Strategies to Maintain Group Cohesiveness Friday, May 6, :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 practices that characterizes a group” Webster’s Dictionary Image from: /image_WP023.html

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 Everybody does (almost) everything Equal pay for all The call team The anesthesiologist who practices pain management Monitoring the troops

Everybody Does (Almost) Everything Flexibility

“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 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 AAM’s predominant form of (private) practice Mutual respect Collaboration on anesthetic plan Shared workload Camaraderie and loyalty

Niches Cardiac (TEE) Pain management Complex pediatrics Critical care Niche anesthesiologists also do “everything”

The Key Image from: pages/equality.html

Equal Pay Shareholder status after three years Equal base draw Overtime incentives available to all Equal distributions

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 Duties of officers, chiefs, residency directors Research initiatives Consulting opportunities New ventures to benefit the group

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 Three high teammates Combined privileges cover all facilities and niches Seven low teammates Cover ten out of house call positions

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 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

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 Problem Solution

The Anesthesiologist who Practices 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 Call coverage OR coverage early and/or late In-house emergency back-up Teaching Expertise to the call team

Pain Chief A peer to facility chiefs Liaison to hospital administration Business and clinical issues

Monitoring the Troops

“You can observe a lot by watching” Yogi Berra Corollary: You can hear a lot by listening

Communicate, Communicate, Communicate Facility Departmental Board of Directors Steering Committee Chief’s Clinical Management Committee Shareholders Future Shareholders Meetings

Other Communication Strategies Reaching out CRNA site managers AAM website Standardization committee Social functions

Issues Identified through Vigilance Morale and burnout Safety Drug seeking behavior Depression Alcoholism Debilitating illness