What makes a good anesthesiologist? What makes a great one? We believe that in considering these questions, anesthesia providers can adopt principles established in successful businesses. Treacy and Wiersema suggest four keys to great success, all of which must be met: (i) excelling in one value discipline (product leadership, operational excellence, customer service); (ii) maintaining threshold standards of performance in the other value disciplines; (iii) improving value year after year; and (iv) building a well-tuned operating model focused on delivering unmatched value. The first two keys represent a framework for what is needed for success. The latter two speak to enduring success.

Product leadership involves delivery of an innovative or especially high-quality product. In anesthesiology, product leadership may result from subspecialty expertise or facility with newer techniques or technology such as transesophageal echocardiography, regional nerve block catheters, or difficult-airway management devices. Anesthesia providers with these skills may have an initial edge, but maintaining this advantage over time may be challenging. Even in the absence of unique subspecialty or technical expertise, focus on the delivery of exceptional quality to create product leadership. The ability to apply current knowledge is key. Recognize, critically interpret, and implement significant medical or surgical (not only anesthesiology) outcomes literature. For example, surgical-site infection-prevention initiatives in the Institute for Healthcare Improvement’s 100K Lives Campaign are based on outcomes data reported in cardiac surgical and general medical journals. Simultaneously, understand details of the case at hand (e.g., How long will the procedure likely last? Is the aorta going to be clamped above or below the renal arteries? How long until the aortic clamp is to be removed?); understand how your choices will affect outcomes. Actively seek information you need to know to make good decisions for the patient and for others in the room with whom you share responsibility.

Operational excellence means being timely, time-efficient, cost-effective, and consistent. Be prepared and organized for your cases. Prepare for subsequent cases so that you minimize the need to return to the room before bringing the next patient back. Shape your practice to minimize the
duration, but more important, the variability, of your procedural and emergence times through recognition of key factors, creation of a thoughtful plan, and efficient movement from one plan to a suitable alternative if needed (e.g., develop your own equivalent of the American Society of Anesthesiologists’ difficult airway algorithm for neuraxial blocks, arterial cannulation, central venous catheters, etc.). One fundamental manufacturing principle is that understanding and minimizing variability through process control is critical to making gains in quality. Be consistent and predictable, yet look actively for opportunities to improve your routine practices.

Customer intimacy involves meeting your customers’ needs or concerns. Learn your customer’s preferred name and put it to use. Make your customers feel that they are important, heard, attended to with a range of services, and that their unique needs are met in a timely manner. Who are your customers? Patients are obviously customers, but so are your anesthesiology colleagues, surgeons, operating room nurses and technicians, pre- and postoperative nurses, anesthesia technicians, biomedical engineers, housekeepers, administrators, and any others who contribute to the overall success of an operating team. Consider the important role of housekeeping staff, whose job includes cleaning all surfaces and devices in an operating room in the same short turnover time that you have. When you keep your area relatively clean and tidy on a regular basis and communicate focused special needs early (e.g., spatter on a particular cable, a nearly empty hand hygiene dispenser), you further infection control measures, you respect the work of the housekeeper, and you gain reciprocal respect. Treat your peers with respect and, perhaps more important, adopt an egalitarian approach. People notice if you mistreat or disrespect any individual, particularly behind his or her back, and then they will wonder what you say about them behind their backs.