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The Medical Director The Medical Director “A Quality Force” “A Quality Force” Susan L. Goelzer MD, MS, CPE Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Ralph Waters MD Distinguished Chair Chair Professor of Anesthesiology, Professor of Anesthesiology, Internal Medicine and Population Internal Medicine and Population Health Health University of Wisconsin University of Wisconsin

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Page 1: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

The Medical DirectorThe Medical Director“A Quality Force”“A Quality Force”

Susan L. Goelzer MD, MS, CPESusan L. Goelzer MD, MS, CPE

Ralph Waters MD Distinguished Chair Ralph Waters MD Distinguished Chair

Professor of Anesthesiology, Internal Professor of Anesthesiology, Internal Medicine and Population HealthMedicine and Population Health

University of WisconsinUniversity of Wisconsin

Page 2: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

The Operating Room EnvironmentThe Operating Room Environment“Century of the Surgeon”“Century of the Surgeon”

Page 3: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

OR CoordinatorOR Coordinator

Management PositionManagement Position

ResponsibilitiesResponsibilities– Direction of PersonnelDirection of Personnel– SchedulingScheduling– Planning and OrganizationPlanning and Organization– Professional ConductProfessional Conduct

Page 4: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Director of Perioperative ServicesDirector of Perioperative Services

Formal Job DescriptionFormal Job DescriptionAdministrative AppointmentAdministrative Appointment– Bases of powerBases of power– Legitimate authorityLegitimate authority– InfluenceInfluence

Oversight of the clinical anesthesia servicesOversight of the clinical anesthesia servicesFacilitation of the efficient use of all resources Facilitation of the efficient use of all resources throughout Surgical Servicesthroughout Surgical ServicesAppointmentsAppointments– Department of AnesthesiologyDepartment of Anesthesiology– Department of SurgeryDepartment of Surgery– Hospital AdministrationHospital Administration

Page 5: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Bases of PowerBases of Power

Control over ResourcesControl over Resources

Technical SkillsTechnical Skills

Body of KnowledgeBody of Knowledge

Ability to InspireAbility to Inspire

Access to OthersAccess to Others

““Power is the ability to effect Power is the ability to effect organizational outcome”: Mintzbergorganizational outcome”: Mintzberg

Page 6: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Areas of SupervisionPower: Resources/Knowledge

Daily Decisions MakingDaily Decisions MakingSchedulingSchedulingAllocation of ResourcesAllocation of ResourcesUtilizationUtilizationPreoperative ClinicPreoperative ClinicPACUPACUAcute Pain ManagementAcute Pain ManagementPerioperative Information ServicesPerioperative Information ServicesOR BudgetOR Budget

Page 7: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Required Skill SetRequired Skill SetPower: Skills/InspirationPower: Skills/Inspiration

Vested interest in Overall OR PerformanceVested interest in Overall OR PerformanceStrong Clinical BackgroundStrong Clinical BackgroundDaily PresenceDaily PresenceStrong Communication SkillsStrong Communication SkillsStrategic PlanningStrategic PlanningSupervision of PersonnelSupervision of PersonnelConsensus Based LeadershipConsensus Based LeadershipFormal Business TrainingFormal Business TrainingNegotiation and MediationNegotiation and Mediation

Page 8: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Reporting RelationshipsReporting RelationshipsPower: AccessPower: Access

DirectorSurgicalServices

(Nursing)

Departmental Chairs

DirectorPerioperative

Services(Medical)

Hospital Administration

OR Executive Committee

OR Committee

Page 9: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Guiding Coalition for ChangeGuiding Coalition for Change

Director of Perioperative ServicesDirector of Perioperative ServicesDirector of Surgical ServicesDirector of Surgical ServicesOR Executive CommitteeOR Executive CommitteeOR Committee ChairOR Committee ChairHospital CEO/COOHospital CEO/COOManagement TeamsManagement Teams

Kotter JP. Kotter JP. Leading ChangeLeading Change. . Harvard Business School Press. Harvard Business School Press. 19961996

Page 10: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

CompensationCompensationDepartment of Anesthesiology (60%)Department of Anesthesiology (60%)– Clinical ComponentClinical Component– Academic ComponentAcademic Component

OR Management Senior RotationOR Management Senior Rotation

Practice Management CurriculumPractice Management Curriculum

– Administrative ComponentAdministrative Component

Department of SurgeryDepartment of Surgery– Administrative SupplementAdministrative Supplement

Hospital (40%)Hospital (40%)– Administrative ComponentAdministrative Component

Page 11: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

The Medical Director The Medical Director Position as a Quality ForcePosition as a Quality Force

LeadershipLeadership

Power/InfluencePower/Influence

Authority Across DisciplinesAuthority Across Disciplines

CollaborationCollaboration

Unwavering SupportUnwavering Support

Team DevelopmentTeam Development

Page 12: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Quality InitiativesQuality Initiatives

Page 13: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

A Partnership for Better CareA Partnership for Better Care– Agency for Healthcare Research and QualityAgency for Healthcare Research and Quality– American Hospital AssociationAmerican Hospital Association– CMS/CDC/VACMS/CDC/VA– Institute for Health Care Improvement (IHI)Institute for Health Care Improvement (IHI)– JCAHOJCAHO– American Society of AnesthesiologistsAmerican Society of Anesthesiologists– American College of SurgeonsAmerican College of Surgeons– Association of Perioperative Registered NursesAssociation of Perioperative Registered Nurses

Page 14: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

Preventing Surgical ComplicationsPreventing Surgical Complications– Surgical Site InfectionsSurgical Site Infections– Adverse Cardiac EventsAdverse Cardiac Events– Venous ThromboembolismVenous Thromboembolism– Postoperative PneumoniaPostoperative Pneumonia

2005 Launch a Multiyear Campaign2005 Launch a Multiyear Campaign

Goal is to reduce complications by 25% Goal is to reduce complications by 25% by the year 2010by the year 2010

Page 15: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

“ “Pay for Pay for Performance”Performance”

Care Management Performance DemonstrationCare Management Performance Demonstration

Physician Focused Quality InitiativesPhysician Focused Quality Initiatives

Premier Hospital Quality Incentive Premier Hospital Quality Incentive Demonstration: Rewarding Superior Quality Demonstration: Rewarding Superior Quality Care Care – Hospitals in the top decile will receive a 2% bonus on Hospitals in the top decile will receive a 2% bonus on

their Medicare payments for the measured conditiontheir Medicare payments for the measured condition– Current cost @ $7 million per yearCurrent cost @ $7 million per year– After three years hospitals without demonstrated After three years hospitals without demonstrated

improvement will receive1-2% lower reimbursementimprovement will receive1-2% lower reimbursement– Total of 278 hospitalsTotal of 278 hospitals

Page 16: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

EvolutionEvolution

Anesthesiologist in ChargeAnesthesiologist in Charge– CoordinatorCoordinator

Operating Room DirectorOperating Room Director– ManagementManagement

Director of Perioperative Services/Vice Chair Director of Perioperative Services/Vice Chair Of Clinical OperationsOf Clinical Operations– Administration and LeadershipAdministration and Leadership

Hospital Leadership PositionsHospital Leadership Positions– VP of Surgical AffairsVP of Surgical Affairs– VP of Medical AffairsVP of Medical Affairs– COO/CEOCOO/CEO

Page 17: The Medical Director “A Quality Force” Susan L. Goelzer MD, MS, CPE Ralph Waters MD Distinguished Chair Professor of Anesthesiology, Internal Medicine

““May the Force Be With You”May the Force Be With You”


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