fei xu
Photo of Fei Xu, anesthesiology technician.
Emily Izzo, U of U Health.
improvement
Find the Root of the Problem to Achieve Long Term Solutions
Anesthesiology techs are essential to the care team, but they are challenged by high turnover. Anesthesia resident Michael Van Tienderen, who was a tech for seven years before going to medical school, worked with fellow resident Matt O’Neal, anesthesiologist Emily Drennan, and senior value engineer Cindy Spangler to develop a lasting solution focused on culture change and career growth for these crucial care team members.
E

ven though anesthesiology is often considered a “do-it-yourself” profession, it takes a whole team to make the process run smoothly. We were reminded of this a year ago, when an adverse safety event in one of our remote locations exposed a weakness within our system and triggered a close examination of our similar sites. Many of our locations were understaffed and missing what we quickly identified as key team players – anesthesia techs. 

Anesthesia techs are vital to our operations. They are the anesthesiologist’s second hand. Throughout the day techs gather, clean and prepare tools before procedures. They respond to emergency situations alongside our anesthesiologists, and provide a much-needed extra pair of hands. Despite their importance to our teams, an institutional survey of anesthesia techs and workplace culture revealed concerns about low salaries, insufficient training and poor communication. 

Our techs were unhappy, and we needed to offer more than a Band-Aid solution. We needed to get to the root of the problem

Understanding the Problem

We wanted to move away from the outdated problem-solving approach of ‘there’s high anesthesia tech turnover and low job satisfaction because of X, Y and Z.’ That approach didn’t seem to address the foundational flaws we saw. Instead, we applied quality improvement principles to identify the underlying issues from our techs’ perspectives. This approach helped us understand what motivates our techs. 

Our first step was to conduct a job satisfaction survey, which included open-ended questions and space for people to respond with free text. We then flagged the questions or comments that were particularly negative or highlighted recurrent problems in our system. Our findings from that survey helped us formulate a more tailored plan of action for our program. 

The survey exposed problems in three prominent categories: pay, knowledge and communication.   

Our Findings

Address Pay

The anesthesia tech position is very low paid, so even though it's an important job and a very technical job, the salary for it is not sustainable. We asked ourselves central questions like, “Who is attracted to this job and why?” While we understood the importance of higher wages, we also wanted to discover what else would motivate our techs to continue to work with us and strengthen our team.  

Increase Knowledge

Their responses to the survey indicated that they weren't getting the training they needed and didn't feel like they were able to address patient questions and issues. We employ a wide variety of anesthesia techs, from highly experienced individuals to new hires straight out of high school with limited training. The disparity between training levels, coupled with high turnover rates and inadequate resources, were driving techs out of our workplace. 

Improve Communication

The survey identified poor communication as one of our greatest weaknesses. Specifically, results showed a lack of open and honest communication between all team members, across a range of credentials and experiences. Survey results also showed that problems were slow to be addressed with effective solutions. Many of our techs felt that, even if they did address specific concerns or safety issues, they weren’t getting any assistance. 

We took the findings of the survey and began to craft a multi-level plan that would empower our techs and give them the resources and attention they needed to do their job well. 

Our Plan

We worked with the HR department to do a market adjustment and create a career path. Even though we were able to reassess salaries, the pay still wasn’t enough to sustain our employees. So we focused on the career path. We looked at people who used to be anesthesia techs that had gone on to succeed in other health care jobs and discovered that many programs, such as our surgical tech program, utilized a similar system. High school students would complete prerequisites as techs under the surgical staff and, once they graduated, they could enter the workforce right away. 

We embraced the inherent turnover rate of this job by creating a career track for students or new hires that wished to pursue an interest in health care. Instead of a turnover rate motivated by dissatisfaction, we offer a starting point for those interested in advancing their careers. In this way, we can promote comprehensive training, mentoring, and shadowing opportunities with our anesthesiologists. 

We wanted to make sure that our anesthesia techs felt confident, so improving our training and resource allocation became a top priority. We asked both our techs and providers where we were deficient in training, and how we could create a safer environment for everybody on the team. 

Mike identified a set of 12 to 14 topics that addressed these different elements. These included information about daily subjects like oxygen delivery items and basic anesthesia workstation setups, to common anesthesia emergencies. We also covered other areas of anesthesia tech, such as pediatric and OB considerations. Then, we selected providers that we thought would be good instructors and created a plan to present these different topics or modules to our techs. 

We plan to record the modules and keep them in a central location where everyone can review them. Then, as new techs are hired at various locations, through different managers, they will all have access to these standardized educational resources around the clock. 

Looking ahead

We recognize that a lot of these goals won’t happen overnight, but we’re working to ensure that these positive changes will last. These strategies will be implemented over the next 2-3 years through programs in high schools, local colleges and our health care system. We hope that these long-term solutions will improve the work experience for our techs. 

Contributors

Michael Van Tienderen

Resident, Anesthesiology, University of Utah Health

Matt O’Neal

Resident, Anesthesiology, University of Utah Health

Emily Drennan

Assistant Professor, Anesthesiology, University of Utah Health

Cindy Spangler

Senior Value Engineer, University of Utah Health