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How to Be a Leader inAnesthesiology & Beyond

Edward R. Mariano, M.D., M.A.S.Professor of Anesthesiology, Perioperative and Pain Medicine

Stanford University School of MedicineChief, Anesthesiology and Perioperative CareVeterans Affairs Palo Alto Health Care System

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Financial Disclosures

• Halyard Health, B Braun – Unrestricted educational program funding paid to my institution

The contents of the following presentation are solely the responsibility of the speaker without input from any of the above companies.

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There is No Universal Answer.

How Do People See Anesthesiologists?

How Do We Want to Be Seen?

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Tips for Being a Leader

• First, be a good doctor.

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Being a Doctor is Still Prestigious

http://www.forbes.com/sites/niallmccarthy/2016/03/31/americas-most-prestigious-professions-in-2016-infographic/?linkId=23952127#32bbe00e1994

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http://www.bmj.com/content/350/bmj.h2647

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Tiffany Ingham

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Wall Street Journal

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How Do These Articles Make You Feel?

What Are You Doing About Them?

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Tips for Being a Leader

• First, be a good doctor.• Have an identity.

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The Era of the “Provider”

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“Hey Anesthesia!”• 60% of the public does not know that

anesthesiologists are physicians

http://www.asahq.org/resources/publications/newsletter-articles/2015/may-2015/residents-review

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Google “Anesthesiologist”

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Anesthesiologist Defined

What is an anesthesiologist? What training is involved?

An anesthesiologist is a doctor (MD or DO) who practices anesthesia. Anesthesiologists are physicians specializing in perioperative care, development of an anesthetic plan, and the administration of anesthetics. He or she has finished college, then medical school (four years), then an internship (one year) followed by a residency in anesthesia (three years). Some anesthesiologists pursue additional years of training (a fellowship).

http://www.hss.edu/what-is-an-anesthesiologist.asp

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Anesthesiologist Better Defined

http://www.kevinmd.com/blog/2014/10/love-anesthesiologist.html

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Have You Seen These Ads?

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What Is Your Desired Image?

• How do you introduce yourself to patients?• Does it change if your attending is present?• Do your patients know that you are a

physician? How?• How do you introduce yourselves to other

healthcare providers?• Do you wear a white coat? Does it matter?

Who doesn’t?

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If Anesthesiologists Are Anonymous

Anesthesia is Just a Commodity

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Tips for Being a Leader

• First, be a good doctor.• Have an identity.• Know the rules of the game.

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Health Care Is Changing

http://www.iom.edu/bestcare

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Publicly-Reported Metrics

• Surgical Care Improvement Project (SCIP) metrics for anesthesia?– Prophylactic antibiotics received within one hour

of surgical incision– Patients on a beta blocker prior to arrival

continued it perioperatively• Anesthesia Quality Institute, AMA, ASA, and

American Board of Anesthesiology are working on new metrics (eg, PONV)

What isNext (or Now)?

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The Triple Aim

Berwick et al., Health Aff (Millwood) 2008;27:759Vetter et al., Anesth Analg 2014;118(5):1131

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Emphasis on Patient Experience

• Patients are surveyed using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)1

• 32 questions• Publicly reported 4 times a year2

• HCAHPS is administered to a random sample of adult inpatients between 48 hours and six weeks after discharge

1. http://www.hcahpsonline.org2. http://www.hospitalcompare.hhs.gov

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Evolution of Anesthesia Practice

• Traditional private practice models are changing– Horizontal integration: merging of small and large

groups to form mega-groups; some are funded by private equity or venture capital

– Vertical integration: acquisition of smaller practices into larger groups (ie, ACOs, HMOs)

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In the News

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MEDNAX Coming Soon?

http://www.mednax.com/newsroom/

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Tips for Being a Leader

• First, be a good doctor.• Have an identity.• Know the rules of the game.• Question the status quo.

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Stop Complaining

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Design, Improvement, and Medicine

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2. Weaknesses 4. Threats

3. Opportunities

5. Potential Goals

Anesthesiology and Perioperative Care ServiceClinical Care, Education, Scholarship, Leadership

1. Strengths

Mission (2015): To provide the highest quality Veteran-centered care by leading, educating, and innovating in anesthesiology and perioperative medicine.

1. 1st Example 1. 1st Example

1. 1st Example 1. 1st Example

How Are You Doing?

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Have a Vision

• To be the model for change and evidence-based medicine that improves Veterans’ health and well-being.

http://www.paloalto.va.gov/anes_mission.asp

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Tips for Being a Leader

• First, be a good doctor.• Have an identity.• Know the rules of the game.• Don’t be satisfied with the status quo.• Establish trust and celebrate team wins.

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My Team

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We Work as a Team

FY11 FY12 FY13 FY14 FY150

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

ANESTHESIA OUT-OF-OR ENCOUNTERS FY11-15

Total419 PRE/POST420 PAIN427 REGIONAL434 NON-OR/APS441 PHONE

NUM

BER

OF

ENCO

UNTE

RS

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2007 2008 2009 2010 2011 2012 2013 2014 20150

5

10

15

20

25

30

35

40

Publications in Peer-Reviewed Journals Cited on PubMed

Anesthesiology/Critical Care Pain

We Share Knowledge as a Team

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We Innovate as a Team

Mariano, Walters, Kim, Kain. A&A 2015;120:1163Walters, Mariano, Clark. Pain Med 2015 July 14

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Tips for Being a Leader

• First, be a good doctor.• Have an identity.• Know the rules of the game.• Don’t be satisfied with the status quo.• Establish trust and celebrate team wins.• Be open to opportunities even it they sound

like more work.

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Know When to Take Off the Mask

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Volunteer and Get Involved• Operating room (Chair)• Pain (Chair)• CPR (Chair)• Research and development (Chair)• Invasive procedures (Co-Chair)• Clinical Product Review (Co-Chair)• Professional standards board (Vice-Chair)• Peer-review (Vice-Chair)• Transfusion (Member)• Laser safety (Member)

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Everyone Starts Somewhere

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Nothing is Easy

Email from a senior faculty member to the entire department shortly after I started:

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Tips for Being a Leader

• First, be a good doctor.• Have an identity.• Know the rules of the game.• Question the status quo.• Establish trust and celebrate team wins.• Be open to opportunities even it they sound

like more work.

http://www.edmariano.com/archives/829