Strategies to Maintain Group Cohesiveness
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Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts. How Do We Do it?. Image from: http://www.aselectronics.com/as/images/teamwork.jpg. Culture. “The set of shared attitudes, values, goals and

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Strategies to maintain group cohesiveness friday may 6 2005 8 30 9 00 am james english m d

Strategies to Maintain Group Cohesiveness

Friday, May 6, 2005

8:30 – 9:00 AM

James English, M.D.

President

Anaesthesia Associates of Massachusetts


How do we do it

How Do We Do it?

Image from: http://www.aselectronics.com/as/images/teamwork.jpg


Culture

Culture

“The set of shared attitudes, values, goals and

practices that characterizes a group”

Webster’s Dictionary

Image from: www.punchstock.com/.../ 2700104/image_WP023.html


Culture1

Culture

  • Patient safety

  • Excellent efficacious service

  • Anesthesia care team

  • Good citizenship at facilities

  • Strong work ethic

  • Equality in workload and compensation


How to perpetuate culture and maintain cohesiveness

How to Perpetuate Culture and Maintain Cohesiveness

  • Everybody does (almost) everything

  • Equal pay for all

  • The call team

  • The anesthesiologist who practices pain

  • management

  • Monitoring the troops


Everybody does almost everything

Everybody Does (Almost) Everything

Flexibility

http://www.funnypart.com/funny_pictures/flexibility.shtml


Everything

“Everything”

  • Straightforward pediatrics

  • Obstetric anesthesia

  • Regional anesthesia

  • Vascular, thoracic, trauma, neurosurgery

  • Rotate to at least three facilities

  • In-house call

  • Call team

  • MD/CRNA anesthesia care team


Rotating

Rotating

  • Necessary for members to absorb culture

  • All MD’s and CRNA’s

  • At least three facilities

  • Practice with familiar personnel/(friends) in

  • different settings

  • Core vs. rotating personnel

  • Employment vs. deployment (deep bench)


Md crna anesthesia care team

MD/CRNA Anesthesia Care Team

  • AAM’s predominant form of (private) practice

  • Mutual respect

  • Collaboration on anesthetic plan

  • Shared workload

  • Camaraderie and loyalty


Niches

Niches

  • Cardiac (TEE)

  • Pain management

  • Complex pediatrics

  • Critical care

  • Niche anesthesiologists also do “everything”


The key

The Key

Image from: www.dontsayyoudidntknow.net/ pages/equality.html


Equal pay

Equal Pay

  • Shareholder status after three years

  • Equal base draw

  • Overtime incentives available to all

  • Equal distributions


Differential compensation for extra clinical endeavors

Differential Compensation for Extra Clinical Endeavors

  • A work in progress

  • Reward and incentivize group members who

  • contribute more

  • Preserve the culture of equality

  • Time, money, titles, privileges


Extra clinical endeavors

Extra Clinical Endeavors

  • Duties of officers, chiefs, residency directors

  • Research initiatives

  • Consulting opportunities

  • New ventures to benefit the group


Before call team

Before Call Team

  • 4 first calls out of house

  • 6 back up calls

  • Facility dedicated

  • Potential for unequal work and time

  • Non call MD’s “trapped” late

  • Four post call MD’s daily


Call team

Call Team

  • Three high teammates

  • Combined privileges cover all facilities and niches

  • Seven low teammates

  • Cover ten out of house call positions


Call team advantages

Call Team Advantages

  • Deeper coverage with the same (or less)

  • number of people

  • Fairer distribution of workload

  • Less late days for non-call people

  • More post-call MD’s available for assignments


Call team coordinator

Call Team Coordinator

  • 1 of 3 high team MD’s

  • Dispatcher and practitioner

  • Receives all bookings, floor calls, pain calls,

  • ICU/ER calls

  • Coordinates location, credentials, expertise


Aam daily call team schedule call team coordinator worksheet

AAM Daily Call Team Schedule/Call Team Coordinator Worksheet


Call team pitfalls

Missed page/CTC incommunicado

Credentialed M.D. occupied elsewhere

Emergency OB when in house MD occupied

Inclement weather

Backup CTC

Avoid dead spots

No alpha pagers

No relayed messages – obtain confirmation

Anticipate thin coverage

Low call team

In-house

Expanded CRNA coverage

Early notification of in-house cases

Location of backup based on time of day, traffic, distance

Facility dedicated MD

Consider in-house or hotel

Four wheel drive vehicles

Call Team Pitfalls

Solution

Problem


The anesthesiologist who practices pain management

The Anesthesiologist who Practices Pain Management


Anesthesiologists practicing pain management

Anesthesiologists Practicing Pain Management

  • 9 doctors to cover 6 sites

  • Practice 50 to 80 percent

  • Rotate to pain clinics and OR’s


Pain specialists practicing anesthesia

Pain Specialists Practicing Anesthesia

  • Call coverage

  • OR coverage early and/or late

  • In-house emergency back-up

  • Teaching

  • Expertise to the call team


Pain chief

Pain Chief

  • A peer to facility chiefs

  • Liaison to hospital administration

  • Business and clinical issues


Monitoring the troops

Monitoring the Troops


Strategies to maintain group cohesiveness friday may 6 2005 8 30 9 00 am james english m d

“You can observe a lot by watching”

Yogi Berra

Corollary:

You can hear a lot by listening


Communicate communicate communicate

Communicate, Communicate, Communicate

Meetings

  • Facility Departmental

  • Board of Directors

  • Steering Committee

  • Chief’s Clinical Management Committee

  • Shareholders

  • Future Shareholders


Other communication strategies

Other Communication Strategies

Reaching out

CRNA site managers

AAM website

Standardization committee

Social functions


Issues identified through vigilance

Issues Identified through Vigilance

  • Morale and burnout

  • Safety

  • Drug seeking behavior

  • Depression

  • Alcoholism

  • Debilitating illness


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