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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.

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



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



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



“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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