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

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: http://www.aselectronics.com/as/images/teamwork.jpg. Culture. “The set of shared attitudes, values, goals and

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

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  1. Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts

  2. How Do We Do it? Image from: http://www.aselectronics.com/as/images/teamwork.jpg

  3. Culture “The set of shared attitudes, values, goals and practices that characterizes a group” Webster’s Dictionary Image from: www.punchstock.com/.../ 2700104/image_WP023.html

  4. Culture • Patient safety • Excellent efficacious service • Anesthesia care team • Good citizenship at facilities • Strong work ethic • Equality in workload and compensation

  5. 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

  6. Everybody Does (Almost) Everything Flexibility http://www.funnypart.com/funny_pictures/flexibility.shtml

  7. “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

  8. 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)

  9. MD/CRNA Anesthesia Care Team • AAM’s predominant form of (private) practice • Mutual respect • Collaboration on anesthetic plan • Shared workload • Camaraderie and loyalty

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

  11. The Key Image from: www.dontsayyoudidntknow.net/ pages/equality.html

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

  13. 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

  14. Extra Clinical Endeavors • Duties of officers, chiefs, residency directors • Research initiatives • Consulting opportunities • New ventures to benefit the group

  15. 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

  16. Call Team • Three high teammates • Combined privileges cover all facilities and niches • Seven low teammates • Cover ten out of house call positions

  17. 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

  18. 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

  19. AAM Daily Call Team Schedule/Call Team Coordinator Worksheet

  20. 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 Call Team Pitfalls Solution Problem

  21. The Anesthesiologist who Practices Pain Management

  22. Anesthesiologists Practicing Pain Management • 9 doctors to cover 6 sites • Practice 50 to 80 percent • Rotate to pain clinics and OR’s

  23. Pain Specialists Practicing Anesthesia • Call coverage • OR coverage early and/or late • In-house emergency back-up • Teaching • Expertise to the call team

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

  25. Monitoring the Troops

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

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

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

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

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