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there every day, that means he or she will be there the day or two before a patient’s surgery, when the preop nurse is receiving information about a patient, the day the anesthesia is delivered and the days following the procedure should any postop compli- cations—be they related to anesthesia or not—arise.”

Also spelled out at this early stage might be the issue of the appointment of an anesthesiologist as the ASC’s medical director, a practice that Sha- piro advises. “Historically in ASCs, there is a medical director. Most often it’s an anesthesiologist, and I argue that it should be the anesthesiologist, particularly if you have what I con- sider to be the best anesthesia situ- ation, which is where you have one individual anesthesiologist who as- sumes responsibility for administra- tive functions related to anesthesia. However, a medical director relation- ship, if established, should ideally be memorialized by a separate contrac- tual document that addresses specific issues such as job responsibilities and compensation.”

Appointing an anesthesiologist as medical director is a gesture of good- will on behalf of the ASC, Wherry says. “If you’re going to lay out sig- nificant expectations of your anes- thesia group, it’s good to give them something in return. I think providing them an opportunity to be the medi- cal director and paying them a fair sti- pend to do that is only right and is one way to get them engaged.”

Other Engagement Mechanisms Appointing an anesthesiologist as medical director is just one of many different approaches your ASC can take to effectively involve anesthesia providers in your ASC’s operations. Wherry advises ASCs to regularly so- licit advice from anesthesiologists not only regarding issues that affect anes-

It is important to recognize that your anesthesia

providers are involved in all elements of patient care and likely interact with most, if not all, members of your clinical staff.”

—David Shapiro, MD, CASC

thesia, but also about the daily opera- tion of the facility. “If you’re a new center and devel-

oping new processes and policies, or if you’re revamping processes and poli- cies, you should include your anesthe- sia providers,” he says. “Invite them to meetings and expect them to come, listen and share their thoughts, and utilize their input. Many of these an- esthesiologists go to different ASCs, so they see how other centers function well and don’t function well, and they also see what works and doesn’t work in the hospital. If you want to get the most out of providers, solicit


input and take their advice when it’s reasonable.”

Shapiro echoes this sentiment, and notes that anesthesiologists can play a pivotal role in setting the tone

for collaboration and communication throughout an ASC regarding its com- mitment to a culture of safety. “The anesthesiologist can foster commu- nication between all members of the staff and demonstrate a commitment to an ASC’s culture of safety. Anes- thesiologists can really support and foster the notion that every single worker in the facility has a huge and important role to play in ensuring pa- tient safety. To make this happen, an- esthesia staff and all employees, need to feel free to voice their concerns without any fear of retribution or re- taliation, and to be recognized as re- ally being a part of that ASC’s culture that focuses on making the patient ex- perience at a given facility, at a given date and for a given procedure not only the most pleasant but the safest and highest quality possible.” To provide opportunities for anes-

thesia providers to share ideas for im- provement or any concerns, Wherry suggests that ASCs schedule meet- ings with the anesthesia group or at least its leadership. “Too many times I’ve seen ASCs just let the anesthesia group come and go and not really in- clude them as much as they should. I think it’s worth insisting on monthly meetings. They don’t need to be long meetings, but they should be meetings with a robust agenda that discusses key issues, such as drug shortages or particular patient care issues, reflect- ing on the previous month and any- thing that didn’t go well and what can be improved; looking at the growth strategy; and examining how anesthe- sia can improve coverage.”

Consider Financial Challenges During meetings and discussions with anesthesia providers, Wherry says, it is important that ASCs do not for- get their anesthesiologists are facing similar economic challenges as other providers. “ASCs need to understand the financial constraints they’re un-


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