Navigating the Clinical Component
Clinical Environment You'll Lead
| Current State |
Your Leadership Goal |
| 12 contracted OR rooms |
Expand to 14 rooms |
| 6.6 FTE physicians taking call |
Recruit faculty to reduce burden |
| 7-8 calls per month per physician |
Sustainable call frequency |
| Recent attrition created gaps |
Rebuild stable faculty base |
Facility: Level II Trauma Center with cardiac capabilities serving Northwest Ohio
Your Operational Responsibilities
Daily OR Board Management:
- Real-time case assignments and room allocation
- Schedule adjustments as emergencies arrive
- Equipment and staff resource management
- Communication with surgical teams about timing and availability
Performance Improvement:
- Identify bottlenecks in room turnover
- Implement process changes reducing wasted time
- Optimize block utilization across surgical services
- Track and improve key metrics (first-case starts, turnover times, utilization)
Liaison & Problem-Solving:
- Primary contact for surgeon complaints and requests
- Interface with hospital administrators on performance
- Navigate competing demands (surgeons, administrators, faculty)
- Distinguish legitimate concerns from unreasonable expectations
Surgical Services Growth
Vascular Surgery:
- 4 surgeons (3 hired recently)
- Open and endovascular procedures
- Steady high-acuity case volume
Orthopedics:
- High volume: trauma, joint replacement, sports medicine
- Regional anesthesia opportunities
- Consistent case flow
Surgical Oncology:
- Breast surgery and urologic oncology
- Range from straightforward to complex multi-hour cases
- Growing service line
Endoscopy:
- 70% volume growth in past year
- Efficiency and throughput demands
- Sedation service scaling challenge
Transplant:
- Regular kidney transplants
- Select liver and pancreas cases
- Adds complexity to scheduling
Cardiac Surgery:
- Stable volume (certification maintenance)
- Cases available for cardiac-trained anesthesiologists
- Not high-growth service
Plastics:
- Currently recruiting surgeons
- Will add microsurgical cases
- Operational planning required
Teaching Oversight
Residency Program You'll Support:
- 12 residents total (3 per year)
- Only anesthesia residency in Northwest Ohio
- 2:1 supervision standard, 1:1 for high-acuity cases
- Associate Program Director handles curriculum (0.8 FTE protected time)
Your Responsibility:
- Ensure faculty maintain educational standards
- Balance OR efficiency with teaching quality
- Address situations where teaching becomes inconsistent
- Coordinate operational decisions with educational goals
- Maintain program accreditation compliance
Leadership Example:
- Residents observe how you manage crises, interact with surgeons, support colleagues
- Your behavior sets professional standards they emulate
- Teaching happens through observation as much as formal instruction
Call Coverage Management
Your Participation:
- Take in-house first call with faculty rotation
- Currently 7-8 calls per month
- Demonstrate shared burden (no leadership exemptions)
- Maintain clinical skills and frontline credibility
Call Structure:
- 1 resident in-house overnight
- Backup resident available for multiple simultaneous cases
- Second-call attending for surge support
- Typical overnight volume: 1-2 ORs maximum
- No OB coverage (no labor epidurals at night)
Your Decision Authority:
- When to activate second call
- How to allocate overnight cases
- When to call in additional help
- Balance patient safety vs. appropriate resource use
Technology & Systems
Epic EMR:
- Monitor OR performance metrics
- Track case volumes and analyze delay patterns
- Generate reports informing operational decisions
- Data visibility for evidence-based management
- System recognized for effective implementation
Care Team You'll Manage:
- 14.2 FTE CRNAs (medical direction model)
- CAAs providing additional coverage
- Managing assignments and supervision
- Addressing performance issues when they arise
- Leveraging team to cover more rooms efficiently
Key Operational Challenges
Metrics You're Accountable For:
- First case on-time starts
- Room turnover times
- Case cancellations due to anesthesia issues
- Overall OR utilization
- Block utilization by surgical service
Stakeholder Pressures:
- Surgeons want faster turnover and more access
- Administrators demand better efficiency metrics
- Faculty need sustainable workloads
- Residents need quality educational experience
- Hospital executives expect measurable improvement
Your Success Criteria:
- Actually improve metrics (not just explain variances)
- Implement sustainable process changes
- Recruit faculty to reduce call burden
- Expand to 14 rooms without overwhelming current team
- Maintain quality and safety during efficiency improvements
Your Clinical Practice
80% Clinical Time Means:
- Most days spent in ORs, not meetings
- Continue providing direct patient care
- Supervise residents during cases
- Take call and manage emergencies
- Maintain anesthesia board certification
Why Clinical Practice Matters:
- Credibility with faculty (you do the work you direct others to perform)
- Understand operational realities firsthand
- Live with consequences of your own decisions
- Stay current with clinical challenges
- Leadership by example vs. distant administration
Case Assignments:
- Complex procedures benefiting from your experience
- Teaching cases where residents need senior faculty exposure
- Coverage filling gaps when others unavailable
- Subspecialty work matching your training (cardiac if applicable)
Pain Management Division
- Separate division led by Dr. Alexander Escobar
- Operates independently with own fellowship
- General anesthesia operations don't overlap
- Clear boundaries between subspecialties
What Effective Leadership Looks Like Here
Boots-on-the-Ground Approach:
- OR board management is your command center
- Real-time decisions visible to everyone
- Failures generate immediate consequences
- Success improves patient care and surgeon satisfaction
Collaboration Required:
- Partnership with Chair Dr. Jenkins (servant leadership model)
- Support faculty during rebuilding phase
- Navigate surgeon relationships and demands
- Interface with hospital executives on strategy
Autonomy With Accountability:
- Make day-to-day decisions independently
- Implement changes without micromanagement
- Held accountable for results
- Escalate significant issues appropriately
Results That Matter:
- Improved OR efficiency metrics
- Successful faculty recruitment
- Reduced call burden for physicians
- Expanded capacity to 14 rooms
- Maintained educational quality
- Surgeon and administrator satisfaction