Anesthesia Patient Safety Podcast

#256 Skin in the Game: A Fresh Flow Podcast Takeover

• Anesthesia Patient Safety Foundation • Episode 256

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This is a Fresh Flow Podcast Takeover Show. The need for strong leadership in anesthesiology has never been more crucial. Join us as we discuss structured mentorship programs and the skills required to develop effective leaders in anesthesia. Dr. Mesrobian shares insights into cultivating future leaders and the importance of training in operational management.

Here are some of the highlights:

• Operating room management and operational efficiency directly impact physician wellness by reducing unpredictability
• Balancing the demand side of anesthesia services represents a crucial opportunity for the specialty
• Scale allows large organizations to develop standardized programs in patient experience and safety
• Anesthesiologists possess unique abilities to manage complex operations that no one else in the hospital can match
• Current residency programs need to incorporate leadership and operational training
• Developing future leaders requires identifying those with leadership attributes and providing structured mentorship
• The lines between academic and private practices are blurring as all face similar challenges
• Hospital partners increasingly expect "skin in the game" with performance metrics tied to financial support
• Standardization of processes offers opportunities to improve efficiency while maintaining safety

To learn more about improving perioperative processes, check out the Fresh Flow podcast, a collaboration between University of Alabama Medicine and the Association of Anesthesia Clinical Directors.

For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/256-skin-in-the-game-a-fresh-flow-podcast-takeover/

© 2025, The Anesthesia Patient Safety Foundation

Speaker 1:

You're listening to the Anesthesia Patient Safety Podcast, the official podcast of the Anesthesia Patient Safety Foundation. We're bringing you the very best from the APSF newsletter and website, as well as the latest information in perioperative patient safety. Thanks for joining us.

Speaker 2:

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Allie Bechtel and I'm your host. Thank you for joining us for another show. We have a very special show for you today. This week we will have another takeover show brought to you by the team over at the Fresh Flow Podcast, and this time their guest is a member of the APSF Board of Directors. So stay tuned. Before we dive into the episode today, we'd like to recognize PPM Preferred Physicians Medical, a major corporate supporter of APSF. Ppm has generously provided unrestricted support to further our vision that no one shall be harmed by anesthesia care. Thank you, ppm. We wouldn't be able to do all that we do without you.

Speaker 2:

We will be tuning in to the Fresh Flow podcast, which is a collaboration between the University of Alabama Medicine and the Association of Anesthesia Clinical Directors. The Fresh Flow podcast brings unique perspectives to the recording studio to help improve perioperative operational processes. Let's meet the hosts. Matt Scherer is an associate professor and director of faculty recruitment in the UAB Department of Anesthesiology and Perioperative Medicine, and Mitch Tsai is an adjunct professor at the UAB Department of Anesthesiology and Perioperative Medicine and a professor in the Department of Anesthesiology at the University of Vermont. He also serves as the president of the Association of Anesthesia Clinical Directors.

Speaker 2:

Their guest today is Dr Jay Mezrobian, who serves on the APSF Board of Directors and is a member of the APSF's Patient Engagement Workgroup. At the time of this Fresh Flow podcast recording, dr Mezrobian was with Team Health, but has since moved on to new opportunities. This is an important conversation about developing effective leaders in anesthesia, as well as training in operational management. These areas can have a big impact on anesthesia patient safety as well. I will include a link to the Fresh Flow podcast in the show notes that you can check out for more information the show notes and transcripts. And now it's time for the Fresh Flow podcast episode Skin in the Game. Here we go.

Speaker 3:

Welcome to another edition of the Fresh Flow podcast. As always, this is going to be a great one. I'm excited about this one. I've been looking forward to it all week. But before we get going, Mitchell, we just got back from Tampa. We just got back from the AACD Perioperative Summit. What'd you think?

Speaker 4:

Well, as one of our participants said last year, the least known, best meeting that he's ever been to. It's a great opportunity to collaborate and I think we just celebrated our 37th year as a society. I'm in an organization but, as the founders put it, we're all experiencing the same issues. We're trying to figure out the solutions for the same problems, so why don't we all get together and figure out the best way that we can move forward?

Speaker 3:

So always a great meeting. It's always a great meeting. It's my favorite meeting of the year. I never come back having not learned something, and that was the case again this year. It's one of those things where I almost don't want to brag about it too much and make it too big, because it's got a nice kind of intimate feel. It's not too big, it's kind of in the sweet spot. But at the same time I mean I just want to hear more cool people come and talk about interesting stuff because, again, I learn every single time and then we also get to hang out with cool people, which is exactly what we got to do this past weekend with Dr Jay Mesrobian, who is our guest today on the Fresh Flow podcast.

Speaker 3:

Jay has kind of done a little bit of everything in anesthesiology and I would say a lot of heavy lifting for our field. If you've been to an ASA meeting, you've seen Jay in some way the assistant treasurer for the ASA, on numerous boards of the ASA, the Anesthesia Quality Institute, the APSF and now with Team Health as their national medical director and chief clinical officer. Jay, welcome in man, Glad to have you.

Speaker 5:

It's great to be here. Mitch and Matt, thanks for having me, looking forward to it.

Speaker 3:

Absolutely, Mitch. You want to kick us off?

Speaker 4:

Yeah. So I think, jay, you're like one of the not few, but one of the anesthesiologists in the country who straddled both the academic and the private practice right. So what attracted you to team health? What are the opportunities, what are the issues that they're going to have to deal with moving forward?

Speaker 5:

Yeah, so appreciate that question. So in my career, mitch, just to clarify, I only spent two and a half years in academia, formerly as a vice chair, but I have spent time interacting with it a lot, whether through private practice, hospital employment or now with Team Health, where we have a number of affiliated community sites of academic departments. So it's always been there either on the periphery or centrally. So it's always been there either on the periphery or centrally. But, to answer your question, what attracted me to Team Health? So this is my second time with Team Health. I started as a regional medical director from 15 to 17, overseeing practices, supporting the practices, and then was recruited back into this chief clinical officer role in January 2020, right before COVID. Yeah, I think.

Speaker 5:

Why did I come back? I think I always respected the people in the company, how they operated, but I really came back for two reasons. One was there was a great opportunity to lead a diverse cohort of about 1,500 anesthesiologists and anesthetists, and boy, that's an attractive challenge. How do you develop training, drive, performance, clinical quality, safety, operations, patient experience across that large enterprise? And second, I return for the culture. It's really collaborative, it's really ethical and it's a physician-led company focusing on patients, and so that's really the other reason I came back.

Speaker 3:

Yeah Well, you rattled off a list of initiatives training, patient experience, clinical quality. How do you drive that in a company that big?

Speaker 5:

Man, it is no small feat to try to standardize and scale something. What I've found is a lot of success comes down to two things being adaptable with your practices. So a practice like Tampa General Hospital huge. So a practice like Tampa General Hospital huge, complicated does just about everything, has different infrastructure and different needs than a four operating room site in relatively rural Ohio.

Speaker 5:

So what we try to do is find what are the common things our practices are asking us to support them with. Well, they're asking us to support them on operational data, help us become more efficient working with our hospitals. They're asking us to help support clinical quality and safety. And I found out from all our chiefs last year the best thing we like from you are when you have safety advisories, can you send those out, because those apply typically to almost every practice. We have a structured patient experience program that we're rolling out across every practice. That involves both didactic training and shadow rounding, observation, and then there's management leadership training, which is kind of done in a standardized way in Knoxville at headquarters for our chiefs and chief anesthetists, but also done informally as well by those supporting the practices. So is it a perfect scaling? No, but are we able to develop solutions in those four areas that apply to all the practices. That's what we're working on and I think in general we've been pretty successful.

Speaker 4:

This podcast is sponsored by UAB and the AACD and, if it's okay to mention, thank you for supporting the organization and thank you for convincing Team Health that sending a team of your Team Health's best clinical directors to come to our meeting would be beneficial to your organization. Taking what you've told us about what you do as a chief clinical officer, how do you see the relationship between sort of team health and AACD moving forward?

Speaker 5:

Hey, Mitch, I just joined because you asked me to.

Speaker 3:

Yeah, he beat the heck out of you about it right Over, and, over and over again. He's relentless.

Speaker 5:

Relentless emails every day, I finally cried, uncle, and said all right.

Speaker 4:

So I think the audience should also know that. I'm grateful that I think I approached you at an ASA practice management meeting at the beginning of my career and you kind of looked at me and said who's this guy? So thank you for acknowledging my existence.

Speaker 5:

So I learned early on it's not just who's this guy, it's who's this guy and what can I learn, because everyone brings a perspective and that's been enormously beneficial beneficial. But, to answer your question, I think I first became a little more aware of AACD about five, six years ago, more intimately when I spoke at the conference, and I've always been really impressed with its relentless focus on perioperative operations. And so when you approached us this year and said, hey, is there an opportunity for you to be an institutional member? Is there alignment there, potentially, the light bulb went off in my head.

Speaker 5:

I said one of our biggest initiatives with our clinicians and our hospital partners is how do we get to be more efficient? How do we use data to drive operating room management, better utilization, better accuracy in case scheduling? Where does technology enter into that as an added tool? And so when you asked, I was like this could be an enormous opportunity to marry how a large group approaches this at the hospital engagement level versus the academic approach, which is very also data-driven. And honestly, mitch, I see the two as an opportunity to inform each other, moving ahead. So I'm super excited about a potential relationship with you.

Speaker 4:

I think I mentioned it at the meeting, but I'm really looking forward to speakers from Team Health and I think there's that real world experience. I've been in academics my entire career but there's that real world experience that I don't think we teach future anesthesiologists until they actually hit the wall right when they leave residency. And then, for your information, dr Matt Schur is our new secretary, so just send him. He's loading the agenda and speaking docket for 2026.

Speaker 3:

That's right, yep, you get my contact info. Send me your folks.

Speaker 5:

Hey, if I could offer one other thing on that, matt and Mitch, real quick. It's so important now to drive or work with our hospital partners on operating room utilization, as an example. It's not just an issue of money, it's an issue of our physician wellness, because people are tired. They're tired when they have to stay later. They're tired of unpredictability. And I see this not just in where we work or private practice, where I've worked, or hospital employment, it's in academics too. To me, this is a high priority for all of us to manage the demand side in a way that's effective, efficient, preserves access. So that's really an opportunity. I think all of us have to move ahead on how to make anesthesiology more effective.

Speaker 3:

Jay, you and I talked about this at the meeting. I've been in private practice myself before coming to academia, talked to a lot of people. There are some perceptions out there about what private equity-backed groups are like. There are varying opinions across the board. One of the things that I heard when you were mentioning all the initiatives that you're driving is that you have infrastructure and you have the means to do a lot of this stuff. We said the same thing when we talked to Rick Dutton from USAP a while back, and so, while there may be some negative connotations, I would offer some of the certainly positive ones, being the infrastructure to do the important things that need to be done. But also we talked about the fact that every group's not the same right. Private equity is not private equity is not private equity. Do you want to speak on that for a moment, just from your perch, from where you sit?

Speaker 5:

Yeah, I mean there's a lot of sub questions in there, which is around scale, around how do we see things compared to other ownership models, and then what are the issues that I should address with private equity? So let me take those one at a time. When we look at risk in anesthesiology, we see the same risks as the broader community. I really think that's true in academic, system-employed private practice, or else Declining payment, a need to maintain market compensation, workforce disruption, supply, demand, imbalance, clinician wellness. These are all top of mind for all of us. So, long-term, we all face the same challenges, which are health system and payer consolidation, really bad implementation of the no Surprises Act and the ever-increasing demand for our services, for all models. To address this storm, we have to develop strategies to address the demand side, as I said, and also clinician supply.

Speaker 5:

But I would also say to you scale. How does that help us improve? How does that maybe give us some means to do things? And I won't say even pretend to say we've solved every problem yet, but there are some advantages to scale. For example, we develop standardized programs, as I mentioned, in patient experience and patient safety for all our clinicians in the service line. We have a standard operational data that we work and show to our clinicians and our clients, allowing them to partner with hospitals when they're willing to work toward fewer late and add-on cases and better utilization. So that ability to produce data to drive that change is critical and we're exploring a couple of pilot programs around emerging technologies related to pre-op optimization and data management and extraction. And I think one other thing about scale you mentioned it in size. I think one thing it allows us to do that probably goes under the radar is really participate actively in the federal independent dispute resolution process and in payment advocacy and litigation strategies against commercial payers. Honestly, scale allows us to fight on multiple fronts for fair payment, as well as with our hospital partners. On management.

Speaker 5:

You mentioned also private equity. I don't know. I might toss that back to you and say what misconceptions are you seeing in private equity you might like me to address, or I can bring up a couple. What would work for you?

Speaker 3:

From the simple perspective of hey, it's all about the money. Right, it's just about the money, it's not about anything else. I think that's one of the more common.

Speaker 4:

Is Team Health, a private equity company?

Speaker 5:

So Team Health is not a private equity company. It is partnered with a private equity company. Team Health is a physician-led company, has been for 40 years. It is led and managed by its physician leaders. Now I guess, reflecting a little bit, I'd say there are two common misconceptions about Team Health I'd address. The first is that somehow the private equity partner diverts revenue away from clinicians. The fact is that somehow the private equity partner diverts revenue away from clinicians. The fact is that partnership doesn't influence the compensation we pay, the clinical care we provide or how we manage our praxis. And in fact in some ways they've been a very good partner for our team during the COVID pandemic. They both sourced PPE for our clinicians and supported full benefits for physicians or clinicians that took voluntary furloughs. Honestly, they were great partners during a really hard time.

Speaker 5:

Probably the most common misconception I hear is there's a large group who somehow rob clinicians of their autonomy and their independence. I see it all the time in social media. I've worked in every practice setting and ownership model. The most burdensome non-compete clause I ever encountered was in an academic department. The only place I ever had asked permission to go advocate for clinicians at the state house was when I was employed by the hospital system, so the reality around clinical autonomy and independence is really quite the opposite. Our clinicians manage their practices daily. We try to support them with high quality education, data-driven analytics and best practices around quality and safety. We work as a team with our clinicians to recruit, to provide practice-level data, to partner with the facility and provide back-office support around human resources, provider services and revenue cycle management. We don't micromanage our practices. We support them.

Speaker 4:

I love that comment about during the pandemic where your partner supported the people that were there, and it reminds me of the story of not too long ago when American corporations, when they were held privately, treated their employees like family. And one of my favorite business stories is the story of Malden Mills. Right During the outsourcing of textiles in the 70s and 80s, somewhere in New England an individual who owned the company said we're going to keep everybody on the payroll until the R&D department comes up with a solution and they invented Polar Tech right, and so sort of that investment and when you see leadership administration investing and I'm sure it scales down to what you do, to the practices across the country people work a little bit harder right, because there's skin in the game on both fronts and I think sometimes we're missing that in academic medicine.

Speaker 5:

That's a good point. I'd be curious to hear your guys' points of view on academic medicine. But I think even in academic medicine the realities of how you run a practice are becoming more apparent than the need to support the clinicians, especially in this labor market. So you have to be able to support your clinicians with tools. I always think about my job, as how do I remove barriers to my physicians and anesthetists doing a good job? And that's kind of one approach I take philosophically to what we provide them to succeed.

Speaker 3:

Bob Stiefel talked in the meeting this weekend that those lines between academic and private practices are beginning to become blurred. Right, we're all working really, really hard, we're all understaffed. Yeah, that's a good point. And to that end, Bob talked about our financial model right now. He talked about what they've seen as far as anesthesia subsidies over the last little while and he talked about some jaw-dropping numbers he talked about the last time it was 600-something percent increases. To this time he presented us 4,000 percent increases. He told us hey, when you present this to your hospital, be ready for them to fall out of their chair. Is that good? We're getting paid more. That's wonderful, right? Is it sustainable?

Speaker 5:

as the other side of that, Where's the balance in this and where do you see that moving forward? That is a great question because I hear you really speaking to the future of our specialty. There is no doubt. Compared to even 10 years ago, stipends are playing a role in just about every group's financial viability. You simply have to have them, whether you're on a teaching mission and a research mission or, in many cases, simply to just fund your recruitment and your staffing. Bottom line is financial viability is critical for all practices now. It doesn't matter where your ownership model is, your size or your location. I think one trend we're seeing is the number and size of the stipends are growing. We're starting to see hospitals and ASCs focusing probably more closely upon what are our practices, what are the practices of their anesthesiology partner, and so I think any practice needs to really deliver on demonstrable quality and safety. They have to bring data to the table to drive operational performance. They probably have to develop some arguments and support for their revenue cycle management, whether it's insourced or outsourced. Can you participate in the independent dispute resolution process? And probably most importantly we're seeing at the hospital level, do you have a culture of problem-solving the service? So the things that used to kind of not get asked before are getting asked now in the wake of these very high stipends and financial support, and they're probably must-haves for any anesthesiology department, regardless of who you are.

Speaker 5:

Regarding salaries and sustainable trend boy, if I had that crystal ball, I'd be not with you guys, I would be elsewhere. Let me give you a different perspective. Boy, if I had that crystal ball, I'd be not with you guys, I would be elsewhere. Let me give you a different perspective. We tend to focus a lot on that from the supply side. How many residents are we producing? How many nurse, anesthetists and CAs are coming out? Can we get more foreign clinicians? Well, let me backtrack. But the real, I think, solution here is going to be how do we demand or control the demand side? So how do you manage the operating rooms every day? Are there technologies that eventually will help us do this more effectively? And I'm not talking about big staffing models, I'm talking about ability to manage preoperative throughput, matching of schedules to reality, things that just help improve the management of demand. Regarding salaries, that's a great question.

Speaker 5:

Two mitigating trends we're seeing on that growth Hospitals and ASCs, I think, are increasingly asking for some sort of at-risk performance linked to the financial support. Not a lot, but I hear the phrase skin in the game a lot. What's your skin in the game? And I think that's probably a realistic ask when they're writing a big check to support anesthesia services. The relationship isn't new, it's just growing. I think the other trend we see a little bit when we talk to hospitals is increased willingness to partner on driving operational efficiency, as in the ways I described before. Better throughput OR utilization, case length, variability, first case on time starts all have different impacts. So I think the other ask, in combined with increased compensation for anesthesiologists, is how do you partner with your system to decrease the cost of care by driving operational efficiency? I believe both can be done, balancing efficiency and safety. You just have to have the data and the will to do it.

Speaker 4:

So you've sort of given us a future state of what the supply side in terms of residents and how we train them, future anesthesiologists, right. And so, from your perspective and what you've been through, most residency programs don't have OR management curriculums. They don't have hospital utilization. All of this is sort of learned on the fly and team health is great. They're going to bring you in, we're going to teach you how to do it our way and there's a way to figure out how to make a better mousetrap. But what do residencies do? What do academic programs do?

Speaker 5:

Yeah, I love that question and just to clarify, we haven't yet developed standard training in that area for our chiefs. We're doing it this year.

Speaker 4:

That would be the AACD annual summit. Dr Mizrobian, AACD annual summit.

Speaker 5:

Dr Mizrobian, we started this interview with opportunities to partner and now we're talking about that. That was a good segue, agreed, but it's imperative and I guess I would start philosophically on that question with should we be teaching operating room management as aggressively as we do airway management to our residents? Because when you think about the future state of what an anesthesiologist will be doing, it is going to be delivering care. But I think the other hidden strength we have, our secret sauce, is managing a complex operation. I don't think anyone else can do it in the hospital. So I think that's an opportunity for us if we're willing to train to it, and you two, being in academic programs, could speak to that feasibility better than I can.

Speaker 5:

I remember when I was chair of the ASA Committee on Practice Management years ago. We did a survey about a decade ago of how people were teaching, if at all, practice management to your point and it was either not at all or we're letting people run the board a little bit for two weeks. I don't want to make too much of a general statement. That may still be the case today. I think there are a few places doing it in a very thoughtful more. How do we have people come out and have basic training on being an OR manager or knowing enough operations that they can start improving their performance in that area, but most aren't. I would probably throw this one back to you two in the academic program and go what are the opportunities to really train our residents and is there time to do so as aggressively in OR management as we do in airway management?

Speaker 3:

and I got a little frustrated with how hard it is because there's not much time. The ACGME has some pretty stringent rules about how we train and I can't argue with them that they're wrong. Right, we have to make outstanding clinical anesthesiologists and we only have so much time to do it. So I've had a hard time kind of squeezing that transition to practice stuff in. I've kind of diverted and taken more of a fellowship approach come and join our faculty and we'll help you do that kind of right after training. So that's been my approach and can I say that it is the right approach. No, that's what I'm trying right now. But it's a tough problem, man, because again, we've got to make great anesthesiologists and what do we chip away if we're going to add something new in is the question. It's a hard problem.

Speaker 4:

So in Vermont, it's a hard problem. So in Vermont it's a small department, so it makes our you know what we want to do with our residents a little more flexible. But I still remember my first days in attending right, july 23rd 2006, and working in OR14 in a lap coli with one of our CRNAs and I'm like I've done the case, but I don't understand this relationship that I have with the CRNA, and I grew up with a generation of CRNAs that I fully, fully respect, right, but we've been able to start, and I think we started in 2010. All our residents actually go through one week of running two rooms, one week of running three rooms with an attending backing them up, and then they get two weeks of OR management. They run the board, they make the schedule, we try to get them to the operational and tactical meetings, if there are meetings at that time, and then, like everybody at the AACD knows, I dump a bunch of articles that nobody really reads. So it's I read them.

Speaker 3:

I read them, buddy.

Speaker 5:

No comment. I admit that's not true. I love your articles.

Speaker 3:

You're a busy guy, jay, we get it.

Speaker 5:

No One thing I know. When I was in Wisconsin I'd love to see this rebooted and I think it is we started a joint effort between the State Component Society and the academic programs to send residents to the ASA Practice Management Conference, which at that time had a resident track and that I looked at as one model just for resident education, as a win-win, because we split the cost, which made it palatable to the department chair and, I think, helped advance the specialty in the training. I'd love to see that model, and I know other states and programs have done that too. I thought it worked really well and might be one worth reexamining and replicating.

Speaker 3:

Yeah, that's a good idea. Fun fact I was speaking at the ASA practice management resident track a few years ago. Funner fact, I had forgotten that I had even submitted the lecture to it, and so when they asked me to speak, I said I think you have the wrong guy. But I showed up, I did the talk. It was virtual, it was around the time of COVID and there was some dude in the crowd apparently named Mitch Sy, because that's when I got contacted and that's when I met Mitch. He's been a tremendous mentor to me, as much as I bust his chops on this show. That's where he found me and that's where I met Mitch. And here we are now gosh what, five, six years later, and look at all the cool things we're doing. So thank you, mitch, for that opportunity you gave me.

Speaker 4:

Absolutely. And now you've exposed to our audience my secret sauce, which is for a while, I was poaching speakers from the ASA practice management meeting for the AACD.

Speaker 3:

He might be in the background at your meeting looking for AACD speakers.

Speaker 4:

As a national organization. How can team health sort of disseminate the best practices and find the local practices that work really well in one place and sort of transplant them to another place?

Speaker 5:

So that is one nice advantage of having scale with practices in 23 or 22 states. So I do learn a lot from our practices. So, for example, at a midsize hospital in Florida I found out they'd been doing a fairly good patient blood management program. So one member of our team went down, studied it, adapted it and we make that available to any practices that wish to adopt it, helping them implement and helping them teach. That's a hard one to do. The other ones are around more operational efficiency. I'll give you an example there In one practice that has a block team.

Speaker 5:

So they have a team that does the nerve blocks, like many practices do. But when the patient goes to the room, instead of waiting for them to get to the room, get settled, come in and do the block, they make sure that that block team gets a notice when the patient is going to the room. So when the patient arrives in the room, block team's there ready to go. If it's a block preoperatively, they place it right away. If it's a tap block post-induction, they'll literally be there ready to do it the minute the patient falls asleep. So I think those types of efficiencies or those types of examples are things you can learn from one practice. And then on my bi-monthly call with all the chiefs, I'll often display this stuff and go hey, here's something Dr X is doing here. If you want to explore this in your site and this would be helpful to you, let me know. We'll get you guys connected. That's a couple examples of where I think having that diverse scale may be helpful.

Speaker 4:

I think you're moving the conversation towards OR management 2.0. And I think that OR management 1.0, we put the timestamps in right Anesthesia control time, turnover times, we put all these metrics in, but it's not a time point in what we're doing in terms of the perioperative space, it's a coordination problem, right? So how do you solve all those coordination problems? I read a book by Vijay Gavindaranjan. He has a co-author on this one.

Speaker 4:

I'm going to destroy it, but it's fusion discovery and it's sort of how do we take the technology and move from not diagnostics, right, but to predictive analysis? And the business example is Rolls-Royce right, they have sensors now on every engine that they have flying in the air and they're collecting data. Tesla does the same thing with all their cars, right? So it used to be. You had a maintenance schedule. You brought the plane down, you fixed the engine, even though it didn't need it. I think GE and Rolls-Royce are moving to a place where they're going to know when the problem is going to become a problem before it becomes a problem. Sorry, that was kind of circular, but how do we, as a specialty right, get to that sort of system where we are being proactive? That wasn't really a question.

Speaker 5:

No, no, no. And boy I'm going to say. This is the second question where if I had the answer to this, I wouldn't be here with you guys, right? The word that pops into my head as you're talking about that is standardization, and it's about that process I gave, or that example I gave around the block team being notified to come in a room and give a block. That's a standardized process. That practice is implemented to save time and be more efficient. So I think about standardization, particularly in big practices.

Speaker 5:

Anesthesiologists are very smart and I bet you, if you put the three of us in a room together, we'd go who has the best way of anesthetizing a 40-year-old pregnant patient for a laparoscopic cholecystectomy, and we'd have different answers and we'd justify it. So our specialty very much has a master builder mentality. But I think when it comes to operations and, to some degree, clinical best practices, there are things you could say maybe this is the approach we should be taking. So I don't know, that's a. You could say maybe this is the approach we should be taking. So I don't know, that's a challenge to teach, right. But I think standardization to your point, mitch, when you asked that question, something that pops into my head is an opportunity to do what you said, which is to get ahead of problems as opposed to reacting to them.

Speaker 3:

Jay, when I hear you talk about all these things, the term that pops into my head is leadership. Right To do all of this stuff, to drive innovation, to drive the future model of our specialty, it takes leadership. You sit in one of those leadership positions, probably one of the biggest ones in our specialty, just given the size of your group. But from a succession planning standpoint, if leadership doesn't just come naturally, if we don't have time to do that in our residency programs, what's your approach? How do you do that? How do you train up the next leaders in your group and in our specialty?

Speaker 5:

Boy, another big issue facing us. Right, we talk all the time about how do you train a leader, but what's the role in the facility in the hospital for an anesthesiologist? I think the first way we train is one approach is to say what are the competencies and things we want a leader to do, and we actually have done that. In my current position, it's been a two-year project to kind of develop a management leadership ebook electric book, electronic book that really lays out 13 areas of competency we believe chiefs should have. And then the goal is how do you get that out to the chiefs, help them implement a lot of these tasks and responsibilities, recognizing the time limitations. So I think there's a structured way to do it and that you're saying these are some truths that we regard around attributes, behaviors, responsibilities of our leaders. But, as you all know, there are things you can't teach and there are some things you learn by skinning your knee over many years, and you don't have enough time on this podcast for me to talk to you about the times I've skinned my knee in leadership. I'll give you an example and this might tie back into how do you teach it. So bear with me here.

Speaker 5:

When I was five years into practice in my private practice in South Carolina. That was a good doctor, competent, got along well with surgeons, staff, everything was fine. So naturally they made me professional director of the group. Now, keep in mind that's alongside a chief of the department and a president of the private practice and, to be perfectly blunt, I had no idea what I was doing. I had never been trained, I had never run a really a committee meeting. I didn't know how to build teams. I didn't know how to really the communication skills that come over time. How do you really listen to someone? How do you synthesize the information? How do you know when to lean in? How do you synthesize the information? How do you know when to lean in, when to lean out, when to hold still on a problem? And boy, five years in. I don't know about you guys, but I probably didn't have the judgment to do that role. So in that case I think I was thrust forward into something that I was not prepared for and the hard truth is that a year and a half later, the group in the hospital jointly dissolved the role.

Speaker 5:

So I carry that with me every day and I think about 25 years later, how am I representing myself to my teams, people on my team? How am I training them to basically do their own work? I think that's a major component as a leader is you have to know when to step back and let your team and your team members do their own work. You should coach them, guide them, but boy, you shouldn't have to tell them what to do. Quoting Steve Jobs, I want people who are smarter than I am to tell me what to do. So I think you have to have that little bit of humility to build that team and hire the right people.

Speaker 5:

But to your question, if I heard it was how do you train the next generation of leaders? I think it starts with identifying. Going back to those attributes, who has the attributes? Who can we identify for perhaps initial mentorship training, and we do that actually at Team Health. There's actually a we call it FMD to be, facility Medical Director to be it's kind of the pre-leadership course, and so if someone has identified someone in the practice who's a successor to the current chief or chief anesthetist, they'll get sent to that course. So I think there are ways to make it structured, but you have to be very intentional about identifying the skillset you want and identifying the leaders who can potentially fit that skillset.

Speaker 4:

I agree with you, jay. I think one of the things that I've sort of come upon and if you look at the foundation of leadership, education, innovation, design thinking, jazz, music, right have have you what you not, it's the same, it's empathy. I teach people how to actually listen and it's a lot like parenting right, leadership right. The only way you know is when you leave and you stop micromanaging right, because somewhere down the road what you really really want deep inside is that your kids, when you're not there, they make the right decision, and even that's hard, but no.

Speaker 3:

I'll quote one of my friends, mitchell Sy, that your role as a mentor is to take somebody to the end of your capability and then throw them as far down the road as you possibly can. So see, mitch, I do listen. From time to time I do pay attention, jay. We've asked you a lot of really hard things here, man, and I want to give you credit. You have stepped up and not backed away from any of it, and I appreciate that and respect it tremendously. But to lighten things up a little bit, we had some time to talk here recently at the AACD Summit we talked about music a good bit. Last show you saw that blew your mind.

Speaker 5:

Blew my mind. Saw Clapton last year.

Speaker 3:

Come on, let's go.

Speaker 5:

And saw him in Royal Albert Hall, our wedding anniversary. The venue was remarkable and when you reflect on the fact he'd probably been playing in that venue for 50 years, it was more remarkable. But what stunned me was the respect on stage. So his voice is a little gone, but every time he played a solo the rest of the musicians would kind of stop on stage and just watch. I mean, they were playing but they'd watch. And that was the part that blew my mind. It wasn't the music or the dynamics around it per se, it was the immense respect they had for this kind of older physician and his body of work. And that venue super cool. If you ever get a chance to go, go Worth it. So yeah, that's the last one. That kind of made me open my mouth a little.

Speaker 3:

We could probably learn a lot from that experience of hey, sometimes the best thing to do is get out of the way, mitch. Anything else, man? Any other questions you got at the last minute here?

Speaker 4:

No, you know, other than Jay did you wear your sunglasses, you know. Thank you for taking the time with us.

Speaker 5:

Yeah, that was fun, you know. So, guys, look, I'm a D student in technology, admittedly, but I know what I need and want.

Speaker 3:

Perfect, we're leaving that in. We're leaving that in, we're leaving that in.

Speaker 5:

So does my dog, and thanks for putting up with it. I I still don't know how that photo gets on my screen. I'm kind of like, how do I get this off here?

Speaker 3:

and I still I gotta ask my kids yeah, exactly, it's terrible reference of what he's talking about. We were talking about linked picture, is that right? You get the risky business sunglasses on, is that? Right.

Speaker 5:

Now you guys are giving me something to do this weekend.

Speaker 4:

So no, but you know, jay, thank you. You know, when I started my career, thank you for taking the time and sort of mentoring a young anesthesiologist and good luck and we hope to see you at the next ACD meeting. In fact, I think we, we will be so looking forward to it.

Speaker 3:

You might, you might get asked to talk. I don't. I think I know the guy that's gonna be planning it. So, uh, we'll see.

Speaker 5:

Uh, absolutely happy to help you guys. It's been a pleasure to be here today and thank you.

Speaker 3:

Jay. Thank you, brother. That wraps us up for another edition of the Fresh Flow podcast. This was fun. I knew it was going to be fun and it was. It was a blast. Thanks for tuning in.

Speaker 2:

We'll see you guys in the next one. See you guys, bye-bye. If you have any questions or comments from today's show, please email us at podcast at apsforg. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit apsforg for detailed information and check out the show notes for links to all the topics we discussed today. Thanks for listening and sharing this podcast. Please continue to do so and, if you get a chance, can you rate our show and leave us a five-star review wherever you get your podcasts, so that we can continue our mission towards improved anesthesia patient safety by reaching a larger audience. Until next time, stay vigilant so that no one shall be harmed by anesthesia care.