Risk aversion, noncompliance + more: 8 internal threats ASCs should know

Pinpointing and addressing internal threats is critical for ASCs to operate successfully and deliver optimal patient care. 

Here, seven ASC leaders spoke with Becker's ASC Review about the internal factors affecting ASCs. 

Editor's note: Responses were edited lightly for clarity and brevity.

1. Noncompliance

Christina Holloway. Administrator of ASC Bala Cynwyd (Pa.): The biggest internal threat to ASCs, and many healthcare organizations, is noncompliance. Lack of consistency in processes and leadership oversight generate subpar documentation and inefficiencies. This can permeate through many levels of an organization and have a direct tangible impact on supply surplus and scheduling inaccuracies. These issues can easily escalate to more complex organizational loss. 

2. Lack of staff education

Tracy Helmer, BSN, RN. Administrator of Seven Hills ASC (Las Vegas): One thing that can be an internally originated threat to an ASC is a term I call economic ignorance. This is a phenomenon where staff are not always aware of the financial needs for efficiency and prudent use of supplies, implants, etc.required to keep the ASC profitable in an environment where reimbursement is so much lower. Transparency and education of staff helps them learn how to provide excellent care in a cost-effective manner for our patients.

3. Lack of staff dedication, engagement

T. Taylor Burnett. CEO of The Plastic Surgical Center of Mississippi (Flowood): I do some consulting work and see the following most often: failure of the ASC management to understand its costs and reimbursements; lack of dedicated staff to manage costs or supplies; and lack of dedicated staff managing reimbursements updates. 

I also see a failure to value assets, including staff, on the subject. The cost to hire, orient and train new staff is staggering. Keep and value what you have. Good staff can 100 percent make or break you.

4. Risk aversion

Alfonso del Granado, CASC. Administrator of Covenant High Plains Surgery Center (Lubbock, Texas): I think the biggest threat to ASCs from within is excess caution. I think we're all a little shell-shocked and would like to avoid taking risks —  as well as recover financially. This is completely understandable, but there are two sides to this population. On one hand, centers that have the means and will to invest in future growth opportunities will be better placed to attract new surgeons with the latest equipment and offer patients the latest treatment options. On the opposite end are the overly cautious centers that will not replace aging equipment nor rehire personnel until the numbers have fully recovered. This leads to loss of surgeon confidence and increased staff attrition. I think those centers will suffer the most in the long term.

5. Inadequate staffing

Valerie Thiele, RN, CASC. Administrator of Madison Street Surgery Center (Denver, Colo.): Our biggest threat currently is maintaining adequate staffing levels and recruitment of new talent. Once a registered nurse leaves the company, replacing the talent is extremely challenging. I feel there is a shrinking pool of RNs looking for new opportunities.

Tammy Stanfield, BSN, RN. Administrator and Director of Nursing of North Pines Surgery Center (Conroe, Texas): Clinically, we have 10 full-time employees and two part-time RN employees. We have to have a versatile staff. There are three pro re nata RNs that work in preoperative care, postoperative care and the perianesthesia care unit. Both part-timers can run an operating room, work in a preoperative setting and/or the PACU. Our administrator can also work in the operating room, preoperative setting and the PACU as a last resort. Since we have a small staff, vacation time must be spread out amongst us — allowing one person at a time to take paid time off.

6. Overdoing outpatient in the ambulatory setting

David Horace. Administrator and Owner of Bel-Clair Surgical Center (Belleville, Ill.): The biggest threat from within is when desire to do more cases outweighs the medical appropriateness of cases that should be performed in an ambulatory setting. The elimination of the inpatient-only list should allow for many more cases to be performed in the ASC setting, but that freedom to do more cases cannot be abused by allowing patients who are at higher risk to be performed in an inappropriate setting.

7. Staff health

Ms. Stanfield: We are small and independent. Our biggest concerns are illnesses such as the flu and COVID-19 — if several staff members are affected. Flu shots are given every year by the facility. Most staff have had their COVID-19 vaccine. We have not experienced this, but we are a small team. 

8. Emergency preparedness

Ms. Stanfield: We stay abreast of any disturbances in the Gulf of Mexico that could develop into a storm system or hurricane. Emergency preparedness is on the forefront of our minds during this time. Fortunately, our governing board of physicians will allow us to reschedule patients during any of these times in an effort to keep all patients, staff and physicians safe — the most recent was an ice storm in Texas.

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