Changing the Culture of an ASC: Q&A With Mike Lipomi of Surgical Management Professionals

Mike Lipomi is president and CEO of Surgical Management Professionals in Sioux Falls, S.D.


Q: How does the culture of an organization affect operations?


Mike Lipomi: Culture is critical part of any organization. Look at any association of people and you will see a culture that has built up around them. It will have an impact on just about everything those people do. For example, the deeply embedded cultures of the Mideast influence how women are treated and a host of other attitudes and concerns. In business, each organization will have its own unique culture. Compare Ben & Jerry's to something like IBM.


Turning to healthcare, you have the culture of hospitals and the culture of ambulatory surgery centers or physician-owned hospitals. They are dramatically different. In the hospital, you see a tremendous distrust of the administration and an animosity toward physicians. There is a nine-to-five attitude: "I want to get my job done and get out of here." No one speaks up. The attitude is, "They don't care what I think, so I won't even talk to them."


In sharp contrast, ASCs and physician-owned hospitals thrive on mutual trust and the focus is taking care of the patient with less regard to "That is not my job." Physicians work closely with nursing staff. When staff members make improvements, they know that they will be rewarded for the success of the whole enterprise.


Q: How do you develop the right kind of culture?


ML: This is an interesting challenge because, traditionally, ASCs and physician-owned hospitals get their employees from the hospital, so you are always up against a certain mentality that is bred by the hospital culture. When you are hiring, you have to be very aware of cultures. They don't just change overnight.


This challenge became quite apparent when we converted an ASC into a much larger physician-owned hospital. We took 40 employees form the ASC, who knew the ASC culture, and we added more than 100 employees from traditional hospital settings. Outnumbering former ASC staff by more than two to one, the new hires from traditional hospitals almost overwhelmed the ASC culture. These newcomers questioned how the ASC employees did things whenever it was different from what was done in their old hospital. That was stressful. However, many of these new hires came to embrace the new culture because they appreciated being rewarded for what they did.


I liken the process of changing an employee culture to herding cattle, which you see a lot of here in South Dakota. To a city-dweller, herding cattle might be all about cracking the whip. But ranchers actually deal with their cattle in a more subtle way: you can't push them too hard, too fast or too much. You have to go with the flow. The rancher rides alongside the cattle, and after awhile he gets to understand what they are doing and how he can incentivize them, based on what they do.


This approach worked well for us in the conversion of the ASC into a physician-owned hospital. My managers would meet with each of the new employees. And every month I would do annual visits with all the employees hired in that month. We talked about three things that are most important for an employee:


1. Have fun. To be a valuable long-term employee, you have to be having fun with what you do. You're spending more time at work than anywhere else –– more time than with your wife, children or other activities such as a sport or a hobby. If you're not happy at work, your whole life is going to be miserable.


2. Build relationships. Relationships at work should replicate your relationships in private life. First there are your relationships with your immediate family, then with your friends, then with your neighbors and so on. Your relationships radiate outward. The same applies to the workplace. Let's say you work in pre-op in an ASC. The other pre-op people are like your family. You have to support them and they have to support you. But you also need to have relationships with people in other departments that you deal with every day, such as the reception area and the surgery area. Having strong relationships with those folks helps you be better at your job.


3. Face financial reality. The operation is trying to make the best use of a limited resource. Do we spend it on productive or on non-productive ways? The money you make for the organization should be used in the best, most productive and most rewarding way, for the sake the investors, the employees and the organization as a whole. Waste is something that is bad for all organizations but often it's easy way to go.  Having the right culture reduces waste and increases profitability.


Learn more about Surgical Management Professionals.


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