Here are five ways ambulatory surgery centers administrators can cut costs by containing staffing costs.
1. Stick to the benchmarks. A multi specialty ASC doing in excess of 300 cases per month should have no more than 10 to 11 hours worked per patient depending on the type of cases performed at the center. Staffing costs have a big impact on the ASC's bottom line.
"The conclusion is that 12.5 hours worked versus 11.0 seems innocuous enough, but it costs $250,000 of net income per year for your center and the investors without any slip in quality of care," Founding Partner of ASD Management Joe Zasa says. An overstaffed center looks very similar to a properly staffed center; thus, use benchmarks to identify potential areas where there are problems, and ask questions. Ultimately, a team approach to staffing is the best way rather than relying on one person to determine staffing patterns.
"The collaborative approach is the best because it creates checks and balances and allows input to hone the correct staffing for your center," says Mr. Zasa.
This benchmark is for productive work hours, which includes patient care prior to, during and after surgery. The preadmission process and postoperative calls, staff education, staff meetings and employees working at the center are all included in the benchmark. The benchmark does not include non-productive paid work hours, vacation, sick leave or jury duty.
2. Set clear expectations with staff. Many ASCs recruit employees directly from the hospital setting, meaning potential employees may be used to a set schedule and pre-determined hours. During the interview process, Mary Sturm, RN, director of patient care services for Surgical Management Professionals recommends you let candidates know that working at an ASC means accepting a flexible schedule. "They need to understand there are rarely guaranteed hour situations, and even full-time people are asked to either not come in or leave early on a slow day," she says.
Honesty and clarity is essential during the interview process to prevent hostility later on, she says. If you let candidates know about your staffing policy, you will probably end up hiring people who understand the financial constraints of an ASC. She says this up-front attitude is even more important in the current economy, when candidates are often looking for full-time employment.
3. Give staff projects when the schedule is light. If you send your core staff members home when the schedule is light, they may become frustrated with the surgery center and seek employment elsewhere. Instead, find projects for staff members to complete on slower days, so that your ASC remains productive while maintaining staff loyalty. Jesseye Arrambide, RN, BSN, CNOR, executive director of Oregon Outpatient Surgery Center in Tigard, says her OR staff members will work on preference cards or complete an assigned monthly chore, such as cleaning out cabinets, wiping down stretchers or cleaning out refrigerators.
"Sometimes we'll have focused studies in our charting for quality improvement, and I'll say, 'You guys need to review this many charts and this is what we're looking for,'" Ms. Arrambide says. She takes staff suggestions for improvement projects, touting a relatively 'flat' management structure that allows for contribution at all levels. "I really like getting suggestions from the staff," she says. "I like to say that collectively, we have hundreds of years of experience."
4. Make sure employees are performing appropriate tasks. In many cases, higher-paid staff are doing tasks that could have been done by people paid a lot less. For example, operative nurses paid $30 an hour might be assigned to scanning documents or calling patients for satisfaction surveys. This work could easily be done by staff earning $10-$15 an hour.
"With salaries making up [a significant portion] of a center's budget, this waste of high-paid staff can add up," Jeff Blankinship, president of Surgical Notes, says. The solution? Ask employees to list each and every task he or she performs. Then closely review these detailed job descriptions to determine which tasks could be shifted to best reflect the skills of each person.
5. Embrace the working manager role. ASC administrators should manage the center efficiently but also work to fill in other roles where needed; the manager just can't delegate to other employees. There must be a balance between clinical and administrative duties. Remember, the manager should not hire people to do their job. If so, the result is an $80,000 reduction in income per employee.
"Cross training is an obvious way to effectively reduce your costs," says Mr. Zasa. "We believe [staffing goals] are easily achievable if our administrators embrace the working manager model instead of hiring additional employees."
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