Managing Anesthesia's Relationship to the Facility

David Henderson: Hey everybody, welcome back to another episode of Time Out for Anesthesia. I'm your host, David Henderson, and I'm bringing back a guest that we've had on recently, and I've pretty much asked her to come back whenever she can. She's so fantastic to talk to and so knowledgeable, and the time we spend with her is so valuable. Welcome back to the show, Chrystale Cigainero from Metro Anesthesia. Chrystale, how are you doing? 

Chrystale Cigainero: Hi, David. I'm good. How are you? 

David Henderson: Hey. I'm doing great. What's news? 

Chrystale Cigainero: Thanks for having me back. [chuckle]

David Henderson: Yeah, you bet. Everything good in your world? 

Chrystale Cigainero: Everything's good. We're growing like crazy, staying busy.

David Henderson: Awesome, awesome, good to hear. I don't know that growth is everybody's story at the moment, but that's one of the reasons I have you on the show because you guys kinda have a really cool recipe for how to grow. We talked a little bit last time. If you guys didn't hear our conversation on the previous episode with Chrystale, I encourage you to go back there, I'll post it in the notes here, but we talked a lot about what it means, especially in a post-COVID world to look after your doctors, your anesthesia providers in your group, and where their minds are anymore, what they're looking for and things like that. We talked a lot about how people are valuing their time a lot differently than they used to. "Yes, I want a job and I wanna work, but I think spending time with my family is actually pretty important." Anyway, a great conversation, and thank you again for that. And I encourage everybody to go back and listen to that.

David Henderson: Today, I wanna switch gears a little bit and talk about a little bit different of a perspective. We talked about things internally, now I wanna talk about things externally, I wanna talk about the way you manage relationships between yourself, the anesthesia group, and the facilities that you serve. So Chrystale, just at the very first, what I wanna ask you is, what's it like on a day-to-day basis, what are some things that are on your mind while you're interacting with facilities that you guys serve? 

Chrystale Cigainero: Well, I think first and foremost, it's important to note that physician leadership is absolutely key when we talk about relationship building between groups and whether it's healthcare systems or at the facility level. While I personally don't interact every day with hospital administration, neither does our CEO or COO, ours is kind of limited or as needed, we do have physicians on the front line who represent Metro in that, and they're the ones really having to focus every day on maintaining that relationship and helping improve efficiency, helping be a problem solver, all of those things. So I would say those are some of the things that they think about daily, what are the needs of this facility, how can we help, how can we partner with administration to either improve efficiency, to streamline a process, to improve patient satisfaction, to improve patient outcomes, whatever the need may be.

Chrystale Cigainero: So it's very important for anesthesia groups to put physician leaders in that role so that they have a liaison between the facility and the group to say, "Here's what's going on at this particular hospital, here's what's going on within this particular health care system." This is their expectation of how their anesthesia group can help navigate this issue or be a problem solver. So let's talk about what we can do, how can we partner with them? And honestly, they're dealing with that every single day, every day can be a new issue, as you know.

David Henderson: Right. So before moving into new issues, what I wanna jump into is kind of standard, what... When you're thinking about winning contracts from facilities or sustaining your current relationships, what are the standard things that a facility is looking for? What do they expect the anesthesia... Other than providing good anesthesia, what are the things that they're looking to your group to provide for them? 

Chrystale Cigainero: I think first on that list is availability, they want a physician group that can be available, that can be flexible and able to adapt as needed according to volume or whatnot in the facility. I think that...

David Henderson: That makes sense.

Chrystale Cigainero: Good patient care is up there. Are the patients still alive? That's a very, step one. Did they make it? Step two, are you available? [chuckle]

David Henderson: Got it.

Chrystale Cigainero: I think that's the biggest thing. You have to remember, every hospital has different OR volumes, every hospital gives different surgeons block days, or they have heavier ortho days some days, or OBGYN cases or GI days or whatever it may be, and that looks different, it's not streamlined across a particular health care system or a particular region, so they have different needs every single day, and so what they need is an anesthesia group who can say, "Okay, whatever you have, we're gonna be here, let's partner together to make that efficient, so you guys are staffing appropriately and we can staff, so to speak, our anesthesia group up to match your needs."

David Henderson: Got it, that makes sense. And so outside of just availability and keeping people alive then, how then... 'Cause those seem relatively basic, very standard, but I would imagine that no anesthesia group who's trying to win a contract goes to a facility and says, "Yeah, we're not super available, or we don't keep patients alive very often."

Chrystale Cigainero: I mean, I guess they're still up probably. But yeah.

[laughter]

David Henderson: So then I guess what I do then is I lean in and I say, Okay, well then how do you distinguish yourself? So how do you distinguish your group in the eyes of facility leadership who are either shopping around, or if they're just generally reviewing the contracts that they have in place and looking at your own relationship? 

Chrystale Cigainero: Yeah, honestly, that is where relationship building is so important. I'll speak for our group specifically. Metro, we are very focused on interpersonal relationships and making sure that our physician leaders have a very tight-knit bond with their hospital administration. I would say that that should be the norm across the board as well. Your physician leaders should have a great relationship with administration, but honestly, it speaks volumes because what you learn is if you implement that at all of your contracted facilities, people talk and they're gonna learn is the reputation of that group consistent. That's a very big factor. Is the reputation consistent? And if it is, that's really how you start to gain that overall reputation of being available or being difficult or whatever it may be for the good or bad. And so the only way to do that is really just build from the ground up, and that starts with the relationships within the facility.

David Henderson: Got it. And it's really... So it's the physicians who are creating that relationship. What makes for a good relationship between a physician and the hospital leadership? 

Chrystale Cigainero: That's a good question. I think adopt mentality of, I see you, I hear you. How can I partner to make it better? 

David Henderson: Okay.

Chrystale Cigainero: Not to say that you're always gonna have an answer right away or you're always gonna be able to give the answer that they want in that moment, but it's important for administration to feel heard and to feel that they have a true partner in this. That their anesthesia group isn't working against them, because if you're not on the same page and you don't have the same goals at the end of the day, it's not gonna be a good fit, right? And that's where people can rear up against each other, or you start to have disgruntled administration or surgeons or physician anesthesiologists or whatever the case may be. If you're not on the same page, that will start to happen and if you don't communicate. So that's the second thing, just constant communication, and I would really suggest that that be face-to-face, verbal communication that's kept up consistently. As you know, I think we've all been victim to the email tone problem or the text tone...

David Henderson: Yes. [chuckle]

Chrystale Cigainero: Where you get a text and you over-analyze, Why did they put a period there and not a comma? Are they frustrated? Are they... Is this it? Is this the last day I'm ever gonna talk to them? But it sounds silly, you do that in your day-to-day relationships, but it's no different in a business setting. You have to be really careful with what you say and how you say it, and while it's much easier to fire off an email, it's also a lot easier to fire off an email filled with emotion that can come across wrong. So I would say...

David Henderson: Right. For sure.

Chrystale Cigainero: Communication is key, making sure that that physician leader is getting face time with administration, talking to the OR staff, the anesthesia techs, the nurse supervisor, just making sure that everybody in that facility knows that they are there to help, and that when they do meet with administration, they can honestly say, Here's the feedback that I've been getting from X, Y, Z, and this is how it pertains to what we're talking about, and I think that that really bodes well overall, and helps create those long-term solid relationships.

David Henderson: That makes a lot of sense. You always make such good sense. Okay, so let me ask you...

Chrystale Cigainero: Let me pass another time, David.

[laughter]

David Henderson: What do stats even mean? From your perspective, so now we have a physician liaison going and he has a relationship, or she has a relationship with the hospital administration, but from your chair and from the CEO's chair, who aren't necessarily doing the interfacing, how do you support that relationship in the background? 

Chrystale Cigainero: So it depends. It depends on what the need is.

David Henderson: Sure.

Chrystale Cigainero: I think that's the beauty of if you have a physician-led group, but you have the support of a professionally managed organization or corporate structure or what not, your support system should really be there to help supplement whatever information is needed, give it to the chief and allow them to present it. So if the issue at hand is efficiency, and let's say administration is saying that they've been getting complaints or hearing comments about inefficiency with anesthesia or inefficiency when blocks are placed or whatever the case may be, the physician leader, we call them chiefs, could be a medical director or whatever it is, they're one person. And while they are the voice and the representative of that group, they're still one person. So what do they need? They need data, so we don't want them to be spending all of their time compiling that data, analyzing that data. They have to be taking care of patients, and then when they're not, they deserve to go home and be with their families. Right? 

David Henderson: Right, for sure.

Chrystale Cigainero: So, they would come to us and say, Hey, here's what the issue is. What can we give them? Like what, how... If you need anything from me, let me know, but here's the end result of what we need. If it's a financial question, if it's a quality of care question, if it's... The list goes on. Patient satisfaction, whatever it may be, we support the physician by giving them whatever data they need because data is really the only thing that you can use to support the need for a new process or a change or honestly to defend yourself as well.

David Henderson: Right, right. Yeah, no, I mean, it probably goes without saying from a Graphium health employee that I completely agree. That that is...

Chrystale Cigainero: Yes. I would hope.

David Henderson: Where it's at. And specifically, we've heard stories from our clients where there are cases where they are going and they're meeting with hospital administration and somebody gets up before them and says, "Listen, we are... We're having efficiency problems specifically, our first case is always late and it's anesthesia's fault."

Chrystale Cigainero: Always. It's always anesthesia's fault.

[laughter]

David Henderson: I do, I get that impression that fingers are always pointed first at anesthesia, and without data you're left with simply an emotional argument back. Really, basically your argument back is "nah-ah".

Chrystale Cigainero: Yeah, right. That's not true. You just don't like me. That's the... Yeah, that's the thing.

David Henderson: Right. And it does, it becomes emotional and it becomes political, and there's... The only way to overcome both of those things in these interpersonal relationships is...

Chrystale Cigainero: Data.

David Henderson: Is to provide data. But when you think about the power of that, to come back more emotionally and more political, all you do is augment the problem until it explodes and the contract just ends, they find somebody else because of everything you've just been talking about. So in that example, we've actually heard from clients who are like, "Listen, I was at this meeting and somebody got up randomly and said, 'Listen, all of our first cases are late and it's because of anesthesia and they need to fix it,'" and they were able actually to get up right then in that moment and pull up a report that said, "First case on time starts, here's us, here's the delays, and here's the delay reason right here." And what you're seeing is 85% of the time, it's actually because of... And name the reason, but it wasn't anesthesia. And they were able to explain what it was. And the great thing about that is not only wasn't able to save the relationship between making anesthesia look good and save that relationship, but it actually was something that they could hand to hospital leadership and say, "Actually, here's the thing that you could actually fix," and all of a sudden your ORs are gonna be however many percent more efficient.

Chrystale Cigainero: Yeah, absolutely, 100%. We've done that ourselves a few times, so I'm happy to hear that other people are... It's a great tool and you feel so much better about it because you know that A, you're not giving an emotional response, but I feel like the data speaks volumes, you don't even have to have a smirk or have a... You're just like, "Oh, okay, here we go, actually here's the bottom line," and you can really save face, so to speak.

David Henderson: Sure.

Chrystale Cigainero: And I think it's so important. So it gets to the bottom line faster, you can help create solutions to solve problems, and all the while saving your relationship with either the surgeon, the nursing staff, administration, and just really making your group look proactive, and I think you can't go wrong when you answer...

David Henderson: I agree, I agree. And when you think about these relationships, I think you guys are interacting with a lot of people who very frequently feel very alone in what they do. When I think about an OR director, for instance, who's faced with inefficiencies or quality problems or something like that, I feel like when those things come up, that person is probably blamed, but when they fix them and when things are going well, they don't hear a word.

Chrystale Cigainero: Oh, agree.

David Henderson: And so I can only imagine that for an anesthesia group to come along and see them and hear them and say, "Listen, I know your job is difficult, and I know what you do is basically magic. Let me give you this as a gift that's gonna show the world the great things that you have done." All of a sudden that relationship is something they're never gonna wanna let go.

Chrystale Cigainero: Yeah, exactly.

David Henderson: And then when somebody does come along and maybe it's a larger anesthesia group who's cutting corners and therefore cutting costs, and able to come in and say, "Listen, their contract is this much, but we are a lot cheaper," now what you have is, instead of you standing there and trying to defend yourself, you have these really nice cornerstones all around saying, "Absolutely not." [chuckle]

Chrystale Cigainero: You're absolutely right. And you start mining that data and you keep it consistent and you let it be something you live with and bring to the hospitals quarterly, weekly, whatever it is that they want, and then fast forward to a time where you're bidding for a new contract, or someone sends out a request to say, "Hey, we're thinking about closing to have an exclusive anesthesia group." That is, I would say the third thing that you would ask, what are they looking for? What would you bring to the table from the business standpoint, if you were bidding for one of these? And it's all of that data. Conceptually, here's what we can bring to the table, here's what our... We're gonna have a chief there, here are the things that they're responsible for, or here are all the things that we're checking, and all of the ways that we're going to help improve efficiencies, and here's how. And so it plays a part not only in sustaining the relationships you have, but it is the leg that you stand on when you're trying to build a new relationship that's based on the need for data and building those relationships.

David Henderson: Yeah. Well, and I think the things that you've said today represent a really holistic view of the system, the fact that you are concerned about a relationship that happens between a chief and between whoever, the director of operations or whoever at the hospital, but outside of that, you have these other players behind the chief, you have the Chrystales of the world, and behind the CEO, you have the director of the OR, and all of these other people. And when you think about it in that way, the support structures that are behind mean so much, and so... Anyway, that's a really sideways way of coming at a compliment to you, because I think we've actually known each other and worked with each other for, how many years now? Six? 

Chrystale Cigainero: Six? Oh, look at that, I think it must be six, I was gonna say six or seven.

David Henderson: Six years, I think that's right. It might be right on the border of six and seven.

Chrystale Cigainero: Been a while.

David Henderson: But that being said, from the get-go, whenever I've seen you working or heard from you or things like that, your mindset is very turned towards, "Hey, the data that we need is X, Y, and Z," because you're very proactive about because they're gonna need this data. And not only they're gonna be expecting this from us, but there's some data that they're not gonna be expecting that they need and they're gonna be surprised by. So I've always valued that about the way that you approach and the way Metro... I'm sorry, I don't mean to make it just the Chrystale show, but...

Chrystale Cigainero: Thanks.

David Henderson: But I do lots of compliments to everybody there, I just think you guys are fantastic. So that's probably kinda tacky to people that are watching the show right now, just because what am I gonna say.

Chrystale Cigainero: You didn't say I was fantastic. [laughter]

David Henderson: I'm sorry. Yeah, sorry, Dr. Miller, just want to say...

Chrystale Cigainero: They're all fantastic, no.

David Henderson: They are, they are.

Chrystale Cigainero: I'm just being the representative right now, that's all, that's everything I'm getting.

David Henderson: Well, and they are very welcome to the show if they ever like specific praise.

Chrystale Cigainero: You know what's so interesting just as a sidebar? Physicians, they're amazing, anesthesiologists, bringing people to the brink of death, holding them there and bringing them back to life is amazing. And you think, "Oh my God, you can do anything," but you ask them to present about themselves for six minutes and there... It's just like full-blown anxiety attack sometimes, where it's like, "I can't... A Power Point? What are you talking about?" And I just look at them like, oh my gosh, it's just... It's nuts. They're so modest and humble as far as not wanting to give themselves accolades for how great they are, they're just like, "No, no, no, I'm fine. Let me just go back to the medical side of this."

David Henderson: That's funny. Well, we will just kind of suck up all the compliments here and make sure that the world knows. Well, Chrystale, this has been really good, and I hope you're having as good a time as I am because I want you back on the show, however often you're able to come. I just think that what you bring to the table is so valuable, and I hope that our audience listening today can appreciate that. Would you be opposed if people wanted to get in touch with you, would it be alright for them to shoot you an email or something like that? 

Chrystale Cigainero: Yeah, sure. Absolutely, yeah.

David Henderson: Cool. Awesome. Alright, well, if you're okay with it, I will include your contact information here, probably just shoot an email address. And then if they have questions... Yeah, yeah.

Chrystale Cigainero: Dating profile.

[laughter]

David Henderson: Whatever you want really. If you want that out there that's fine.

Chrystale Cigainero: Oh my God, I'm joking, David.

David Henderson: No, but please feel free to reach out to Chrystale if you have any questions. Of course, if you ever wanna reach out to me, you can always contact us at timeout@graphiumhealth.com. Chrystale, once again, thank you and we will see you next time. Everybody watching and listening, thank you so much. Have an awesome...

Chrystale Cigainero: Thank you for having me.

David Henderson: Yeah, no, great. Have an awesome evening, afternoon, I don't know what time you're listening, I just realized I'm wishing you a good evening, but...

Chrystale Cigainero: Good evening, everyone.

David Henderson: It may be morning where you are, have a wonderful day wherever and whenever you are. David Henderson signing out for Time Out for Anesthesia. Bye bye.