Is the Heart of Your Operating Room Healthy and Strong?

In a healthy and strong body, the heart works efficiently to provide nutrients and oxygen to the entire body. This ensures the entire, complex system is working at its peak. A weak heart, on the other hand, slowly starves the body, and this inefficiency opens the body to disease and all sorts of other problems. Therefore, we pay attention to our diets and exercise to keep our hearts strong, so we can enjoy the benefits of its efficient functioning.

Anesthesiology is the heart of the operating room. Like a human body, the OR needs its entire, complex system to work at peak efficiency to help ensure great patient outcomes and the overall financial health of the hospital. In fact, surgical services generate up to 75% of total hospital margin[1], making it a critical service line for health system and hospital P&Ls. This key revenue driver in combination with the movement of surgical cases to ASCs reinforces the absolute requirement for a healthcare system’s financial health to keep operating rooms and perioperative services running smoothly. An often overlooked and underappreciated component of surgical services efficiency is the anesthesiology department, yet if this component fails, the OR fails. 

As the heart of the OR, anesthesiology departments must have strong leadership to be successful. Strong leaders help their OR colleague have better work-life balance by keeping the anesthesia department running in a timely and efficient manner. They take responsibility for pre-admission testing by defining clinical protocols and helping nurses optimize and prepare patients for surgery, which contribute to keeping the schedule on track by starting surgical cases on time. Strong leaders also develop excellent working relationships with surgeons and communicate proactively to address potential issues, creating buy-in and trust in the OR. In short, a strong anesthesia leader pivots how OR colleagues view anesthesiology from being a mere “service provider” to being a critical, value-added member of the OR team.

The perspective of the OR team has a virtuous effect on the entire anesthesia group, helping them to “push-in” where their expertise can most benefit both the OR and the hospital. For example, the group can provide medical directions to help with medication guidelines and establishing co-morbidity screening protocols. Anesthesiologists can help solve standard OR headaches like unhappy physicians and staffing problems. Active anesthesia groups will take a leadership role oversight of the PAT clinic and in the OR daily huddle, activities that help mitigate concerns from routine scheduling issues to complex interpersonal dynamics that might risk impacting the hospital. Through this kind of involvement, anesthesia groups are helping the hospital use the anesthesia department as efficiently as possible, reducing the stipends that are often paid out as a result of poor planning and insufficient management oversight. Finally, this increased efficiency enables anesthesiologists to engage in wider-hospital initiatives where their skills can help such as serving on the Surgical Services Executive Committee, Bylaws, Credentialing, Quality, etc. Additionally, the anesthesiology group should fully participate in hospital network contracts including CIN/ACO, bundles, and primary insurance contracts.

However, things do not always run smoothly. Here are two scenarios to consider:

  1. What if the anesthesiology group is considered part of the problem instead of a partner by the hospital leadership?

It is important to answer several questions and form a strategy to resolve gaps identified by the assessment. We recommend a staff and surgeon survey with specific and direct questions. Some frequent findings in a dysfunctional anesthesiology department may include for example, the group’s mission and goals are not aligned with the hospital’s goals. This speaks to group culture and is ultimately determined by group leadership. To help anesthesiology leadership, a set of defined metrics should become part of the anesthesiology services contract. Some examples include quality, volume, time efficiency (TOT, FCOTS, etc.), staffing, P&L impact, and insurance contracting expectations. We recommend the hospital hold the anesthesiology group to defined metrics with stipend, or other hold backs for metrics not met. The metrics should be reviewed quarterly to allow for transparency and the opportunity to develop collaborative solutions to problems.

  1. What if there is a void or weakness in anesthesiology leadership?

The group can best serve their (and their hospital’s) long-term interest by acknowledging the deficit and working collaboratively with the hospital. It is far easier for all parties to identify a new leader rather than replace the entire group due to a poorly performing department. The group may seek to identify a new leader within the group, but this is often fraught with internal political struggles. The hospital may assist the group in identifying an external interim leader to assist the group’s assessment of culture, compensation, staffing, and scheduling. By doing so, the group gets a different insight into how they can better partner with the hospital.

Finally, as we can see from the critical importance of strong anesthesia leadership in both helping the OR and hospital while avoiding the pitfalls of poorly performing groups, a leadership succession plan is essential. Groups and their hospital partners need to know how many anesthesiologists are on track for retirement and plan an appropriate and timely recruiting plan to avoid staff shortfalls. Candidates for future leadership, including external hires, need to be groomed and given opportunities to work directly with current leadership, so that any transition can be as smooth as possible. This grooming, or mentoring process may take 6-12 months, so adequate time needs to be part of any transition plan. By following this basic approach, anesthesia groups help the OR and hospital avoid unnecessary disruptions as new leadership takes the helm.


Anesthesiology is the heart of the OR, and it must work at peak efficiency for the OR and hospital to be strong and healthy. Underperforming anesthesia groups and leaders have a powerful adverse impact, so issues need to be addressed swiftly and thoughtfully. For a variety of reasons, that may be difficult to do independently, so highly qualified service providers like Surgical Directions can help you improve your anesthesia group’s performance and provide leadership options and mentoring. However you choose to accomplish the goal, keep the heart of the OR beating strong.

About Surgical Directions

Surgical Directions is a national consulting, leadership and analytics partner to hospital systems and medical groups who seek to improve their perioperative and anesthesiology services. Our team of experienced practitioners tackle critical operational problems and are committed to achieving the target financial, operational, and clinical outcomes. Surgical Directions has successfully helped more than 400 healthcare clients nationwide increase patient access, optimize governance, reduce cost and, most importantly, improve patient care. Additional information is available at, and the firm may be contacted at

Lee Hedman, Executive Vice President, Surgical Directions, LLC


Joshua Miller, M.D., Physician Managing Director, Surgical Directions, LLC



[1] Resnick, A. S., Corrigan, D., Mullen, J. L., & Kaiser, L. R. (2005). Surgeon contribution to hospital bottom line: not all are created equal. Annals of Surgery, 242(4), 530–539. Retrieved from:

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