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Fall 2006

Surgeon Satisfaction: A 360 Degree Perspective

Hugh Morgan
CMPE Director, AtlantiCare Anesthesiology

Why has surgeon satisfaction become as important to health care leaders as clinical and financial outcomes? Each year, health care facilities throughout the world spend hundreds of thousands of dollars on surgeon satisfaction surveys in an attempt to arrive at the elusive answers to what truly satisfies a surgeon? The thought being that if the surgeon is satisfied, then the patient will be satisfied and business will be good. Practically every American industry, to include healthcare and business, is brimming with thousands of articles, theories and studies about the critical importance of customer satisfaction in steering organizational success. The dilemma is that the act of satisfying is in as much a subjective action as it is a subjective assessment. To satisfy, and in turn be satisfied, is a personal perspective that can typically be shared and appreciated, but likely not universally scripted and accepted. In many ways, customer satisfaction follows the simple Golden Rule; treat others as you want to be treated.

Where the customer satisfaction waters in the health care have become muddied is that the traditional customer (the patient) has joined an ever growing list of customer stakeholders to include the community, hospital administration and surgeons. Our challenge isn’t in understanding and accepting the ideas and principles of customer satisfaction, but rather in defining who we are supposed to satisfy? In recent years, a great deal of customer satisfaction endeavors in health care have been focused around the surgeons or the “revenue producing” customers. The shift in health care from patient-centric satisfaction to what I would refer to as “macro” satisfaction has placed operational burdens and unjust expectations on the specialty of anesthesiology. The industry is strewn with defeated anesthesiology groups who often times are forced to succumb to administratively supported surgical expectations. How then is it possible for an anesthesiology practice to survive and thrive in an era of surgeon-centric satisfaction?

First and foremost, an anesthesiology practice must define the diverse satisfaction stakeholders for who they are responsible to include patients, nursing, administration and surgeons. The group should seek to understand both the common and unique expectations of each stakeholder group through personal meetings and feedback surveys which ultimately produce the satisfaction criteria and goals. Although hard to believe, patient’s seem to have become the least arduous to satisfy. Typically, patient’s simply expect to be treated with compassion and respect and to receive the highest quality and safest medical care with the best possible outcome. Administration is a little more challenging to satisfy in that they usually expect anesthesiology practices to infallibly provide anesthesia services and meet fluctuating clinical coverage requirements without pause or cancellation and within the most financially insolvent manner possible. Fairly straightforward expectations, right? The quandary is that administration’s satisfaction expectations are often directly associated, if not embedded, with that of surgeon satisfaction expectations resulting in a tag-team of operational and financial burdens for an anesthesiology practice. The key is to concurrently address the administrative and surgical satisfaction expectations so that there is a clear understanding by each stakeholder as to how satisfaction expectations can directly impact anesthesiology’s ability to effectively satisfy at the expense of group operations. It is essential to arrive at a set of reasonable, achievable and mutually beneficial administrative and surgical expectations so that the satisfaction criteria are universally known and not subject to whimsical modifications. Although some satisfaction expectations are somewhat broad and inherently subjective such as, “adequate coverage” and “immediately available” it is usually more evident to notice and hear about the absence rather than the presence of satisfaction. How often have we heard that if all is quiet, things must be good?

An important facet in achieving surgeon satisfaction is the ability of an anesthesiology practice to be duly recognized by administration and surgeons as medical colleagues of the surgical staff. Too often, anesthesiology is viewed as a hospital “service” and not as a medical practice with a critical role in the overall safety and care of the patient. Although anesthesiology touches numerous clinical environments throughout a hospital, perhaps the most important and visible involvement is within the Perioperative arena. From the preoperative assessment through post surgical recovery, anesthesiology plays a vital role in the customer satisfaction of the various perioperative stakeholders, most notably the surgeons. Anesthesiology is the third cog, the others being nursing and surgery, in the wheel that effectively spins perioperative/surgical services. Like a tire, if any one of these preoperative”cogs” experiences problems, the tire goes flat and unfortunate accidents can occur. It is important then for each of the preoperative disciplines to be accountable to each other for a variety of satisfaction criteria to include patient safety, clinical competency, professional behavior and workflow efficiencies. The challenge is to develop the mutual perioperative satisfaction criteria and measurement tool for which each of the perioperative disciplines will be accountable and to encourage global participation as a means to achieving higher levels of performance and satisfaction.

Earlier this year, with input from my perioperative leadership colleagues at AtlantiCare, I initiated the development of a 360 degree Perioperative Satisfaction Survey to purposefully achieve higher levels of mutual perioperative satisfaction and drive higher levels of perioperative performance. The 360 degree approach for survey and evaluation purposes is not a new concept as business leaders have successfully used 360 surveys as a means of assessing leadership at every organizational level. Although surgeon specific satisfaction surveys had previously been attempted at AtlantiCare, the thought was that a comprehensive 360 degree survey would likely surface common satisfaction and dissatisfaction themes affecting all of the perioperative disciplines to include the surgeons. The intent was to obtain definitive feedback on the common satisfaction and dissatisfaction themes so that the leadership of each perioperative discipline could address the universal issues of the discipline rather than issues of isolated dissatisfaction. A set of mutually inclusive satisfaction criteria with basic effective scoring was developed and scoring that fell above or below acceptable targets required supportive elaboration so that dissatisfaction could be effectively addressed. The leaders of each perioperative discipline were tasked with distributing the 360 degree survey to their respective colleagues. Each perioperative discipline had the opportunity to survey each of the other disciplines as well as their own discipline. As with any feedback survey, it was important to establish deadlines for survey submission dates so that feedback is timely and action plans for improvement can be efficiently developed. The survey success is completely dependant on the level of participation or you will have developed the best satisfaction survey with no feedback to improve satisfaction or performance.

The key point is that to achieve higher levels of surgeon satisfaction is to concurrently achieve higher levels of nursing and anesthesiology satisfaction. Within the perioperative arena,none of the disciplines can achieve high levels of satisfaction without the other disciplines also being effectively satisfied. It comes down to a mutual respect and understanding of the critical roles that each discipline plays in determining the performance, culture and overall success of perioperative and surgical services. In the end, it becomes an exercise in futility to attempt to satisfy one discipline, namely surgeons, at the expense of the other two perioperative disciplines, nursing and anesthesiology.