Episode #304 Infinite Anesthesia Is Not Unlimited Propofol

[Dutton] “I am a practicing anesthesiologist. I’m on the front lines every day trying to deal with our workforce shortage, the enormous demand for anesthesia services every day, and the need for every qualified anesthesia clinician to pitch in and get the work done.

Uh, it’s stupid for us to be wrangling with scope of practice issues or other concerns when. There’s more than enough work for everybody. And when it’s so important for us to have a harmonious team every day to get done what we need to get done, any kind of politics in this area just impairs access for our patients.

It affects the day-to-day provision of care. Uh, we know that it lowers the quality of care. So, I work every day toward our infinite future where we can all be rowing in the same direction. That’s why I’m passionate, uh, about the infinite future of anesthesia care. Thank you.”

Thank you so much to Dr. Richard Dutton for opening the show today.

Hello and welcome back to the Anesthesia Patient Safety Podcast. I’m your host, Alli Bechtel. Today, we will be talking about “Infinite Anesthesia” And no, this does not refer to a never-ending supply of Propofol. Infinite Anesthesia is an approach to perioperative care the encompasses a mutually supportive workplace that maximizes patient care with every encounter in a way that appreciates every team member. Perioperative teams can embrace this culture of trust and teamwork that encourages all anesthesia professionals to see one another as respected fellow players in the infinite game of perioperative care with the pillars of intentional and respectful interprofessional dialogue, learning, and team building. Want to learn more? Stay tuned!!

Before we dive further into the episode today, we’d like to recognize GE Healthcare, a major corporate supporter of APSF. GE Healthcare has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, GE Healthcare – we wouldn’t be able to do all that we do without you!”

Our featured article is “Leading Infinitely in Perioperative Care: An Anesthesia-Led Relational Leadership Model” by Matt Sherrer and colleagues. This article is an APSF Newsletter article published online February 1^st, 2026. To follow along with us, head over to APSF.org and click on the Newsletter Heading. The first one down is APSF Newsletter Articles. Then, you can scroll down until you get to our featured article, and I will include a link in the show notes as well.

Before we get into the article, we have exclusive, behind the scenes content from several of the authors. First up, let’s hear from Matt Scherer to talk about why he wrote this article.

[Matt Scherrer] “ Hi, my name is Matt Sherrer. I’m an associate professor of anesthesiology at UAB in Birmingham. I’m also the Assistant Dean for Faculty Affairs in the UAB Hearsay School of Medicine. I’ve had the pleasure of leading the Lead Infinitely workshop series at UAB for the past year, and I’ve seen this workshop series grow and scale beyond the perioperative space. The initial workshops that we had included registered nurses, circulating nurses. Nurse anesthetists and anesthesiologists, and the overwhelming feedback that I got was ‘Matt, the material was great. We really enjoyed it. We loved the discussions we had. However, we really need our surgeons to be here. We really need our proceduralists to be here.’ And so, as the workshop has grown, I’ve seen the value of bringing in everyone on the team, and I’ve also been able to watch the series expand beyond the perioperative space in the different areas of the hospital. And my new role as assistant dean, that’s what I get to do. I get to take this message to other people all across this, the footprint of this hospital system, and I think the unique capability and opportunity for anesthesia leaders here lies in the fact that we have relational equity across the hospital system. There’s really no place in the hospital that we don’t have influence and impact in relationships, and I think that is the unique opportunity.

[Bechtel] Thank you so much to Matt for helping to kick off the show. Now, it’s time to get into the article.

Perioperative medicine is a team support, and strong teamwork is needed to help keep patients safe. The authors propose the concept of leading infinitely which involves reaching across disciplines and complex environments to build relationships and incorporate multiple perspectives into decision-making to help provide the highest quality and safest patient care. This may be a brand-new concept for you so let’s see where it started and how it can be applied in your department.

The authors provide an analogy. In 1994, a company called Cadabra was founded and would later go on to become Amazon. The company started as a small online bookstore in Jeff Bezos’ garage with a focus on building trust with online book enthusiasts. From that foundation, Amazon has become a massive global marketplace. Anesthesia leaders can learn from this. It starts with an intense focus on the relationships that we develop across the healthcare system to move from perioperative patient safety experts to applying our skills, wisdom, and experience to the entire healthcare system with infinite leadership.

Let’s check out the 2023 Anesthesia and Analgesia article, “The Infinite Game: One Possible Future of Anesthesia in the United States” by Sherrer and colleagues. In this article, the authors highlight the differences between finite and infinite games. Finite games are played by known players, have fixed rules, have clearly defined beginning, middle, and end, have a winner and loser, and the goal is to win the game. For infinite games, there are the players are known and unknown, there are no exact or agreed upon rules, there is no finish line or end to the game, there is no winning or losing, and the goal is to keep playing the game. The business and practice of anesthesia have been thought of as a finite game in the past, but we need to consider that the future of anesthesia practice is really an infinite game. The authors go on to define Infinite Anesthesia which involves these 5 core values:

1. Advance a just cause to create a mutually supportive workspace that optimizes patient care with every encounter in a way that values every team member.
2. Build trusting teams that work in an innovative, efficient, and safe environment with excellent communication. This involves innovative clinical workflows with preprocedural triage protocols, remote attending supervision with ready availability for rescue, and continued technological advancements in monitoring and medications.
3. Study your worthy rivals. Here keep in mind that in infinite anesthesia instead of seeing other anesthesia professionals as the opponent, there is a dedication to collaboration and mutual respect.
4. Prepare for existential flexibility with knowledge of mechanical, systems, and human factors engineering, crisis management, crew resource management, situational awareness, and business and finance modelling to be health care leaders.
5. Demonstrate the courage to lead by recognizing underlying tension, celebrating past successes, and learning from failures with a creative drive to generate new ideas and experiments.

I encourage you all to check out this article to read more about Infinite Anesthesia. These were only some of the highlights to help provide a foundation for the rest of our discussion. Check out the show notes for the citation.

Back to the APSF article and the authors next discuss the concept of crossing “the chasm:” This brings us to the 1991 book by Geoffrey Moore, “Crossing the Chasm: Marketing and Selling High Tech Products to Mainstream Customers.” This book includes a framework for businesses looking to grow by moving through different stages in the technology adoption lifecycle. To cross the chasm, it is important to understand the differences between customers who want the newest thing and those who want complete solutions and convenience. Check out Figure 1 in the article for a visual depiction of the technology adoption lifecycle. Crossing the chasm occurs during the Early Adopters phase. Before crossing the chasm, there are the innovators and some of the early adopters. For wide-scale market adoption, you need to win over the mainstream customers which only happens by first focusing on finding and serving specific niche markets and then the early majority, late majority, and laggards will jump on board.

We can apply this business model to innovative ideas as well. For new ideas to gain traction, innovators will need 15-18% market penetration and this requires an initial focus on the first 12.5% of early adopters. Once you have this group on board with the new idea, the early majority will be next. You can think of it as crossing the chasm or as a tipping point and you can get past this pivotal stage to widespread adoption with trust and building relationships.

Now, the authors bring us into the perioperative space and the topic of trust. This is a big threat to patient safety since according to the Joint Commission up to 70% of serious medical errors are due to poor communication. We are making progress in this area with active listening, open discussion, and mutual respect, but there is more work to be done. We need civility in healthcare to help prevent incivility-related patient harm going forward. The way forward to the highest quality, safest care involves collaboration, civil communication, and trust.

There are some significant challenges in healthcare including limited resources, decreased reimbursements, and workforce shortages and the solutions will require innovative thinking. We are seeing some progress already with a growing focus on relational leadership in health care. Relational leadership involves building and sustaining collaborative relationships with individuals and groups across health care systems to incorporate multiple perspectives into decisions-making. For organizations to be resilient, they must prioritize long-term organizational health instead of the short-term bottom line.

Enter anesthesia leaders as health system leaders. The authors tell us that we need to re-envision anaesthesiology’s role from the volume-based perioperative professional to the orchestrator of value across the care continuum. Here’s why anesthesia professionals are well-suited to this promotion:

• Clear communication, consensus-building, and collaboration are skills that anesthesia professionals use daily in clinical practice.
• Experts in patient safety and teamwork.
• Wide-ranging diverse knowledge of many different specialties and experiences in complex and unpredictable environments
• Strong foundation for cultivating trusting relationships based on all these different clinical experiences
• Ability to identify the early adopters in the healthcare system. Remember, this is crucial to focus on the early adopters in order to cross the chasm for downstream widespread adoption of new ideas and innovations later.

This is our chance to make a real difference in the health care system by improving patient experience, safety, and efficiency.

We have so much more to talk about and we hope you are excited about learning more about leading infinitely. We’ll be getting more into that next week. Spoiler alert: We will be talking about making the move from infinite anesthesia with a focus on trust and teamwork where all anesthesia professionals see one another as respected fellow players in the infinite game of perioperative patient care to go one step further to Leading Infinitely which encompasses collective intelligence and teaming, humility, civility, discovery driven planning, and the infinite game mindset with a larger team in the health care system.

Before we wrap up for today, we are going to hear from another author who shares with us why he is so passionate about our infinite future as anesthesiologists. Let’s take a listen now.

[Dutton] “Hi, this is Dr. Richard Dutton. I’m the chief of Anesthesia at the University of Maryland Capital Region Hospital in Washington, DC. I am a practicing anesthesiologist. I’m on the front lines every day trying to deal with our workforce shortage, the enormous demand for anesthesia services every day, and the need for every qualified anesthesia clinician to pitch in and get the work done.

Uh, it’s stupid for us to be wrangling with scope of practice issues or other concerns when. There’s more than enough work for everybody. And when it’s so important for us to have a harmonious team every day to get done what we need to get done, any kind of politics in this area just impairs access for our patients.

It affects the day-to-day provision of care. Uh, we know that it lowers the quality of care. So I work every day toward our infinite future where we can all be rowing in the same direction. That’s why I’m passionate, uh, about the infinite future of anesthesia care. Thank you.”

Thank you so much to Matt and Richard for contributing to the show today and your infinite work in this area! We can’t wait to hear from more authors next week on the show!

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

That’s it for today’s episode. If this conversation sparked a thought or gave you something to take back to your practice, make sure you’re subscribed so you don’t miss future episodes. You can listen wherever you get your podcasts, and sharing the show with a colleague really helps spread the word about improving patient safety in anesthesia. Thanks for listening.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2026, The Anesthesia Patient Safety Foundation