Paragon Surgery Center administrator on developing positive relationships with physicians and staff

Deborah Herdman, RN, is administrator at Paragon Surgery Center in St. Thomas, U.S. Virgin Islands.

Ms. Herdman will serve on the panel “What Administrators Need to Thrive in the Next 24 Months” at Becker’s ASC Annual Meeting. As part of an ongoing series, Becker’s is talking to healthcare leaders who plan to speak at the conference on Oct. 27-29 in Chicago.

To learn more and register, click here.

Editors note: This article experienced a delay in publishing. Mentions of the Becker's ASC Annual Meeting are in reference to the October 2022 event.

Question: What is the smartest thing you’ve done in the last year to set your organization up for success?

Deborah Herdman: One of things that the director of operations and I are working on is cross training of staff. With the exception of one nurse, we initiated the cross training so that our pre-op and PACU nurses can circulate in surgery and in procedures. We are a small facility and being on an island, it’s a challenge to get experienced staff. We’re providing opportunities for our staff to enhance their skills and capitalize on their strengths. We encourage staff to be engaged and to develop their own skills to support their value. We think the staff is excited and pretty happy about being able to provide care in more than just one area. Our employees that staff the registration area also provide a bit of financial counseling to patients and families, plus they can also provide care as a medical assistant helping to get patients ready and to discharge them. Everyone here feels that they will do anything to help patients and their families to ensure they have an excellent experience at our Center.

The second thing is we purchased an EMR and oftentimes, surgery centers this size can’t afford to make that investment. We are very limited on space and were in a sea of paper charts, so we made the decision to go ahead and get the EMR. We also enhanced our chart to include extended follow-up phone interviews for patients.

Q: What are you most excited about right now and what makes you nervous?

DH: We are most excited about CMS expanding the procedure list for surgery centers. There are many procedures that are being done in the hospital that could be safely done at the surgery center.

What makes me nervous is that it seems to be very challenging to stay in compliance with all the required reporting. This additional work often comes with additional operational costs that require balancing against declining reimbursement.

Another issue that makes me nervous is the cost of new technology which is needed in order to stay competitive. For example, one of the surgery centers that I worked with previously had a surgical robot. That costs over a million dollars, and that’s the older model robot. For many physicians, it’s unsatisfactory to use older technology.

Q: How are you thinking about growth over the next 12 months?

DH: First of all, keeping our current customers –- physicians and patients –- happy by doing whatever we can to facilitate scheduling and throughput is essential. Streamlining processes and building relationships is vital. Retaining customers is always more economical than obtaining new ones. Physicians will be forgiving of workflow interruptions when they know you’re on their side and doing everything that possible to facilitate their time with us and make it as efficient as possible. As an example, we’ve had some physicians express concerns about codes being changed, and so I talked with our billing company and shared their concerns that physicians are ultimately responsible for coding and that the coders cannot change the code without having a discussion with the physician. We set up a program to easily notify us when we need to discuss concerns about a code before billing is finalized. This has been successful and a big relief to physicians. Things like that — showing the physicians that you really are on their team. Our entire staff has this mindset. If they see something that needs intervention, they will step up and make a suggestion as to how it might be done better.

Of course, as a newer ASC, we’re also looking to recruit new physicians. We ask them to come visit our Center and meet the staff, keep them updated on our activities, and review their procedures to assure them that we can safely and efficiently provide the highest quality care to their patients.

Q: What will healthcare executives and leaders need to be effective leaders for the next five years?

DH: We need to continuously develop ourselves professionally and personally. Cultivating good networking skills provides shared learning opportunities. 

Develop an annual, dynamic strategic plan and encourage your governing board to be engaged in projects which will be essential to moving that agenda forward.

Communication and diplomacy are fundamental. Perfecting a high degree of emotional intelligence will shape our ability to not only deal with a variety of personalities but also with generational and cultural diversities.

Q: What is your strategy for recruiting and retaining great teams?

DH: Being a small Center, our staff and our physicians are our work family. If somebody’s been struggling with something, we take the time to nurture them. Together, we take the time to recognize any accomplishments — personal and professional — both at our team meetings and one-on-one. We have two managers and we’ve empowered them to recognize people on-the- spot and they are very good at it. I don’t think we really had to train them to do that; instinctively it was just there.

We have monthly team meetings, and all staff can add to the agenda for discussion of any issues that are important to them. Our meetings are open and flexible and any physician or board member is welcome to join us. 

Our physicians contribute to staff education by making presentations about their specialties and provide some of the mandatory annual education. We have an electronic education program and every quarter we select courses and get feedback from the staff on the quality and relevance of the programs. We also get input from the staff regarding what they are interested in learning more about, such as: Excel, Word, foreign languages, etcetera. We ask them, “What would be the most useful for you?” So, it’s not only focused on the professional, it’s also for personal enhancement.

We have an internship program with the Department of Labor here. They will send us candidates to interview that we can select to work for 12 weeks with us. It’s about 360 hours and the Department of Labor pays for their time here. The other internship we’re working on is with the University of Virgin Islands with their college of nursing. It’s exciting to see that students can develop an interest and a better understanding of perioperative nursing and it is an opportunity for us to perhaps grow our own staff — and oftentimes they want to stay once the student is immersed in our environment.

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