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AANA. The AANA has spent much time and effort developing programs to help states improve almost every aspect of anesthetist practice. WANA has been ahead of the national organization on some issues, but they have heavily invested in education and guidance in a myriad of topics both clinical and administrative. I now appreciate fully the importance of our national organization and what an indispensable element it is to our survival and prosperity.
Government Reform of Healthcare. This may be a double-edged sword; however, if we pay attention to the dynamic changes occurring and exercise extreme vigilance, it may be a great opportunity (see Canadian Parable).
WANA Alliance Building. The AMA has stated that all care belongs to them and therefore all non-physicians need to be supervised. All non-physician providers in response have started to unite to counter the AMA push for dominance.
Proof is Power. The AANA has got it right, the active defense for slander or liable is proof (IOM report etc). Proof is Power is an AANA program that provides us with information to debunk attempts to paint CRNA care as inferior or unsafe.
Have you ever asked yourself what happened to our Canadian Colleagues? It occurred to me that the disappearance or elimination of nurse anesthetists coincided with the implementation with National Health Care (1948-1962). The nurse anesthetists provided anesthesia services to remote underserved areas. It seemed only rational that they would be valuable providers in the new system. That was not the case, however; the providers that offered high quality cost effective anesthesia services were eliminated. In the summer of 1962, Saskatchewan physicians paralyzed the system with a strike. In 1984, the "Canada Health Act" was actively supported by the CMA (Canadian Medical Association) and at the same time becoming a founding member (CMA) of HEAL (Health Action Lobby) lobbying the federal government to increase funding and advantage. Did this turnaround in attitude come from the physician lobby being granted dominion over all care? The history of the elimination of nurse anesthetists is not clear, but the ownership of the health care system by physicians is always at the cost of other providers. This caste system leads to decreased autonomy and opportunity to practice for advanced practice nursing. One article response I read claimed that this occurred through a concerted effort to convince the public that any care other than that provided by physicians was unsafe.
What are we to learn from this? National Health Care schemes are not always friendly to Advanced Practice Registered Nurses (ARNP) or any non-physician providers. We must ramp up our vigilance and stay active in the process that is evolving. A role in rule setting is not only vital at the national level, but also statewide and locally. At times like these, I am reminded of the famous maxim "all politics is local" a phrase coined by former Speaker of the House Tip O'Neill. If all WANA members would call on their state and federal legislators and establish a personal contact with them, anesthetists become valuable constituents. WANA and AANA have been working on an information package to help members connect with their representatives. The most effective way to connect with a representative according to an AANA expert is to "Tell your story."
Game Theory: The Prisoners' Dilemma In the future, there will only be just so many "anesthesia dollars" and the anesthesia world will be cast into the classic Prisoners' Dilemma. "Two men are arrested, but the police do not possess enough information for a conviction. Following the separation of the two men, the police offer both a similar deal - if one testifies against his partner (defects/betrays), and the other remains silent (cooperates/assists), the betrayer goes free and the cooperator receives the full one-year sentence. If both remain silent, both are sentenced to only one month in jail for a minor charge. If each 'rats out' the other, each receives a three-month sentence. Each prisoner must choose either to betray or remain silent; the decision of each is kept quiet. What should they do?" What is striking about this are the choices, on one hand the rational choice would be to escape negative consequences by turning on the other. The second choice, though not the rational option, is cooperating with the other players, which turns out to be the best. The hospital and the anesthetist are the players. If the hospital does not allow anesthetists to compete by eliminating them from the table, they put themselves at a disadvantage. When any service/ product is monopolized the service is more expensive and poor in quality. Conversely, if both types of anesthesia providers are respected and included in the process, a zero sum game becomes a win-win with quality, availability, and cost effective anesthesia as the result.
Kaizen Kaizen is a continuous improvement management style that incorporates information from the entire organization. Kaizen, comes from the Japanese for "improvement" or "change for the better." The path to improvement for our association is from the bottom up and the leadership approach. Two ways to accomplish what will be needed to protect our profession are 1) improving communication by dividing the state in districts/regions and obtaining local input and 2) districts also allow us to tailor our message from the constituents to the local elected officials.
Please know I welcome any questions or concerns and will respond ASAP. Send me an e-mail to pjscorbett@mac.com or by contacting WANA through our web site at http://www.wana-crna.org.
As WANA President, I sincerely hope your holiday season was filled with joy!
Patrick Corbett, CRNA, ARNP WANA President
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Patrick Corbett WANA President
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