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10 Keys to Being a Great ASC Administrator

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Operating a successful ambulatory surgery center is like running a small city — not a small feat. It takes a deft hand and excellent leadership. An ASC administrator must be like a chief operating officer and chief development officer of a center. He or she must be able to recruit business in one way or another and be able to assure operations run in an excellent manner. Here are 10 key thoughts on what it takes to be a great ASC administrator.

1. Financial fluency. Healthcare is a business, so great administrators will have a firm grasp on the financial aspects of keeping a center's doors open. "I would emphasize [looking] for trends as well as outliers on the [financial] reports. Identifying either can help you be proactive for planning and budgeting," says Andrew Weiss, administrator of The Endo Center at Voorhees (N.J.) and treasurer of the New Jersey Association of Ambulatory Surgery Centers. From cash flow to labor costs, administrators must be able track, measure and improve upon financial benchmarks.

2. Physician recruitment skill. Though there seems to be a never-ending amount of work to do within the four walls of an ASC, great administrators will remember to look beyond their centers' doors. "Continue to recruit and attract physicians in your area. Treat the physicians like customers and recognize them when you see them in your center," says Neal Maerki, RN, CASC, administrator of Bend (Ore.) Surgery Center. "Continue to ask your non-partners why they are at your center, what do they like and what could you do better."

3. Organized OR management and clinical competency. Recent research suggests it is possible for single surgeons to run multiple ORs. Getting to that level of efficiency, however, requires precise time management. Administrative responsibilities for OR efficiency includes using block scheduling best-practices, scheduling staff appropriately, stressing the importance of an on-time start and having realistic expectations for turnover times. It's also important for administrators to communicate with clinical leaders about building an ASC culture of adherence to proper protocols and checklists for all staff members involved directly or indirectly with patient care.

OR efficiency also includes shrewd supply-chain management. According to Surgical Directions CEO Jeff Peters in a Becker's Hospital Review report, non-labor costs can be between 40 percent and 60 percent of all OR costs. Working with OR staff to standardize equipment and minimize waste can be a great way to keep an efficient OR.

4. Supply chain savvy. Administrators may not be directly responsible for ordering supplies, but great leaders understand the process of finding and ordering the necessary items in a cost effective manner. Be prepared to delegate, but know the ins and outs of your center's supply chain. "Invest in your materials manager. This is the person that is quarterbacking your supply chain," says Mr. Weiss.

5. Key specialty know-how. Understanding key specialties is not just about maintaining case volume in a center's existing service lines. It also demands that administrators seek new opportunities. Developments in operating room technology mean higher acuity cases, such as total joints, and specialties, such as neurosurgery, are migrating to the ASC setting. Take the time to learn what specialties are a good fit for your ASC, market and patient base. Aggressively pursue the specialties that will position your center for success. "Fully investigate current reimbursement contracts that are in place and whether the specific specialty or procedures were addressed under current reimbursement contracts," said Stephanie Martin, administrator of St. Augustine (Fla.) Surgery Center in a Becker's ASC Review report.

6. Expert-level knowledge of credentialing, licensing and Medicare certification rules and regulations. Credentialing is extremely problematic for ASCs seeking accreditation or re-accreditation; the highly detailed process is the number one cause of accreditation problems observed by surveyors from every major ambulatory accreditation organization.

"If an organization doesn't have a person with those kinds of skills, that's often where they may fall short," said Michael Kulczycki, MBA, CAE, executive director of The Joint Commission's Ambulatory Accreditation Program. He recommends if administrators can't directly handle accreditation themselves, they should find the right person, provide them with the time they need to create a good system and check in regularly to assess compliance with accreditation and readiness for surveys.

7. Safety and quality prioritization. Better patient safety is an oft-mentioned advantage ASCs have over hospitals. Administrative support for the creation of and adherence to comprehensive infection control and patient safety is necessary to maintain this advantage. Daily huddles, dissemination of quality information, checklists and a trained infection preventionist are all great ways to keep ASC surgery valuable and safe.

Keeping ASC quality high also requires administrators to have flexibility and a positive attitude, according to Ms. Martin. "An administrator needs to be a good listener, be honest, have patience, and be flexible. One-hundred different things come up in a day that weren't on the list to be addressed but require attention. It is really important to prioritize and re-prioritize to get the most important things done and to roll with the punches," she says.

8. Staff search and retention capabilities. An ASC is only as good as the people who staff it. A great administrator recognizes talent in potential hires and works to keep excellent staff members on board. "Everyone has a part in running things smoothly. They take pride in their work, and the administrator does not have to micromanage," said Lori Martin, administrator of Summit Surgery Center in Reno, Nev., in a Becker's ASC Review report.

9. Good physician and patient satisfaction maintenance. Physicians and patients are both ASC customers. Physicians can choose to perform cases elsewhere, and patients can choose to undergo procedures at a hospital or another surgery center. Maintaining high levels of satisfaction in both groups is paramount to case volume and a center's reputation.

"A good ASC administrator must have the ability to communicate effectively with surgeons, who can be very demanding and have very strong personalities," says Bruce Feldman, MS, CPPM, administrator and director of operations at Island Endoscopy Center in West Islip, N.Y. "They need to have the ability to listen and involve their surgeons in the decision making process, especially when it comes to purchasing new equipment and instrumentation."

"You have to make the physician's experience seamless, so he doesn't have to do extra work. It goes back to customer service — facilities have to remember physicians are some of their most important customers," said Kelli McMahan, vice president of operations at Pinnacle III in an Becker's ASC Review report.

Patient satisfaction initiatives, whether conducted through a simple survey or more in-depth, allow ASC administrators to gauge the patient experience and find ways to improve it. "It helps us see our center through their eyes as a patient," said Slocum Surgery Center administrator Shelley Yuva in a Becker's ASC Review report. "We, as employees, do this day-in and day-out and have a very different functional assessment."

10.  Ability to stay ahead of the curve. Healthcare is changing rapidly and placing pressure on providers to keep pace. ASCs are well-positioned as high-quality, low-cost providers, but truly successful centers will seek innovative ways to stand out through initiatives such as price transparency or bundled payments.

"I think an area where all who run ASCs can improve is to give serious thought to embracing the same discipline and competition [that] the free market forces all other businesses to endure," says Keith Smith, MD, administrator of the Surgery Center of Oklahoma in Oklahoma City. "This mindset will continue to set the quality, price and value of ASCs apart from the monolithic hospitals and their bankrupting charges."

More Articles on ASC Issues:
8 Questions for ASCs on Their Value and Sustainability
How Far Gone is Too Far Gone? An ASC Turnaround Story
10 ASCs Making the News This Week

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