This chapter will focus on what is historically and currently known from the published literature about healthcare leadership, leadership theories, and styles. Additional discussions will further describe the complex operating room (OR) suite environment, challenges inherent to an OR leadership position, physician leadership, organizational culture, and conflict resolution strategies.

As part of the third edition of Operating Room Leadership and Perioperative Practice Management, this chapter adds up, to the OR reservoir, new vital insights that help learners in their pursuit of mastering anesthesia best clinical practices. With the emergence of new technologies in anesthesia industry, specialists feel the urgent need to potentially embrace change and follow the current trends.

Prioritizing a culture change into the OR is the way to deal with such new challenges. Culture change is a collective experience which starts with an efficient medical director who sets values and creates the organizational culture, leads teams, keeps everything under control and rooted in OR main goal “to provide the highest standards of patient care quality.”

To achieve this goal, it is of paramount importance to implement strategies to change culture in the fundamental structure of the department. Chapter 6 provides principles and practices for promoting interpersonal communication, managing diversity in a way that benefits outweigh drawbacks, improving patient safety and aligning the OR’s human resource management. The culture change in these key elements will bring the dynamism to create and maintain a successful and safe OR environment.

Office-based surgery and anesthesia are becoming more common and widespread due to the changing nature of healthcare delivery. Increased costs, labor shortages, and reduced reimbursements continue to have outsized impacts on where surgery and anesthesia are performed. The shift from hospitals to surgery centers and physicians’ offices are a natural progression of economic and social forces on healthcare delivery. Innovation and safety are high priorities so that the delivery of this kind of care can be done effectively.

Monitored anesthesia care (MAC) has been increasingly utilized in anesthesia services for diagnostic or therapeutic procedures for various non-surgical and surgical procedures in the last several decades [1]. It is also steadily increasing in demand by many different medical specialties: cardiology for cardioversion, defibrillation, transesophageal echocardiography, pacemaker/defibrillator implantation or removal, cardiac catheterization, and other cardiac monitoring devices; gastroenterology for endoscopic examinations, potential biopsies, and other therapeutic interventions; urology for cystoscopy, etc. [1, 2]. MAC has also been gradually applied for more complex procedures in patients receiving endovascular aortic stent placements, transcatheter aortic valve replacements, and even sophisticated procedures like Mitroclip. The aims of MAC for procedures are to enhance patient comfort and cooperation, maintain airway patency and hemodynamic stability, thus facilitating efficient and safe completion of the scheduled procedures.

Modern dentistry has made much progress in pain control and in providing a patient-friendly service, which has expanded the dentist’s ability to perform a wide range of treatments in a pain-free environment. Nevertheless, despite revolutionary new dental techniques, it is well recognized in the dental literature that substantial fear exists concerning seeking dental care. This fear can be so extensive that people from all races and socioeconomic categories can be affected by it in some form.

Certain patient populations requiring sedation for procedures present the clinician with challenging decisions regarding their care and management. Some underlying medical disease states, airway abnormalities, or extremes of age require cautious pre-procedural assessment and planning when sedation is required to minimize the incidence of morbidity or mortality. It should be noted that some of these higher-risk patients should only be sedated by trained anesthesia providers. The following commonly encountered conditions are considered high risk and are associated with a higher rate of complications: old age, obesity, chronic obstructive pulmonary disease, coronary artery disease, and chronic renal failure. This chapter discusses important features of these higher-risk patients and practice management when sedation is required. In all cases, appropriate monitoring, prudent selection and dosing of sedative agents, and careful assessment are important to ensure the best outcome for these higher-risk patients.