Leading a Surgery Center During a Time of Change: Q&A With John Wipfler and Linda Ruterbories of Orthopaedic Surgery Center
John Wipfler, CEO of OA Centers for Orthopaedics in Portland, and Linda Ruterbories, ANP, director of OA's Orthopaedic Surgery Center, discuss the process and challenges of leading an ambulatory surgery center through times of change.
Q: How do you approach change as a surgery center leader?
John Wipfler: As leaders, we need to be very focused on how to be creative and adaptive, and create organizations that are very fluid. Change is the new "normal." We have to be constantly moving our organization and seeing the change as an opportunity — you can't allow it to overwhelm you or view it as something that's fearful.
Q: What significant sources of change do you face in your practice today?
JW: Our payor relationships are all related to our clinic practice. We want to partner with businesses looking for greater value in healthcare and figure out how to deliver that. Under the "tiering and steering" model, large employers are talking about identifying providers and facilities that provide high quality and a lower cost, and then "steering" their beneficiaries to those providers. Healthcare is increasingly defined by the relationship of cost and quality, and surgery centers have a leg up all around on both of those items.
We have to think about how we position ourselves so that people who are sending patients to us realize we provide that great value and high quality. We're building those kinds of partnerships by working with other physician practices in Maine and aligning ourselves with other specialists. We want to be able to compete as specialists in the new accountable care organization world as it evolves — we created an alliance through a specialty Independent Practice Association that puts us in a good position to compete for contracts.
Q: How do you motivate your employees to adapt in times of change?
JW: You need to manage your staff and physicians so that they can come along with you. You need a high level of communication, and you need to be as transparent as possible with everybody.
Linda Ruterbories: We're lucky to have creative individuals in leadership positions and employees who are excited about challenges and change, and they feel accountable when we're making a change and want to be a part of it.
JW: A piece of this is creating an organizational culture, where all of the staff are engaged in knowing that change is necessary and part of our expectation. That allows them to really throw themselves fully into whatever the initiative is. When we're hiring and training, we're creating an environment and an expectation where people understand that there needs to be a lot of adaptability. If you have that underlying culture, managing the change gets easier. In our surgery center, which Linda directs, they're really great at identifying how to drive costs down, how to serve the patients better and how to make the patient experience higher quality — they're always looking for a better way.
Q: What qualities do you look for in prospective employees to ensure that you are building an adaptable team?
LR: I'm constantly interviewing to find the right candidate, even if there is not a position open. If I'm sent a resume, I'll bring them in and say, "While there's no position available right now, I'd like to interview you and in the event that something comes up, we will call you. During the interview process we'll discuss our different ideas and mindsets related to change and the important aspects of patient care. If a position opens up, I'll call the candidate who was the best fit and ask if they would like to start per diem full time.
During that time we can gauge their work ethic and mindset, and at the same, they can evaluate us. So that after spending about 12 weeks here, we determine whether or not it's a good fit. I get the majority of the full-time employees that way — I would say the per diem employees work out 80 percent of the time.
JW: Also, somebody who's willing to step into a per diem position has more ability to take on risk. A per diem position is riskier because you're not in a locked-down employed position, and if you're willing to do that, you probably have a more fluid mind and approach in terms of being able to step out of the normal construct of how you do things.
LR: When you have per diem employees, if a full time employee leaves, you know you'll always have somebody in training to replace them — there are no gaps in time where the other employees are stretched to cover the open positions.
Q: What have been some of your greatest leadership challenges and how have you overcome them?
JW: When leaders face resistance from employees, it can feel like they're being challenged. Resistance often means we are not communicating the change effectively enough or not engaging everybody effectively enough. Maybe we're moving too fast and not giving enough information, and people don't understand why the change is happening. Resistance allows us to slow down, communicate more and really ask people where the resistance is coming from.
LR: Our expectation is that we're going to have a period of resistance going on regardless. It's just a matter of whether that period is going to be longer or shorter.
JW: You have to expect it and put it in the right context. You have to think, "This is telling us something about how we're not doing this as effectively as we could be, so let's figure out where we're dropping the ball." Any sort of change is a complicated process, but it's rewarding when you can boost it effectively and create an organization that's fluid.
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