Anesthesia Provider Evaluations
Author: Cynthia M. Roehr, CPA, CMPE
- Reliable and timely in work attendance.
- Contributes to OR efficiency.
- Approachable and open to input and questions from staff and colleagues.
- Avoids unprofessional conduct and comments.
- Engages in activities to improve the practice.
Are there any providers on your groups that could improve on any of those points? Do they know they could improve? Do they have any incentive to improve?
Years ago, when I was the Chief Administrative Officer of a mid-sized independent anesthesia group, I had a President that kept asking the group “How do we know we are good? We think we are, but how do we know?” and “How can we get better?” Through his leadership, initiatives were undertaken to answer those questions. One was to evaluate our anesthesia providers. It was transformational for the group, as the result was to eliminate use of locums, reprimand misbehavers and coach those needing improvement. It changed the group’s culture and added accountability among members. It spoke to the power and importance of provider evaluations.
As a whole, anesthesiologists are conflict adverse. And giving feedback (i.e. performance evaluations) involves confrontation. Thus, very few groups muster the energy to undertake this important task. But providing feedback is the only way to improve individual performance thereby improving the group.
Most anesthesia groups allow their members to function with a great deal of autonomy and in fact, most work in silos. Thus in evaluating providers, input should be sought from the entire team that surrounds them. While this is mainly nurses, there are surgeons, techs, desk personnel and others that are also acutely aware of (and impacted by) an anesthesia provider’s job performance. Best practice is to use anonymous surveys scored on a Likert Scale (strongly agree to strongly disagree, etc.).
Questions should be centered on the “Three Pillars of Physician Excellence: Availability, Affability and Ability.” These “three A’s” have been in literature for over a decade and are the key to job performance. Availability would address issues such as timeliness and reliability. Affability applies to communication skills and style. And Ability can be observed in attentiveness and clinical outcomes. Groups can develop their own questions; to be most valuable, they should be matched to the roles of the surrounding team – i.e. the preop team probably knows nothing about nausea rates just as the post-op team knows little about the timeliness of a provider’s typical daily arrival. Questions regarding CRNA or AA performance might differ from those of anesthesiologists or supervising anesthesiologists. Citizenship and surgeon satisfaction should not be ignored.
Individuals respond differently to feedback. Some accept and embrace it. They understand that “perception is reality.” These are star providers and will self-correct and alter behavior to conform to the desired goals. They have been openly accepting feedback, learning from it and improving their entire careers – that’s why they are stars.
We are all aware of anecdotal reports indicating that simply posting provider on-time start statistics can rein-in tardy individuals. Posting blinded survey scores or data can likewise help hone-in outliers. However, there are individuals that will not change unless there are ramifications for remaining at the status-quo. Financial incentives (carrots or sticks) can work. It has been shown the most effective motivator is a penalty whereby the pool of penalty money goes to peers. Consider a “swear-jar” where the pot is ONLY split among those that never had to contribute – the behavioral change will be more significant than if that pot is used to buy lunch for everyone.
Some individuals either will not or cannot change their behaviors. Counseling and professional help should be considered and/or offered. Use legal counsel whenever dealing with situations of this magnitude. There can be ADA, discrimination and other significant issues involved. But sometimes it is best to remove the provider from the group, even if litigation is likely.
A common struggle occurs when a provider has recurring issues or deficiencies, but none seem to rise to the level necessitating dismissal. Employment-relationship fatigue results when leadership expends frequent or ongoing oversight or discipline for a single individual. Certainly, removing partners is difficult and should only be undertaken with the assistance of legal counsel, but if employment fatigue is prevalent, this action should be strongly considered. Feedback from surveys will document and validate the negative impact such an individual is having on the overall impression and “brand” of the practice. Independent feedback can support and empower leadership to make the necessary changes.
Hospitals and ASC’s appreciate groups courageous enough to evaluate and self-correct their members. Share survey results with these c-suites along with OR management, as it awards credibility to anesthesia leadership. Facilities want assurances that anesthesia leadership is monitoring and managing its personnel; they want to know their patients are receiving excellent care.
We all know that a single provider’s misbehavior or trait can negate all the goodwill that has been amassed by the entire group. Provider evaluations and feedback are essential to assure that groups are not blindsided by individual aberrations or global deficiencies. Those groups that evaluate their providers, listen to the feedback and use it to improve, will become star groups and solidify their partnership with their facilities.
Cindy Roehr is a CPA with over a quarter-century of anesthesia and practice management experience. She has been a frequent speaker at ASA and MGMA conferences and consults with groups on provider performance evaluations, hospital contracting, governance, financial modeling and RCM issues. Additional information about Ms. Roehr and additional articles pertaining to practice management may be found at www.roehrconsultingllc.com