ASC leaders facing scheduling gaps, turnover and friction between anesthesia and the surgical team often try to adjust the processes. An Aug. 13 white paper from North American Partners in Anesthesia argues that operational breakdowns in anesthesiology departments are often caused by cultural problems, not just a process failure.
The paper, written by Clavio Ascari, MD, chief clinical officer at NAPA, contends that anesthesiology departments rarely fail because they lack processes. They fail because of breakdowns in execution, support and sustainability that trace back to culture.
Here are five takeaways for ASC leaders:
1. Operational fixes alone don’t hold. Efficiency pressures and staffing shortages tend to prompt operational responses such as new schedules, protocols and staffing ratios. The white paper argues those fixes rarely create lasting change if the underlying culture is misaligned. Well-designed systems degrade over time when engagement and ownership erode, while strong culture allows operations to stabilize on their own because teams collaborate more effectively. Process improvements are sometimes necessary, but not sufficient on their own.
2. Three signs point to a cultural breakdown, not just an operational one. The white paper groups warning signs into three categories. The first is staffing instability: high turnover, difficulty recruiting and growing reliance on locum tenens coverage. The second is provider disengagement, marked by a narrow focus on individual duties, withdrawal from shared accountability and a “clock in, clock out” mentality. The third is deteriorating teamwork, including surgeons who feel unsupported by anesthesia, weakening collaboration with nursing and an anesthesiology team that operates in isolation from the rest of the perioperative unit. Individually, these can look like isolated problems. Together, the paper argues, they signal a cultural breakdown.
3. Traditional hierarchies can work against a strong culture. Leadership structure is important, but not just any structure will be successful. The paper argues that traditional hierarchical models can actually contribute to cultural dysfunction in departments made up of anesthesiologists, certified registered nurse anesthetists and certified anesthesiologist assistants.A collaborative leadership model — with integrated management structures that reflect the makeup of the care team, so each group feels represented and valued rather than managed as individual task-performers — can often work better.
4. Scheduling is a cultural signal, not just a logistics exercise. How a department builds its schedule says as much about its culture as any survey could, according to the white paper. Fair distribution of shifts, built with clinician input, reinforces respect and a sense of collective ownership. Inconsistent scheduling does the opposite, creating dissatisfaction that can compound into staff turnover and disengagement. The paper also points to cross-organizational engagement as a marker of strong leadership: leaders who actively solicit input from surgeons, nursing and administrators position anesthesiology as a knowledgeable, aligned partner rather than a siloed function.
5. Strong-culture departments share three habits. The paper points to three practices that distinguish high-functioning anesthesia departments. The first is empowering dialogue: clear expectations, visible performance metrics and constructive feedback that uses data to drive improvement rather than to punish. The second is managing conflict directly, with early intervention on toxic behavior to protect team dynamics and preserve leadership credibility. The third is facilitating growth, by giving clinicians room to build new skills and take on expanded responsibilities so their full capabilities are put to use. Departments that get this right, the paper states, are better positioned to attract and retain talent, strengthen collaboration across the perioperative team and deliver more consistent, reliable performance.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
