The Medical Director A Quality Force

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The Medical DirectorA Quality Force

• Susan L. Goelzer MD, MS, CPE
• Ralph Waters MD Distinguished Chair
• Professor of Anesthesiology, Internal Medicine
  and Population Health
• University of Wisconsin

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The Operating Room EnvironmentCentury of the
Surgeon
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OR Coordinator

• Management Position
• Responsibilities
• Direction of Personnel
• Scheduling
• Planning and Organization
• Professional Conduct

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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

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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
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Areas of SupervisionPower Resources/Knowledge

• Daily Decisions Making
• Scheduling
• Allocation of Resources
• Utilization
• Preoperative Clinic
• PACU
• Acute Pain Management
• Perioperative Information Services
• OR Budget

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Required Skill SetPower 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

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

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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

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The Medical Director Position as a Quality Force

• Leadership
• Power/Influence
• Authority Across Disciplines
• Collaboration
• Unwavering Support
• Team Development

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Quality Initiatives
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• 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

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• 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

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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 cost _at_ 7 million per year
• After three years hospitals without demonstrated
  improvement will receive1-2 lower reimbursement
• Total of 278 hospitals

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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

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May the Force Be With You