Traci Albers, administrator at High Pointe Surgery Center in Lake Elmo, Minn., and Linda Phillips, RN, administrator at Southgate Surgery Center in Southgate, Mich., discuss strategies for completing an organized and profitable ambulatory surgery expansion.
1. Collect staff member feedback in the early stages. The expansion at High Pointe Surgery Center included a larger staff lounge and locker rooms, both of which were planned with ongoing feedback from employees. "Our staff lounge went from a small room to a beautiful new space with a kitchen. We also added spacious, modern locker rooms with additional restrooms," says Ms. Albers. "The additions made the staff feel appreciated and happy."
To gather initial design feedback, Ms. Albers says the center posted expansion plans on a bulletin board with an attached sheet for staff to write down suggestions. Staff members could also discuss feedback directly with designated department representatives who attended design meetings with the architect, contractors and management leading up to the expansion, she says.
This process allowed the center to incorporate specific staff member requests into the overarching vision for the expansion. "We told the architect that we wanted a calm, quiet environment," says Ms. Albers. Additional staff requests included a "homey living environment appropriate for families" in the front office.
2. Communicate often with staff members throughout the expansion process. Because changes occurred frequently during expansion, Ms. Albers says frequent communication with staff and physicians was crucial. "We had six remodeling phases, and there was something changing every week," she says. "We stayed operational through the whole thing; therefore communication was imperative."
Important rooms were often unavailable during the remodeling process, and staff members needed to be aware of how to handle patients on those days. "There was one point where we lost three phase two rooms — how would we accommodate patients on that day?" says Ms. Albers. "We had to recover patients in atypical locations, like pre-op. We had to adjust workflow and normal routines." Communication was necessary to keep all staff members organized and informed of these changes, she says.
3. Keep patients informed of the expansion progress. Patient satisfaction scores at High Pointe Surgery Center did not drop throughout the remodeling process despite the occasional need to use substitute rooms, says Ms. Albers. "I attribute that to the staff, because they informed patients why we're doing this expansion and emphasized that the surgery center will be better when it's done," she says. "They did an exceptional job of managing patient perception throughout the entire process."
4. Don't overlook the addition of storage spaces. With a heavy focus on revenue-enhancing expansion, storage space is typically one of the first things eliminated when cutting building project costs, says Ms. Albers. But while storage space does not generate revenue, it is a significant staff satisfier that should not be overlooked. "We've been short-sighted in looking at our storage needs — more space would have been beneficial for us but because of the limited footprint we had to work with, we had to make difficult choices on what stayed what was eliminated," she says. "You really do need storage in ancillary spaces to support the ORs."
5. Pay attention to small details in the early phases. Simple details like locks and door stoppers are easy to overlook but can end up being significant daily inconveniences for the staff if not appropriately planned. "When the OR staff was hauling garbage into closets, we realized we needed hold-open doors," says Ms. Albers.
It is also a good idea to double-check assumed measurements before proceeding with remodeling. "We installed privacy doors in pre- and post-op rooms, and we assumed that they were wide enough to fit gurneys and wheelchairs," she says. "But we should've taken a closer look at dimensions early on — we ended up making modifications to the doors to give us additional space. Little things like that make a big difference to staff on a day-to-day basis."
Ms. Phillips says she wishes Southgate Surgery Center had incorporated space for a second receptionist at the front desk and a private room to meet with families. "When you're doing your floor plan, you never think of everything you should plan for, and there's always something you wish you would've thought of," she says. "I wish I could have added two more rooms for pain cases."
6. Expand with the future in mind. Ms. Phillips says it is important to incorporate the surgery center's long-term goals into any plans for expansion. "In three years, my goal is to add another specialty, for example," she says. "When new physicians come on board, they trial you and don't bring in as many patients. But we made two overflow bays, just in case we get busy, or just in case someone has an extended recovery time. Now, we're at the point where those are regularly used bays, so it was a good thing that we added them." If it is possible to build for the future without taking up a large amount of non-productive space, the surgery center should do so, said Ms. Phillips.
In the business office, Ms. Phillips planned for extra phones, faxes and copiers. "We installed a phone jack in every spot where somebody could potentially sit, even without adding phones at the time," she said. The expansion also included several multi-purpose rooms equipped with a built-in wraparound desk and overhead shelving to handle present and future employees. "We made it so that multiple people — transcription, billing, marketing and finance employees — could work in that room when we needed them, and it has been immensely useful," she says.
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1. Collect staff member feedback in the early stages. The expansion at High Pointe Surgery Center included a larger staff lounge and locker rooms, both of which were planned with ongoing feedback from employees. "Our staff lounge went from a small room to a beautiful new space with a kitchen. We also added spacious, modern locker rooms with additional restrooms," says Ms. Albers. "The additions made the staff feel appreciated and happy."
To gather initial design feedback, Ms. Albers says the center posted expansion plans on a bulletin board with an attached sheet for staff to write down suggestions. Staff members could also discuss feedback directly with designated department representatives who attended design meetings with the architect, contractors and management leading up to the expansion, she says.
This process allowed the center to incorporate specific staff member requests into the overarching vision for the expansion. "We told the architect that we wanted a calm, quiet environment," says Ms. Albers. Additional staff requests included a "homey living environment appropriate for families" in the front office.
2. Communicate often with staff members throughout the expansion process. Because changes occurred frequently during expansion, Ms. Albers says frequent communication with staff and physicians was crucial. "We had six remodeling phases, and there was something changing every week," she says. "We stayed operational through the whole thing; therefore communication was imperative."
Important rooms were often unavailable during the remodeling process, and staff members needed to be aware of how to handle patients on those days. "There was one point where we lost three phase two rooms — how would we accommodate patients on that day?" says Ms. Albers. "We had to recover patients in atypical locations, like pre-op. We had to adjust workflow and normal routines." Communication was necessary to keep all staff members organized and informed of these changes, she says.
3. Keep patients informed of the expansion progress. Patient satisfaction scores at High Pointe Surgery Center did not drop throughout the remodeling process despite the occasional need to use substitute rooms, says Ms. Albers. "I attribute that to the staff, because they informed patients why we're doing this expansion and emphasized that the surgery center will be better when it's done," she says. "They did an exceptional job of managing patient perception throughout the entire process."
4. Don't overlook the addition of storage spaces. With a heavy focus on revenue-enhancing expansion, storage space is typically one of the first things eliminated when cutting building project costs, says Ms. Albers. But while storage space does not generate revenue, it is a significant staff satisfier that should not be overlooked. "We've been short-sighted in looking at our storage needs — more space would have been beneficial for us but because of the limited footprint we had to work with, we had to make difficult choices on what stayed what was eliminated," she says. "You really do need storage in ancillary spaces to support the ORs."
5. Pay attention to small details in the early phases. Simple details like locks and door stoppers are easy to overlook but can end up being significant daily inconveniences for the staff if not appropriately planned. "When the OR staff was hauling garbage into closets, we realized we needed hold-open doors," says Ms. Albers.
It is also a good idea to double-check assumed measurements before proceeding with remodeling. "We installed privacy doors in pre- and post-op rooms, and we assumed that they were wide enough to fit gurneys and wheelchairs," she says. "But we should've taken a closer look at dimensions early on — we ended up making modifications to the doors to give us additional space. Little things like that make a big difference to staff on a day-to-day basis."
Ms. Phillips says she wishes Southgate Surgery Center had incorporated space for a second receptionist at the front desk and a private room to meet with families. "When you're doing your floor plan, you never think of everything you should plan for, and there's always something you wish you would've thought of," she says. "I wish I could have added two more rooms for pain cases."
6. Expand with the future in mind. Ms. Phillips says it is important to incorporate the surgery center's long-term goals into any plans for expansion. "In three years, my goal is to add another specialty, for example," she says. "When new physicians come on board, they trial you and don't bring in as many patients. But we made two overflow bays, just in case we get busy, or just in case someone has an extended recovery time. Now, we're at the point where those are regularly used bays, so it was a good thing that we added them." If it is possible to build for the future without taking up a large amount of non-productive space, the surgery center should do so, said Ms. Phillips.
In the business office, Ms. Phillips planned for extra phones, faxes and copiers. "We installed a phone jack in every spot where somebody could potentially sit, even without adding phones at the time," she said. The expansion also included several multi-purpose rooms equipped with a built-in wraparound desk and overhead shelving to handle present and future employees. "We made it so that multiple people — transcription, billing, marketing and finance employees — could work in that room when we needed them, and it has been immensely useful," she says.
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