Fellowship in the Management of Perioperative Services
- Fellowship Curriculum
- Fellows
- Instructors
- Clinical Workload
- Knowledge Base for Fellowship
- Staffing and Scheduling
- Appendix
This fellowship in management, entrepreneurship, and leadership for the clinician is one of the first of its kind to be offered by a Department of Anesthesia. 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. The Fellow audits courses on the Stanford Campus and then applies that knowledge in relevant projects.
Alex Macario - Principal Faculty
Professor of Anesthesia and Health Policy and Research
Kent Garman
Clinical Professor of Anesthesia
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.
Fellows
| Name of Fellow | Main Project | Current Position |
 Mitchel Tsai M.D.2008 |
Patient satisfaction with a telephone-based preop assessment at a rural, academic medical center |
Faculty, University of Vermont |
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| Jaume Balust M.D. 2007-2008 |
Anesthesia Information Systems in Europe | Faculty, Chief of Service, Barcelona, Spain |
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| Harshu Chaobal D.O. 2005-2006 |
Economics of Acute Pain Service | Faculty, Mt. Sinai, NY, NY |
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| Chris Eggers-Halbeis MD 2005-2006 |
Anesthesia Information Systems in USA; Anesthesia Workforce in Europe | Consulting, Director of Medical Affairs Sonnenhof Swiss Health Ltd., Berne, Switzerland http://www.sonnenhof-swisshealth.ch |
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| Cate McIntosh MBBS 2004-2005 |
Part-time clinical anesthesia practice: economic, quality, and safety issues; Economics of Simulation Education | Faculty, John Hunter Hospital, Newcastle, Australia; Director, Simulation Program, Hunter New England Skills & Simulation Centre |
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| Harrison Chow M.D. 2004 |
Economics of RFID tagged sponges | Community Anesthesia Practice, Entrepenuer, San Jose, California |
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| Tom Archer M.D. 2000 |
Preoperative Clinic IT; Surgery Center Economics | Faculty, Director of OB Anesthesia, UCSD, San Diego, CA |
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| Miguel Canales M.D. 1999-2001 |
Robotic surgery | Entrepeneur, Restoration Robotics, Mountain View, California |
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| Anthony Chung M.D. 1999-2000 |
Cost-effectiveness of a trial of labor after previous cesarean | Community Anesthesia Practice, North Carolina |
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| Leo Montejo M.D. 1999 |
Anesthesia Billing IT | Entrepeneur |
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| David Glenn M.D. 1998-1999 |
OR management | Community Anesthesia Practice, California |
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| John Navarro M.D. 1997-1998 |
Anesthesia Information Systems; Analgesia for labor pain: a cost model. | Community Anesthesia Practice, Oklahoma |
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| Craig Scibetta M.D. 1997-1998 |
The impact of managed care on anesthesia residency training; Analgesia for labor pain: a cost model. | Community Anesthesia Practice, California |
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| Patrick Burch M.D. 1996-1997 |
Policy and Politics in Anesthesia | Deceased |
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| Matthew Weinger M.D. 1996-1997 |
Patient Safety and Medical Simulation, | Faculty, Vanderbilt; Norman Ty Smith Chair in Patient Safety and Medical Simulation, Professor of Anesthesiology, Biomedical Informatics, and Medical Education |
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| William Fritz M.D., M.B.A. 1996 |
Free standing surgery centers-quality improvement | Community Anesthesia Practice, Chief, Johnstown, Pennsylvania, |
Instructors
- 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 development of clinical expertise is essential to the Fellowship year. The Fellowship salary is funded by working in the general Operating Room Suite a total of 40 days during the year. The Fellow is required to take 16 first calls (5pm - 7am) and 16 second calls during the year.
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
Knowledge
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
Planning
- 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
Budget
(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
- 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
Protocols
- 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
Appendix
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 its economic implications. Differential information and communication in economical organization.
