Their first objective was to convince the staff and physicians that their problems could be fixed. “We really had to get the people on board for us to implement any change,” says Ms. Hargrave-Thomas. “Once we could get the staff and the physicians behind us, we knew the quality would improve. The staff and physicians really did care with their heart and soul about their organization, they just didn’t have the right tools in place to succeed.”
They spent the first year and a half correcting “people problems” and bringing everyone together into a more cohesive group. The ASC’s medical director Kevin Neff, MD, was instrumental in helping the facility to achieve this goal, which was fully realized by breaking down the barriers that existed within and between departments.
“In most ASC’s you have several different departments — business office, pre-op holding, recovery and the operating room,” says Ms. Hargrave-Thomas. “In our facility and many of the facilities I’ve been in, staff felt their department was ‘their little world and nobody was going to come into their world and tell them what to do’ and they had no reference to appreciate what went on or happened in anyone else’s ‘little world.’ One of our main objectives was to get our staff to work better by improving how we communicated, because we knew our patient care would improve with better communication between the different areas.”
The breaking down of the barriers was ultimately achieved through cross-training of the peri-operative staff and opening up all communication channels.
Beginning the cross-training program
The cross-training program took about a year to develop and implement at the ASC (which was recently named a Great Surgery Center to Work For by Becker’s ASC Review). “First, we identified a few key people — those that were interested — and worked with them,” says Ms. Butterfield. “People fear going into other places, so you need to take the brave ones, work with them so they can then go back to the less brave and let them know it wasn’t too bad. Eventually, everyone gets on board because they realize cross-training isn’t something to be scarred about and that the others that did it found it interesting and rewarding.”
Cross-training is typically performed on the slower days at the ASC. “We would buddy people up with a mentor to show them the ropes and keep anyone from feeling alone. There is nothing worse than “sink or swim” mentality, so we made sure to avoid that,” says Ms. Hargrave-Thomas. “I’d have to say that our staff have embraced stepping out of their box and gaining new experiences. Based on employee feedback they liked how we went about improving quality of patient care by expanding everyone’s knowledge of each others departments.”
Significant benefits realized
Now a few years into the program, the benefits to both patients and staff members is quite apparent.
“Some of the things we’ve seen is how much better everyone communicates, and it’s no longer the adage ‘its not my job’ but its about teamwork, every job is important no matter what it is,” says Ms. Hargrave-Thomas. “If we need an extra hand in the OR, I’ve got somebody I can pull from pre-op. If I need any extra hands in PACU, I can pull somebody from OR. It’s really made a difference.”
Ms. Butterfield says cross-training gives staff members a well-rounded look at a patient peri-operatively versus just their portion of the experience. “They get to see what everybody does and how everything affects the patient versus just what they did,” she says. “When you take a pre-op nurse through the cross-training experience, you’re not teaching her to become a circulating nurse but rather introducing her to why and what she does in pre-op is so important to what happens in the OR. Something as simple as shaving a person in pre-op makes a difference to the OR team, for example. The pre-op nurse learns that if they shave poorly or not enough, then the OR team has to waste time re-shaving and dealing with hair on the OR bed. It makes the ‘light bulb’ go off and makes them a more effective pre-op nurse. The same applies to taking a recovery room nurse through the cross-training experience. The nurse finally understands why a patient complained their arm hurt when it was their hand that had surgery, realizing it may have been a tourniquet that was applied. Now she can use that knowledge to better explain discharge instructions or what kind of complications a patient should look out for post-operatively.”
The same holds true for the business office, says Ms. Hargrave-Thomas. “We’ve cross-trained them all to do front desk, insurance verification, scheduling and accounts receivable,” she says. “Once they could see and touch what the other person’s job was, they discovered things like ‘this is why I need to make sure the addresses and demographic information are correct, because if I don’t do it right here, then the person on the back end doing A/R will have to clean that mess up and we see a delay in payment for us.’ Cross-training really makes everyone start thinking cause and effect.”
Learn more about Lakes Surgery Center.
Read more surgery center best practices:
– Critical Surgery Center Mistake: Failure to React to Departing Physician
– 5 Ways Pennsylvania’s Doylestown Surgery Center Saved $400K
– 5 Areas Profitable Surgery Centers are Still Leaving Money on the Table
