Strategies to Maintain Group Cohesiveness
1 / 31

Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. - PowerPoint PPT Presentation

  • Uploaded on

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: Culture. “The set of shared attitudes, values, goals and

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D.' - kasia

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Strategies to Maintain Group Cohesiveness

Friday, May 6, 2005

8:30 – 9:00 AM

James English, M.D.


Anaesthesia Associates of Massachusetts

How do we do it
How Do We Do it?

Image from:


“The set of shared attitudes, values, goals and

practices that characterizes a group”

Webster’s Dictionary

Image from: 2700104/image_WP023.html


  • 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



  • 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


  • 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


  • Cardiac (TEE)

  • Pain management

  • Complex pediatrics

  • Critical care

  • Niche anesthesiologists also do “everything”

The key
The Key

Image from: 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


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



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


You can hear a lot by listening

Communicate communicate communicate
Communicate, Communicate, Communicate


  • 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