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7 Big ASC Staffing Issues & What to Do About Them

DoctorHere are seven of the biggest staffing issues for ambulatory surgery centers and how administrators and physician owners can tackle them.

1. Too many staff hours per case

When your center goes beyond the benchmarks, bring the physician investors and entire governing body together to discuss strategies for reduction. This could mean more compact scheduling, part-time employees, flex hours or process changes at the ASC.

"It's great to have a bunch of employees at the ASC, but when each additional employee costs $80,000 out of the physician's pocket, it's time to pay more attention to staffing," says Founding Partner of ASD Management Joe Zasa. "Embrace a collaborative approach to staffing with proper checks and balances, use benchmarks and set realistic goals for managers. These strategies allow you center to be more efficient without diminishing the quality of care."

2. Overtime

ASCs can increase the amount of work accomplished each day by cross-training staff members in at least two areas. Having flexible, proficient staffers can also free up clinical personnel to focus on their tasks in the operating room, thus increasing OR throughput and daily case volume, says April Sackos, CASC, vice president of revenue cycle management at Ambulatory Surgical Centers of America.

She also recommends scheduling employees with flex hours to reduce overtime costs and avoid paying an employee for a block of hours when only a few hours of work were needed.

"It is also beneficial to use per diem nurse staffing, as they can be cancelled when not needed and don't have high associated benefit costs," she says.

3. Downtime

If your ASC maintains a lean staff, cross-train everyone to help with different functions at the center. This will minimize downtime and maximize efficiency to support patient volume growth in the future.

"The biggest, most beneficial thing you can do is cross-train," says Summit Surgery Center at Saint Mary's Galena Administrator Lori Martin, RN. "When our receptionist has down time and doesn't have any more work with making charts, she posts bills and keeps our accounts payable in order. Our credentialing person is cross trained to do reception. People have endless tasks that they can complete during their downtime."

Staff members can take on projects to fill that downtime with constructive initiatives. Staff members can work on patient call backs, quality improvement studies, patient control or other special projects to stay productive during the day. Ms. Martin says there isn't normally any non-productive time in the center, but if there is on a rare occasion, she'll send the employee home.


In recent years, OSHA has begun paying more attention to ambulatory surgery centers. Administrators and physician owners want to ensure they provide a safe working environment for employees and comply with the federal regulations. Most centers have include policies, procedures and employee training programs to maintain compliance, according to a report from Sandra Jones, executive vice president of ASD Management. Requirements include:

•    Annual education on bloodborne pathogen exposure
•    Taking action when exposure occurs
•    Personal protective equipment and engineering control for sharps safety

Ms. Jones recommended reviewing employee education materials, sharps injury prevention and other policies and procedures to ensure they comply. Another person on staff can also review the policies and provide new insight on improving them. This person can also review the CDC Workbook and compare it with your policies.

5. Bad attendance

Arriving late to work once in a while isn't cause for alarm, but chronic tardiness and other attendance difficulties is often an indicator of other problems. Tom Jacobs, CEO of MedHQ, advises ASC leaders be attentive to early warning signs, but to not come down too hard after the first late arrival, but when it happens multiple times within a few weeks it's time for another approach.

"There are often personal problems, such as health issues or family issues, and there are resources that can help them with that," says Mr. Jacobs. "If someone has an elderly parent that takes a turn for the worst, maybe they need an approved leave of absence. If the employee has financial issues they may need employee assistance program referrals. That can be a good way to address some of the personal problems. Everyone wants privacy and you don't have to be their counselor, but you can give them a place to go for help."

6. Disputes

Poor communication and disputes between employees cause a bad working environment and culture. Some issues can be prevented by approaching employees to settle the dispute instead of letting it fester.

"There are positive ways to go about solving disputes between employees," says Mr. Jacobs. "Get them involved in the center and be realistic about the problems. Don't let them fester. As managers, we sometimes feel like we are not in control and we try to figure out how to take control. The quickest way to control a situation is to ask questions. It's your job to find out about a disagreement or misunderstanding and be the person of authority in that situation."

7. Bonus incentives

An all-encompassing bonus program for staff members can help incentivize better quality at the ASC and promote collaboration around your center's success. Common bonus structures for staff include setting aside a percentage of distributions for staff members and either giving flat bonuses to everyone or providing bonuses based on the employee's base pay.

"It's easy to do one standardized plan, you really tweak it depending on where the center is in the life cycle," says Tim Bogardus, senior vice president of operations at Regent Surgical Health. "There are a lot of ASCs that incentivize leadership positions, such as business office managers to reach collection goals or clinical managers to meet their metrics. I wish more ASCs could figure out how to involve all staff, but it becomes difficult to track how they contribute to the center's success."

People at surgery centers often wear many different hats, and often the best employees wonder why they stay at the ASC when they could go to the hospital, do their cases and then go home. "There are some programs that are complicated allowing staff members the opportunity to make extra money every month, but it becomes difficult to figure out how to distribute that," says Mr. Bogardus. "You have to find a very standardized way of doing it."

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