1. On-time case starts. Surgery centers are by nature more efficient than hospitals, and surgeons expect to take advantage of that efficiency when they invest or bring their cases to the center. Lynn Dugan, RN, BSN, administrator of Paramount Surgery Center of Mesa (Ariz.), says when a surgeon first arrives at her surgery center, she sets clear expectations about timeliness and explains that when one surgeon is late, it affects the other scheduled cases. She then monitors physician start times and brings the data to the governing board to review.
"If it's just random and minor and we know that, that's fine, but if it's chronic, the governing board might make the decision to have a financial penalty toward the physician causing delays," she says. Ms. Dugan says she has also given her director of nursing and charge nurse authority to bump the chronically late surgeon if necessary.
Jared Leger, CEO and managing partner of Arise Healthcare, says surgery centers can provide designated physician parking to make it easier for physicians to get to the surgery center. "We try to do things to make them more efficient," he says. "We have designated parking so the doctor can park there and then walk into the ASC through the back entrance." He says this provides an advantage over the hospital, which will probably ask physicians to park further away in a parking garage.
2. Flexible scheduling. Chris Metz, MD, an orthopedic surgeon with Brainerd Lakes Surgery Center in Baxter, Minn., says while the normal start time at his surgery center is 7:15 a.m., the staff will start cases at 6:30 a.m. if needed. He says he appreciates being able to perform bigger procedures after less-complex procedures, rather than having to perform big cases back-to-back and causing delays.
Try to accommodate physicians when they want to add cases at the last minute, David Kelly, MBA, CASC, administrator of Samaritan North Surgery Center in Dayton, Ohio, and employee of Health Inventures, says. At his surgery center, the scheduler tries to keep available time on the schedule every day so patients can be scheduled at short notice. "You have to have free time in your schedule so it's not all blocked," he says. "Try to have one room per day in the morning or afternoon where you can put those extra cases."
Ms. Dugan says her ASC tries to make scheduling easier by building a relationship with the physician office. Her staff has developed a binder for the physician office scheduler that includes information on the key contacts in the surgery center, a template for the H&P, order form and patient information form and a list of the items the patient should receive prior to surgery. "We set up a one-on-one meeting between the office scheduler and the surgery center scheduler, and the surgery center scheduler goes to the office and brings the binder and talks to them about how we do it here," she says. She says establishing a face-to-face relationship is the best thing you can do to make sure your physician's cases are brought to the ASC.
3. Appropriate equipment and supplies. Nothing is more frustrating for a physician than arriving at the operating room to find that the center has laid out inappropriate equipment, Mr. Kelly says. He says his specialty resource nurse tries to keep physician preference cards up-to-date by paying attention to physician requests. "It'll send a physician over the edge if they think, 'I've told you five times that I don't use this or I want something else,'" Mr. Kelly says.
Ms. Dugan adds that physicians get frustrated when they notice staff members opening an expensive supply that is not appropriate for the case. "Physicians know that if you open the wrong stent or the wrong supply, that can [offset] the profit of the case," she says. "You need to educate the staff to make sure they understand the surgeons see the center as a business."
Her ASC staff has created a high-cost item spreadsheet that staff references to make sure they understand supply costs. "We have a policy in place that says no high-cost item will be opened until it's been verified with the surgeon and surgical tech prior to the case," she says.
4. Knowledgeable staff. Happy physicians love their team and enjoy working with them, Ms. Dugan says. Ideally, you should try to keep effective ASC staff members working at your center for as long as possible. They will become experts in your physicians' procedures, and your physicians will get used to working with the same, competent people. Ms. Dugan says she tries to boost employee longevity by letting staff members know they are appreciated on a regular basis. "I'm a big believer in team-building, so we celebrate everyone's birthday, Nurses Day and Tech Day," she says. "It's the small things that make people want to come to work."
While you would ideally like to keep your top workers for as long as possible, sometimes staff members have to leave and you are forced to hire new people. Ms. Dugan recommends using a temp agency to hire new staff members for the front office. "You pay more up front, but if they're not a good fit, you don't have to go through all the termination paperwork," she says. For clinical staff, she hires PRN initially and then moves people to full-time status once she knows they fit well with the center. She also recommends looking for team members with ASC experience.
Mr. Leger says surgery centers can please physicians by involving them in the hiring process as well. When an Arise surgery center needs a new team member, the administrator asks the physicians for their input. For example, he says if an ASC needs a new surgical tech, the physicians can usually recommend a few people to come in for interviews.
5. Notification of staffing changes prior to surgery. You may have to add an unfamiliar face to the OR if one of your staff members calls in sick or goes on vacation, Ms. Dugan says. But if you are replacing a familiar staff member with someone the physician has never met before, make sure to notify the physician beforehand to prepare him or her for the change. Let them know you have screened and hired a temporary staff member and invite the physician to give feedback on how the new person performs. "If the surgeon walks in and doesn't recognize the people, they automatically assume the [new staff members] don't know what they're doing," she says.
6. Efficient case turnover. Dr. Metz says many physicians open or join surgery centers for the added efficiency, so short waiting times and prompt case turnover is essential. "We came from a hospital that wasn't necessarily as efficient as we wanted, and the ability to balance cases has been a nice change from that situation," he says.
Surgery centers are challenged to keep room turnovers efficient without overstaffing and losing money, Ms. Dugan says. If possible, the ASC should use a "floating team" to keep an eye on each room while physicians are working. "Especially if you're running multiple ORs, you need a charge person and a surgical tech or assistant to keep an eye on what's happening with each room and who's going to be done quicker," she says. New infection control guidelines require more in-depth cleaning, so you may need to allow for 10 minutes to prepare a room for the next case.
She says surgery centers can also improve room turnovers by making a note when a room will transition from a complicated, equipment-heavy case to a simpler case. "If you're doing a very large sinus case that has tons of equipment and then you're doing another one that's somewhat simple, you need more turnover time to get that equipment out," she says. "If you put that in the schedule, the surgeon sees that it's not affecting their time."
7. No case cancellations due to inadequate screening. Mr. Kelly says physicians will become easily frustrated if the ASC has to cancel cases due to inadequate patient screening. Case cancellation hurts patient satisfaction and revenue and disrupts the physician's schedule, so it should be avoided whenever possible. At his surgery center, the anesthesiologists provide the guidelines for preoperative phone calls, and staff members follow those guidelines to catch any patients that are at increased risk of complications. This could mean patients who are overweight, suffer from sleep apnea or respiratory problems or have a history of adverse reactions to anesthesia. "If they're over a certain age or have a history of heart disease, they may need an EKG ahead of time," he says. Preoperative phone call staff should ask clear, direct questions that get to the root of the patient's history and current medication use. Additionally, leveraging technology, like an online pre-op assessment tool where the patient enters his own health history at his leisure and his own pace, is a great way to get complete information.
Dr. Metz says patients should also be fully prepared for their surgery by the time they arrive at the surgery center. "I think the physician clinics that refer patients here are all about education and making sure patients are comfortable with what's going to happen to them," he says. Surgery centers should make sure to distribute information on the surgical procedure and process to avoid panicked or confused patients on the day of surgery.
8. Satisfied patients. Patient satisfaction can be impacted by a variety of factors, including wait times, staff attitude and postoperative recovery. Physicians want their patients to report a satisfying experience in the surgery center, so your relationship with your surgeons will suffer if your staff is rude or your cases are significantly delayed. Make sure that staff are coached on friendly, professional behavior, and ensure that when case delays occur, you apologize to the waiting patient and keep them up-to-date on the situation. Mr. Leger says surgery centers can also go the extra mile by providing tracking tools in the waiting room to inform family members of the surgery's progress. "We have an LDC monitor that shows the patient's initials and where they're at in the process," he says.
Mr. Kelly says patient satisfaction can also be impacted by the instructions they receive for postoperative care. "One of the challenges we all have is that patients and family members do not always remember what you tell them, so our goal is to provide comprehensive discharge instructions," he says. "It minimizes headaches for the doctors by increasing compliance with post-op care. The doctors don't want a patient coming into the office and saying they didn't know what they were supposed to do after surgery."
9. Decisions supported with data and benchmarking. Surgery centers with limited budgets can't please every physician by using 10 different vendors for the same supply within a specialty, Mr. Kelly says. In these cases, you may have to explain to your physicians that you can't afford the "latest and greatest" technology they would like, and you would prefer them to standardize some supplies to save money. To effectively communicate this to your physicians, use data and benchmarking tools to back up your decision, he says. "They want information in terms of trending, showing benchmarks and highlighting actual expense compared to budget," he says. "Physicians are very competitive, so they don't want to see their name in last place [when it comes to cost]."
Mr. Leger says partner physicians are "trained to analyze data," meaning surgery centers should present financials rather than trying to convince them with anecdotes. He says his surgery centers give physicians a 15-page financial report as well as a front-page summary sheet that addresses financial progress. "If the physician is busy, it takes five minutes to read the study and understand how we're doing," he says.
10. Someone to act as a "go-between" to facilitate positive hospital and physician partnerships. If your surgery center has investor partners, the administrator should act as a "middle man" to create a mutually favorable relationship between the parties, Mr. Kelly says. "The doctor wants to focus on providing quality clinical care, which the hospital desires as well, while also being fiscally responsible," he says. "As the administrator, you've got to act as the go-between and help build those relationships by bridging the gap in each partner’s vision of success and deliver results." These partnerships need this "middle man" to bring the hospital and physicians together to implement successful business plans from what is sometimes perceived as competing or unaligned priorities. This is especially important to soothe tensions in cases where they were previously competitors.
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