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Eliminate Staffing Overlaps: 7 Strategies to Run a Lean ASC

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Mary SturmSurgical Management Professionals Senior Vice President of Clinical Operations Mary Sturm discusses seven tactics to eliminate staffing issues for more efficient and cost-effective ASC staffing.

1. Assess the staffing plan daily. "One of the most important things ASC administrators can do to avoid staffing issues is create a specific staffing plan for every day based on the surgery schedule for the following day," says Ms. Sturm. "By doing that, the manager can tweak the arrival time of staff and somewhat predict their departure times."

For instance, if the typical shift is 6:30 a.m. to 3 p.m., but no cases are scheduled until 9 a.m. the next day, notify the staff member they don't need to arrive until 8:30 a.m. "It's extra work for the managers, but it's worth it to save staffing dollars to fine-tune the centers staffing schedule every day," says Ms. Sturm. "It requires some oversight from the ASC managers."

2. Monitor end-of-day work and send staff home early. The ASC manager is also responsible for monitoring when staff members clock-in and clock-out to reduce overtime when possible. During the afternoon, managers can also review whether to discharge staff early.

"The manager needs to evaluate the remaining work at the end of every day and monitor whether surgery center staff should be clocking out and going home," says Ms. Sturm. "There is a tendency for people to hang around and look busy, but when you really evaluate it, there is no purpose for having a full complement of individuals there with little work to be done."

3. Compress the surgery schedule. From a staffing perspective it doesn't make sense to have someone working cases in the morning, take a three hour break, and then work a few more cases in the afternoon. While surgeons may want to schedule cases at different times, it's difficult to keep staff busy during the downtime and you can incur significant savings with compressed schedules.

"If you can work with the scheduling staff and surgeons to compress that gap and avoid staffing issues, it's great," says Ms. Sturm. "Sometimes that's a real challenge because surgeons might have a block at the hospital in the morning or clinic time in the afternoon and can't bring cases in at different times to the ASC. If you have gaps and can't compress your schedule, the leaders need to work with the staff to remain productive and have expectations for productivity when cases aren't going on."

4. Benchmark and predict staffing needs. Each center works with a different set of circumstances that impact staffing needs. Case mix, volume and surgeon preferences all have an impact on how the center is staffed. Whenever possible, benchmark against similar centers to see where there's an opportunity to improve.

"Benchmarking data can give you some productivity measurements based on your volume and case mix," says Ms. Sturm. "It's one tool managers have to evaluate where they are in the scheme of other centers doing similar things. They can examine their payroll report and benchmark changes from month to month to see whether payroll is creeping up, even when case volume is static or declining."

5. Monitor overtime and eliminate where possible. Staffing and practice management software make it easy for managers to monitor overtime. Sometimes overtime is unavoidable — circumstances dictate nurses or staff members stay late to finish a case — but that doesn't mean working overtime is inevitable for that pay period.

"The manager can let a nurse leave early on another day to make up that time," says Ms. Sturm. "The recurrent theme here is it takes diligence on the part of the ASC leadership to understand their roll in managing labor expense and overtime for that responsibility. It doesn't happen in a void; it's something that takes some effort and assembly every day."

6. Create upfront expectations on flexible scheduling. Staff members don't like giving up overtime hours, and in some cases have come to expect it. However, as ASC managers running a lean organization can't allow excess staffing expenses. The best way to create a culture of flexible scheduling is by mentioning it upfront to new employees.

"Set the stage for people during the hiring process; tell them flexible schedules is the culture and expectation of your organization and make sure that will work for them," says Ms. Sturm. "However, it's a real balancing act for the manager because most people need some semblance of steady income."

Focusing too much on "low census" time might drive good employees to look for work elsewhere because they can't cover their expenses. "I never want to lose great staff over mandating low census," says Ms. Sturm.

7. Use staff attrition to your advantage. Staffing overlap issues can sometimes resolve themselves through staff attrition. When a staff member leaves, carefully consider whether a new staff member is needed to fill that vacancy, or whether someone already on staff can pick up the hours.

"If you are having a decline in your schedule — maybe you lost a practitioner or two, or something happened to reduce your volume — you can reconsider whether to fill that spot," says Ms. Sturm. "Maybe that position was full time and now you can make it a part time position. That takes critical thinking to see where the opportunities are to tighten up staffing."

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