Arvind Movva, MD, CEO of Heartland Clinic Regional Surgicenter, shares seven tips to keep operations running smoothly at a busy, multispecialty ambulatory surgery center. 1. Set expectations high. The first step to running an efficient center is demanding your staff to exceed average expectations. "Your staff will be surprised when you push them, but they will quickly work towards meeting higher expectations," says Dr. Movva. Address issues such as CMS "never events," which still have the possibility of occurring, and always be prepared. The staff must constantly go over admitting and discharge protocols. Identify any employee error patterns that are occurring and address the issue immediately. Each member of an ASC's staff needs to maximize his or her potential. "A physician can do 20 colonoscopies in a day, but he needs the staff to support this," says Dr. Movva.
The better orchestrated your staff is, the more time physicians can spend with patients. The ideal situation allows surgeons to fluidly move from room to room, case to case. Staff members may express interest in rotating throughout the center, but this sacrifices efficiency. When staff members train and excel in one area that is what they should be doing.
"A center's staff should do things over and over again until they have reached an expert level," says Dr. Movva. At this point, a center will experience happier physicians, greater efficiency, improved quality of care and higher profits.
2. Hire the right people for the right positions. Motivated staff members will take responsibility for themselves and constantly work to be the best at what they do. They will review anything that goes wrong and fix it on their own. "If you begin with individuals who want to excel simply for the reward of being good at their jobs, everything else takes care of itself," says Dr. Movva.
The key to efficiency is doing everything correct every time. When something goes wrong, stop and analyze it. "You need to put the right people in the right positions at the right time with the right tools," says Dr. Movva. Beyond addressing errors, a center's staff needs to be flexible to allow for the unexpected that can happen on a day to day basis.
ASCs should have a constant flow of activity; a stop-and-go system is counter to an efficient center. "Everything needs to be coordinated and at speed, like a pit crew on a race team," says Dr. Movva. At his center, one of the pillars of efficiency is the administrator. She is a former endoscopy nurse, so she is involved in the administrative and clinical aspects of daily operations.
3. Don't be afraid of staff turnover. Many centers grow concerned over staff turnover rates, but this can actually be a positive sign. "If your center is doing well, other ASCs, hospitals and private practices will try to recruit your staff," says Dr. Movva.
Do not make the mistake of overpaying your staff just to avoid turnover. Bring in new people and train them to reach your center's level of expectations. In the short term this may cost a center more, but in the long run it is less expensive than overpaying existing staff members.
"There is a certain amount of judgment involved. Someone may be valuable, but at a certain pay threshold, backfilling the position is a better long-term decision," says Dr. Movva. Identify staff members that have a poor attitude towards improvement. "You can always teach the motivated, but a highly skilled employee without motivation only leads to higher costs and poorer quality of work and overall staff morale. Everyone needs to be a team player," he says.
4. Hold all team members equally accountable. A center should perform 360 degree employee reviews. Managers reviewing staff members should be subject to review themselves by those they supervise. "Just because you are a manager does not mean that you are infallible. Everyone needs to be held accountable at all times," says Dr. Movva.
Every member of a center's team needs to be geared towards improvement, and it's important to determine who is causing the issue. High-ranking physicians driving case load should not be allowed to abuse their position, and staff members at each level should have respect for all team members.
5. Meet as team frequently. At Dr. Movva's center, there are standing quarterly meetings and management meetings on a weekly basis, but if something goes wrong an impromptu meeting can be held immediately.
"If there is a system problem or employee problem, letting it go only makes it worse. A problem will multiply across more and more cases if it is left unaddressed," says Dr. Movva. Staff members are welcome to informally meet with Dr. Movva on a daily basis.
"Meeting on only a quarterly basis will mean lost revenue and backtracking. You are wasting time and money," he says. Making small, frequent course corrections is much easier to accomplish than implementing large changes three or four times a year.
6. Ask your staff for feedback. Listen to all staff members at each level. "All staff members need to have the feeling that they can speak up and suggest points of improvement," says Dr. Movva. "Your staff is your eyes and ears. Administrators will not know the daily ins and outs." Avoid the hierarchical staff structure; if your staff is afraid to speak up, administrators will not understand how to smooth out the small wrinkles that get in the way of a smoothly-run ASC.
"Staff members are encouraged to bring a problem and possible solution to the table," says Dr. Movva. At his center staff members have equal opportunity to discuss relevant issues at monthly meetings and through emails and online message boards.
7. Listen to your patients. One of the keys to high patient satisfaction is communication. Keep a line of communication open between your staff and a patient's family. Designate a staff member as a patient's discharge connection and follow up with your patients.
"Listening to your patients is taking the pulse of your center," says Dr. Movva. It is important to address any low scores on patient satisfaction surveys. The most constructive patient satisfaction surveys have low scores in only a few areas. These patients have taken time to fill out the survey; areas they point out may be something the center has never thought to address before. Target these areas for improvement.
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