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- [00:00]
A
Hello, everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series. So today we're going to talk about what CEOs need to know before changing anesthesia partners. And joining me for this conversation is Dr. Josh Lumbley, the Chief Quality Officer and Senior Vice President of Physician Operations at Northstar anesthesia. Dr. Lumbley, so glad to have you with us on the podcast today. Thanks for being here.
- [00:28]
B
Yeah, Erica, thanks for having me.
- [00:30]
A
We're so glad to have you. And before we get into the heart of our conversation, wanted to know if you could just briefly walk our listeners through your own professional journey and maybe share a little bit about the work that you're doing right now.
- [00:42]
B
Yeah. So, Erica, I'm a practicing anesthesiologist and I serve as the Chief Quality Officer for Northstar Anesthesia. And I think about my role as kind of a overlap of three circles, so a Venn diagram that typically are usually separate in healthcare. So first, I'm the clinical lead on our business development efforts. So I am the person in the room with hospital administrators when they are evaluating anesthesia partners. And then secondarily, when those partnerships begin, I typically serve as the executive clinical sponsor, helping to stabilize the practice during the startup and transition period. And then thirdly, I oversee our Office of Clinical Quality. So I focus on patient safety, performance improvement, and supporting clinicians across our multiple hundreds of clinical locations, both ASCs and acute care hospitals. And so what's really interesting is that those first two experiences, seemingly very disparate, being in the room during a hospital evaluation and being present during the early months of a new partnership, directly inform how I think about quality and operational stability. So from my standpoint, you know, we're talking today about anesthesia transitions, and I think about those not really just as contracts, but more so complex clinical systems that have to work reliably starting from day one.
- [02:19]
A
That's so well said, Dr. Lumbley. And I think your perspective coming from, you know, it sounds like you have your. Your hand in a lot of business operations, clinical operations. You have a really well rounded perspective that you're bringing to partnerships and to this podcast episode today. So I'm excited to dig in and learn a little bit more about what these partnerships should look like when they're effective. And we know that anesthesia right now is an area of care delivery that is certainly facing a lot of strain from a workforce standpoint and in other areas. So. So I think it's important to Start high level here and just maybe start at the beginning and that's selecting a new anesthesia partner. I think executives probably assume that maybe the hardest decision is selecting the right partner. But I'd love to know how that compares to what you're observing in the field. You know, does that selection process, does that ring true for you as the most difficult part or does the real challenge start somewhere else?
- [03:13]
B
Yeah, it's a great point. So of course when you, if you as a hospital administrator have gotten to the point where you are considering transitioning anesthesia services, you have really focused on a really complex, difficult problem. So maybe you're lacking in leadership, maybe you're lacking in confidence and your existing partner being able to scale and grow with you as an organization, maybe the group that you've got has some clinical deficiencies or maybe frankly you feel like they are lacking in, you know, the leadership and the operational sort of savviness that you need in a good partner. And yes, wrestling with that decision making process does feel very complex. And you may feel like that's the hardest decision, but in reality it's really the first step of a multi step, complex problem that you've got to solve. So the test really begins the day the transition starts. So the day you announce we are going in a new direction with our anesthesia services, because anesthesia touches nearly every surgical case in the hospital, every procedural case in the hospital. And if your confidence in the staffing model, the leadership structure, the recruiting pipeline, if those aren't already in place, then you can start to see, really even before the transition has taken place, some challenges and friction around or staffing and meeting the procedural volume needs that currently exist with your existing footprint. So really the best transitions are the ones that are the quietest, the ones where you really don't have a whole lot of hand wringing and teeth gnashing in the operating room. Surgeons and procedural, they seen the same level of coverage, their cases continue to start on time. Clinical teams, the ancillary perioperative team, they feel supportive. And I guess ultimately that doesn't happen by accident. You got to have months of preparation, dedicated preparation, a good mechanism for communicating with your partner. Recruitment that's already underway, retention that's already underway, leadership on the ground early, and a pretty clear operational plan to all the salient stakeholders. So when I am communicating with hospital leaders, I'll tell them, you know, look, the contract, what we are agreeing upon, that's the decision point. But the operational stability is ultimately going to be what's going to define the success of this transition.
- [06:05]
A
Really helpful points about transitions, Dr. Lumbley. It sounds like, if I'm following it sounds like a lot of complexity and preparation and intention goes into the transition. But the best transitions, I think you put it, they happen quietly and they don't feel like big transitions. Do I have that right?
- [06:24]
B
Yeah, yeah, exactly.
- [06:25]
A
Yeah. Well, let's, let's go a little further there. You know, when CEOs and COOs are looking at anesthesia groups, what questions do you think reveal whether a group can actually deliver that stable, quiet transition rather than just making a strong pitch?
- [06:42]
B
So I think there's four themes I would say that need to be explored to, that'll really clarify and reveal a lot about what a transition with a prospective partner, what that's going to look like. So the first is who on your team is going to be responsible for the transition and when are they going to be here? Is this a person who's going to be here, you know, a smattering of days after announcement and then say, hey, I think we're good. I'm going to handle interviews from my home office in another state and then you'll see me on the transition date. And if that leader is someone who's going to do that, that's a warning sign. There needs to be a leader, an operational and a clinical leader that is part of the team with the new partner who's going to be the point person and is going to be a face that is seen with great regularity leading up to the transition and post transition. The second one is, do you have a recruitment pipeline that you feel like, that you feel confident in in this market? No one's going to have just a pipeline of providers that aren't doing clinical anesthesia that they can say, hey, you know, 90 days from now, I'll have you a full team that's ready to go. But really, you should feel some confidence in your prospective partner's capacity to be able to staff your operating rooms and recruit in a market, no matter how difficult or challenging that market is. Thirdly, ask them point blank, what is the first, what is the transition and what does the first 90 days look like operationally and from a clinical, you know, meeting the clinical needs and the contracted points of service that your department of anesthesia should cover. So that's going to look like what, what is contingency staffing? Are you dependent on 1099 PRNs, full timers, et cetera? Do you have, will you have a schedule made up that our perioperative staff can look at and feel confident that the names that are listed on this schedule are in fact going to be the people that show up on, on those days. And how are you going to communicate stability with our proced lists and our surgeons? And then the last one is retention, retention, retention. How are you going to gain trust with our existing department of anesthesia such that you are retaining a good portion of the anesthesiologists and nurse anesthetists at that location? So obviously you want to instill confidence or you want to have confidence as a hospital executive in the group's capacity to recruit, but you also want to have confidence in their capacity to, to retain existing clinicians and hold on to clinicians that they bring on board. Because ultimately the success long term of the department revolves around your new partner's capacity to focus on building a stable clinical culture. So that day in and day out, the anesthesiologists, the nurse anesthetists, the AAs that you have staffing, your operating rooms are the same day in and day out,
- [10:10]
A
really, really helpful questions that you've shared here, Dr. Lumbley. So questions around whether leadership is present, what the pipeline looks like, clarity around the first, first 90 days, and then retention as you've underscored, really important questions for leaders to keep in mind. And I kind of want to flip that question on the other side and talk about, you know, based on what you've seen, what are early warning signs that an anesthesia transition is not going well and that it's putting or stability at risk? And if and when you've seen that happen, what actions do you recommend that leaders take when those signs appear?
- [10:48]
B
So I think the first and the most obvious red flag is you're talking to your new partner and saying, how are things going? And they say it's perfect. No problems at all? None. There's not been any challenges, no missteps, no unexpected things that have happened. And that sort of, that just does not exist. That's a panacea. There are always going to be unexpected things that happen during a transition of anesthesia services. I really think that the key is how does the group and how does your partner adapt to those unknown unknowns that occur during a transition of anesthesia services? So at a high level, if you have a partner that says it's perfect, no problems whatsoever, that's a red flag because there are undoubtedly things that are not going to go according to plan during a transition. It is how your partner handles those sort of challenges that Sort of elucidates their skill set in being able to successfully make that transition. So having said that, I think that the earliest warning signs tend to be around operations rather than clinical. So this is going to be increased open shifts, last minute schedule, changes in with great frequency. That indicates a heavy dependence on locum tenants, 1099 labor, non full time staff, and really any sort of tension or vibe shift that you're picking up in the operating room indicating some friction between the department of anesthesia perioperative staff and surgeons and their capacity to get cases booked. So sometimes that's going to be delayed first time starts, sometimes that's going to be operating rooms shutting down earlier than expected and stacking cases one after the other after the other, indicating some decreased capacity for you to get your cases done or your surgeons to get their cases done. At the end of the day, ultimately that is a early warning sign that there's a staffing strain that's existing there. And when you as an administrator see that you should expect transparency from your partner. That is not to say that when you see it, that's a sign that things have gone sideways and you've made the wrong decision. Because as I said, you know, there are unknown unknowns as it relates to staffing anytime there's a transition. But what you should expect from your partner is transparency. And so that should be your partner proactively communicating to you challenges that are arising or certainly when pressed, your partner being clear eyed and honest with some of the challenges that that they are having in the operating room as it relates to staffing. So that person should be sharing staffing data, recruitment progress, retention progress and any of the mitigation plans that might be that they have for solving the current state staffing plans. So ultimately what I'm saying is staffing transitions are, they are going to be, these trans sorts of transitions are very challenging and challenges and unexpected events will occur. But really what is going to distinguish a partner that's going to be with you for the long time is how quickly they surface those problems, how they communicate those problems to you and how as a good partner, they address those problems in coordination with you and your perioperative staff.
- [14:40]
A
Yeah, Dr. Lumbley, it sounds like transparency is such a foundational piece of this relationship. You know, acknowledging that realistically this is going to be a complex and challenging transition. But data transparency, accountability sounds like those are the things that can help ameliorate the effects of those potential red flags or at least to feel reassured that your partner is able to address them.
- [15:03]
B
Exactly.
- [15:04]
A
Yeah. Well, let's go ahead and shift gears just a little bit here. I want to talk a little bit more about recruitment and retention. I know that we touched on earlier in the episode that staffing in general and anesthesia right now is quite strained. What do you think CEOs should understand about the anesthesia labor market right now? And how can they tell whether a prospective partner really does have a credible staffing strategy versus just a hopeful one?
- [15:31]
B
Yeah, it's a great point. And there is really no secret sauce to fixing the labor market challenges that exist. Ultimately, it's not as white hot as it was in say 21, 22 and 23, but you still have an exquisitely tight labor market for anesthesiologists and nurse anesthetists with increasing demands for their services both at the hospital based business as well as the ASC based business. So of course recruiting is critical, but I would argue that that as a good partner we should be doubling down and focusing on retention as well. So yes, there's the first R which is recruiting, but there's also a second really important R which is retention. And both of those need to be addressed satisfact with your prospective anesthesia partner. So that is going to mean how do you bring folks to the door and once you get them through the door, how do you hold on to them? So that's going to be are we establishing a strong leader in place that really leads the department in a strong fashion, distributes call, distributes schedules equitably, is developing other leaders under them and is your partner one that can depend on sort of a national base as it relates to recruiting? Certainly you want to be able to call upon clinicians from all across the country, but also do they have a great deal of knowledge in your specific market for bringing new people through the door? And then what is their across their footprint? What is their retention number look like? It's not just bringing people through the door, as I said, it's holding on to them. And are the people that they're bringing through the door are These temporary partial FTEs, locum tenants, clinicians that of course are going to get the cases done but may not be contributing to the overall culture in the department so that you have a stable department with the same faces day in and day out. And so I think so much focus can be dedicated towards recruiting and filling empty spots. But a good partner should be able to articulate the their capacity to once they get people through the door, we hold on to them we invest in their careers as leaders. We invest in their careers clinically and operationally so that they're growing their careers, they have some career progression and they are stable in seat. And so you're seeing them day in and day out in your department.
- [18:24]
A
Dr. Lumbley, you've given us such fantastic insights, ones that are really tangible as well. So I just want to say I appreciate how specific you're being and all of these considerations that leaders should be looking at when they're looking at anesthesia partners or perhaps in the early stages of the partnership and the transition to round us out. I wanted to just end on something that we already kind of addressed, and that's the concept of accountability. Because I think that can kind of tie together everything that you've shared with our audience today. In practical terms, what are the commitments, reporting structures or leadership behaviors that really do show that an anesthesia group has, so to speak, skin in the game?
- [19:05]
B
Yeah, I mean, this relationship cannot be transactional. It has to be consultative and a true partnership. So it's got to show up in leadership structure and it has to show up in on the ground behavior. And sometimes when you hear skin in the game, you think, well, what is that? What are the financial risks that my partner. Partner is taking? And I like to turn that on its head and say, what are the investments that your partner is making above and beyond the contract to make sure that this contract is sticky and they are true partners in helping you grow your surgical volume. So the first one is, what does leadership look like? Is there a leadership on the ground from the organization in the transition, and is there leadership investment in terms of growing leaders at the local level so that you've got a strong medical director, a strong chief CRNA and a strong operations leader that's going to be engaged with you and with your surgical teams as you try to grow surgical volume secondarily? Is, are they transparent? Are they transparent financially and are they transparent operationally? Staffing, giving quality metrics, what the performance looks like in the department? Is it a black box that you really. I don't really know what staffing looks like there. I don't really know what their quality metrics look like. I don't really know what their revenue cycle looks like. That cannot be the case. It has to be open book, transparent reporting as a true partner. And then I think last but not least, are they partners? Are they truly invested in your medical staff and aligned with you and your hospital success? So that's got to be, you know, number one of course recruiting. It's got to be leadership development, it's got to be retention, and it's got to be aligning around like system based quality initiatives so that we collectively are accountable when there are challenges that arise. And we collectively are both, you know, rowing in the same direction as the Department of Anesthesia with the hospital Department of Surgery perioperative. So ultimately your partner should not look like a vendor. The best relationships are going to be true integrated clinical partnerships.
- [21:21]
A
Such a fantastic insight. Dr. Lumley, before we close, is there any final piece of advice or insight that you'd want our leadership audience to hear, especially if they're considering an anesthesia change in the next year?
- [21:34]
B
Yeah, I think great question. If I could leave with any bit of insight, it would be focus as much attention on the transition plan as you do the actual contract itself and the evaluation period of your prospective anesthesia vendor anesthesia partner. So questions about recruiting, questions about leadership presence, questions about leadership development or stability, etc. What do things look like? Not on just announcement day or transition day, but what do things look like six months from now? Because the goal is not just to select a partner, it's to make sure that that transition is invisible, is quiet, as I said earlier to your surgeons, to your patients. Because when that happens, it usually occurs because the hospital and your anesthesia partner have aligned for a long term partnership view, not just a we're going to make the first through the first 90 days and there's not going to be any hiccups in the operating room. We are aligned collectively for a long term partnership in mind and we're making decisions with that long term mentality in place.
- [22:46]
A
Dr. Lumley, I want to thank you for all of your thought leadership today and the fantastic insights that you've shared with our audience. I know they have a lot to think about here as we close the episode and just want to thank you for all the practical advice and the wisdom.
- [22:59]
B
Well, fabulous. Thank you so much for hosting. It was a great time.
- [23:03]
A
Oh, likewise. And of course we'd also like to thank today's podcast sponsor, Northstar Anesthesia listeners. Be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.