Many ambulatory surgery centers are familiar with compact scheduling — scheduling many cases in a row to avoid excessive downtime — but they may not be optimizing these tactics to fully reap the benefits of a busy surgery center and staff. Here are eight steps for ambulatory surgery centers to really impact their bottom line with compact scheduling from MedHQ CEO and EndoLabs Administrator Tom Jacobs and Summit Surgery Center at Saint Mary's Galena Administrator Lori Martin, RN.
1. Allow physician control of block scheduling. EndoLabs, a gastroenterology/endoscopy surgery center in Indiana, plans four blocks of time each day and allows physicians to control scheduling within their blocks.
"We tell physician schedulers that they can schedule patients within the blocks for their physicians," says Mr. Jacobs. "The physicians essentially control their schedules. We want to group procedures closely together and compact the schedule as much as possible. Usually the physician schedulers know that, so if the physician has four cases, they schedule an hour or two-hour time block for those cases."
The ASC may run into trouble if surgeons schedule cases for 8 a.m. to 10 a.m. and then again at 1:30 p.m. to 4:30 p.m., but nothing in between. The gap could lead to staff downtime and non-productivity.
2. Benchmark for schedule optimization. Pay attention to case statistics and employee payment to find the number of paid hours per case for your organization. Benchmark that number to find the threshold where you are most profitable.
"We have an easier time hitting the profitability benchmark if we have 15 cases scheduled per day," says Mr. Jacobs. "There is a drop-of in profitability if we are over or under that number. We let everyone know that and try to coordinate appropriately."
The ASC can still accommodate for special cases, but largely tries to schedule 15 or more cases per day. "Once we communicated with the schedulers and doctors about these benchmarks and the impact of a slower day versus a bigger day, they were in tune with us and wanted to help us make things as efficient as possible," says Mr. Jacobs.
3. Communicate gaps to other surgeons. There should be constant communication between ASC schedulers and physician practice schedulers, especially during vacation or meeting season. Ask practice schedulers to inform the ASC when the surgeon takes time off so you can give their time to other surgeons that week.
"We have to set up at the beginning of the day and take down at the end, so we want as many cases as possible in the middle," says Mr. Jacobs. "We want to keep surgeons and patients happy as well, so we communicate with them about vacation time and make sure we can fill those gaps when necessary."
4. Consider where to save time during set-up and take-down. Experience will make nurses and surgical techs more efficient with set-up and take-down every day, but there may be additional opportunity to speed the process by cutting unnecessary waste or steps.
"We used to take an hour at the beginning of the day to set up and we were able to cut that to 45 minutes, and that makes a significant difference in time saved for the entire year," says Mr. Jacobs. "The impact of these overhead hours diminishes on a per case basis. We realized that the standard of coming in an hour ahead of time was too much and so we were able to cut that down, and that saved 195 hours per year."
5. Stay productive during downtime. Sometimes downtime can't be avoided, but staff members can take on projects to fill that downtime with constructive initiatives. Staff members can work on patient call backs, quality improvement studies, patient control or other special projects to stay productive during the day.
"The people who work at ASCs enjoy the quicker pace environment and they'll usually have free time to pursue these other projects," says Mr. Jacobs. "The staff doesn't want to be idle; they want to be involved with everything going on at the center."
6. Cross-train staff members. If your ASC maintains a lean staff, cross-train everyone to help with different functions at the center. This will minimize downtime and maximize efficiency to support patient volume growth in the future.
"The biggest, most beneficial thing you can do is cross-train," says Ms. Martin. "When our receptionist has down time and doesn't have any more work with making charts, she posts bills and keeps our accounts payable in order. Our credentialing person is cross trained to do reception. People have endless tasks that they can complete during their downtime."
Ms. Martin says there isn't normally any non-productive time in the center, but if there is on a rare occasion, she'll send the employee home.
7. Close down on slow days. When surgery centers have one day that is consistently slow every week, consider closing down that day and working the clinical staff for four longer days per week. This saves on overhead and could compact the schedule even more.
"Some parts of the business, like the clinical aspect, you can flex to four days," says Ms. Martin. "Other parts, like the business portion, must happen all five days."
You can also implement this policy on a micro level by rearranging cases the week before for particularly slow days.
"We ask doctors on slow days to move their cases to a different day and sometimes we close the center down with only a skeleton crew to collect money, answer calls and complete business office functions," says Ms. Martin. "Sometimes it's better for staff to collect four tens or four nines that week then scattered hours for all five days."
8. Commit to low turnover times. The culture at the ASC should promote low turnover times and staff members really need to buy-in to the process. Surgeons need quick turnovers so they can get back to their practices or the hospital, and efficiency could allow more cases into the ASC overall.
"We try to allow only a little time between cases to meet the surgeons' expectations," says Ms. Martin. "Having staff motivated to do that is important. We make these expectations clear to the staff; they must be willing to participate in all aspects of success at the center. I hired two people without medical experience for reception and materials management, and they have done a really excellent job. They were motivated to succeed."
More Articles on Surgery Centers:
5 Ways or ASCs to Beat Sequestration Payment Cuts
8 Steps for Smooth ASC Patient Flow
Physician Recruitment Trends for ASCs: Q&A With Paul Eiseman of Regent Surgical Health
1. Allow physician control of block scheduling. EndoLabs, a gastroenterology/endoscopy surgery center in Indiana, plans four blocks of time each day and allows physicians to control scheduling within their blocks.
"We tell physician schedulers that they can schedule patients within the blocks for their physicians," says Mr. Jacobs. "The physicians essentially control their schedules. We want to group procedures closely together and compact the schedule as much as possible. Usually the physician schedulers know that, so if the physician has four cases, they schedule an hour or two-hour time block for those cases."
The ASC may run into trouble if surgeons schedule cases for 8 a.m. to 10 a.m. and then again at 1:30 p.m. to 4:30 p.m., but nothing in between. The gap could lead to staff downtime and non-productivity.
2. Benchmark for schedule optimization. Pay attention to case statistics and employee payment to find the number of paid hours per case for your organization. Benchmark that number to find the threshold where you are most profitable.
"We have an easier time hitting the profitability benchmark if we have 15 cases scheduled per day," says Mr. Jacobs. "There is a drop-of in profitability if we are over or under that number. We let everyone know that and try to coordinate appropriately."
The ASC can still accommodate for special cases, but largely tries to schedule 15 or more cases per day. "Once we communicated with the schedulers and doctors about these benchmarks and the impact of a slower day versus a bigger day, they were in tune with us and wanted to help us make things as efficient as possible," says Mr. Jacobs.
3. Communicate gaps to other surgeons. There should be constant communication between ASC schedulers and physician practice schedulers, especially during vacation or meeting season. Ask practice schedulers to inform the ASC when the surgeon takes time off so you can give their time to other surgeons that week.
"We have to set up at the beginning of the day and take down at the end, so we want as many cases as possible in the middle," says Mr. Jacobs. "We want to keep surgeons and patients happy as well, so we communicate with them about vacation time and make sure we can fill those gaps when necessary."
4. Consider where to save time during set-up and take-down. Experience will make nurses and surgical techs more efficient with set-up and take-down every day, but there may be additional opportunity to speed the process by cutting unnecessary waste or steps.
"We used to take an hour at the beginning of the day to set up and we were able to cut that to 45 minutes, and that makes a significant difference in time saved for the entire year," says Mr. Jacobs. "The impact of these overhead hours diminishes on a per case basis. We realized that the standard of coming in an hour ahead of time was too much and so we were able to cut that down, and that saved 195 hours per year."
5. Stay productive during downtime. Sometimes downtime can't be avoided, but staff members can take on projects to fill that downtime with constructive initiatives. Staff members can work on patient call backs, quality improvement studies, patient control or other special projects to stay productive during the day.
"The people who work at ASCs enjoy the quicker pace environment and they'll usually have free time to pursue these other projects," says Mr. Jacobs. "The staff doesn't want to be idle; they want to be involved with everything going on at the center."
6. Cross-train staff members. If your ASC maintains a lean staff, cross-train everyone to help with different functions at the center. This will minimize downtime and maximize efficiency to support patient volume growth in the future.
"The biggest, most beneficial thing you can do is cross-train," says Ms. Martin. "When our receptionist has down time and doesn't have any more work with making charts, she posts bills and keeps our accounts payable in order. Our credentialing person is cross trained to do reception. People have endless tasks that they can complete during their downtime."
Ms. Martin says there isn't normally any non-productive time in the center, but if there is on a rare occasion, she'll send the employee home.
7. Close down on slow days. When surgery centers have one day that is consistently slow every week, consider closing down that day and working the clinical staff for four longer days per week. This saves on overhead and could compact the schedule even more.
"Some parts of the business, like the clinical aspect, you can flex to four days," says Ms. Martin. "Other parts, like the business portion, must happen all five days."
You can also implement this policy on a micro level by rearranging cases the week before for particularly slow days.
"We ask doctors on slow days to move their cases to a different day and sometimes we close the center down with only a skeleton crew to collect money, answer calls and complete business office functions," says Ms. Martin. "Sometimes it's better for staff to collect four tens or four nines that week then scattered hours for all five days."
8. Commit to low turnover times. The culture at the ASC should promote low turnover times and staff members really need to buy-in to the process. Surgeons need quick turnovers so they can get back to their practices or the hospital, and efficiency could allow more cases into the ASC overall.
"We try to allow only a little time between cases to meet the surgeons' expectations," says Ms. Martin. "Having staff motivated to do that is important. We make these expectations clear to the staff; they must be willing to participate in all aspects of success at the center. I hired two people without medical experience for reception and materials management, and they have done a really excellent job. They were motivated to succeed."
More Articles on Surgery Centers:
5 Ways or ASCs to Beat Sequestration Payment Cuts
8 Steps for Smooth ASC Patient Flow
Physician Recruitment Trends for ASCs: Q&A With Paul Eiseman of Regent Surgical Health