Redefining Customer Service

n response to Ms. Bierstein’s “Practice Management” column “Customers of Anesthesiology” (February 2006 ASA NEWSLETTER), I would refer any and all interested to an article by Jerry Ippolito, President of the Surgery Management Improvement Group, in the Fall 2004 Communiqué bulletin of Anesthesia Billing Consultants.¹

There is increasing pressure on anesthesiologists by surgeons and administrators to drive patients through the operating arena at an ever-increasing rate. Often, little attention is paid to the myriad factors contributing to inefficiencies outside the anesthesiology department.

A few years ago, I was approached as chief of my department by the chief of surgery who stated that “You guys are not getting the patients in the (operating) rooms on time.” My partners recorded all late first starts and categorized the causes into one of four categories: patient not ready, room not ready, anesthesia not ready and surgeon not ready. Over nine months, we found that surgeon unavailability accounted for half of all delays in the first case of the day.

Our institution has managed to shave two to three minutes off of our average turnaround time to under 20 minutes. Meanwhile the extreme variation in the operative times between various members of the surgical staff persists. Two to three minutes makes very little difference when it may take one surgeon an hour or more time to complete a case compared to his/her colleagues.

Mr. Ippolito’s model for an efficient surgery department requires surgeons to “look at his or her colleague and state … you are consistently late and that disrupts my practice.” It requires anesthesiologists to say to their colleague, “…you are consistently late and delay the schedule. Do you know how that makes us look?” It requires any physician to take his/her colleague aside and say, “Two of our best nurses have resigned because of your poor behavior…and I will not tolerate it.” These are the more difficult things we need to do to address inefficiencies.

Surgeons are the driving engine of the operating room. They are our customers, and we need to work together to keep everyone happy. The reality is, however, that we also have a patient who is more than just our customer. If we don’t attend to our patient, they may not be alive later to complain to the customer service department. It is our responsibility sometimes to block the surgeon’s efforts to get the patient into the operating room if the patient is not ready. We have made the practice of anesthesia so safe that even our physician colleagues do not understand the gravity of what we do.

I’m all for efficiency and pleasing our customers, but we must always remember that our first duty is to our patient whose welfare and safety must trump all other concerns. The trend to treat the patient as our customer undermines the bond between doctor and patient and the oath to which we swear as physicians and patient advocates.

Michael T. Grier, M.D.
Anderson, South Carolina

Reference:
1. Ippolito J. Surgical program inefficiency, Governance and impact on anesthesiology programs. Anesthesia Billing Consultants Communiqué. 2004; 9(3):10-12,14-15.

Second City Lives Up to Nickname in Blood Bank Debate

he April 2006 issue of the ASA NEWSLETTER (“Chicago: Welcome to the Neighborhood”) reports a commonly held misperception that we would like to correct. In that article there is a statement, “In 1937, Chicago became home to the first blood bank in the United States.” The Mayo Clinic Rochester staff meeting records of April 14, 1937, report that it was “Our practice of the last few years, of keeping blood in the refrigerator and of considering it usable for about twelve days has increased the tendency toward small transfusions of 200 to 250 cc of blood as compared to procedures when blood was not refrigerated.”¹ They show a table of the percentage and types of transfusion reactions dating back to 1934. The publication by Moore further documents this information.²

Therefore the first blood bank in the United States was actually in Mayo Clinic, Rochester, Minnesota.

Gregory A. Nuttall, M.D.
S. Breandan Moore, M.D.
Rochester, Minnesota

References:
1. Lundy JS, Touhy EB, Adams RC. Annual Report for 1936 of the section on anesthesia: Including data on blood transfusion. Proceedings of the Staff Meetings of the Mayo Clinic. 1937; 12(15): 225-238.
2. Moore SB. A brief history of the early years of blood transfusion at the Mayo Clinic: The first blood bank in the United States (1935). Transfus Med Rev. 2005; 19(3):241-245.