Here eight ambulatory surgery center administrators discuss how their centers achieve high levels of efficiency.
Q: What are the most important factors that you find contribute to the overall efficiency of your ASC?
Leslie Cottrell, administrator, Baptist Physicians Surgery Center (Lexington, Ky.). Our ASC opened with a clear vision of expectations and goals to promote excellent service and quality patient care. Accountability is reinforced throughout our facility from employees, management team, administrators and board of managers. Patients and providers have a choice of facilities which is reinforced to our employees. Customer service is essential to our success. Daily operational events are assessed to develop alternatives for improvements in providing an efficient and empathetic environment with the highest level of patient care.
Lucinda Hay, Managing Director, Center for Specialty Care (New York). At the Center for Specialty Care, we strive to: coordinate staff hours to maximize productivity and minimize cost; consolidate OR scheduling to maximize efficiency; and to minimize inventory and manage supply costs on a daily basis. Of course, on-time starts and quick OR turnaround times help keep delays to a minimum. We have a flat management model which allows for direct, quick communication between departments and from all staff directly to the CEO. Physicians also feel free to discuss any issues from equipment to staffing with any staff member and that information is communicated to the appropriate individual, department head or CEO. We are unusual because we are a non-hospital, non-physician, family-owned business. This frees the center to focus on the ‘big picture’. Decisions can be implemented quickly, in some cases within hours.
Bruce Kupper, CEO of MEDARVA Healthcare, Stony Point Surgery Center (Richmond, Va.). First and foremost, our efficiency is driven by the fact that we hire experienced nurses, operating room techs and anesthesia providers. Our staff members are confident in their clinical and organizational skills. We have also designed our stations and systems around the needs of the staff so they don't have to walk a long way to get things. One of the newest things I'm excited about is a patient tracking software program we recently implemented that works on a touch screen display. The program was developed in-house by our staff and lets us know when patients arrive, if they've been registered, when they are in pre-op, what order they are in for surgery, if they're in the operating room and when they are in post-op. All the information presented on multiple monitors throughout our facility that can be accessed by our staff and the physicians. We are more efficient by establishing a strong relationship between the pre-op and OR teams, eliminating a dividing line that can sometimes exist between the two groups and it all starts with training and communication.
Jeff Wigton, director of operations, Central Maine Orthopaedics (Auburn). We have done a lot to improve efficiency within the last year. We have worked to prepare for the unplanned, which can be extremely detrimental to timing in an ASC. It is critical to focus on preoperative patient management, which can be instrumental in avoiding last minute cancellations. Preparing ahead of time is also key from a patient satisfaction stand point. We work to do all intake at the point of service, know anything that will complicate the perioperative work ahead of time and avoid chasing down information after the patient has already undergone a procedure. The better trained your staff is, the less you have to go back and redo work. Our center concentrates on performing the day-to-day tasks correctly the first time.
Keith Smith, MD, administrator, Surgery Center of Oklahoma (Oklahoma City). An anesthesiologist is in charge of the schedule and our schedule is blocked. We have also overstaffed such that each surgeon generally has two full OR crews and more than one anesthesiologist. This makes for extremely efficient use of the facility.
Ann Cariker, administrator, Great Basin Surgical Center (Elko, Nev.). We take into consideration the efficiency of our surgery center based on parameters and guidelines that measure quality and safety, physician needs and satisfaction, employee engagement and satisfaction, customer satisfaction, and financial processes. Our quality and safety measures are based on national benchmarking standards and evidence-based medicine. All staff are involved in quality improvement. For example, hand hygiene compliance is a component of all employee evaluations. We ensure cross training of all employees so that staffing issues are not problematic. Each center manager meets with direct reports and/or customers on a one-to-one basis at least once a month to determine individual needs and recognize those employees and medical staff members that demonstrate excellent customer service. Every employee and medical staff member that takes part in a patient’s care signs a “Thank You” card, which is mailed to the patient’s home. Financial components of the center are reviewed daily, including AR tracking and trending, cash collections, timely billing, complete insurance information and any other details that could impact appropriate payment. The administrator and business office manager meet every day to review all the aspects of the reimbursement process. If you align the employees and medical staff, hold people accountable for their actions and communicate frequently, an organization is on the right path.
Brad Harmon, administrator, Northern California Surgery Center (Turlock, Calif.). Ambulatory surgery centers have a big advantage over hospitals. Physicians are able to save more time, patients are generally healthier, turnaround time is much quicker and the atmosphere tends to be much more personal. We have cross-trained our team in all areas. Every surgical staff member has the capability to provide support in the pre-operative and post-operative areas. Our center also uses Medical Passport, which allows patients to provide their medical background online prior to coming in for their procedure. Our nurses don't need to spend time chasing down the information after the patient has already arrived. The national average for hours spent on a case is 12 and we currently operate at seven to six hours per case. Physician supplies are standardized. We review supply costs and present the lower cost options to our physicians. We collaborate and switch to lower costs where we can. It is all of the little things that save time and money. We look at saving a few dollars and few minutes where we can and it all adds up.
Sonja Christmas, administrator, Cy-Fair Surgery Center (Houston). Here at Cy-Fair Surgery Center we work together as a team; each employee fills a specific niche and has cross training to help out in any area that needs it. The center handles its own billing, collecting, insurance claims and medical records. The endoscopy room is the first area of the center to transition to EHR and each new patient file is scanned to be saved in electronic form. The staff meets formally once a month to discuss how the center is running and often meets once a week as needed. Every staff member is self-sufficient. Cy-Fair surgery center averages 60 to 80 procedures a week done by about 20 physicians.
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Q: What are the most important factors that you find contribute to the overall efficiency of your ASC?
Leslie Cottrell, administrator, Baptist Physicians Surgery Center (Lexington, Ky.). Our ASC opened with a clear vision of expectations and goals to promote excellent service and quality patient care. Accountability is reinforced throughout our facility from employees, management team, administrators and board of managers. Patients and providers have a choice of facilities which is reinforced to our employees. Customer service is essential to our success. Daily operational events are assessed to develop alternatives for improvements in providing an efficient and empathetic environment with the highest level of patient care. Lucinda Hay, Managing Director, Center for Specialty Care (New York). At the Center for Specialty Care, we strive to: coordinate staff hours to maximize productivity and minimize cost; consolidate OR scheduling to maximize efficiency; and to minimize inventory and manage supply costs on a daily basis. Of course, on-time starts and quick OR turnaround times help keep delays to a minimum. We have a flat management model which allows for direct, quick communication between departments and from all staff directly to the CEO. Physicians also feel free to discuss any issues from equipment to staffing with any staff member and that information is communicated to the appropriate individual, department head or CEO. We are unusual because we are a non-hospital, non-physician, family-owned business. This frees the center to focus on the ‘big picture’. Decisions can be implemented quickly, in some cases within hours.Bruce Kupper, CEO of MEDARVA Healthcare, Stony Point Surgery Center (Richmond, Va.). First and foremost, our efficiency is driven by the fact that we hire experienced nurses, operating room techs and anesthesia providers. Our staff members are confident in their clinical and organizational skills. We have also designed our stations and systems around the needs of the staff so they don't have to walk a long way to get things. One of the newest things I'm excited about is a patient tracking software program we recently implemented that works on a touch screen display. The program was developed in-house by our staff and lets us know when patients arrive, if they've been registered, when they are in pre-op, what order they are in for surgery, if they're in the operating room and when they are in post-op. All the information presented on multiple monitors throughout our facility that can be accessed by our staff and the physicians. We are more efficient by establishing a strong relationship between the pre-op and OR teams, eliminating a dividing line that can sometimes exist between the two groups and it all starts with training and communication. Jeff Wigton, director of operations, Central Maine Orthopaedics (Auburn). We have done a lot to improve efficiency within the last year. We have worked to prepare for the unplanned, which can be extremely detrimental to timing in an ASC. It is critical to focus on preoperative patient management, which can be instrumental in avoiding last minute cancellations. Preparing ahead of time is also key from a patient satisfaction stand point. We work to do all intake at the point of service, know anything that will complicate the perioperative work ahead of time and avoid chasing down information after the patient has already undergone a procedure. The better trained your staff is, the less you have to go back and redo work. Our center concentrates on performing the day-to-day tasks correctly the first time.Keith Smith, MD, administrator, Surgery Center of Oklahoma (Oklahoma City). An anesthesiologist is in charge of the schedule and our schedule is blocked. We have also overstaffed such that each surgeon generally has two full OR crews and more than one anesthesiologist. This makes for extremely efficient use of the facility.Ann Cariker, administrator, Great Basin Surgical Center (Elko, Nev.). We take into consideration the efficiency of our surgery center based on parameters and guidelines that measure quality and safety, physician needs and satisfaction, employee engagement and satisfaction, customer satisfaction, and financial processes. Our quality and safety measures are based on national benchmarking standards and evidence-based medicine. All staff are involved in quality improvement. For example, hand hygiene compliance is a component of all employee evaluations. We ensure cross training of all employees so that staffing issues are not problematic. Each center manager meets with direct reports and/or customers on a one-to-one basis at least once a month to determine individual needs and recognize those employees and medical staff members that demonstrate excellent customer service. Every employee and medical staff member that takes part in a patient’s care signs a “Thank You” card, which is mailed to the patient’s home. Financial components of the center are reviewed daily, including AR tracking and trending, cash collections, timely billing, complete insurance information and any other details that could impact appropriate payment. The administrator and business office manager meet every day to review all the aspects of the reimbursement process. If you align the employees and medical staff, hold people accountable for their actions and communicate frequently, an organization is on the right path.
Brad Harmon, administrator, Northern California Surgery Center (Turlock, Calif.). Ambulatory surgery centers have a big advantage over hospitals. Physicians are able to save more time, patients are generally healthier, turnaround time is much quicker and the atmosphere tends to be much more personal. We have cross-trained our team in all areas. Every surgical staff member has the capability to provide support in the pre-operative and post-operative areas. Our center also uses Medical Passport, which allows patients to provide their medical background online prior to coming in for their procedure. Our nurses don't need to spend time chasing down the information after the patient has already arrived. The national average for hours spent on a case is 12 and we currently operate at seven to six hours per case. Physician supplies are standardized. We review supply costs and present the lower cost options to our physicians. We collaborate and switch to lower costs where we can. It is all of the little things that save time and money. We look at saving a few dollars and few minutes where we can and it all adds up.
Sonja Christmas, administrator, Cy-Fair Surgery Center (Houston). Here at Cy-Fair Surgery Center we work together as a team; each employee fills a specific niche and has cross training to help out in any area that needs it. The center handles its own billing, collecting, insurance claims and medical records. The endoscopy room is the first area of the center to transition to EHR and each new patient file is scanned to be saved in electronic form. The staff meets formally once a month to discuss how the center is running and often meets once a week as needed. Every staff member is self-sufficient. Cy-Fair surgery center averages 60 to 80 procedures a week done by about 20 physicians.
More Articles on ASC Issues:
100 Great Places to Work in Healthcare
6 Hiring Practices for Successful Ambulatory Surgery Centers
8 ASC Administrators on Healthcare Reform