5 Management Problems That Hurt Surgery Center Productivity and Morale

Sound management is essential in a surgery center because profitability depends so much on employee efficiency and productivity. John Merski Jr., Managing Partner and Executive Director of Human Resources for MedHQ, discusses five management challenges that negatively impact employee satisfaction and retention in surgery centers.

1. Insufficient management training.
Mr. Merski says the most common management problem he sees at surgery centers is a general lack of management training. He says surgery center administrators are frequently hired for their operational, financial or clinical skills with little emphasis placed on their "people skills" or management abilities. In many cases, an OR nurse may be promoted to the position of administrator without undergoing management training.

"Managers are not born, and most surgery center managers today do not go to school for management," he says. "They're usually someone who is a strong technician and is picked by upper management to advance, and when they get to the next level, they are armed with very little management skill." He says most managers fall into one of three categories: overly nice, overly harsh or effective. Unfortunately, Mr. Merski sees more "overly nice" and "overly harsh" managers than effective ones simply because they have not undergone the proper training. He says if a surgery center administrator is hired without management experience, they should undergo training in order to learn how to direct people.

2. Inadequate compensation to retain staff.
Economic pressures are making life more difficult for surgery center employees, who often experience unpredictable hours and lower compensation than they would receive at the local hospital. Mr. Merski says employee dissatisfaction can increase quickly if the surgery center is not offering a competitive compensation and benefits package.

He says most surgery centers fail to create a rationale that lays out how much each employee will make. "Of all the surgery centers I have been exposed to, very, very few have a structured compensation and benefits program," he says. "When they hire someone, they think, 'We'll just pay him $20 an hour because that's what we've done before.'" He says surgery center leaders should sit down and look at national and local benchmarks to determine a salary range for each employee. Then they should take into consideration individual experience, responsibility, impact on the center and pool of candidates to determine a fair wage.

3. Failure to discipline employees properly. Mr. Merski says the number one rule of employee discipline is, "Act early." Don't wait until the twentieth time an employee shows up late to work to say something, because your reaction at that point will be much stronger than if you had spoken to the employee the first time. "If you notice a behavior not up to the standards of the company, you need to intercede with the gentlest approach at coaching," Mr. Merski says. "When that fails, you need to take a direct and structured approach that may result in the termination of the employee."

For example, when an employee comes in late for the first time, sit down and ask him or her about the reason for the lateness. Assure them that you understand but that the surgery center needs their presence and punctuality to function properly. That way, if the employee comes in late again, you can take a slightly more direct  approach, until eventually you start discussing suspension, pay cuts or termination. It is well known that a "retooling" of an employee is considerably more beneficial to the workplace than a replacement if it can be completed properly.

4. Hesitancy or unprofessionalism around layoff decisions. Surgery centers must increasingly make tough decisions when it comes to staffing due to reimbursement /economic pressures. "Administrators have to worry about being efficient with the amount of money they have to use — they must decide whether they need five people or three, four people or nine," Mr. Merski says. He says in many cases, administrators do not have the money to support their entire staff, but they keep staff members at the center because they are afraid of the repercussions of layoffs.

"I've seen many administrators who are not getting as many surgery cases as they planned for, so they don't have enough money to support the entire staff, and yet they continue to keep them and drain the company because they can't decide who should go," he says. When layoff decisions happen, he says, often administrators choose employees based on who they like rather than who is most valuable. He says staffing decisions should be based on employee productivity and value versus salary or popularity. For example, a surgery center employee who is paid more but is very valuable to the organization should be retained over a surgery center employee who is paid less and has less of an impact.

5. Perception of favoritism.
Surgery centers are generally small workplaces, and small workplaces are breeding grounds for inter-office conflict, Mr. Merski says. If one surgery center employee thinks another employee is not qualified for his or her job, they may believe the administrator is playing favorites. Mr. Merski says this can be avoided by first limiting the hiring of anyone from the administrator's family or close friend group. "If you happen to hire your wife or your next door neighbor, you're not going to be able to get away from accusations of favoritism," he says.

He says it also helps to hold open staff meetings, where every employee can raise concerns or ask questions and be given the same amount of time as everyone else. Don't hold private meetings unless you have to — while the intention might be completely innocent, your employees may inadvertently view it as favoritism.

Related Articles on Human Resources in ASCs:
Keeping Orthopedic Practice Employees Happy: Q&A With Dr. Jack Stewart
ASC Companies Announcing Executive Moves in 2011
5 Strategies for Surgery Centers to Compete With a Local Hospital for Employees

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