6 ASC administrators share the most challenging conversations they have ever had

Six ambulatory surgery center administrators discuss some of the most difficult conversations they have had over the course of their careers.

Question: What is the most difficult conversation you ever had with a colleague?

Kecia Norling, RN, CNOR, CASC, Administrator, Northwest Ambulatory Surgery Center, Portland, Ore.: The most difficult conversation I had was with my clinical director years ago. She was a great registered nurse who was very detail oriented and great at the paperwork part of the job. Unfortunately, she was not as strong at the leadership and human relationship part of the job. It became an issue that I couldn't ignore and I told her in a conversation that I needed to remove her as the clinical director.  

I offered to make her the quality assurance and performance improvement coordinator, but her feelings were instantly hurt and beyond repair. She quit her job, and I lost a great RN and a good friend. I learned the hard way that it is very difficult for the administrator to have friendships within the surgery center. I have analyzed the conversation many times to see if I could have handled it differently. Unfortunately, there are no easy ways to handle these difficult HR issues. I know I did the right thing as a boss, but I lost a friend in the process.

Seth Silver, MD, CEO and Medical Director, The Ambulatory Care Center, Vineland, N.J.: This past year a colleague of mine had extensive metastatic prostate cancer. His prognosis was very guarded and his overall function was deteriorating. His wife controlled his counseling. She felt if I was forthright with him he would die. So per the wife's wishes metastatic lesions were fractures, muscle pulls or painful reactions to medication. I was frequently requesting, reminding and notifying the radiation oncologist and OR oncologist to evaluate a lesion further. The difficulty for me was the lack of honesty with this patient, friend and colleague. He has died and I still do not know if I was right with how I counseled him.   

Terri Mahoney, BN, CNOR, CASC, Administrator, Bluffton-Okatie (S.C.) Surgery Center: I find the most difficult conversations come when the person [you are conversing with] has a lack of insight into themselves and/or their practice. I find during these situations it is often helpful to have a comparison available as well as something documented as a reference.
Kris Kilgore, RN, BSN, Administrative Director, Grand Rapids (Mich.) Ophthalmology Surgical Care Center: One of the most difficult conversations I had to have was when one of the physician owners wanted to add a case at noon on a day when the surgery schedule was full, and he told the surgical schedulers, who report to me, not to ask me or inform me about this case but to just add it.
My staff, who are loyal to me and know the proper protocol for adding procedures, called me to add this case. What the physician was demanding was not realistic as all of the operating rooms were in use all day.
I went to the clinic, located in the same building as the ASC, to discuss this issue with the physician. I asked if he had a few minutes to talk about his added case and then we went into an exam room and closed the door. I told him why we could not do the case at the day or time he requested but I gave him two other options of when he could add the case. He was not thrilled but chose the same day but with a 4:40 p.m. start time.  

The cases in the ASC would be done in one OR, and he would be finished with his clinic schedule. Then I put 'my big girl pants on' and discussed how his request made me feel disrespected and not important to my staff and other members of the healthcare team. I went on to explain the protocol I use to add cases, and that I never say no, but I look at the entire schedule to offer choices that work for the patient, the physician and the ASC.  I have learned with all my years of experience in this center and working with physicians that you can’t say no because they dig their heels in but you need to say 'let me look at all of the options' so you can choose one that works well for all of the people involved.
Patrick Haley, Administrator, Santa Cruz (Calif.) Surgery Center: Growing a business is always exciting, but on occasion the correct operational choice is to downsize. The hardest meeting I've had to hold was to announce to staff that cutbacks were on the horizon and that some of them would be out of work that day, while others would be terminated in the weeks to come.

Individual terminations are hard, but when making a group announcement of this type I found it important to be as clear, concise and brief as possible with the initial message. When emotions run high it seems the retention of what is said diminishes, and in a group setting the chatter begins immediately. It often feels easier when presenting this sort of information to talk circles around the core issue but it truly is best to hit it head on and in the simplest terms possible. Even if the message is an unfortunate one, you want everyone to walk away with the same understanding of what was just conveyed.
Sarah Malaniak, CASC, Administrator, Ambulatory Center for Endoscopy, North Bergen, N.J.: One of the most difficult conversations I've had to have was with an employee who had a child who was blind, and she was excessively absent. While I understood, her absenteeism was affecting the center. We had an open and honest discussion about her situation at home and the center, and she ultimately decided to resign on good terms, but it was a horrible conversation to have to have, especially since I have children of my own and can't imagine how hard that would be. I still keep in touch with her and she keeps me updated on her life. She was grateful for the patience I had with her while she worked at the center. But it was tough.

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