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Tony Mira, Chairman and Chief Executive Officer of MiraMed

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The Skills Anesthesiologists Need to Be Effective Executives

Leadership has never been more important in anesthesiology than it is today.  As the specialty demands and takes ownership of increasing levels of responsibility in healthcare reform, the quality of leadership becomes one the fundamental factors that determine success.  Developing the Perioperative Surgical Home (PSH), the most exciting organizational concept to emerge within anesthesiology this century, requires outstanding leaders.  So does maintaining the highest quality of patient care in each anesthesiology department or practice.

Recognizing the value of leaders and also their role in enhancing each others’ skills as well as those of the broader community, the Anesthesia Quality Institute (AQI) has created an Anesthesia Leadership Registry, a database of more than 250 ASA members who serve in leadership roles. The purposes of this registry are threefold, according to Richard P. Dutton, MD, MBA, Executive Director of the AQI (“Data, Data, and More Data—Where’s the Value?” Presentation given at the ASA Practice Management Conference in January 2015):

  • National understanding of our “footprint”
  • Networking for existing leaders
  • Mentoring for new leaders

A recent article in the Harvard Business Review, The Skills Doctors and Nurses Need to Be Effective Executives, by Sachin H. Jain, MD,  chief medical officer of the CareMore Health System (HBR Online, April 7, 2015) described three distinct skills that clinicians must have in order to lead effectively.  These skills are the foundation for successful clinical practice in any specialty including anesthesiology and pain medicine; a shift in perspective is necessary, though, for the transition to managing a health care enterprise such as a hospital or health system, or even a payer organization.

First is operations management and execution.  According to Dr. Jain, “Many physicians and nurses excel at operations management because it requires the same kind of detail and complexity that is required to effectively manage a large clinical load.  In clinical work, we must constantly triage patients and parse significant amounts of low and high-level detail.  Many clinicians manage a small operation in the form of their own clinical practice or ward before shifting to leading larger operations.”  This is certainly true of anesthesiologists, many of whom are used to managing the care of several patients concurrently in an environment that depends on teamwork.  Determining how best to meet the needs of one surgical patient ready to be extubated, another patient with significant airway problems and a third patient about to deliver by C-section, while in the back of one’s mind is that morning’s discussion with hospital administration about needed improvements in room turnover times—for example—requires a well-honed ability to distinguish between urgent tasks and important, non-urgent activities.  In addition to possessing the ability to prioritize an ever-growing number of demands, the clinician must remain flexible in order to shift priorities.  Good anesthesiologists tend to match this description by training and perhaps by inclination.  As newly-minted executive leaders, they must learn to act with urgency and ownership to build an organization’s workflows and address its problems.

Another leadership skill that draws on the knowledge and experience of clinicians is setting and defining strategy.  Effective strategic management involves, in addition to the ability to identify opportunities, the wisdom to decide both what to pursue and what not to pursue, Dr. Jain reminds us, citing strategy expert Michael Porter.  Opening up an endoscopy suite may look like an attractive opportunity but it may be less compelling than staffing a cardiac cath lab even though the cath lab will consume all available resources for the near future.  By the same token, a health system may have to choose between two surgery center acquisition candidates.  A physician leader must acquire the skills to decide upon appropriate trade-offs.

The third requisite skill to which Dr. Jain points is people leadership.  Academic and residency training does not prepare physicians to hire and fire, or even to manage subordinates, any more than does the education for other professions.  As Dr. Jain notes, “When thrust into a management or leadership position, many clinicians have never hired or fired anyone in their life.”  He suggests, therefore,

To accelerate the development of their people-management skills, clinicians should partner closely with fellow business leaders and HR professionals. These colleagues can be instrumental in helping them surface their needs and identify tactics to build and manage high-performance teams. These colleagues can also serve as sounding boards when they must make hard decisions and hold inevitable hard conversations.

The above list of executive skills that can be studied and mastered is far from exclusive.  Some of the qualities that go into solid leadership are personal attributes, starting with the desire to lead.  As stated in Chapter 1 of ASA’s Manual for Anesthesia Department Organization and Management, “[t]he best leaders understand people and business, maintain fairness, create clear visions, build trust, and communicate effectively.”  These are skills that become better and better as the executive gains experience.  Their importance cannot be overstated.  James D. Grant, MD wrote in the Administrative Update in the September 2014 issue of the ASA Newsletter that:

Physicians need to take greater roles in health care leadership. Health system reform needs to be led by physicians building common goals and leading teams that effectively move health care delivery in the right direction. Physician anesthesiologists are seen as leaders and visionaries who have a keen understanding of the complexities of health care systems.

With the right combination of personal characteristics, motivation, training, the future looks bright for—and because—of anesthesiologists and pain physicians who step up to lead.

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