Two Keys to Reducing Staffing and Supply Costs With Theresa Palicki of Eastside Surgery Center

Staffing and supplies represent two of the biggest expenses for surgery centers, and they are two areas ASCs should focus on to control with improved business practices. Theresa Palicki, administer of Eastside Surgery Center in Columbus, Ohio, shares two ways her center was able to reduce these costs.

1. Cross-train nurses. Eastside previously experienced huge swings in its caseload throughout the week, with some days having as few as five or six cases and others as many as 30 cases. However, since nurses were compartmentalized into pre-op, OR and post-op areas, staffing numbers would rarely change. "Our staffing costs were horrific," Ms. Palicki says. "On slow days, our nurses would be sitting around doing fluff work."

Eastside eventually hired a new director of nursing, who insisted on cross-training all nurses on staff throughout the center. "Nurses may be reluctant at first, because pre- and post-op nurses are uncomfortable working in the OR and vice versa," Ms. Palicki says. "However, we saw our staffing costs decrease by 26 percent from 2008-2009, and nurses were better able to assist one another."

Ms. Palicki notes that the process can take a long time and does require an initial cost, but the results will pay for the start-up. "Because I don't have clinical background, I wasn't aware that each nursing position is very different, but there are nuances that need to be learned," she says.

In their cross-training program, Eastside appoints a "champion" of each department that a nurse will shadow. "The observer is not in the staffing model, and their job is to observe and learn from the experienced nurse," Ms. Palicki says. "As they get more and more comfortable, they are slowly integrated back into the staffing model until they are fully trained on the job's responsibilities."

The entire process, from orientation to cross-training, takes 90 days, in accordance with Joint Commission compliance requirements. Surgery centers must account for the cost incurred during this time, as the employee that is training will be paid, but is not part of the staffing model, according to Ms. Palicki. "You have to consider the trainee as a 'brand new' employee for those 90 days," she says.

2. Educate surgeons on supply costs and alternatives. Ms. Palicki says her center has access to great pricing due to its affiliation with OhioHealth and Health Inventures and their group purchasing organization. However, the center still saw supply cost problems, mainly when it came to surgeon awareness on how much supplies were. "Most surgeons will choose an implant or a supply because it is the newest or we had an information session with a rep earlier in the week," Ms. Palicki says. "Surgeons were not aware of the price difference between the new product and another comparable one."

To help educate surgeons, Eastside's materials manager developed a spreadsheet that showed physicians their supply costs compared with alternatives currently used at the center. "Ultimately, we just armed the physicians with the information and left the final decision up to the surgeon," Ms. Palicki says. "We found that if there was no specific preference, the surgeons tended to go with the cheaper option."

Eastside's spreadsheets focus on products currently in use at the center. Ms. Palicki notes that if a surgery center wants to switch to a comparable, less expensive offering from its supplier or GPO, the decision would likely have to go through the medical executive committee for final approval.

Eastside Surgery Center is a joint venture between physicians and OhioHealth. It is managed by Health Inventures. Learn more about Eastside Surgery Center. Learn more about Health Inventures.