Growth Mindset in Anesthesiology
Anesthesiologists must embrace a growth mindset by expanding beyond traditional operating room roles to lead value-based perioperative care transformation, directly engaging in research, quality improvement, and multidisciplinary coordination to improve patient outcomes and reduce mortality. 1
Why Growth Mindset is Essential for Patient Care
The American Society of Anesthesiologists explicitly calls for anesthesiologists to "think beyond the box of the operating theatre" and expand into areas where their expertise in acute physiology, risk assessment, and crisis management can create value throughout the entire perioperative continuum. 1, 2 This represents not an expansion of current roles but rather a "rediscovery of our value to the healthcare community at large." 1
Direct Impact on Morbidity and Mortality
Comprehensive preoperative optimization programs led by anesthesiologists at institutions like Duke University, Brigham and Women's Hospital, and University of Pittsburgh Medical Center have demonstrated the ability to modify risk factors including malnutrition, anemia, diabetes, chronic pain, and cognitive vulnerability before surgery, directly reducing postoperative complications and mortality. 1
Anesthesiologists must take shared accountability for all surgical outcomes, not just anesthesia-related complications, as this broader perspective enables identification and prevention of complications traditionally viewed as "surgically related." 3
Implementing evidence-based protocols for postoperative delirium prevention, multimodal opioid-sparing analgesia, and early mobilization requires anesthesiologists to lead beyond the intraoperative period. 2
Specific Growth Mindset Behaviors That Improve Outcomes
Research and Data-Driven Innovation
Direct involvement in research to assess and develop evidence-based approaches is identified as "perhaps one of the most important contributions we can make as anesthesiologists," particularly since current data supporting many perioperative programs remains limited. 1
Building clinical decision support systems and partnering with information technology groups to create validated data dashboards enables iterative improvement and risk adjustment that directly impacts patient safety. 1
Quality improvement is an infinite process that evolves in response to emerging threats from new medications, procedures, and systematic risks—requiring continuous learning rather than static expertise. 4
Leadership in Multidisciplinary Coordination
Anesthesiologists occupy a unique position to coordinate care across the entire surgical continuum because they interact with patients, surgeons, primary care providers, and specialists at multiple touchpoints. 2
Leading preoperative assessment clinics that provide holistic evaluation including frailty measurement, cognitive status, nutrition assessment, substance use screening, and mental health evaluation requires expanding clinical knowledge beyond traditional anesthesia domains. 1, 2
Implementing "surgical pause" protocols for high-risk patients requires anesthesiologists to engage in shared decision-making with surgeons and patients, sometimes counseling against surgery when patients are poor candidates—a leadership role that demands confidence in expanded clinical judgment. 1, 2
Adaptation to Value-Based Care Models
The COVID-19 pandemic exposed vulnerabilities in fee-for-service models when operating room volumes collapsed, demonstrating that anesthesiologists who cannot adapt beyond traditional roles face existential threats to their specialty. 1
Focusing on cost avoidance through reduced complications rather than volume-based revenue requires a fundamental mindset shift toward measuring success by patient outcomes rather than case numbers. 1, 2
Segmenting patients based on complexity and risk to personalize care delivery demonstrates the application of growth mindset principles to clinical practice, continuously refining approaches based on patient characteristics. 2
Common Pitfalls When Lacking Growth Mindset
Confining practice solely to the operating room when anesthesiologists' expertise can add value throughout the perioperative continuum represents a fixed mindset that limits impact on patient outcomes. 2
Assuming "not all anesthesiologists will be able or willing to play a role in these new activities" is acknowledged by the ASA, but those who do expand their roles must be supported by colleagues, as collective advancement of the specialty benefits all patients. 1
Failing to engage in continuous quality improvement leaves systematic threats to patient safety unaddressed, as quality improvement is never fully complete but must evolve over time. 4
Resisting collaboration with other specialties (such as geriatricians for elderly patient care or psychiatrists for cognitive assessment) limits the comprehensive risk mitigation that improves outcomes. 2, 5
Practical Implementation of Growth Mindset
Immediate Actions
Establish or participate in preoperative optimization clinics that address modifiable risk factors weeks before surgery, using multidisciplinary teams to coordinate interventions. 1, 2
Implement clinical pathways and quality metrics with data collection systems that enable measurement of complications, mortality, and other outcomes that impact performance. 1
Engage in research projects designed to test strategies for promoting high-quality perioperative care, even when current evidence is limited. 1
Long-Term Development
Pursue additional training in perioperative medicine and critical care to effectively participate in initiatives that extend beyond traditional anesthesia practice. 1
Develop expertise in palliative care to offer more diverse treatment options for patients undergoing palliative procedures. 1
Build partnerships with hospital administration and surgeon leadership to implement value-based care initiatives, recognizing that shared goals include providing better care at decreased cost. 1
Measuring Success
Focus on patient-oriented outcomes and satisfaction rather than process metrics alone, as patients ultimately decide quality based on their experience and functional recovery. 3
Track return to optimal functional, cognitive, and psychological health as the primary measure of perioperative success, not just absence of immediate complications. 2
Share results with other institutions for continued improvement across the nation and world, contributing to collective advancement of the specialty. 1