What kills workplace culture in ASCs and how to solve it: 8 administrator insights

From lapses in communication to poor morale among staff, eight ASC administrators told Becker's ASC Review what they feel hurts workplace culture most and how they overcome the challenges.

Note: Responses were edited for length and style.

Claudette Fox, BSN, RN. Administrator at Short Hills Surgery Center (Millburn, N.J.): ASCs strive to hire highly talented and productive staff who deliver excellent care to the patients we serve. Staff working at ASCs are generally paid well and are often rewarded with perks such as merit- and market-based increase and employee appreciation celebrations and gifts.

The killer of this culture is when employees are sent home when there is a low census or the cases end early for the day. If there are no cases or low census, then there is no revenue or low revenue on those days. If a staff member worked extra hours earlier in the week to accommodate late booked cases or add-on cases and then are sent home early on another day, they forfeit overtime pay. It is important to build a strong foundation with the staff, reward them when you can and let them know in multiple ways that they are appreciated. Staffing with the appropriate amount of staff and ensuring that staff are working at the top of their license or certification is also important to maintain good morale.

Anna Weaver, MSN, RN. Administrator at EmergeOrtho-Wilmington (Leland, N.C.): Lack of communication between all departments in the ASC is the biggest culture killer. Leadership needs to set the example by clearly communicating with the team. Another is a lack of transparency contributes to gossip and a lack of teamwork. Daily or twice daily team huddles contribute to increased communication, which will improve patient safety and quality.

Amanda Gunthel. Administrator at Wilton (Conn.) Surgery Center: I think the No. 1 culture killer in an ASC, or any organization for that matter, is a failure in leadership. Nothing directly impacts culture more. There's a long list of organizational issues commonly labeled as culture killers, but I believe they are all symptoms of problems in leadership. An effective leader will engender and protect a culture where these issues cannot persist.

Becky Ziegler-Otis. Administrator at Ambulatory Surgery Center of Stevens Point (Wis.): My top two would be gossip and territorial attitudes, and they definitely impact one another. Gossip is typically negative information that damages the reputation of a co-worker, supervisor, provider or the facility itself. A successful ASC requires a team-oriented environment, and the negativity of gossip can erode teamwork and lead to territorial attitudes. Though difficult, it is important to address gossip, as it can do irreparable damage that can linger on for a prolonged period of time.

Christine Washick, RN. administrator at Triangle Orthopaedic Surgery Center (Raleigh, N.C.): I would have to say negativity is at the top of the list and can spread like wildfire. Staff are not always to blame, and culture needs to start at the top. Owners, management and staff working together and feeling supported. The solution is not difficult, just needs to be consistent:

1. No task is beneath anyone, no matter one's title.
2. Patients come first.
3. Staff feel that leadership supports and advocates for them.
4. Problems are addressed promptly and fairly.
5. Hard work is recognized and appreciated.
6. We value each other as humans, not just "worker bees."

Christa Probson, RN. Nurse administrator at Preston Surgery Center (Frisco, Texas): In my experience, the No. 1 culture killer in an ASC is having a staff member with a bad attitude. The saying "One bad apple can spoil the whole apple cart" is very true. So, you have to find ways to make your staff happy. The No. 1 thing is having open communication with all of your staff members. Be honest with them and reward good behavior. If they do a good job, praise them, tell them how much you depend on them and how much you appreciate their great attitude. In meetings, always tell them they are an awesome team, and that their great spirit and attitude makes your facility great. Make them feel empowered and that what they say matters to you.

Jessica Hovland, DNP, RN. Administrator at the Ambulatory Surgery Center at UT Health Austin (Texas): Over half of nurses entering executive leadership or administration in any healthcare organization are not prepared educationally. One of the best ways to foster a supportive perioperative culture is to understand your workforce and apply different leadership styles to varying challenging situations. My doctorate in education helped me to understand the soft and hard skills needed to lead a culture of positivity and adaptability. Further education is the antidote to toxic cultures.

Barb Draves. Administrator at The Surgery Center (Cleveland): The No. 1 culture killer in an ASC is lack of appreciation for what each person contributes to the "ASC Puzzle." Every day in an ASC is a puzzle. Some days it is a harder puzzle than others, and if all the pieces do not fit together, it isn't going to get completed.

We believe the way to solve this is for everyone to be cross-trained in all areas and understanding how each person fits into the completed puzzle. Mutual respect for one another's jobs within the ASC and how each job is intertwined into the final puzzle and realization that there is no "I" in "team" is key. That must start at the top and be believed at the top.

Benita Tapia. Administrator at 90210 Surgery Medical Center (Beverly Hills, Calif.): I would say the No. 1 culture killer is not having a culture of safety — a culture of hiding issues for fear of [intimidation] or being scolded for pointing out a problem. Allowing staff to know there is transparency, communication and support of a culture of safety can save patients' lives and empower staff to feel their role is important, they understand greatest growths and learning can come from our mistakes.

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