The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine and Population Health University of Wisconsin

The Operating Room Environment “Century of the Surgeon”

OR Coordinator Management Position Responsibilities –Direction of Personnel –Scheduling –Planning and Organization –Professional Conduct

Director of Perioperative Services Formal Job Description Administrative Appointment –Bases of power –Legitimate authority –Influence Oversight of the clinical anesthesia services Facilitation of the efficient use of all resources throughout Surgical Services Appointments –Department of Anesthesiology –Department of Surgery –Hospital Administration

Bases of Power Control over Resources Technical Skills Body of Knowledge Ability to Inspire Access to Others “Power is the ability to effect organizational outcome”: Mintzberg

Areas of Supervision Power: Resources/Knowledge Daily Decisions Making Scheduling Allocation of Resources Utilization Preoperative Clinic PACU Acute Pain Management Perioperative Information Services OR Budget

Required Skill Set Power: Skills/Inspiration Vested interest in Overall OR Performance Strong Clinical Background Daily Presence Strong Communication Skills Strategic Planning Supervision of Personnel Consensus Based Leadership Formal Business Training Negotiation and Mediation

Reporting Relationships Power: Access Director Surgical Services (Nursing) Departmental Chairs Director Perioperative Services (Medical) Hospital Administration OR Executive Committee OR Committee

Guiding Coalition for Change Director of Perioperative Services Director of Surgical Services OR Executive Committee OR Committee Chair Hospital CEO/COO Management Teams Kotter JP. Leading Change. Harvard Business School Press. 1996

Compensation Department of Anesthesiology (60%) –Clinical Component –Academic Component OR Management Senior Rotation Practice Management Curriculum –Administrative Component Department of Surgery –Administrative Supplement Hospital (40%) –Administrative Component

The Medical Director Position as a Quality Force LeadershipPower/Influence Authority Across Disciplines Collaboration Unwavering Support Team Development

Quality Initiatives

A Partnership for Better Care –Agency for Healthcare Research and Quality –American Hospital Association –CMS/CDC/VA –Institute for Health Care Improvement (IHI) –JCAHO –American Society of Anesthesiologists –American College of Surgeons –Association of Perioperative Registered Nurses

Preventing Surgical Complications –Surgical Site Infections –Adverse Cardiac Events –Venous Thromboembolism –Postoperative Pneumonia 2005 Launch a Multiyear Campaign Goal is to reduce complications by 25% by the year 2010

“Pay for Performance” “Pay for Performance” Care Management Performance Demonstration Physician Focused Quality Initiatives Premier Hospital Quality Incentive Demonstration: Rewarding Superior Quality Care –Hospitals in the top decile will receive a 2% bonus on their Medicare payments for the measured condition –Current $7 million per year –After three years hospitals without demonstrated improvement will receive1-2% lower reimbursement –Total of 278 hospitals

Evolution Anesthesiologist in Charge –Coordinator Operating Room Director –Management Director of Perioperative Services/Vice Chair Of Clinical Operations –Administration and Leadership Hospital Leadership Positions –VP of Surgical Affairs –VP of Medical Affairs –COO/CEO

“May the Force Be With You”