the medical director “a quality force” susan l. goelzer md, ms, cpe ralph waters md...
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The Medical DirectorThe Medical Director“A Quality Force”“A Quality Force”
Susan L. Goelzer MD, MS, CPESusan L. Goelzer MD, MS, CPE
Ralph Waters MD Distinguished Chair Ralph Waters MD Distinguished Chair
Professor of Anesthesiology, Internal Professor of Anesthesiology, Internal Medicine and Population HealthMedicine and Population Health
University of WisconsinUniversity of Wisconsin
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The Operating Room EnvironmentThe Operating Room Environment“Century of the Surgeon”“Century of the Surgeon”
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OR CoordinatorOR Coordinator
Management PositionManagement Position
ResponsibilitiesResponsibilities– Direction of PersonnelDirection of Personnel– SchedulingScheduling– Planning and OrganizationPlanning and Organization– Professional ConductProfessional Conduct
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Director of Perioperative ServicesDirector of Perioperative Services
Formal Job DescriptionFormal Job DescriptionAdministrative AppointmentAdministrative Appointment– Bases of powerBases of power– Legitimate authorityLegitimate authority– InfluenceInfluence
Oversight of the clinical anesthesia servicesOversight of the clinical anesthesia servicesFacilitation of the efficient use of all resources Facilitation of the efficient use of all resources throughout Surgical Servicesthroughout Surgical ServicesAppointmentsAppointments– Department of AnesthesiologyDepartment of Anesthesiology– Department of SurgeryDepartment of Surgery– Hospital AdministrationHospital Administration
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Bases of PowerBases of Power
Control over ResourcesControl over Resources
Technical SkillsTechnical Skills
Body of KnowledgeBody of Knowledge
Ability to InspireAbility to Inspire
Access to OthersAccess to Others
““Power is the ability to effect Power is the ability to effect organizational outcome”: Mintzbergorganizational outcome”: Mintzberg
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Areas of SupervisionPower: Resources/Knowledge
Daily Decisions MakingDaily Decisions MakingSchedulingSchedulingAllocation of ResourcesAllocation of ResourcesUtilizationUtilizationPreoperative ClinicPreoperative ClinicPACUPACUAcute Pain ManagementAcute Pain ManagementPerioperative Information ServicesPerioperative Information ServicesOR BudgetOR Budget
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Required Skill SetRequired Skill SetPower: Skills/InspirationPower: Skills/Inspiration
Vested interest in Overall OR PerformanceVested interest in Overall OR PerformanceStrong Clinical BackgroundStrong Clinical BackgroundDaily PresenceDaily PresenceStrong Communication SkillsStrong Communication SkillsStrategic PlanningStrategic PlanningSupervision of PersonnelSupervision of PersonnelConsensus Based LeadershipConsensus Based LeadershipFormal Business TrainingFormal Business TrainingNegotiation and MediationNegotiation and Mediation
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Reporting RelationshipsReporting RelationshipsPower: AccessPower: Access
DirectorSurgicalServices
(Nursing)
Departmental Chairs
DirectorPerioperative
Services(Medical)
Hospital Administration
OR Executive Committee
OR Committee
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Guiding Coalition for ChangeGuiding Coalition for Change
Director of Perioperative ServicesDirector of Perioperative ServicesDirector of Surgical ServicesDirector of Surgical ServicesOR Executive CommitteeOR Executive CommitteeOR Committee ChairOR Committee ChairHospital CEO/COOHospital CEO/COOManagement TeamsManagement Teams
Kotter JP. Kotter JP. Leading ChangeLeading Change. . Harvard Business School Press. Harvard Business School Press. 19961996
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CompensationCompensationDepartment of Anesthesiology (60%)Department of Anesthesiology (60%)– Clinical ComponentClinical Component– Academic ComponentAcademic Component
OR Management Senior RotationOR Management Senior Rotation
Practice Management CurriculumPractice Management Curriculum
– Administrative ComponentAdministrative Component
Department of SurgeryDepartment of Surgery– Administrative SupplementAdministrative Supplement
Hospital (40%)Hospital (40%)– Administrative ComponentAdministrative Component
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The Medical Director The Medical Director Position as a Quality ForcePosition as a Quality Force
LeadershipLeadership
Power/InfluencePower/Influence
Authority Across DisciplinesAuthority Across Disciplines
CollaborationCollaboration
Unwavering SupportUnwavering Support
Team DevelopmentTeam Development
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Quality InitiativesQuality Initiatives
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A Partnership for Better CareA Partnership for Better Care– Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality– American Hospital AssociationAmerican Hospital Association– CMS/CDC/VACMS/CDC/VA– Institute for Health Care Improvement (IHI)Institute for Health Care Improvement (IHI)– JCAHOJCAHO– American Society of AnesthesiologistsAmerican Society of Anesthesiologists– American College of SurgeonsAmerican College of Surgeons– Association of Perioperative Registered NursesAssociation of Perioperative Registered Nurses
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Preventing Surgical ComplicationsPreventing Surgical Complications– Surgical Site InfectionsSurgical Site Infections– Adverse Cardiac EventsAdverse Cardiac Events– Venous ThromboembolismVenous Thromboembolism– Postoperative PneumoniaPostoperative Pneumonia
2005 Launch a Multiyear Campaign2005 Launch a Multiyear Campaign
Goal is to reduce complications by 25% Goal is to reduce complications by 25% by the year 2010by the year 2010
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“ “Pay for Pay for Performance”Performance”
Care Management Performance DemonstrationCare Management Performance Demonstration
Physician Focused Quality InitiativesPhysician Focused Quality Initiatives
Premier Hospital Quality Incentive Premier Hospital Quality Incentive Demonstration: Rewarding Superior Quality Demonstration: Rewarding Superior Quality Care Care – Hospitals in the top decile will receive a 2% bonus on Hospitals in the top decile will receive a 2% bonus on
their Medicare payments for the measured conditiontheir Medicare payments for the measured condition– Current cost @ $7 million per yearCurrent cost @ $7 million per year– After three years hospitals without demonstrated After three years hospitals without demonstrated
improvement will receive1-2% lower reimbursementimprovement will receive1-2% lower reimbursement– Total of 278 hospitalsTotal of 278 hospitals
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EvolutionEvolution
Anesthesiologist in ChargeAnesthesiologist in Charge– CoordinatorCoordinator
Operating Room DirectorOperating Room Director– ManagementManagement
Director of Perioperative Services/Vice Chair Director of Perioperative Services/Vice Chair Of Clinical OperationsOf Clinical Operations– Administration and LeadershipAdministration and Leadership
Hospital Leadership PositionsHospital Leadership Positions– VP of Surgical AffairsVP of Surgical Affairs– VP of Medical AffairsVP of Medical Affairs– COO/CEOCOO/CEO
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““May the Force Be With You”May the Force Be With You”