5 big dysfunctions in ASCs — And how to fix them

Janie Kinsey, RN, CASC, administrator at Saint Luke's Surgicenter—Lee's Summit discusses five big dysfunctions that can occur at ambulatory surgery centers and solutions to fix them.

1. Preoperative assessment chaos. When ASCs struggle with lopsided payment systems, it's difficult to budget the proper staffing to cover preoperative assessments. This is especially true as the population becomes heavier, sicker and older. "We must adapt our processes to grow with the times," says Ms. Kinsey.

Pre-anesthesia screening nurses are required in most centers to make this process smooth. In smaller centers, it can be the same person assigned to do that every day; in larger facilities one or more people can fill this role. "Adequately assessing and preparing for patients before they are in our centers will decrease same-day cancellations and delays," says Ms. Kinsey. "Additionally, this preparation increases patient and staff satisfaction."

2. Supply chain management — backordered supplies and increasing costs. The supply chain becomes dysfunctional as backordered items or pharmacy shortages mean ASCs don't have everything they need to host cases when scheduled. "It can be challenging to ensure that all the necessary items are available for each and every case," says Ms. Kinsey.

Dedicated supply chain management staff can reduce stresses with backorders and rising prices. Assign materials managers to monitor specific supply or pharmacy item subsets.

"For example, a scrub tech who works in the ENT room every week adds valuable insight into the needs for the coming week," says Ms. Kinsey. "Also, surgeons may share information about upcoming cases or vacations with OR personnel that would otherwise be unknown to the Materials Manager. These coordinators can also monitor the usage and inventory of hard-to-get items, allowing plenty of lead time for replacement."

3. Scheduling and billing office disorganization. These functions are traditionally done through paper records and interactions, leaving room for error. Now, however, there are automated systems to help accommodate scheduling, billing and inventory demand.

"However, the success of these systems often depends on the quality of set up and maintenance given to them," says Ms. Kinsey. "Providing adequate time for planning and implementation of these systems will increase the long-term successes and benefits."

There are many products available, including electronic health records, that can improve efficiency and communication between physicians and other providers, as well as physicians and patients.

"Many vendors will bring new products into your facility with no charge just for using their wares," said Ms. Kinsey. "An example might include barcode systems for inventory and integration of lab results into the EHR system or an automated payment estimator that can shave hours from the workload of financial counselors."

4. Assigning the right tasks to staff members. Staff members who are in the wrong position can create chaos at the ASC.

"Allocating the right people with the proper tasks becomes vital to balancing quality care and physician investment," says Ms. Kinsey. "Promoting the strengths of the individuals within your organization where certain individuals may excel or struggle allows the administrator to deal with those situations accordingly."

Identify needs in the facility and use resources to address issues so the environment is happy and more efficient for everyone.

5. Weak leadership and culture. The leader sets the tone for their organization, and leaders who are negative or unable to lead effectively will have an impact on the center. The ASC is more efficient when staff and physicians are satisfied.

"An effective way of promoting facility efficiency is the immediate recognition of optimal behavior," says Ms. Kinsey. "This is essential for a thriving environment."

People are often trained to follow leaders as a young age, but not always act as a leader.

"Although when you act as a leader and promote a healthy, worthwhile behavior on a daily basis, much of the staff will begin to follow your lead," says Ms. Kinsey. "For the rest who choose not to abide by that behavior, immediate correction is crucial."

More articles on surgery centers:
16 ASCs recently adding new specialties & procedures
Credentialing is key—7 ways to avoid mistakes & keep your patients safe
How to use the 4 pillars of ASC lean staffing without sacrificing you’re a-team employees

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