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Anesthesiology:
doi: 10.1097/ALN.0000000000000114
Reviews of Educational Material

Operating Room Leadership and Management

Chakraborty, Indranil M.B.B.S., M.D., D.N.B., C.M.Q.

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The phrase “Leaders are born, not made” may have an element of truth to it. For some, however, it may be just another cliché. But even the “natural” leaders need correct vision and foresight, proper conceptual understanding and recognition, the right tools, proper work environment, and infrastructural support to succeed. I am neither a “leader,” natural or otherwise, nor do I claim to be one. But, let’s face it, most of us harbor that often hidden desire to be successful and to be recognized. And, like it or not, both of those designations usually require some shades of leadership and management skills. Keeping that limited self-justification in perspective and with some confessed trepidations, I picked up Operating Room Leadership and Management, by Dr. Kaye and colleagues, for review.
The operating room leadership and management sphere has no shortage of metrics, theories, concepts, texts, software, courses, and other material. Some would argue that there is too much! But what really excited me and, I must admit, surprised me a bit as well was that this book was edited by and contributed to significantly by fellow anesthesiologists. And it makes perfect sense. As anesthesiologists we are deeply invested in the successful and efficient operations of the surgical services. Therefore, we bring to the table a unique management perspective. Every so often we are the critical piece of the puzzle that gets lost in the melee.
This textbook has 27 chapters divided in to four sections. Considering the herculean task at hand and the complexity of the subject matter, it is surprising that the authors could limit the size of the book to fewer than 300 pages. There is also a good mix of contributors to the text, ranging from senior-level physicians to auditors, quality managers, and administrators from both the academic and private sectors. It even includes some residents and fellows, which I think adds to the value and depth of the narrative.
The first section deals with leadership and strategy. This was my favorite part of the book for purely philosophical reasons. There are four chapters dedicated to understanding concepts of leadership, successful operating room environment, strategic planning, and the art of decision making. This section will be especially interesting if you are new to these concepts. It will help build your interest and gives ample opportunities for introspection. The authors will take you on a journey of self-realization and self-identification of the different leadership styles and management skill sets that you may or may not possess. There is also evidence-based discussion about several interesting topics, including which leadership strategy works in what situations, the obstacles to effective leadership, psychology that operates in the surgical services, development of purpose, strategic planning, and analysis. The discussions of the concept and importance of emotional intelligence in the background of operating room management, strategies on how to improve it, and the process of decision making made for an interesting read.
The second section has six chapters dealing with economic considerations, efficiency, and design. Here, the reader will find detailed discussion of varied topics, such as revenue and expenses in health care, staffing and scheduling, operating room efficiency, productivity, evaluation of operational and financial performance, and many more. Of special interest was the detailed discussion of operating room design and construction and their effect on efficiency and productivity. There are detailed drawings, maps, and figures of operating room design and manpower flow that add value and depth to the conversation.
The third section delves into discussion of surgical and anesthesia practice management. This is where the rubber meets the road, if you ask me. Probably, this section will be the most useful in understanding the concepts behind the day-to-day functioning of anesthesia practice models. Topics are varied and exhaustive, but some of the interesting ones include: the nuts and bolts of planning, maintaining, and evaluating the efficacy of physician-directed preoperative clinics; perioperative standards; productivity measurement and incentive plans; personnel compensation for anesthesia services; and billing and coding issues. The fourth section is devoted to discussing safety standards and information technology. This deals with topics under significant public limelight and debate, such as the health safety standards under the Joint Commission and the Centers for Medicare and Medicaid Services, pay-for-performance model of reimbursement, medical informatics, and simulation.
The book is very well written and it flows in a simple narrative style. The topic and chapter selection also seemed logical and broad based. The authors have craftily interspersed the material with apt and logical samples and examples that make a world of difference in grasping the concepts and make them reasonably easy to understand. At no time did I feel the text lacked depth of information or dearth of references. It is an introduction to the basic concepts of operating room management and it fully justifies the claim of being an excellent evidence-based text. It is not the final word in the management revolution, but it does not profess to be one either. And I am still amazed that the authors could justifiably summarize the varied topics within 300 pages.
This book really widens your understanding of the dynamics of a successful surgical practice and will be extremely useful for different healthcare professionals with career interest in this field. I believe materials like these should be an integral part of the curriculum for anesthesia residency training programs throughout the country. Although a part of me wants to shout out loud that every one of us in clinical operating room practice must read a book like this, it may end up appealing only to a niche readership. I hope I am proved wrong.
Indranil Chakraborty, M.B.B.S., M.D., D.N.B., C.M.Q.
,University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas. chakrabortyindranil@uams.edu

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