How to Increase Efficiency at an ASC: 5 Thoughts from Dr. Ricardo Borrego of Dearborn Surgery Center

Dearborn (Mich.) Surgery Center averages 12,500 procedures every year or between 50 and 60 each day. With 75 practicing physicians in 11 different specialties, the center has to maintain efficient processes in order to function at such a high level in a multi-specialty facility.

"The efficiency that the DSC has is based upon the unified goal that the physician is a key customer," says Ricardo D. Borrego, MD, MSBA, medical director. "Turnover differentiates us from hospital-based services, and patient satisfaction keeps us motivated. To clarify this, our patients' satisfaction and safety are our core values, but the difference is most facilities stop short of recognizing that the physicians' satisfaction is key to continued success. Our differentiation is always starting on time, maintaining consistent low turn over times and expediting the patients without any feeling of being rushed."

In fact, Dr. Borrego says the center was started when a group of physicians became frustrated with the unpredictable hospital environment and founded the center to run like "clockwork." Dr. Borrego and DCS's executive director Linda T. Prister, RN, MSBA, offer five tips for maintaining efficiency at a busy surgery center.

1. Have schedulers meet with surgeons' offices. Dr. Borrego says efficiency in the center starts when cases are scheduled. Quarterly or semi-annually, schedulers in the ASC meet with the schedulers in all of the surgeons' offices to discuss issues such as types of cases and insurance coverage. This way, the schedulers in the physicians' offices know exactly what to do when the surgeon tells them to schedule a surgery at the outpatient center.

"This encourages synchronicity within the offices," he says. "We try to make the scheduling process easier and more understandable on both ends. A key element of our success is our ability to recognize and appreciate the value and influence a physician's office scheduler has on our Center. As in life, mutual respect fosters long term relationships."

2. Standardize all processes. Dr. Borrego says the center has an established protocol for most patients based on best practices, however patients with co-morbidities and extenuating circumstances such as patients with pacemakers or other health issues are evaluated individually prior to surgery. Having standardized practices ensures consistent and safe surgery for our patients. This way, staff is aware of what documentation is needed prior to the procedure so there are no avoidable cancelations the day of surgery.

"Standardized care provides efficiency, however we treat each patient as a unique individual with distinct medical histories," he says. "All our patients' histories are reviewed by an anesthesiologist prior to surgery. All these processes are established so that there's nothing missed along the way," he says.

Another way DCS standardizes processes is through a surgery checklist that includes all steps of the patient experience from registration to discharge, Ms. Prister says. DSC was one of the first centers to implement such a checklist. The center implemented the checklist in spring 2009 and has "buy in" among staff which results in compliance. Surgical safety checklists are currently being recommended for implementation and usage for surgery centers by CMS, and the Dearborn Surgery Center has a long history of usage prior to being instructed to comply.

3. Synchronize staff duties and responsibilities. Each and every staff member at DSC has specific duties during the day, so the center runs with precision.

"All of the staff members at the DSC understand what is expected from them as to their roles and responsibilities for their daily duties," Dr. Borrego says. "They have accountability for their performance and are able to function as self-directed professionals. Trusting your staff to do their job allows for efficiency as well as creates pride resulting in the staffs' desire to exceed the expectations of our patients."

Ms. Prister says the center has enough staff to be able to synchronize duties and responsibilities.

"What's happening is that there's always movement," she says. "There aren't these start ups and stops. There's always fluid, forward movement. When staff know what is expected from them and share the same goal of efficiency, they can be self-directed to proactively anticipate issues and manage their time and resources."

An example of this synchronicity is seen in room turn over, she says. After a procedure is completed, one member of the clinical team takes the patient back to the recovery area, while another cleans the OR and another interviews the next patient. The center's average OR turn over time is under five minutes.

"They're all going at the same time," she says. "That's why the turn over is so good. There's not that start and stop. Everyone is on the same page, going in the same direction and everyone meets at the starting gate at the same time. Most persons simply call this teamwork."  

4. Implement a flexible schedule. One common pitfall of surgery centers — and medical offices in general — is empty schedule time where staff members are just standing around. To maximize use of the center's time, DSC uses a block schedule but adjusts that schedule on an as-needed basis, Ms. Prister says.

"We will adjust the schedule even on a daily basis," she says. "If a physician needs to optimize the schedule or to make some changes, we can do that. We start with a framework of what we typically do, but we actually change it based on the day."

This system does not work without dedicated staff members that are willing to accommodate their schedules to match the flow of cases at the center, Ms. Prister says. If a physician wants to start at 6 a.m., the staff has to be willing to come in early.

"Optimizing productivity of the OR schedule is a key financial indicator because large gaps in schedules carry overhead expense without any generated revenue," says Dr. Borrego. "Being flexible in scheduling aligns resources to revenue."

5. Have anesthesia take an active management role. One of the things that distinguishes DSC is the role of anesthesiologists in the center's daily operations and management, Ms. Prister says.

"Our team is led by [me], as the medical director, or one of my colleagues," Dr. Borrego says. "In this role, anesthesia takes an active role in oversight and running of the surgical schedule. Patients have to be seen and ready in order to have the cases start on time. The anesthesia team is not passive participants but active initiators of service and efficiency."

Ms. Prister says this adds a level of accountability that is often absent from hospital programs. She recalls talking to some hospital managers who believed that a medical director lead by anesthesia would provide the necessary efficiency and consistency needed in a hospital environment.  This model could mimic the "outpatient surgery arena" and improve efficiency, she says.

Related Articles on ASC Turnarounds:

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What Surgery Centers Should Expect in 2012: 15 ASC Market Trends

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