Below is a copy of a letter I sent for a position as vice-chair of anesthesia at a large teaching hospital.  I’ve long thought that most vice-chairmen needed to expand their skill sets.

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Dear Dr. —-,

As you proceed with your search, I would like to clarify my approach to the description for Vice Chair for Clinical Anesthesia. It’s a bit different than how it was done when I was a senior consultant at KFSH&RC in Saudi Arabia teaching residents, and while teaching at Tufts during a locum tenens.  However, I thought both of those could be improved upon.

Operating Room

Scheduling:
Analysis of current OR scheduling program and modification (if necessary) to have it render more immediately useful information to coordinate the day’s schedule, and to collect data for longer term analysis of policies,  procedure dependent intra-op delays due to technique or equipment, and personnel evaluations with the intent to discover good practices and those that need improving.  Locate constraints, define and decrease designated turnover times to the minimum requested or that which is financially best while decreasing risks to patient and personnel.

There are two schedulers that I have modified for use in the OR (and outside the OR).  Each has certain attributes that make it a better choice depending upon the situation.  Each can be used to run the day’s schedule while collecting data for later analysis.  The later analysis is done by transferring the data to a multi-dimensional spreadsheet that can easily handle a billion records yet is versatile enough for rapid discovery of patterns from any recorded attribute (field).  If patterns are discovered, or if outliers are discovered, contextual information is available by going back to the original scheduler for the details and relationships of all factors relevant to each instance of interest.

This should permit quick evaluation of best practices of scheduling between cases (inter-case), and discovery of best practices intra-case (ex: anterior vs lateral approach to hip operation).  Relative merits of regional vs general anesthesia and their effects on the whole days schedule should become apparent as would improvement of individual residents ability to induce or block patients.  The improvement of surgical residents (based on time to perform procedures or parts of procedures) can easily be tracked so that attendings can focus on areas that individual residents may need additional instruction.

Communication:
There are several free or inexpensive communication systems that can be adapted and implemented depending upon the currently available system.  The system should help coordinate activity within a service (gen surgery, anesthesia, etc) or within a working environment (OR and floor, radiology, etc.) and relieve the need for an intermediary to pass on information.  Their communication systems also permit collection of information for pro-active, or retro-active, analysis of problems and events if desired.

Data collection:
As above, plus designing and using the appropriate database for collection and analysis of whatever data needed for evaluation of personnel, procedure, or equipment.

Quality improvement:
Using the above to coordinate with other departments to achieve designated goals of quality and financial improvement.


Teaching objectives: 

Anesthesia: regional, ob, pediatrics, neuro, general, ortho, etc.; game theory and options, risk management, constraint theory, rapid turnover, efficiency; compare and contrast hospital anesthesia systems and cultures in and outside the US.

Business: Finance, real options, risk management; accounting theory pitfalls in practice; constraint theory



Managerial objectives:

Call and Holiday Scheduling:
Discussion, evaluation, and implementation of various systems for equitable scheduling with the goal of maximizing personal utility functions either through rigid scheduling techniques or fictitious currency techniques (stock market approach).

State and agency requirements:
Using hospital and personal connections to understand and fulfill regulatory requirements.

Thank you for your consideration,