortable and safe anesthetic but that the whole surgical experience leaves the patient satisfied and happy that they chose that particular facility. Unfortunately, experience has told us that even great clinicians do not always understand or appreciate the importance of their demeanor and attitude. The ultimate success of a practice has much more to do with what happens outside the operating room than within its four walls. 

The specialty of anesthesia is unique in many ways. The training of providers focuses on their diagnostic analysis, their clinical skills and their ability to evaluate all possible variables in the formulation of the anesthesia plan. As is often said, while the surgeon is only focused on a very small part of the patient’s anatomy, the anesthesia provider must see and manage the whole patient and his or her responses to the trauma of surgery. Anesthesia providers pride themselves on being vigilant monitors of body systems and problem-solvers. Each anesthetic is a unique formulation of the provider's interpretation of patient concerns and expectations, the specific anesthetic requirements of the surgical procedure and the surgeon, and any other patient or operative factors that may apply.

By accepting a provider as a member of a practice, the management assumes the provider is competent and qualified to provide a quality experience. It is usually only exceptionally negative outcomes that cause the practice to question a provider's qualifications and/or competence. While hospitals may require customer service questionnaires, it is the rare practice that performs any type of consistent or rigorous quality control. The prevailing philosophy of most practices can be likened to professional fraternal organizations, for which the primary objective is to protect each other. There is no greater challenge in most practices than the need to terminate a partner.

Quality Control

There are, of course, some notable exceptions to this. One of these was one of our large west coast clients that many years ago implemented a 360-degree review of all providers. Each provider's annual review involved a compilation of questionnaire results from patients, surgeons, OR staff and other members of the practice. The medical director was responsible for the entire process and would meet with each provider to discuss strengths and weaknesses that should be addressed. Failure to address and improve negative findings would ultimately lead to termination of employment. 

While such a process might seem too complex and burdensome for the typical practice, this is the kind of quality control that most hospital administrators expect. As practices grow and as turnover rates increase, hospital administrators typically want to know how the practice is monitoring the consistency of customer service provided and what actions are being taken to ensure that it is consistently exemplary. The reason they prefer to contract with private practices is so that the anesthesia providers are held accountable for the specific terms of the agreement. Such a concept of customer service has been the hallmark of most successful businesses for years. Why should it be any different in medicine?

There is a common saying in business that one cannot manage what one does not measure. While businesses focus on each aspect of a process in terms of its impact on profitability—which obviously also applies to large anesthesia practices—the most important focus of anesthesia practices must be on their value proposition. Is every provider in every case enhancing the practice’s overall value proposition? Accountants may have erasers to fix their mistakes, but clinicians do not have such an option. Exceptions and outliers must be identified, assessed and addressed in such a manner that they do not recur. Provider profiling may seem anathema to many anesthesia providers, but it is an inevitable consequence of the current competitive market environment.

If you have any questions on this topic, please reach out to your account executive.

With best wishes, 

Rita Astani
President—Anesthesia