Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

A Transparent Transition: Feeling Valued as an Anesthesia Advanced Provider

5/8/2017 12:26:50 PM | 11 comments

providence hospital anesthesiaIn 2016, our anesthesiology team at Providence Hospital in Washington, D.C., learned that CEP America would be taking over our contract. Just two years before, we'd transitioned from hospital employees to management by one of the big corporate groups. Here we go again, we thought.
The previous experience left us feeling demoralized and undervalued. Anesthetists have a lot of insight into what's working and what's not in the department. But as corporate employees, we didn't have much of a voice.
We figured CEP would bring more of the same. How wrong we were.
From day one, CEP was different. The leaders valued anesthetists' experiences and opinions and worked with us to transform our operating room (OR). In today’s post, I’ll share how CEP made the transition a positive one.

Life as a Certified Anesthesiologist Assistant

Saral Patel, CAA, anesthetist at Providence HospitalI became a Certified Anesthesiologist Assistant (CAA) because I wanted to work directly with patients in a challenging, fast-paced environment. Today as a CAA, I do pre- and post-anesthesiology evaluations, give epidurals, respond to code blues, and carry out the treatment plan set by the anesthesiologist.
In 2002, I started working at Providence Hospital, which follows the anesthesia care team model. Under this arrangement, the anesthesiologist delegates certain patient care tasks to CAAs and nurse anesthetists (CRNAs). We administer the anesthesia and monitor the patient during surgery under the medical direction of an anesthesiologist. The care team model allows an anesthesiologist to direct up to four ORs simultaneously .

Uncertainty About Our Future

When we found out that CEP was picking up our contract, there was apprehension and anxiety. Our last transition had been really stressful, and we weren't ready to go through it again.
New management brings a lot of unknowns. What would CEP expect of us? Would salaries and scheduling change for the worse? Also, we knew that CEP was based in California where the care team model is less common. Would they even keep the anesthetists around? And if so, would they understand our role and value that we bring?

How CEP Was Different: A Smooth Transition

Fortunately, the CEP leaders realized that this contract transition was a life-changing event for us providers. At our first meeting, before their start date, they acknowledged how emotional and disruptive the process must be. They were very transparent about their intentions, stating that they were coming in to help us address some of our pain points as a department.
This was actually welcome news, because we knew our surgical services could be doing better. We needed to improve efficiencies in the OR and cut down on cancellations, delays, and billing issues. Our team also needed help nurturing relationships between physicians, anesthetists, and hospital staff.
The previous management group had come in with a preformed plan. We had no input and two choices: adapt or move on.
By contrast, the CEP mentality was very collaborative. Vice President of Anesthesiology Peter Nosé, MD, along with Cyndy Flores, PA-C, Director of Advanced Provider Strategy and Innovation, flew across the country several times to meet with our team to discuss our concerns. They held Q-and-A sessions for every shift and posted drop-in office hours. They also asked for our feedback and cared what we had to say.
One tough thing about being an anesthetist is seeing problems but not having the authority to fix them. But Dr. Nosé really encouraged us to get involved in improving our department. He genuinely wanted to hear our perspective about what was working and what wasn’t.
That was such a game changer for us. We knew that if a VP and Director were taking time to listen, CEP would be different.

A Personal Touch

Another thing we immediately loved about CEP was that the new leadership made such an effort to get to know us providers. They held social events to help us bond as a team and open the doors of communication. One small detail made a big impression: At orientation, each of us received an HR folder with our name on it.
The previous corporate group hadn't bothered much with names. Nor had they differentiated between the needs of CAAs and CRNAs. They'd just bundled all advanced providers under a single CRNA umbrella. But with CEP, we were delighted to receive paperwork and welcome materials tailored to us individually.
CEP's compensation packages were equitable, fair, and flexible regarding individual needs. Before the contract change, I'd been considering reducing my hours to part-time. As it turns out, CEP's full-time anesthetist contracts are 30 hours per week. This was ideal for me, allowing me to work fewer hours without losing full-time status and benefits.
Overall, the level of support we've received has been exceptional. Dr. Nosé, Cyndy Flores, and the other leaders are understandably super busy. However, they always return calls and are available for questions and feedback. I'd have never dreamed of having that kind of connection and accessibility in our previous corporate group.

Leadership Opportunities for Advanced Providers

From day one, anesthesiologists and anesthetists were encouraged to get involved with CEP on the organizational level. Even though we had just joined, our leaders invited us to CEP's annual conference, their biggest educational and networking event of the year. Not just to attend, but to talk about our hospital, our care team model, and our best practices and lessons learned.
Much to my delight, I was invited to present at the anesthesia practice line’s business meeting, introducing anesthesiologist assistants and the care team model. I also attended a dinner for anesthesiology providers, where I met some fantastic people from across the country. Through my new connections, I was invited to join CEP's Advocacy Committee, becoming the first advanced provider to do so.

Positive Changes

Overall, our anesthesiology department's transition to CEP has gone very well. We’ve retained most of our providers and welcomed some new ones. A year later, we are fully staffed with enthusiastic providers who are at the top of their game.
Under CEP management, we've increased OR efficiency and decreased our surgery cancellations. Surgeon and nurse satisfaction is up, and we're working steadily through our billing issues. We’re also in the midst of developing a new pre-op clinic, which helps prepare patients while preventing delays and cancellations.
It’s been wonderful joining the CEP team. We’ve made significant progress at our site. A lot of doors have opened for me professionally through the connections I've made. I’m excited to work on the pre-op clinic and can’t wait to see the progress we’ll make!

Visit our website to learn more about anesthetist careers with CEP America.

Aimee Nalle
Nice article Saral. I remember meeting you during the start-up phase and all the questions and concerns everyone had (understandably so). It is validating to know that your experience with CEP has lived up to our pre-contract explanations!
5/11/2017 11:28:50 AM

David Carter
Thank you for sharing your "joining CEP America" journey - from the apprehension that preceded to the full engagement and seizing of opportunities today. Thank you also for highlighting the "Care Team Model" and its effectiveness. It's a pleasure having you all as part of the CEP America family.
5/9/2017 2:38:07 PM

Carol Darden
Great to hear your perspective! Thank you, Saral!
5/9/2017 12:13:04 PM

Mukesh Kumar
Very optimistic. Nice to know one more aspect of ur life. Doing wonderful job. Good luck for future.
5/9/2017 11:12:42 AM

Kevin Riggs
Thank you for sharing your experience and for your participation in the non-clinical activities offered by CEP! What a great way to enhance your career. Keep up the awesome work!
5/9/2017 7:37:50 AM

Gregg Mastropolo CAA

I enjoyed reading this article very much. Nice to see the contrast you made to the different management styles and how it affected your work environment and moral.
5/9/2017 6:41:12 AM

Noopur Mehta,CAA
Awesome job Saral! A great representation of our department!
5/8/2017 6:28:47 PM

Noopur Mehta,CAA
Awesome job Saral! A great representation of our department!
5/8/2017 6:28:18 PM

Daniel Mesaros, CAA
Well deserved! Good group of anesthesia providers!
5/8/2017 6:04:54 PM

Cyndy Flores
Always so positive! It has been a joy welcoming anesthetists into the CEP family and we all look forward to a long and happy relationship! I appreciate all the help you have given to CEP!
5/8/2017 3:31:07 PM

Peter Nosé, MD
Now, the teacher becomes the student ...
Thanks for inspiring me, Saral. Great perspective and feedback!
5/8/2017 2:43:46 PM