Driving Effectiveness for the Next Generation ​of Anesthesia Leadership​

Listen

Watch

Read

Jeff Peters (00:05):
I think maybe the first question is, how do you within your groups go about identifying and mentoring anesthesia leaders? Is there a formal process? Do you give it much thought?

Joseph Rodrigo, DO (00:22):
Well, I'll get started with a recent example. So been working on a very large department transition private group to an employee model. And within that, when I sat down with the chief medical officer, one of his first questions he asked me, he was like, "Who do you choose as a leader? When do you hire a leader? How do you identify these leaders?" I said, "It's really interesting." I said, "You can advertise and people are going to apply for it and they're either going to have experience or not. " I said, "But especially in this situation with a department transition, I would rather get people on the ground and kind of look at them and watch them work and see who people gravitate towards. Actually, you see those characteristics in the people as opposed to somebody just applying for the position online or something." I said, "I typically, when I'm looking for a leader, the last person I'm going to look at is the first person to apply for the job because there's a lot of people out there looking for titles and maybe they have the experience, maybe they don't.

(01:27):
I'm more interested in looking at the people that other people respect and you can quickly identify who people are going to follow. And then when you kind of see that in the person, then you can kind of sit them down, ask them questions if they're even interested in it, do they realize they have these leadership qualities? Because there's very specific things that leaders bring and most people that are good leaders don't even realize they have it, they just do it. And so that's kind of the first thing that I look at. And of course, you're always going to find people that are just going to kind of fall in your lap that apply for a job. And it's like, wow, those people are perfect. But it's interesting when you're in this long enough, you can sit in a room and you can pick people out that have those leadership qualities, even if they don't know they're leaders.

Mark Wimberly, MD (02:14):
Joe's ... Mine on?

Joseph Rodrigo, DO (02:16):
Yeah.

Mark Wimberly, MD (02:17):
Joe's right on as far as identifying those people within your own practice that people gravitate to. From our experience, we've actually started a formal process that we did not have a formal process, let's just call it five or six years ago. Now, as we onboard people, we actually are pairing up every physician, every CRNA with a mentor from day one. So that creates the onboarding process, smooths it out. That first few weeks, if they have questions, they go straight to that person they're assigned to, they build a relationship. And that helps with the onboarding. From a physician standpoint, we have assigned a mentor and we work with them and we get to know them. So making sure they're successful because so much goes in to recruiting nowadays. If you are lucky enough to hire people, bring them on, the last thing you want to do is for that person to not engage in the group and then desire to leave after six months or a year.

(03:23):
So we look at it as it's a long-term relationship. We're going to hire somebody, we're going to bring them in. I'm going to make sure that they are successful, meaning we give them all the tools they need, whether that's not ... And I don't mean really clinically. You come out of training, you know what to do clinically book knowledge. This is all your soft skills. So how are they going to manage difficult cases, manage politics in the OR, manage staffing?

Jeff Peters (03:50):
Are there politics? Really?

Mark Wimberly, MD (03:52):
What's that? Exactly.

Jeff Peters (03:54):
Very insightful.

Mark Wimberly, MD (03:55):
Those are the things that nobody does teach you in residency or in training in general. So we actually really have a formal process now, which we did not years ago.

Tom Rossi (04:09):
It's great. It's great to hear that because the fact that you're formalizing it, both of you have a thought about how to do this, because in many cases, we see organizations that really don't have necessarily that thought through. And there's no way to help build those skills, not only the soft skills, which are super important, as Mark said, but also the financial acumen, the business acumen, those pieces of the puzzle that the anesthesia leader will need to be sitting down with the CFO, with the controller, with these folks, and not be able to build the spreadsheet, but be able to talk to them about the spreadsheet and be able to speak their language. And if you can build those relationships as the leader with the different groups, the financial team, the operations team, the nursing team, the quality team, all of those relationships pay back in spades as you go forward.

Jeff Peters (05:11):
So in a lot of organizations, there's a sense that anesthesia isn't working well. How do you identify a dysfunctional anesthesia leader and how do you address the dysfunction in such a way that it doesn't destroy the department?

Mark Wimberly, MD (05:39):
That's a difficult question.

Joseph Rodrigo, DO (05:42):
Yeah. I'll take a quick stab at it. Obviously, one of the things I'm very-

Jeff Peters (05:48):
There's some hospital leaders in this room that are very focused on this issue at the very moment.

Joseph Rodrigo, DO (05:55):
It comes down to, with leadership, we've got three or four new division leaders within the department that I've been working with and trying to develop them, get them the skillsets and all of that. But one of the things I always teach as a leader, you want obviously people to follow you. How do people follow you best? It's how you treat other people. So I think the first dysfunction you're going to see is how they're treating the other people. In the complaints you're going to hear of, "Oh, he's not being fair to me," or, "He's doing this or that. " And so it's really, that's kind of the first thing that jumps off the page is how does that person treat other people and how do people respond to that person? That's going to be the kind of first thing like, "We've got a problem with this leader."

Tom Rossi (06:41):
And not only do they complain, but they actually vote with their feet, they're gone. The team is gone. The retention is a huge issue in those scenarios.

Mark Wimberly, MD (06:53):
I was going to say from our standpoint, we actually really work on retention. So when you do hire someone, the next step is their satisfaction. So we do a lot of things across our company to make sure we have retention.

Jeff Peters (07:10):
So anesthesia physician leadership is important, but as more of our workforce is made by including CRNAs, how do you not only identify a CRNA leader, but how do you integrate that CRNA leadership into the department leadership? Because that integration at the top is key to making things work on a daily basis.

Mark Wimberly, MD (07:41):
Well, we actually, from our standpoint, we take our CRNA leadership. We have two of them, two chiefs, and we really work with them on a daily basis to align with them. And we value their opinion. Because when we're making these global decisions, we really, as far as our staffing and our APPs, we really don't make decisions without informing them and getting their buy-in because they know exactly boots on the ground, what our staff is saying. So we engage them. And then we also engage all of our staff. Even last weekend, we had a yearly round table with all of our staff. We met at a restaurant, we paid for everything, everybody had a good time, but the point of it was to engage with all of our staff, get their opinions, let them know we care. We listen to them, what changes can we all make to do better for them?

(08:41):
And then we're all aligned. I mean, we have to take our staff's opinions very seriously because we're all competing for staff and we're all... have to be aligned on the same page. Yeah.

Jeff Peters (08:54):
Sort of as a follow-up question, you don't have an annual one, but do you have monthly meetings? What goes on regularly to keep that dialogue going?

Mark Wimberly, MD (09:07):
Me specifically? Okay. I mean, for me specifically, I'm actually 100% clinical also. So not only is my title the president of the group, but I'm also full clinical. So I'm in the operating room every single day with them. So I'd actually think it gives us an advantage because we identify stuff right away and we don't ask our staff to do anything that I'm not willing to do myself, meaning, "Oh, well, someone needs to go staff this location. Someone needs to do this. " Well, I'm doing it myself. So I understand where they're coming from and they value that.

Jeff Peters (09:44):
Yeah. I don't think we should ignore that, at least in organizations that I've looked at, and particularly in academic organizations, the anesthesia department that functions the best is where the department chairperson is in the OR at least one day a week and takes call because you can't lead from an office and you can't lead anecdotally. And just like you said, you learn more by practicing clinically of what needs to change than you could ever find out from a spreadsheet.

Joseph Rodrigo, DO (10:30):
Yeah. It comes down to street credibility. It's really difficult to manage people without putting yourself in their place. Just like Mark said, the best way to manage people, the best way to get a feel for how the department's functioning is to be amongst the team and actually do the work. And it's different. I do a lot of transitional work, and I'm temporary in and out of these situations. I don't get to develop as many relationships, but I try to instill that on my division chiefs because they're responsible for their area. But I'm like, on your days off when you're doing your arts time, your admin time, still make yourself known. Don't just disappear so that way people know you're around, you're always available to them. So you have to be present. Physical presence around your team is important.

Tom Rossi (11:25):
I'd just add a lot of the models that we've seen have a heavy clinical component, maybe not 100%, that's tough to pull off, but a heavy clinical component, but also some protected time for leadership, administration, sometimes research, all those things can be part of that puzzle too. Yeah.

Jeff Peters (11:44):
I'm going to ask a question and then we'll sort of open it up to the audience to try to be more responsive to your needs. But how do you think the training of anesthesia providers needs to change or be modified so that we're developing anesthesia leaders and exposing them to leadership theories and examples as part of their training? What needs to change?

Joseph Rodrigo, DO (12:19):
That's tough. Obviously, it would be great to have a rotation or whatever it is during residency. We're kind of learning the business side, understanding a little bit about billing, developing some of those other skillsets. Clinically, we're all going to come out and be great, hopefully, but that's what we do. And that is one of the biggest missing pieces that we see where people come out. And when I was young, fresh in practice, I used to sit in our office with our office manager just getting my mail and I would just ask her questions and probably annoy the crap out of her, but just trying to understand how we got paid, how the contracts work, things like that. I think it's very imperative that we get people involved. And this new generation of people coming out, they're great clinicians, but they don't really have the desire and drive to be leaders.

(13:12):
Now that we don't ... We've got fewer big private practices in anesthesia. They don't come in learning how to run a practice. They don't really aren't involved in that business side of it. They just want to come in, do a great job, punch in, punch out, make some money. So how do we entice those? And I think people that are natural leaders are going to gravitate, but we just don't have that many. But again, there are people that have the skillset, they just don't know it.

Jeff Peters (13:40):
Other thoughts?

Mark Wimberly, MD (13:43):
I think that as far as in residency, it's tough to say there needs to be dedicated time to learn that stuff. I mean, you only have so much time in residency or your training. A lot of it's just real world. You just have to have the desire to want to learn it. So when we get people in, for us, a new grad, we have to spend time with teaching them how to navigate that. I mean, but it's probably some of the most ... A predictor of your success as a career might hinge more on that than it is if you just know the book knowledge. I mean, that might be just as heavy as far as being successful as a clinician.

Joseph Rodrigo, DO (14:24):
Yeah. One of the things that we have done in the transition I'm working on is we've built out a waterfall structure of getting more people involved in leadership. So different committees, we developed an APP lead structure for different sites that report up to our APP director. And so we really tried to spread out the department purposefully to get more people interested in leadership, kind of more boots on the ground, kind of paying attention to stuff what's going on. So then you're building that structure and then as people decide, I like this, then you've got a natural built-in flow of future leaders. And it's not always easy to do in more of a private practice. This is being developed more as an academic practice, but it's something to do very similar to what Mark talks about with partnering up with a mentor and kind of getting these providers interested in the things that those of us do.

Tom Rossi (15:17):
Yeah, I love that, that you guys spread that leadership and it kind of allows you to find leaders. I know some of the larger organizations like Mike at HCA, they've developed a leadership academy in- house that they use. Others are doing things through some of the organizations, American Association of Physician Leadership. AAPL has some excellent modules. You can attain a certified physician executive, a CPE through that. So there's all kinds of ways. Some even are doing physician MBA programs as well on the side to grow their knowledge. There's lots of options.

Jeff Peters (15:57):
Yeah. One large group in the Midwest, there's a particular, one of the more senior leaders feels that it's his mission to nurture the future leaders. And he makes everybody that comes into the group aware that if you're interested in leadership or you're just interested in getting further exposure to the business of anesthesia, I'm here to help you. And what he starts with is asking them to read the book. I'm sure everybody in this room's read crucial conversations. And then he sits down with the anesthesia leaders in training once a week and talks about it and then relates it to problems they've experienced. And it's usually an outburst between an anesthesiologist and a surgeon or not treating the nurses with the level of respect that's had. So it's not just giving them the didactic training, but then finding examples where people could have handled situations a little bit better and doing it. But before we end, does anybody have any questions in the audience for the panel that we may not have covered? Okay. Well, thank you. We've certainly enjoyed the opportunity to share some of our thoughts.

Be Our Guest

Do you have an anesthesia perspective to share? We’re always looking for healthcare leaders to discuss the industry's most pressing challenges. Apply below for a chance to be featured.