Two recent, highly publicized incidents involving anesthesiologists underscore the importance of sustaining a culture of respect, accountability and safety in the operating room, McKesson experts say.
Last summer, a jury in Northern Virginia awarded a local man $500,000 after a voice recording made during his colonoscopy revealed that the attending anesthesiologist and gastroenterologist had repeatedly ridiculed and insulted the unconscious man during the procedure.1
In January 2015, the daughter of comedian Joan Rivers filed a malpractice suit against a New York City clinic after Rivers went into cardiac arrest during a routine throat procedure. Rivers died a week later, in September 2014, from brain damage caused by lack of oxygen. The lawsuit alleges the attending physicians failed to properly observe and monitor Rivers’ deteriorating vital signs. During the operation, one of the physicians allegedly snapped photos of Rivers under anesthesia.2
Both incidents highlight the need for practice guidelines that encompass not only patient safety but also ethical and professional standards of behavior, according to Lynn Cook, compliance program director for anesthesia for McKesson Business Performance Services (McKesson), and Jackie Velilla, McKesson’s executive director, anesthesia client management.
“Anesthesiologists play a very important role for hospitals, even when they’re part of an independent practice,” Velilla said. “Oftentimes, they’re the first point of contact for a patient before they enter the operating room. So it’s important that they establish a positive tone for the entire patient encounter and conduct themselves in a thoroughly professional manner. Basically, it’s an opportunity for them to shine, as a clinician, as a representative of the hospital and as an advocate for the patient.”
The changing anesthesia environment
According to Velilla, the ongoing evolution in healthcare has led to increased consolidation among independent anesthesia groups and the emergence of mega-practices spanning multiple states. At the same time, a growing number of anesthesiologists are opting to leave private practice for hospital employment. These changes have undermined workforce stability and increased transience among clinicians, she said.
In addition, anesthesiologists are taking on greater responsibility for peri-operative care and operating room management and consequently are interacting more with patients, hospital staff and other clinicians.
It is therefore important for practices to establish written codes of conduct that delineate expectations regarding how clinicians should comport themselves. One might assume that adhering to standards of professional behavior would go without saying, Cook said. But as recent events have shown, that’s not always the case.
Along with a written code of conduct, practices should thoroughly vet new clinicians to determine if they’re culturally compatible with the organization. This includes not only physicians but physician extenders, who play an increasingly important role in most anesthesia practices.
“Everyone is going to have the technical training,” Cook said. “But what you need to determine is whether they also have the bedside manner and the interpersonal skills to represent the practice in the best light.”
Mentoring new hires is an effective way to teach appropriate, ethical and professional behavior, Velilla said. Experienced clinicians can demonstrate how to interact not only with patients, but with other physicians, operating room nurses, the patient’s family and the post-anesthesia care unit (PACU) staff.
“Mentoring doesn’t have to be forever, maybe one or two months,” she said. “But it’s important because it helps establish baseline expectations, and improves the likelihood that the new clinician will adopt the most effective communication approaches. They’ll learn by example.”
Surveys can point to course corrections
Another tool that can help sustain professionalism among the anesthesia team is the use of periodic surveys to assess how the practice has performed and is perceived. Patient satisfaction surveys are important and groups should coordinate with hospitals to collect relevant data from their patient assessments. Equally valuable, Cook said, are regular surveys of surgeons. The surveys can help identify reoccurring issues or problems, and likewise serve as a starting point for ongoing communication with physicians to collectively improve processes and services.
“You definitely want to cultivate your relationships with surgeons and keep close tabs on their level of satisfaction with the group’s performance, because this can lead to improvements that benefit all parties,” Velilla said.
Ultimately, she added, developing a responsive, ethical and professional anesthesia team will help groups strengthen their hospital contracts in an increasingly uncertain healthcare environment. By consistently delivering excellent patient care and increased patient satisfaction, the pressure to reduce costs can be minimized.
“Ethical behavior is the backbone to any successful business,” Velilla said. “There can be no cutting corners. Anesthesia leadership that is involved and communicative with staff is the best way to establish and sustain an environment where ethical behavior is automatic.”