Q: You joined Greenspring in June 2009 and were faced with a few challenges — one being time management and efficiency issues. How did you identify and address these issues at the center?
Georganna Howell: There were issues with time management across the center. Surgeons were not appropriately scheduling cases and had built in a 30-minute turnover time. The staffing pattern and physical flow of the center had no rhyme or reason with regard to how patients were moving about the center.
I first began by asking surgeons if they could cut their turnaround time down to six to eight minutes and explained that they would be able to bring in more cases. Any change leads to some resistance, so I began with the physicians on the board. By reducing our turnaround time we have seen our business increase by 40 percent. The surgeons came on board because they could see it in the bottom line.
I had to take time to work with the staff on this issue. This was a group of people who were used to the luxury of having the additional time to prep patients for the OR. I faced the challenge of asking them and demonstrating that they could do this task quickly and appropriately in 10-15 minutes.
We also redesigned the flow of the center, putting anesthesia closer to the ORs and the ORs closer to the PACUs. I took the time to explain to those who were being moved the cost and efficiency reasons for why we made the decision.
Q: How did you manage to bring staff members on board with the changes in the schedule and patient flow?
GH: You have to include everyone in on the process. In my case, I created a plan of action, which I presented to the board. We then brought the plan to the staff level. Everyone was willing to at least give it a try. We ran trials and then received feedback on what worked well and what didn’t work and then made changes before rolling out the plan.
Q: Inventory control was another challenge you faced coming into Greenspring. What were some of the ASC’s issues and how did you address them?
GH: We were overstocked, which can easily happen. ASCs often think if you have one, you will need five, in case something happens. Again, I started at the board level and asked the surgeons to figure out how many cases they typically performed in two weeks. Then we figured out the time lapse between when we ordered supplies and when they arrived to determine how many of each supply we truly needed to have on-hand at a given time. We also looked at where we could standardize items on the shelves.
Next, I rebuilt our surgical packs. We are an orthopedics surgery center, so our surgeons tend to use the same pack. We had to look at a separate pack for our pain management physicians as well. I asked the surgeons to rethink what they needed in the packs and then put together the new ones. Next, I shopped the packs around to suppliers to find the best price.
As a result of these two methods, we have reduced inventory by 60 percent, which would otherwise be wasted money on the shelf.
Q: What suggestions do you have for other ASCs when shopping surgical packs to vendors?
GH: First of all, you have to know what’s in your pack. You don’t want to be in negotiations and not know what you are looking for. Also, make sure you read your contracts with your suppliers and group purchasing organization to see what they have and then shop around. Pick three sources. I think picking more than three is just wasted time, because you will typically find your top two choices and throw out one based on quality.
Make sure you trial each pack, because that’s your truth. If the supplier gives you an inferior product, they are out of the running. Consult with your physicians. Discuss what they think and make sure they all agree on the pack. Tweak your pack if necessary and see if substitutions result in substantial charges. Then go back to the supplier and see if they’re willing to work with you.
I think we tend to forget that we are the consumer for our suppliers. We spend our days taking such good care of patients we tend to be empathetic in all situations, and we forget to be a rock solid business person. I’ve found that when you tell a supplier that you are going to be purchasing thousands of these supplies in a year, they will be more willing to cooperate.
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