William Mulhall, RN, partner with Merritt Healthcare and Chris McMenemy, vice president at Ortmann Healthcare Consultants, discuss the process behind hiring an effective surgery center administrator.
1. Outline the job description. Mr. Mulhall and Ms. McMenemy agree that the first step to hiring a new administrator is deciding what you are looking for. In a surgery center, that generally means deciding whether you want to prioritize a business background or a clinical background. Ideally, your administrator will have knowledge of both areas, but many candidates will have only one, so you have to be prepared to make the choice. "The job description will include information about whether you're looking for someone with a clinical background, or whether you want a purely business person to fill the role of [administrator as CEO]," Mr. Mulhall says.
He says it's acceptable to open the job search to both types of candidates and then narrow down your criteria once you see who applies. "I don't know that you can go out looking for one or the other — you'll get both no matter what you do," he says. "In our most recent situation, 95 percent of the applicants were business-related people without a clinical background, and we ended up hiring someone in the smaller portion of the pool who had both a clinical and a business background."
2. Prioritize ASC experience. Ms. McMenemy says the ideal candidate for an ASC administrator position, unsurprisingly, is a former ASC administrator. However, the pool of available ASC administrators is small, so you will likely interview candidates who come from a hospital background as well. If possible, prioritize those candidates who have spent some time in a surgery center. "There's a different way you have to look at things in an ASC to make it profitable or break even," she says. "Someone who's already been in an ASC is used to that." She says while hospital candidates may make a good fit, physician practice administrators are usually not appropriate for the position unless they have been performing office-based surgery. Ms. McMenemy adds that a strong ASC employee without administration experience could also learn the role of the administrator without too much difficulty.
She says if you can't find someone with surgery center experience, look for a hospital or physician practice employee who seems enthusiastic about the ASC industry. "It's really important to find someone who is passionate about the job," she says. "I've worked with people who seem less passionate about their surgery center than I am, and that's not good." She says if the employee doesn't have ASC experience, look for someone who has completed education and training courses. These signify that your hire will be willing to put in the time to learn the administrator role.
3. Ask physician owners and colleagues for suggestions. ASC physicians and consultants may know of candidates who have the necessary qualifications, Mr. Mulhall says. "We generally have candidates that the physician groups would like to see interviewed, and we usually interview those people first to see where they stand," he says. Interviewing these people first lets physicians know you respect their opinion and want to find an administrator they like. However, do not think you have to hire someone just because they were recommended by your surgeons.
Ms. McMenemy says if your physician-owners cannot recommend a candidate, you may want to talk to other colleagues in the ASC industry. IT consultants, coding and billing managers and equipment vendors may know of ASC administrators who are unhappy in their current position. "They may hear of something they think is really good, or they can pass your information on to someone they know," she says. "It never hurts to talk to your vendors and colleagues and say, 'Have you heard of anyone that would be a good fit?'"
4. Publicize locally and nationally, if applicable. If talking to physicians and colleagues doesn't turn up the perfect candidate, you can use the local paper and national publications and career sites to publicize as well. Ms. McMenemy says for lower-level positions, Craigslist is helpful, but she doesn't find it as effective for administrators. She says in her experience, administrator candidates tend to find ASC jobs through the local newspaper, national industry publications or sites such as Monster.com or CareerBuilder.com.
5. Conduct a pre-interview. Don't take every candidate who applies in front of your physician group and ask for feedback, Mr. Mulhall says. Instead, go through resumes and select a handful of qualified candidates for a pre-interview. Conduct a phone or in-person interview with those candidates and eliminate the people you know you would not hire.
Ms. McMenemy and Mr. Mulhall say they look for several traits upfront before they bring candidates in front of physicians. First of all, candidates must be personable, enthusiastic and easy to talk to, since these traits are essential for dealing with ASC employees, physicians, patients and consultants on a regular basis. Second of all, candidates must seem to be able to handle stressful situations. In other words, do they seem organized, level-headed and able to delegate, or will they fall apart when they are surprised by an ASC surveyor?
6. Check references and background. Before you take a candidate in front of your physician group, check references and background. You don't want your physicians to get excited about a candidate, only to find out that his or her references are terrible or the candidate lied about something on the resume.
7. Invite physicians to interview the candidate. Once you have narrowed the pool down to 3-5 candidates, ask your physicians if they are interested in participating in the interview process. Ms. McMenemy says physician participation can range from one physician sitting in on the interview to a group of 10 physicians conducting a "town hall"-style interview with each candidate.
When you weed out candidates, Mr. Mulhall recommends looking for traits that would not gel with your ASC physicians. "I can kind of weed out certain people based on what the physicians are going to react well to," Mr. Mulhall says. "I'll talk to them a lot about their past experience which will give me insight into how they deal with the physicians' questions."
8. Ask about prior experience. Mr. Mulhall says you can tell a lot about a candidate by asking pointed questions about prior experience. "I try to talk to them about their past experience and have them give me a real-life example of something they went through at a previous job," he says. "Then they take me through the process of correcting or reconciling the issue within that job." He says this question can help determine whether ASC administrators are able to delegate to other employees, whether they play favorites with staff members and whether they can operate under stress, among other issues.
9. Pitch a salary. Mr. Mulhall and Ms. McMenemy agree that you should go into a salary negotiation with an idea of how much you want to pay your new administrator. They recommend using ASC Association or VMG Health benchmarking data to determine how much administrators are paid in your region or based on your net revenue, case volume or number of operating rooms. Once you have researched the average salary for the position, you can ask the candidate, "What is your salary requirement?" or make an offer. If you ask for a salary requirement, you can either meet the requirement or make a new offer. If you make an offer, the candidate may ask for more money or accept your offer.
Keep in mind that you may have to offer more money if you have a limited pool of candidates. "If we have a significant pool of acceptable candidates, it may drive the [salary] down because we have a lot of people to pick from," Mr. Mulhall says. "If we have a smaller pool of candidates or a very strong candidate, the number may go up because we don't have [many choices]."
10. Orient the new administrator. An ASC administrator position involves many different tasks, all of which may require some orientation for the new employee. Mr. Mulhall says his company spends time with the new administrator on a day-to-day basis, going over policies and requiring the administrator to research accrediting body rules and CMS guidelines. After a few days of one-on-one instruction, the administrator does an informal sit-down with ASC staff and starts to get acclimated to the daily life of the center.
Ms. McMenemy says her company starts the administrator off with a three-day training program that goes over the goals for the next six months. The company leaders then sit down with the surgery center's lead physician to go over the necessary amount of communication between physician and administrator. "Does he want to be copied on everything, or does he just want a weekly meeting, or does he want the administrator to just call when he's needed?" she says. She says the company also keeps a spreadsheet for the administrator that outlines the necessary tasks to successfully open the surgery center.
Related Articles on ASC Operations:
5 Best Practices for Marketing Surgery Center Physicians on the Web
Section 179: Last Call for Large Capex Deductions in 2011
5 ASC Budget-Related Statistics to Track and Benchmark
1. Outline the job description. Mr. Mulhall and Ms. McMenemy agree that the first step to hiring a new administrator is deciding what you are looking for. In a surgery center, that generally means deciding whether you want to prioritize a business background or a clinical background. Ideally, your administrator will have knowledge of both areas, but many candidates will have only one, so you have to be prepared to make the choice. "The job description will include information about whether you're looking for someone with a clinical background, or whether you want a purely business person to fill the role of [administrator as CEO]," Mr. Mulhall says.
He says it's acceptable to open the job search to both types of candidates and then narrow down your criteria once you see who applies. "I don't know that you can go out looking for one or the other — you'll get both no matter what you do," he says. "In our most recent situation, 95 percent of the applicants were business-related people without a clinical background, and we ended up hiring someone in the smaller portion of the pool who had both a clinical and a business background."
2. Prioritize ASC experience. Ms. McMenemy says the ideal candidate for an ASC administrator position, unsurprisingly, is a former ASC administrator. However, the pool of available ASC administrators is small, so you will likely interview candidates who come from a hospital background as well. If possible, prioritize those candidates who have spent some time in a surgery center. "There's a different way you have to look at things in an ASC to make it profitable or break even," she says. "Someone who's already been in an ASC is used to that." She says while hospital candidates may make a good fit, physician practice administrators are usually not appropriate for the position unless they have been performing office-based surgery. Ms. McMenemy adds that a strong ASC employee without administration experience could also learn the role of the administrator without too much difficulty.
She says if you can't find someone with surgery center experience, look for a hospital or physician practice employee who seems enthusiastic about the ASC industry. "It's really important to find someone who is passionate about the job," she says. "I've worked with people who seem less passionate about their surgery center than I am, and that's not good." She says if the employee doesn't have ASC experience, look for someone who has completed education and training courses. These signify that your hire will be willing to put in the time to learn the administrator role.
3. Ask physician owners and colleagues for suggestions. ASC physicians and consultants may know of candidates who have the necessary qualifications, Mr. Mulhall says. "We generally have candidates that the physician groups would like to see interviewed, and we usually interview those people first to see where they stand," he says. Interviewing these people first lets physicians know you respect their opinion and want to find an administrator they like. However, do not think you have to hire someone just because they were recommended by your surgeons.
Ms. McMenemy says if your physician-owners cannot recommend a candidate, you may want to talk to other colleagues in the ASC industry. IT consultants, coding and billing managers and equipment vendors may know of ASC administrators who are unhappy in their current position. "They may hear of something they think is really good, or they can pass your information on to someone they know," she says. "It never hurts to talk to your vendors and colleagues and say, 'Have you heard of anyone that would be a good fit?'"
4. Publicize locally and nationally, if applicable. If talking to physicians and colleagues doesn't turn up the perfect candidate, you can use the local paper and national publications and career sites to publicize as well. Ms. McMenemy says for lower-level positions, Craigslist is helpful, but she doesn't find it as effective for administrators. She says in her experience, administrator candidates tend to find ASC jobs through the local newspaper, national industry publications or sites such as Monster.com or CareerBuilder.com.
5. Conduct a pre-interview. Don't take every candidate who applies in front of your physician group and ask for feedback, Mr. Mulhall says. Instead, go through resumes and select a handful of qualified candidates for a pre-interview. Conduct a phone or in-person interview with those candidates and eliminate the people you know you would not hire.
Ms. McMenemy and Mr. Mulhall say they look for several traits upfront before they bring candidates in front of physicians. First of all, candidates must be personable, enthusiastic and easy to talk to, since these traits are essential for dealing with ASC employees, physicians, patients and consultants on a regular basis. Second of all, candidates must seem to be able to handle stressful situations. In other words, do they seem organized, level-headed and able to delegate, or will they fall apart when they are surprised by an ASC surveyor?
6. Check references and background. Before you take a candidate in front of your physician group, check references and background. You don't want your physicians to get excited about a candidate, only to find out that his or her references are terrible or the candidate lied about something on the resume.
7. Invite physicians to interview the candidate. Once you have narrowed the pool down to 3-5 candidates, ask your physicians if they are interested in participating in the interview process. Ms. McMenemy says physician participation can range from one physician sitting in on the interview to a group of 10 physicians conducting a "town hall"-style interview with each candidate.
When you weed out candidates, Mr. Mulhall recommends looking for traits that would not gel with your ASC physicians. "I can kind of weed out certain people based on what the physicians are going to react well to," Mr. Mulhall says. "I'll talk to them a lot about their past experience which will give me insight into how they deal with the physicians' questions."
8. Ask about prior experience. Mr. Mulhall says you can tell a lot about a candidate by asking pointed questions about prior experience. "I try to talk to them about their past experience and have them give me a real-life example of something they went through at a previous job," he says. "Then they take me through the process of correcting or reconciling the issue within that job." He says this question can help determine whether ASC administrators are able to delegate to other employees, whether they play favorites with staff members and whether they can operate under stress, among other issues.
9. Pitch a salary. Mr. Mulhall and Ms. McMenemy agree that you should go into a salary negotiation with an idea of how much you want to pay your new administrator. They recommend using ASC Association or VMG Health benchmarking data to determine how much administrators are paid in your region or based on your net revenue, case volume or number of operating rooms. Once you have researched the average salary for the position, you can ask the candidate, "What is your salary requirement?" or make an offer. If you ask for a salary requirement, you can either meet the requirement or make a new offer. If you make an offer, the candidate may ask for more money or accept your offer.
Keep in mind that you may have to offer more money if you have a limited pool of candidates. "If we have a significant pool of acceptable candidates, it may drive the [salary] down because we have a lot of people to pick from," Mr. Mulhall says. "If we have a smaller pool of candidates or a very strong candidate, the number may go up because we don't have [many choices]."
10. Orient the new administrator. An ASC administrator position involves many different tasks, all of which may require some orientation for the new employee. Mr. Mulhall says his company spends time with the new administrator on a day-to-day basis, going over policies and requiring the administrator to research accrediting body rules and CMS guidelines. After a few days of one-on-one instruction, the administrator does an informal sit-down with ASC staff and starts to get acclimated to the daily life of the center.
Ms. McMenemy says her company starts the administrator off with a three-day training program that goes over the goals for the next six months. The company leaders then sit down with the surgery center's lead physician to go over the necessary amount of communication between physician and administrator. "Does he want to be copied on everything, or does he just want a weekly meeting, or does he want the administrator to just call when he's needed?" she says. She says the company also keeps a spreadsheet for the administrator that outlines the necessary tasks to successfully open the surgery center.
Related Articles on ASC Operations:
5 Best Practices for Marketing Surgery Center Physicians on the Web
Section 179: Last Call for Large Capex Deductions in 2011
5 ASC Budget-Related Statistics to Track and Benchmark