Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

How to Be a Leader in Anesthesiology and Beyond

11,507 views

Published on

I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader. In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts: 1) I must be getting old; and 2) This isn’t going to be easy.

I came up with a short list of lessons that I’ve learned over the years. While some examples I included are anesthesiology-specific, the lessons themselves are not. Please feel free to edit, adapt, and add to this list; then disseminate it to the future physician leaders who will one day take our places.

Published in: Healthcare

How to Be a Leader in Anesthesiology and Beyond

  1. 1. @@EMARIANOMD How to Be a Leader in Anesthesiology & Beyond Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
  2. 2. @EMARIANOMD 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.
  3. 3. @EMARIANOMD There is No Universal Answer. How Do People See Anesthesiologists? How Do We Want to Be Seen?
  4. 4. @EMARIANOMD Tips for Being a Leader • First, be a good doctor.
  5. 5. @EMARIANOMD 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
  6. 6. @EMARIANOMD http://www.bmj.com/content/350/bmj.h2647
  7. 7. @EMARIANOMD Tiffany Ingham
  8. 8. @EMARIANOMD Wall Street Journal
  9. 9. @EMARIANOMD How Do These Articles Make You Feel? What Are You Doing About Them?
  10. 10. @EMARIANOMD Tips for Being a Leader • First, be a good doctor. • Have an identity.
  11. 11. @EMARIANOMD The Era of the “Provider”
  12. 12. @EMARIANOMD
  13. 13. @EMARIANOMD “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
  14. 14. @EMARIANOMD Google “Anesthesiologist”
  15. 15. @EMARIANOMD 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
  16. 16. @EMARIANOMD Anesthesiologist Better Defined http://www.kevinmd.com/blog/2014/10/love-anesthesiologist.html
  17. 17. @EMARIANOMD Have You Seen These Ads?
  18. 18. @EMARIANOMD 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?
  19. 19. @EMARIANOMD If Anesthesiologists Are Anonymous Anesthesia is Just a Commodity
  20. 20. @EMARIANOMD Tips for Being a Leader • First, be a good doctor. • Have an identity. • Know the rules of the game.
  21. 21. @EMARIANOMD Health Care Is Changing http://www.iom.edu/bestcare
  22. 22. @EMARIANOMD 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 is Next (or Now)?
  23. 23. @EMARIANOMD The Triple Aim Berwick et al., Health Aff (Millwood) 2008;27:759 Vetter et al., Anesth Analg 2014;118(5):1131
  24. 24. @EMARIANOMD 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.org 2. http://www.hospitalcompare.hhs.gov
  25. 25. @EMARIANOMD 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)
  26. 26. @EMARIANOMD In the News
  27. 27. @EMARIANOMD MEDNAX Coming Soon? http://www.mednax.com/newsroom/
  28. 28. @EMARIANOMD Tips for Being a Leader • First, be a good doctor. • Have an identity. • Know the rules of the game. • Question the status quo.
  29. 29. @EMARIANOMD Stop Complaining
  30. 30. @EMARIANOMD Design, Improvement, and Medicine
  31. 31. @EMARIANOMD 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?
  32. 32. @EMARIANOMD 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
  33. 33. @EMARIANOMD 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.
  34. 34. @EMARIANOMD My Team
  35. 35. @EMARIANOMD We Work as a Team 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 FY11 FY12 FY13 FY14 FY15 NUMBEROFENCOUNTERS ANESTHESIA OUT-OF-OR ENCOUNTERS FY11-15 Total 419 PRE/POST 420 PAIN 427 REGIONAL 434 NON-OR/APS 441 PHONE
  36. 36. @EMARIANOMD 0 5 10 15 20 25 30 35 40 2007 2008 2009 2010 2011 2012 2013 2014 2015 Publications in Peer-Reviewed Journals Cited on PubMed Anesthesiology/Critical Care Pain We Share Knowledge as a Team
  37. 37. @EMARIANOMD We Innovate as a Team Mariano, Walters, Kim, Kain. A&A 2015;120:1163 Walters, Mariano, Clark. Pain Med 2015 July 14
  38. 38. @EMARIANOMD 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.
  39. 39. @EMARIANOMD Know When to Take Off the Mask
  40. 40. @EMARIANOMD 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)
  41. 41. @EMARIANOMD Everyone Starts Somewhere
  42. 42. @EMARIANOMD Nothing is Easy Email from a senior faculty member to the entire department shortly after I started:
  43. 43. @EMARIANOMD 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

×