![Page 1: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/1.jpg)
Strategies to Maintain Group CohesivenessFriday, May 6, 2005
8:30 – 9:00 AM
James English, M.D.President
Anaesthesia Associates of Massachusetts
![Page 2: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/2.jpg)
How Do We Do it?
Image from: http://www.aselectronics.com/as/images/teamwork.jpg
![Page 3: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/3.jpg)
![Page 4: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/4.jpg)
Culture
“The set of shared attitudes, values, goals andpractices that characterizes a group”
Webster’s Dictionary
Image from: www.punchstock.com/.../ 2700104/image_WP023.html
![Page 5: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/5.jpg)
Culture
•Patient safety •Excellent efficacious service•Anesthesia care team•Good citizenship at facilities•Strong work ethic•Equality in workload and compensation
![Page 6: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/6.jpg)
How to Perpetuate Culture and Maintain Cohesiveness
•Everybody does (almost) everything•Equal pay for all•The call team•The anesthesiologist who practices pain management•Monitoring the troops
![Page 7: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/7.jpg)
Everybody Does (Almost) Everything
Flexibilityhttp://www.funnypart.com/funny_pictures/flexibility.shtml
![Page 8: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/8.jpg)
“Everything”
•Straightforward pediatrics•Obstetric anesthesia•Regional anesthesia•Vascular, thoracic, trauma, neurosurgery•Rotate to at least three facilities•In-house call•Call team•MD/CRNA anesthesia care team
![Page 9: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/9.jpg)
Rotating
•Necessary for members to absorb culture•All MD’s and CRNA’s•At least three facilities•Practice with familiar personnel/(friends) in different settings•Core vs. rotating personnel•Employment vs. deployment (deep bench)
![Page 10: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/10.jpg)
MD/CRNA Anesthesia Care Team
•AAM’s predominant form of (private) practice•Mutual respect•Collaboration on anesthetic plan•Shared workload•Camaraderie and loyalty
![Page 11: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/11.jpg)
Niches
•Cardiac (TEE)•Pain management•Complex pediatrics•Critical care
Niche anesthesiologists also do “everything”
![Page 12: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/12.jpg)
The Key
Image from: www.dontsayyoudidntknow.net/ pages/equality.html
![Page 13: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/13.jpg)
Equal Pay
•Shareholder status after three years•Equal base draw•Overtime incentives available to all•Equal distributions
![Page 14: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/14.jpg)
Differential Compensation for Extra Clinical Endeavors
•A work in progress•Reward and incentivize group members who contribute more•Preserve the culture of equality•Time, money, titles, privileges
![Page 15: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/15.jpg)
Extra Clinical Endeavors
•Duties of officers, chiefs, residency directors•Research initiatives•Consulting opportunities•New ventures to benefit the group
![Page 16: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/16.jpg)
![Page 17: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/17.jpg)
Before Call Team
•4 first calls out of house•6 back up calls•Facility dedicated•Potential for unequal work and time•Non call MD’s “trapped” late•Four post call MD’s daily
![Page 18: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/18.jpg)
Call Team
•Three high teammates•Combined privileges cover all facilities and niches•Seven low teammates•Cover ten out of house call positions
![Page 19: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/19.jpg)
Call Team Advantages
•Deeper coverage with the same (or less) number of people•Fairer distribution of workload•Less late days for non-call people•More post-call MD’s available for assignments
![Page 20: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/20.jpg)
Call Team Coordinator
•1 of 3 high team MD’s•Dispatcher and practitioner•Receives all bookings, floor calls, pain calls, ICU/ER calls•Coordinates location, credentials, expertise
![Page 21: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/21.jpg)
AAM Daily Call Team Schedule/Call Team Coordinator Worksheet
![Page 22: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/22.jpg)
Call Team Pitfalls
• Missed page/CTC incommunicado
• Credentialed M.D. occupied elsewhere
• Emergency OB when in house MD occupied
• Inclement weather
• Backup CTC• Avoid dead spots• No alpha pagers• No relayed messages – obtain
confirmation• Anticipate thin coverage• Low call team• In-house• Expanded CRNA coverage• Early notification of in-house cases• Location of backup based on time of day,
traffic, distance• Facility dedicated MD• Consider in-house or hotel• Four wheel drive vehicles
Problem Solution
![Page 23: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/23.jpg)
The Anesthesiologist who Practices Pain Management
![Page 24: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/24.jpg)
Anesthesiologists Practicing Pain Management
•9 doctors to cover 6 sites•Practice 50 to 80 percent•Rotate to pain clinics and OR’s
![Page 25: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/25.jpg)
Pain Specialists Practicing Anesthesia
•Call coverage•OR coverage early and/or late•In-house emergency back-up•Teaching•Expertise to the call team
![Page 26: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/26.jpg)
Pain Chief
•A peer to facility chiefs•Liaison to hospital administration•Business and clinical issues
![Page 27: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/27.jpg)
Monitoring the Troops
![Page 28: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/28.jpg)
“You can observe a lot by watching”
Yogi Berra
Corollary: You can hear a lot by listening
![Page 29: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/29.jpg)
Communicate, Communicate, Communicate
•Facility Departmental•Board of Directors•Steering Committee•Chief’s Clinical Management Committee•Shareholders•Future Shareholders
Meetings
![Page 30: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/30.jpg)
Other Communication Strategies
Reaching outCRNA site managersAAM websiteStandardization committeeSocial functions
![Page 31: Strategies to Maintain Group Cohesiveness Friday, May 6, 2005 8:30 – 9:00 AM James English, M.D. President Anaesthesia Associates of Massachusetts](https://reader036.vdocuments.site/reader036/viewer/2022062714/56649d3a5503460f94a15323/html5/thumbnails/31.jpg)
Issues Identified through Vigilance
•Morale and burnout•Safety•Drug seeking behavior•Depression•Alcoholism•Debilitating illness