Learning From the Best in Anesthesiology

  • Hertzberg, Linda, MD, FASA
| Apr 27, 2015

It was a beautiful sunny weekend on the Embarcadero in San Francisco while the CSA 2015 Annual Anesthesia Meeting & Workshops were underway.  Despite the wonderful weather the action was just as hot inside as outside and it showed in the attendance in the meeting rooms. Under the expert guidance of program chair Edward Mariano, MD, MAS, and with an overall attendance of nearly 220 individuals from seventeen states and five foreign countries, 29 exhibitors, the CSA is calling this meeting a big success.

One of the biggest strengths of the meeting was definitely the group of speakers recruited by Dr. Mariano.  Since the meeting format is relatively simple with only two concurrent sessions, refresher courses and problem based learning discussions (PBLDs), the entire meeting is centered on the quality of speakers and selection of topics. The PBLDs in particular afforded attendees opportunities to spend focused time in a small group setting with some well-known and sought after speakers in anesthesiology, including Zeev Kain, MD, MBA, Linda Mason, MD, Adrian Gelb, MBChB, Sandra Kopp, MD, Ronald Pearl, MD, PhD, Piyush Patel, MD and more.

In the two PBLDs that I attended, one on “Lessons in Process Improvement: What Works and What Doesn’t” with Anita Honkanen, MD of Stanford University and “How Do I Convince My Hospital to Start a Perioperative Surgical Home (PSH)?” with Zeev Kain, MD, MBA of UC Irvine, I felt like I was hearing up to date information on these topics from the most knowledgeable experts in their fields.

Dr. Honkanen focused on how to apply principles of  “lean” management to process improvement projects in a hospital setting. Essentially, lean is centered on making obvious what adds value by reducing everything else. For many, lean is the set of "tools" that assist in the identification and steady elimination of waste. As waste is eliminated, quality improves while time for processes and cost are reduced. Dr. Honkanen used an example of a patient throughput project at Stanford Hospital to guide the group through an exercise of making a lean process work.

Dr. Kain took a slightly different approach, discussing the PSH in general terms and encouraging the physicians in the PBLD group to try to look at what is achievable in small pieces at each individual institution. He encouraged us to look for allies and champions for PSH related projects (such as preop preparation, pain management or enhanced recovery after surgery) on the local level among our practice partners, surgeons, and hospital administrators by demonstrating specific benefit to patients and to our institutions.

We were honored to have Patricia Kapur, MD, former Chair of the UCLA Department of Anesthesiology, and the 2011 ASA Rovenstine Memorial lecturer, give the Leffingwell Honorary Lecture this year. Dr. Kapur currently serves as the Executive Vice President of UCLA Health and the Chief Executive Officer of the UCLA Faculty Practice Group.  In these management capacities, Dr. Kapur is uniquely positioned to understand the roles and relationship of physician anesthesiologists in a larger system of integrated health care, and how we can stretch our skills and expertise beyond the OR for the benefit of our patients and our specialty.

She encouraged anesthesiologists to take an active role in designing and managing all patient care sites: as OR, PACU and pain management directors and involvement in the ICU and other perioperative care. Like Dr. Kain in the PBLD, Dr. Kapur spoke of how anesthesiologists can thereby demonstrate increased value or services to the hospital and health system, surgeons and proceduralists.

The coming system of value-based care is concerned with right care being delivered at the right time, and in the right place (the lowest complexity site) to enable us to lower the total cost of care. Dr. Kapur believes that anesthesiologists can and should definitely be a part of a value based care system. Patient loyalty to a health care facility or provider comes from a good experience; patient navigation through an episode of care done well or poorly will makes a big impression on a patient and anesthesiologists can influence these processes.

Dr. Kapur discussed aligning incentives in the accountable care world. Global risk in these payment models makes the goals of the population health clearer. Under shared savings models there is a need for internal agreement on distribution of payments.  In any system there needs to be individual physician and provider incentives as an explicit part of compensation model. These should be aligned with external and internal reporting metrics such as quality, patient experience, and resource use. “You have to talk to the other people … we can’t have the other specialties making decision about how we are going to be paid.”

She emphasized that to achieve these goals anesthesiologists with leadership skills and expertise must become involved in the larger health care delivery system. Dr. Kapur challenged all of us to think more globally about health care and how we as individuals and a specialty could have a major impact on the delivery of care to our patients.

After an intense three days the meeting concluded on Sunday.  We look forward to seeing everyone in San Francisco again next year. Visit our calendar for a complete listing of our upcoming CME meetings.

Check out the full photo album of the meeting on Facebook!


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