Management of Perioperative Services

The Department of Anesthesia at Stanford University Medical Center offers a one-year fellowship in the Management of Perioperative Services focusing on entrepreneurship, management, and leadership for the clinician.

Fellows receive training and research opportunities in the economics and management of the operating room suite and affiliated perioperative functions. Instructors are drawn from members of the Stanford University Hospital administration, Medical Staff, Nursing Staff, Business School, and the Departments of Economics, Health Research and Policy, and Anesthesia. Fellows audit courses on the Stanford Campus (including the Business School), participate in seminars held by experts in various disciplines, and then apply acquired knowledge to research projects related to solving real problems in the management of perioperative services.

Salary is provided by the Department of Anesthesia. Applications and other fellowship materials can be obtained by contacting Alex Macario M.D., M.B.A, at (650) 723-6411.

Principal Faculty: Alex Macario M.D.

Fellowship Curriculum

The Fellowship curriculum consists of 3 components:

  • Lecture courses in the University are chosen to provide didactic sessions regarding critical principles of management. (See Appendix for summary descriptions of some of the courses available to the Fellow to audit.)
  • Seminars provide instruction and opportunity to explore concepts with experts in the management of perioperative services. Fellows are given assigned reading prior to seminars. Discussion with the instructors is intended to clarify understanding of reading assignments as well as requiring Fellows to extrapolate to apply analytical skills.
  • The fellows work with instructors chosen from the nursing staff, anesthesia department, and hospital administration to gain real life experience in applying principles involved in OR and department management. The Fellow uses cases describing common OR management problems to learn quantitative and qualitative management skills.


Name of Fellow Year Main Project Current Position
Joel Pash DO 2013-2014 TBD Community Practice, Canada
Kristen Telischak MD 2013-2014 TBD Anesthesia Resident Beth Isreal
Loren Riskin MD 2013-2014 Quality Improvement Stanford Anesthesia resident
John Santiago MD 2011-2012 Economics of bedside transthoracic ultrasound Kaiser Washington DC Anesthesia Group
Jennifer Dubrawski MD 2011-2013 Physician group management Community Practice, Los Angeles
Steve Liu MD 2010-2011 Economic assessment of fiberscopes Pain Fellow, Columbia
Bassam Kadry MD 2010-2011 Complex Event Processing and Computerized Checklists Stanford faculty
Mitchel Tsai MD 2008 Patient satisfaction with a telephone-based preop assessment at a rural, academic medical center Faculty, University of Vermont
Jaume Balust MD 2007-2008 Anesthesia Information Systems in Europe Faculty, Chief of Service, Barcelona, Spain
Harshu Chaobal DO 2005-2006 Economics of an Acute Pain Service Community Practice, New jersey
Chris Egger-Halbeis MD, MBA 2005-2006 Anesthesia Information Systems in USA; Anesthesia Workforce in Europe Hospital C.E.O.
Hirslanden Beau-Site Hospital, Bern, Switzerland
Cate McIntosh MBBS 2004-2005 Part-time clinical anesthesia practice: economic, quality, & safety issues; Economics of Simulation Education Faculty, John Hunter Hospital, Newcastle, Australia;  Director, Simulation Program, Hunter New England Skills & Simulation Centre
Harrison Chow MD 2004 Economics of RFID tagged sponges Community Anesthesia Practice, Entrepenuer, San Jose, California
Tom Archer MD 2000 Preoperative Clinic IT; Surgery Center Economics Faculty, Director of OB Anesthesia, UCSD, San Diego, California
Miguel Canales MD 1999-2001 Robotic surgery Entrepeneur, Vice President and Medical Director, Restoration Robotics, Mountain View, California
Anthony Chung MD 1999-2000 Cost-effectiveness of a trial of labor after previous cesarean Community Practice, North Carolina
Leo Montejo MD 1999 Anesthesia Billing IT Entrepeneur, San Francisco Bay Area
David Glenn MD 1998-1999 OR management Community Practice, California
John Navarro MD 1997-1998 Anesthesia Information Systems Community Practice, Oklahoma
Craig Scibetta MD 1997-1998 Analgesia for labor pain: a cost model Community Practice, Arizona
Patrick Burch MD 1996-1997 Policy and Politics in Anesthesia Deceased
Matthew Weinger MD 1996-1997 Patient Safety and Medical Simulation Faculty, Dept of Anesthesia  Vanderbilt; Norman Ty Smith Chair in Patient Safety and Medical Simulation, Professor of Anesthesiology, Biomedical Informatics, and Medical Education,Vanderbilt
William Fritz MD, MBA 1996 Free standing surgery centers-quality improvement Community Anesthesia Practice, Chief of Anesthesia, Johnstown, Pennsylvania


  • Hospital Management
    • T. Long
  • Anesthesia Services
    • A. Macario - cost and decision analysis
    • S. Fischer - preoperative evaluation program
    • T. Vitez - quality improvement, statistical quality control, planning
  • Operating Room Nursing
    • R. Heinen - material management and personnel resource
    • D. Christ - strategies for OR schedules, information systems
    • S. Hoopes - outpatient surgery
  • Health Economics Instructors on Campus (not all possible faculty are listed)
    • M. Hlatky, MD
    • A. Garber, MD, PhD
    • L. Lenert, MD
    • A. Enthoven, PhD
    • D. Owens, MD

Clinical Workload

Continued patient care experience and development of clinical expertise is essential to the Fellowship year. The Fellowship salary is funded by working in the general Operating Room Suite as an attending anesthesiologist (Clinical Instructor appointment) approximately 12 hrs a week and includes 1-2 late shifts or overnight calls/mth.

Knowledge Base for Fellowship

Health economics

Relationship of OR to hospital and health care system. Economics of Health and Medical Care (HRP 256) gives understanding of where profession/specialty is, how we got there, where we might be going. History of evolution (100 years) of delivery and financing of U.S. health care (e.g., Starr: The Social Transformation of American Medicine)

Management of Hospital and health care institution

  • How hospital is organized
  • How organization works and how to get things done
  • How Medical staff relates to hospital
  • "Economics" of hospital

Operating Room/Ambulatory Surgery Center Management

Organization and financing

  • Use flow sheets to understand customers and equipment
  • OR Managers

    • Admissions
    • Anesthesia
    • Surgery

Management tools (Equipment)

  • computer
  • software
  • schedule personnel
  • schedule ORs
  • schedule operations & patients
  • material management
  • spreadsheets
  • databases


  • Computer applications
  • database management/statistics
  • graphics
  • OR management programs

Continuous Quality Improvement

  • Deming WE: Out of the Crisis. MIT Center for Advanced Engineering, Cambridge, Mass. 1982
  • Walton, M. (1986) The Deming Management Method, Perigee, New York, Juran , J.M. (1992) Juran on Quality by Design, The Free Press, New York
  • Crosby, P.B. (1979) Quality is Free, McGraw Hill, New York


  • Juran JM: Quality Planning
  • Harvard Project Manager software

Problem solving

  • Scholtes PR et al: The Team Handbook. Joiner Associates, 1988
  • William Franklin How to Solve Any Problem

Statistical Process Control (system analysis & system control)

  • Grant EL, Leavenworth RS: Statistical Quality Control 6th ed. Mc Graw Hill 1988
  • Ishikawa K: Guide to Quality Control: Unipub New York New York (2nd edition) 1982 - call 1-800- 521-8110 to order book
  • Terry Vitez seminar


(Ms. Duperrault, Ms Bird, Stanford course on cost accounting)

  • purpose
  • how to make one (include various types such as rolling budget)
  • how to use it during the year

Decision making

  • Eco 281
  • Eco 282
  • Rubenstein MF: Patterns of Problem Solving; Prentice Hall 1975
  • Raiffa H: Decision Analysis: Introductory Lectures on Choices under Uncertainty. Random House, 1968
  • Chernoff H, Moses LE: Elementary Decision Theory Dover,1986


  • Operations research 154
  • Time management
  • Seminar by outside consultant
  • Stanford resource

Interpersonal relationships

  • Eco 386
  • Scholtes PR et al: The Team Handbook. Joiner Associates, 1988
  • Berne E: I'm OK, You're OK. Grove Press
  • Peck MS: The Road Less Traveled. Simon & Schuster, 1978
  • seminar by outside consultant (Jim Alspaugh)

Statistics and Data Analysis

  • Designing Clinical Research, Hully S, Cummings S. Williams & Williams, 1988
  • Primer of Biostatistics, Glantz S. McGraw Hill 4th edition, 1982

Cost Benefit Analysis & Cost Effective Analysis

  • Warner KE, Luce BR: Cost-Benefit and Cost-Effectiveness Analysis in Health Care. Health Administration Press, Ann Arbor, Michigan, 1982
  • Eisenberg JM: Clinical Economics A Guide to the Economic Analysis of Clinical Practices. JAMA 1989; 262:2879-2886
  • TSI database
  • HRP 392

Risk Management

  • Marketing your ideas, products, and services - Ann Fife, Don Gibbons
  • Doyle M, Straus D: How to Make Meetings Work. Jove, 1982 (outside consultant)

Staffing and Scheduling


  • Clinical Pathways
  • Practice Protocols
  • Shoemaker TS: Practice policies in anesthesia: a foretaste of practice in the 21st Century. Anesth Analg 80: 388-403, 1995

Measurement science

  • Surveys
  • Time studies
  • Productivity studies

Research Project

Apply research principles to OR management project

  • SUH OR Management committees can provide ideas
  • select project (including justification)
  • possible 2-4 projects / fellow
  • consider different areas in OR and surgical services

    • choose or design an Anesthesia staffing program
    • clinical pathways
    • cost study
  • plan project (including budget)
  • funding
    • intramural/extramural
  • present proposal
  • execute analysis phase
  • decide changes to be made
  • institute changes
  • analyze net results
  • write report
  • present report to Stanford
  • publish paper
  • present paper at nationwide meeting
  • Anesthesia Department Grand Rounds - 2/yrs


Description of a few of the many courses available in the University. After discussion with faculty, fellows are expected to audit selected courses offered by the University.

School Of Medicine

  • Health Research & Policy 256: Economics of health & medical care - Empirical, institutional and theoretical analysis of problems of health and medical care, measurement, valuation, and determinants of health; physicians, hospitals and the drug industry, financing and organization of medical care; public policy issues.
  • Health Research & Policy 392: Cost-Benefit Analysis in Health Care - Study discussion of the main literature on the principles of cost-benefit analysis applied to health care. Emphasis is on insights into the art of practical application.
  • Research in Progress Seminars, Wednesday afternoons at 130pm: Fellows throughout University pursuing health economics research present ongoing projects. Faculty provides guidance and critique early in research progress.

School of Engineering

  • Operations Research 154: Operations research - introduction to techniques and models of operation research: theory and computation of optimal selection of decisions under certainty. Linear programming, network optimization models; dynamic, non-linear and integer programming.
  • Interdisciplinary Seminar on Conflict Resolution - (same as Eco 386, Law 325, Psych 283) - Addresses problems of conflict resolution and negotiation from an interdisciplinary perspective.

School of Humanities & Sciences

  • Economics 281: The Economics of Uncertainty - The theory of choice under uncertainty: the Neumann Morgenstern and Savage theorems. Subjective and objective probabilities. The evaluation of risky prospects and the demand for assets.
  • Economics 282: Theory of Information and Organization - The value and cost of information. Demand for information and