How to Find Elusive Efficiencies in ASCs

Andy WhitenerAren't we are all looking for operational efficiencies? It would seem after years of looking for inefficiencies we would have found them all and arrived at near perfection.

However, running an efficient surgery center or any service for that matter requires constant effort. Why? We are human and work with humans. Staff with good habits leave and new staff are hired that come in with different work habits and expectations. We have a tendency to let inefficiencies slip in and rarely do efficiencies do the same. We forget or compromise, "just this once." Over a couple of weeks the exception becomes the rule. This isn't to say the exception wasn't a good idea; it just needs to stay that way. Nevertheless, management has to be vigil to create a culture that embraces finding those elusive efficiencies. First and foremost, it is a team effort. The most impressive improvements I have seen to increase efficiencies are the result of all the stakeholders working together.


In every ASC, a looming opportunity is improving effective communication between the departments: the business office, pre-op, OR, CS and post-op. I don't care for the analogy but in many ways managing efficient surgeries are similar to an assembly line. Assembly lines run most efficient when each component has what it needs (supplies, patient, staff, physician, etc.) "just in time." Then no part of the assembly line is running faster or slower than the others. Rather they move in an intentionally coordinated fashion. If one component gets out of step there is unproductive time. The different departments in an ASC must communicate any changes from the schedule so adjustments can be made. An example would be calling patients to come in earlier when it is projected the flow is getting ahead. This would help minimize potential down time.

Gaps: Time Management

You may know the famous saying from the movie It's a Bug's Life, "gaps happen." Although gaps will happen they don't need to be wasted time. Keep a list of tasks that need to be completed and encourage staff to complete non-clinical tasks in between cases, if time permits (education, stocking, etc.). Eliminating gaps is a critical surgeon and center satisfier. Don't hesitate to request physicians to delay or move their schedule up 30 minutes. Physicians won't mind if they can do it and they trust you have done everything you can to maximize their time. It is also important when making such a request to make sure they know the request is just that, not a mandate.


Enforce in and out times for your staff. Write them on the schedule, if necessary, and then communicate that exceptions should be approved by their supervisor. Make sure your staff takes a lunch break. There is always more to do but much of it doesn't have to be completed during lunch as it always seems to get done in the normal course of the week.

Utilize your exempt clinical managers as second nurses in PACU when appropriate. That way you can release, for example, a PACU nurse early each day. Stagger start times in pre-op and post-op. A nurse manager can be second nurse at the start of day or at the end of the day, or to cover for lunch.

Stagger start times for office staff. Have one office staff member start 30 minutes late one day each week. I find it much easier if I need to tighten up on hours to ask staff to come in a little later as opposed to leave early. It is just more successful.

Sometimes when volume spikes we get behind in our office with routine duties and utilize one of our cross trained surgical techs to assist. My one request is we only use extra help in the office when we are below our budgeted hours/case. This also helps me align management and staff incentives, as we all have a vested interest in an efficient center.

When we do get a request for help I ask the requester to tell me how long it will take to complete a certain task and then stick to it. Enforcing this time limit is helpful, as most people want to achieve a target.

Releasing one tech from two-tech surgeries as early as possible can create efficiencies. In many cases the second tech is not needed the entire time. The released tech can stock the ORs, clean instruments perform daily tasks or help reduce turnover times in other rooms. At the end of each surgery our circulators announce overhead "turnover room three," for example. This lets any free hand know where turnover help is appreciated. This is a universal time saver as well as another satisfier for your surgeons.

Educate and mentor teammates on how to implement and assist in the efforts to create an efficient center. The opportunities you focus on as the administrator will become the focus of your staff. Eventually you want to establish a culture where your staff is coming to you with ideas. You will find the most opportunities and the best ideas for improvement come from the staff in the trenches!

The Best Staff

Reward those who make the best use of their time with more time on the schedule. Try and schedule your surgeons to work consistently with the same staff. There is no doubt that a team familiar with everyone's processes tends to be more efficient. One concept that management has to get comfortable with is the employee lifecycle: hiring, firing and growing staff. It is an ongoing process. The right team makes a big difference.


My last admonition is to myself. Don't be a "no first person." I struggle with this. Try different approaches. Keep in mind you can't step out of your box and try something just once to see if it works. I can almost assure you that the first time you try something different it won't have the intended outcome. Give any new procedure at least three to five opportunities to work. Even if it doesn't work I suspect all the participants will learn something that will contribute to better solutions.

Andy Whitener, MSPT, MBA
Administrator Gainesville Surgery Center
An affiliate of Surgical Care Affiliates

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