Same-Day Surgery Manager: Improve your relationship with anesthesia services

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Austin, TX

I have had several individuals contact me regarding a past article in which I mentioned that the service that administrators find the most difficult to work with is anesthesia.

Since I wrote that article, I have tried to understand from where the problems arise. After further conversations with the original group and others, especially anesthesia personnel, it appears that many of the problems same-day surgery programs are having result from poor communication.

Most of the problems arise from three areas in the initial setup of the outpatient surgery program:

  1. Anesthesia personnel tell me that they didn’t know they were going to be expected to stay in the center until the last patient of the day’s ride finally showed up.
  2. They didn’t know that they must have a contract with every carrier (provider) with which the outpatient surgery program has a contract. Many anesthesia groups across the country are boycotting certain insurance providers because of what they think are poor rates. You have to be sympathetic to their cause, but you also have to understand the role of the outpatient surgery program in providing coverage for their patients.
  3. Another area of dispute between anesthesia coverage and ongoing same-day surgery management is identifying, by name, those individuals within an anesthesia group that the surgeons wish to not rotate through the facility. Can that be done? Actually, it can be and is done in many same-day surgery programs. Being sympathetic to the chief of the anesthesia group, you can imagine what that type of request must do internally to their cohesiveness. Yet you also can appreciate a new program that knows that "Dr. Brown" does not adopt the same philosophy of marketing to the surgeons, staff, or patients of the new facility. He may be considered too slow, constantly late, or abusive to the staff, and the surgeons do not want to deal with his personality. It’s hard to blame them if they have a history with that individual.

Other ongoing issues that are a result of anesthesia include:

  • Anesthesia staff not wanting to open another OR to accommodate another case.
  • Anesthesia staff not wanting a large gap in time between the end of one case and the start of another.

    This situation is especially true of new programs that are trying to accommodate the surgical staff and be available to meet their needs.

  • Anesthesia staff’s desire to "run the board" or control the "back of the house" functions of the same-day surgery program. Since anesthesia staff members are compensated only for the time they are with a patient, they want to compress that time as much as possible. It’s hard to blame them.
  • Anesthesia staff’s lack of willingness to assist in room turnover. That situation goes against what was stated in the last item, but the fact is that some staff members do not have the same incentives to be time efficient. Unless they were told that their contract depended upon help with turnover times, what can you do?
  • Anesthesia staff’s lack of willingness to clean up after themselves. This is the old "Your mother doesn’t work here" issue in that the staff of the same-day surgery program don’t feel that they need to clean up and put away anesthesia equipment and supplies after the case. Often anesthesia personnel forget how much the nurses assist them during induction and transfer.

So what can be done? You need to deal with these issues yourself, but these are my ideas that historically have worked in other facilities:

  • Clearly define the role of anesthesia up front. We recommend that you come up with a list of your expectations for the anesthesia group of what you expect from them so there are no questions later. Clearly, there is always room for negotiations, but that needs to occur before the contract is signed, not after the fact.
  • Work with the anesthesia group if there is a contract dispute. Often just giving them time to work out the details of their contract will suffice. You are in a long-term relationship with them. If you have to give them two or three months of room to negotiate a better carrier contract, it won’t effect you significantly. You might need them to help you someday on a similar issue.
  • If you definitely do not want Dr. Brown in your center, state it and stick by it. But often a better way to start the relationship is to allow all members of the department to rotate through the center until there is a problem with a particular individual.

    We all act differently in new surroundings.

  • Anesthesia staff need to understand that you are going to have to be accommodating to the surgeons. If they repeatedly refuse to work with the center by not accommodating late bookings, then you need to address it and let them know that the same-day surgery program will consider those refusals when it is time to renew their contract.
  • A good anesthesia group can make or break a surgery center. You want them on your side (without compromising your mission statement). If they want to assist in running the board, make sure that it is not your pride that is getting in the way of the potential new efficiency they can bring.
  • Room turnover contributes to the well-being of every member of the organization. If a member of the anesthesia department is too good to help you, then refer back to the item above on accommodating the surgeons.
  • This is a give-and-take issue. There might be a very good reason they are not helping you. Sit down and discuss it. I have never seen a situation in which this type of problem cannot be fixed.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.

Contact Earnhart at 8303 MoPac, Suite C-146. Austin, TX 78759. E-mail: searnhart@earnhart.com. Web: www.earnhart.com.)