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Aug 11
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Leadership Defined – Best Qualities of an ASC Leader

Leadership Defined – Best Qualities of an ASC Leader

By ASC Management, Leadership No Comments

Jennifer Post’s article, 11 Ways to Define Leadership, published in the leadership section of Business News Daily on March 29, 2017, listed qualities of highly effective leaders alongside relevant quotes from current leaders and business founders. I found many of the viewpoints on the definition of leadership useful for the ambulatory surgery center (ASC) industry. The author’s main point also struck a chord. She maintains leadership is subjective, but its foundation is formed from one thing – the ability to build consensus and establish a following among individuals and teams.

I have been fortunate to learn from highly effective ASC leaders. Those I admire possess a variety of styles, but at the core, they all build momentum around common clinical and business-related goals.

In evaluating the day-to-day behaviors of these effective surgery center leaders, I identified the things they did that were most inspiring to me. I paired each tenet of a good leader with relevant quotes on leadership from Ms. Post’s article. I created the following as a guide for myself in hopes I can integrate these leadership traits into my daily interactions with my surgery center teams.

Step 1: Care

Leadership is about people serving people, inspiring people, and caring about people. You must show you care through your daily actions.

Our surgery centers often lean on staff to be excellent in a fast-paced environment, which is what we are known for. However, this can leave staff feeling the pressure to keep up. It is important to provide our presence, support, education, and creative tools so staff feel equipped to deal with the day-to-day operations of their departments.

“Leadership is serving the people that work for you by giving them the tools they need to succeed . . . [Team members] should be looking forward to the customer and not backwards, over their shoulders, at you . . . [Give] genuine praise for what goes well and lead by sharing in the responsibility early and immediately if things go bad.” –Jordan French, founding CMO, BeeHex, Inc. 3D Food Printing

Step 2: Communicate

When a leader does not communicate well, team members don’t feel valued. Good communication involves listening, truly understanding, and respecting others’ opinions. ASC staff members must be critical thinkers and doers. Impromptu conversations with staff member about problems in the center can result in some of the best ideas to resolve them. This requires leaders to have conversations, ask for input, listen, and think before throwing out an idea.

“Any time you work with a group you should expect disagreement. You should embrace dissent. Teamwork isn’t about going along. It’s about hearing all views, admitting mistakes, and sharing risks and rewards jointly.” – Gary Kelly, CEO, Southwest Airlines

“In my experience, leadership is about three things: to listen, to inspire and to empower. Over the years, I’ve tried to learn to do a much better job of listening actively making sure I really understand the other person’s point of view, learning from them, and using that basis of trust and collaboration to inspire and empower.” –Larry Garfield, president, Garfield Group

Step 3: Have Character

Over-prepare, admit weaknesses, and allow others to assist you. This builds a culture where team members feel valued and fulfilled.

“Adversity does not build character, it reveals it.” –James Lane Allen, novelist

“Leadership is the ability to see a problem and be the solution. So many people are willing to talk about problems or can even empathize, but not many can see the problem or challenge and rise to it. It takes a leader to truly see a problem as a challenge and want to drive toward it.” –Andrea Walker-Leidy, owner, Walker Publicity Consulting

Step 4: Be Competent

Effective leaders know their business and their team. A competent leader is reflected in a competent team. Encourage and help your team gain certifications or specialized training that will make your facility better by providing staff members with gratification and betterment of themselves. Promote from within your organization to your leadership roles. Create your own OR nurses using peri-op 101. Hire clinical directors with the intent of nurturing them in ways that will allows them to assume administrator roles.

“To me, leadership is about playing to strengths and addressing weaknesses in the most productive and efficient way possible. It’s about knowing your team and yourself, and doing your best job to set both up for success.” –Samantha Cohen, co-founder, Neon Bandits

Step 5: Have Courage

As many times as things go right, they go wrong. Leaders need to be the ones sitting in front of a board owning up to mistakes made. However, if a leader can take the situation, apply corrections, and discuss that process, blame is removed so the problem can be fully dissected. If we look at every issue as a potential opportunity to prevent its recurrence, people stop avoiding the issues.

“A leader is someone who has the clarity to know the right things to do, the confidence to know when she’s wrong, and the courage to do the right things even when they’re hard.” –Darcy Eikenberg, founder, RedCapeRevolution.com

Every leader has his or her own style and strategy, and every company its unique challenges. Recruiting and retaining talent in healthcare is a financial and intellectual investment. Effective leadership helps ensure we get the most out of the time and money we spend finding and training team members, because effective leaders build and retain top talent.

“There is no one-size-fits-all approach, answer key or formula to leadership. Leadership should be the humble, authentic expression of your unique personality in pursuit of bettering whatever environment you are in.” –Katie Christy, founder, Activate Your Talent

Jovanna Grissom, Vice President of Operations

1Business News Daily article March 29, 2017 11 Ways to Define Leadership

Aug 03
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Managing difficult employee behavior

Help! My Employees are Keeping Me Awake at Night!

By ASC Management, Leadership No Comments

Lately, when faced with a work situation that taxes my emotional reserve and keeps me awake at night, I turn it on its head. I view the issue from a different perspective; change the tape that’s repeatedly playing in my brain by altering the order of the words.

For example, when I hear, “I’ve got a difficult employee and I don’t have a clue what to do,” I reframe the problem and respond with, “Let’s talk about the difficult behavior this person is exhibiting that is creating frustration for you in the workplace.” Shifting our dialogue to focus on the behavior rather than the person, creates a much-needed level of objectivity that allows for more effective problem solving.

Let’s face it, as leaders, we are bound to encounter employees who exhibit behaviors that are difficult to manage. An employee who simply fails to show up to work on time can create havoc in a facility. Being met with resistance when asked to perform a task in a specific way can derail a surgery center team’s attempts to ensure patient safety.

If you’re like most people, you don’t enjoy confrontation. So, you chalk the behavior up to “a bad day” or, when the behavior rears its ugly head consistently, excuse it with, “That’s just how Marianne operates. She’s not interested in hearing feedback.” But, it’s your job to deal with these behaviors effectively to minimize the ripple effects. The harsh reality is, if you don’t deal with difficult behaviors, the problems will only get worse. And, if you don’t document your actions, it is as if you never responded.

When you find yourself wondering why an employee is being so difficult, avoid succumbing to “stinkin’ thinkin’.” In other words, avoid personalizing the behavior.

Here’s an example. Tom, your receptionist/registrar, reports to the surgery center 10 to 15 minutes late every morning. He is responsible for checking patients in promptly. If he’s not there, patients either end up waiting for him to arrive or his co-workers must stop what they’re doing to perform his job. This is annoying enough on its own. But he has the nerve to saunter in with a Starbucks coffee in hand, jovially greeting everyone on the way to his workstation. The patients love him. They have no idea he’s the one who created the tension they sensed upon their arrival. As he settles into work, capably completing the tasks his co-workers have started for him, you overhear a steady stream of employees filing past your office muttering, “Really? He does this every day. Why does he insist on making everyone miserable? I’m tired of doing his job. Doesn’t he recognize we’ve got our own tasks to perform to ensure surgeries start on time?”

Tom, contrary to what is now popular belief, likely does not wake up every morning planning to upset everyone. He’s laid back – a strong suit when it comes to interacting with patients nervously anticipating their planned procedure – and approaches everything in stride, including sleeping through his alarm, a long line at Starbucks, and having to circle the parking lot three times to find an empty spot.

To deal effectively with Tom’s tardiness, it’s important to accurately identify the problem behavior. On the surface, it might appear the problem is slacking – showing up late because Tom wants others to perform his job. After all, that’s what his co-workers have surmised. However, after talking with Tom, you realize he is on a completely different wavelength. He truly is unaware his behavior negatively impacts the start of everyone else’s day.

Now that you’ve identified the true difficulty, you can effectively manage Tom’s future behavior by having a conversation with him. People who are on a different wavelength, need clearly defined communication that outlines expected results.

Your conversation may proceed along these lines. “Tom, I need you to be at your workstation ready to check in our first patient on time each morning. I expect you to clock in at 5:45, then immediately report to your desk to ensure you are prepared for 6:00 a.m. arrivals. Adhering to this regimen will serve our patients well. The value you bring to our organization will be enhanced when your co-workers realize they can rely on you to greet patients and get them checked in promptly. Our physicians will recognize a change in how quickly they are able to get started each morning. I’m going to document our conversation today as a coaching session. Now that you recognize how important it is for you to be on time to perform an essential requirement of your job, I’m confident you will figure out how to report to work promptly every day.”

I recognize this is only one example of dealing with a difficult behavior. And, more importantly, I’ve assumed the conversation went well. You talked to Tom, he saw the light, he altered his behavior, and being late to work is not something that occurs anymore. I’m aware, however, that’s not always the case.

My point is this: when you separate the person from the behavior, accurately identify the problem, and promptly address with the employee how their behavior impacts the organization, you have a much greater chance of achieving a successful outcome. Those successful outcomes will not only lead to a happier, more united facility, they will allow you to sleep much better at night!

Kim Woodruff, VP of Corporate Finance & Compliance

Jul 26
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ASC Infection Control Program

How to Develop an ASC Infection Control Program

By ASC Management No Comments

Surveillance, prevention, and control of infection in ambulatory surgery centers is a frequent deficiency cited in state, Medicare, and accreditation surveys. ASCs are required to have an infection control program that outlines purpose, goals, specific risks, methods of data collection, and strategies used. The program also must identify how and when the infection control program is evaluated. Because most centers do not have a full-time infection control nurse or officer solely dedicated to this role, this requirement can seem daunting. With some luck, the Infection Control Officer (ICO) might get to a meeting once a year and complete the training required to hold this position.

The purpose of infection prevention is to protect the patient, health care workers, visitors, and others in the health care environment. In an ASC especially, it needs to do so in a cost-effective manner. How can you effectively and efficiently ensure infection prevention in your setting?

1. Start by setting infection control program goals.

  • Identify and reduce the risk of endemic and epidemic facility-associated infections.
  • Report appropriate information to internal surgery center leadership and public health authorities.
  • Develop communication linkage between professional and health care workers, patients, families, public health professionals, and the community.
  • Create plans to respond to emerging infections and bioterrorism.
  • Promote a zero tolerance of hospital acquired infections (HAIs).

2. Explain how infection control is embedded in your organization. Spell out how the ICO integrates with committees, the reporting structure, and the sources utilized for evidence-based practices. For example:

  • The ICO is part of the Continuous Assurance Committee and oversees the infection control program.
  • Under the direction of the Medical Director, the ICO investigates all suspected outbreaks. This occurs in collaboration with the appropriate medical and administrative staff.
  • Using the most correct and useful statistical process, data is collected, analyzed, and reported.
  • The ICO has access to comparable community data to determine if rates within the center are above or below those in the community.
  • The ICO develops this plan using data from CDC/NHSN/NNIS.
  • The board of managers approves the infection control program, types and scopes of activities, and training materials. They review this plan at least annually to evaluate its effectiveness in the center.

3. Create a prioritized risk assessment. The risk assessment should focus on internal and external factors. This helps form a complete picture of the risks that exist. Prioritize the identified risks based on the potential impact, probability, and the organization’s preparedness. This is your base for determining what activities you should perform and at what intervals.

  • External: Consider patient populations and cultural reactions to health care. Examples are community issues, such as high rates of TB. These factors are not fixed. As situations arise in the community, a new risk assessment may be necessary.
  • Internal: Focus on your high volume/high acuity cases. Think about instrumentation and the associated cleaning problems (i.e., long, luminated). Consider the physical plant in which you provide care. Are there risks? Do you have a water feature in your lobby?

4. Identify and summarize your activities.

  • Remember to take credit for activities you already perform. This can include monthly and 90-day SSI surveillance, prophylactic ABO administration tracking, and bloodborne pathogen exposure monitoring/reporting and outcomes.
  • Based on your risk assessment, you may track things like monthly monitoring of SPD logs, environment of care items, and hand hygiene. Ensure each one of these activities has a summary explaining the process, frequency of tasks, and documentation undertaken.

5. Spend time discussing and documenting the strategies you will use.

  • A good general statement is “TJC, AAAHC, OSHA and pertinent federal, state, and local regulations pertaining to infection control are being implemented and followed.”
  • Include items such as staff training on PPE, TB, hand hygiene, and cleaning. In addition, list the local, state, and federal contacts and reporting requirements, as well as communication with other health care facilities and providers in your community.

It is important to formally evaluate and revise your goals and program, or portions of the program, at least annually and whenever risks significantly change. Make sure your evaluation addresses the assessment of the success or failure of interventions for preventing and controlling infections and responds to concerns raised by leadership or others. The evaluation should always address how relevant infection prevention and control guidelines are based on evidence and have evolved. In the absence of evidence, cite expert consensus.

Oftentimes, daunting tasks are made less so when you have a framework to follow. Once you get the ball rolling, you are more likely to find an internal champion to serve in the ICO role. Ensure you support your ICO as they tackle program specifics by allocating the funds necessary to secure appropriate training and advance program goals. Before you know it, you’ll have a thriving program and your ASC will significantly reduce the likelihood of being cited for an infection control related deficiency.

Jovanna Grissom, VP of Operations

Jul 20
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Everyone Sells

Everyone Sells

By ASC Management, Leadership No Comments

I have been in sales nearly my whole life. As a kid during the summer, my friends and I sold lemonade, snow cones, or our old toys from a stand in the neighborhood. From the ages of twelve to fifteen, I rented a table at comic book conventions to buy and sell to other collectors. At the age of sixteen, I had to sell myself in a job interview. When I graduated from college with a degree in physical therapy, I “sold” patients on my ability to assist them in recovering from a variety of physical ailments. To ensure the most optimal outcome, I needed them to “buy” into how important it was for them to be actively involved in their own recovery process. As I moved into formal management and leadership positions, my sales challenge progressed. I was charged with getting my teams or clients to buy into the vision or direction I was “selling.” And, as a business owner, I’ve sold my company’s services to prospects.

Yes, I’ve been selling a long time. That’s what got me excited about a recent Harvard Business Review article by Rebecca Knight titled “How to Improve Your Sales Skills, Even If You’re Not a Salesperson.”1 In it, she quotes Thomas Steenburgh, professor at the University of Virginia Darden School of Business, who states, “Selling is moving somebody else to action.” As managers and leaders, that’s what we do every day. Ms. Knight then proceeds to provide fantastic advice regarding how to think about sales and make oneself more comfortable with the thought of selling.

Although Ms. Knight’s article was focused on actual sales, I viewed it from the aspect of managing and leading people. The principles are the same. Effectively selling your team or clients on your vision and implementation strategy requires the same four tools Ms. Knight identifies as those required to effectively sell products or services.

Reflect.  Look back on the great leaders you’ve worked with in your career. How did they inspire you or your team to achieve more? I always say, management is getting people to do what they are supposed to do, but leadership is helping them achieve more than they thought they could. I had a boss who was great at providing what I needed. He broke down bureaucratic obstacles in the organization that kept me from being successful. Once he paved a path for me, I understood he expected me to deliver results. I’ve tried to adopt a similar leadership style.

On the flip side, reflecting back to poor leaders allows us to learn what not to do as well as what types of behaviors to avoid. I had another boss who was ruthless. She actively sought out weaknesses. The more vulnerable the victim the better, especially if that person reported directly to one of her subordinates. My takeaway from that experience was to make sure my team members were always prepared. Furthermore, I made it clear I would always stand with them.

Put yourself in your counterpart’s shoes. I appreciate the old saying, “To truly know someone, you need to walk a mile in their shoes.” Empathy is the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings and thoughts of another. A leader may be able to fake empathy once or twice. However, the people you are leading will quickly identify whether you are truly empathetic or just paying them lip service.

Understand what motivates your group. Tie the motivations of individuals to your vision to accomplish your goals. I once worked for a senior VP who desperately wanted to expand his territory. He asked what my goals were. I told him I wanted to become an area manager. He replied with, “Then build an area.” He proceeded to provide me the resources, encouragement, and, when necessary, the interference, to build an area. The result was both visions were realized.

Plan, prepare, and practice. You only have one chance to make a first impression. If you’re trying to sell your team on a shared vision for success, obtain buy-in by preparing an initial “pitch” to get them on board. Not being successful the first time doesn’t doom the plan or idea for the future. However, being ill-prepared during the initial roll-out seriously reduces the chance of success going forward.

  • Plan: Identify objections you may encounter ahead of time. Know the people you are preparing to lead or motivate.
  • Prepare: Know your facts. Understand your data. Do your research.
  • Practice: Find a friend or family member with whom to practice your presentation. Or, at the very least, pitch it to yourself in front of a mirror.

Stay calm and don’t brag. Staying calm is especially important if you don’t receive the response you expected. If there is resistance to your plan when initially presenting it to your team, keep your wits about you. You may find additional research is required. Sometimes, you need to work through the plan with your team gradually. Generally speaking, losing your temper or panicking will make things worse.

Bragging or making the project or vision about you is a sure path to difficulty. I have seen managers try to motivate staff or physicians to get behind a vision but these individuals were so ego-centric it was clear to their audience the plan was really about the manager, not the team. Generally, “me” based managers fail.

Again Ms. Knight quotes Thomas Steenburgh, “Very few parents say they want their kids to grow up to be a salesperson.” If these parents truly understood the versatility of the sales skill set, they would appreciate that a sales career can prepare their kids for a life of leadership.

Robert Carrera, President/CEO

1 https://hbr.org/2017/05/how-to-improve-your-sales-skills-even-if-youre-not-a-salesperson

Jun 29
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Taking Care of Your “Second Victims” After an ASC Adverse Event

Taking Care of Your “Second Victims” After an ASC Adverse Event

By ASC Management, Leadership No Comments

Life is full of unexpected events. Despite our best efforts, bad things happen. If you work in clinical settings like ASCs long enough, it is likely you will encounter an unexpected event where the outcome is not optimal. Hopefully the resultant harm is minimal, but sometimes it’s not. Adverse events can lead to painful infections, injuries that require surgery, permanent damage, and death. Research shows medical errors are the number three cause of death in the United States.

When an adverse event occurs in a surgery center, the primary concern is the well-being of the patient and their family. With patient needs tended to, leadership works to prevent the mistake from occurring again.

While all of this is happening, potentially overlooked or underappreciated are the needs of your staff. Most ASC physicians and clinical staff pursue a career in medicine because they enjoy taking care of people. Many will establish emotional connections to patients. Surgery center caregivers often use possessive phrases – “these are my patients.” With such strong connections formed, caregivers may suffer significant distress if an adverse event results in patient harm. Given the nature of care provided in ASCs, staff rarely deal with emergencies or surprises. This can magnify the shocking effects of an adverse event.

The term “second victims” describes health care providers involved in an adverse event and traumatized by the incident. They often feel responsible for the outcome. The weight of the experience can have short- and long-term effects. These can include:

  • feelings of guilt, sadness, and shame,
  • distraction, both at and outside of work,
  • second-guessing of knowledge and skills, and
  • personal harm, even suicide.

Here are some recommendations that may help provide support to caregiver “second victims” following an adverse event.

1. Determine affected staff and evaluate.

Identify who served on the clinical team caring for the harmed patient. Clinical ASC supervisors and the administrator should then work to evaluate the impact of the event on involved staff. The administrator and medical director should evaluate the impact on physicians. These evaluations can include one-on-one conversations with team members about their response to the incident. They can help determine if staff are experiencing any emotional trauma.

Do your best to make staff feel comfortable about sharing their thoughts and feelings. While some team members may not open up to you, simply reaching out can help. Doing so conveys you are genuinely concerned about staff well-being and not just determining the cause of the incident.

2. Address patient ratios.

It is difficult to predict how team members will cope with an adverse event, even one that inflicts minimal harm. From a staffing perspective, it may behoove you to assume the worst. Expect involved caregivers to require time to process the situation — time that may keep them out of the ASC or lead to reduced shifts. Immediately address patient ratios and redistribute patient loads to allow for coping and account for reduced staff. You do not want someone treating patients not emotionally or physically prepared to deliver quality care.

3. Provide support.

Offer your support to those team members who indicate some form of trauma. Discuss how they are feeling. Ask if there is anything the surgery center can do for them. This may include providing longer breaks or shorter shifts (if possible). Let them know they can speak to leadership at any time if they find themselves distracted or struggling with emotions.

Note: Not everyone on your team will feel comfortable sharing their emotions or requesting assistance. Keep an eye on team members for signs of struggling. If your gut tells you someone is having a difficult time or you notice changes in behavior (e.g., crying), speak with this team member. Work to obtain an honest answer on their state of mind; it can impact your risk management.

4. Offer professional counseling.

As helpful as it can be for ASC leadership to provide support, some caregivers may require or want outside professional counseling. Have the ability to offer such counseling, even if no one takes advantage of it. Some caregivers may initially dismiss the offer only to take advantage of it later. What’s important is to have counseling available and for caregivers to know how to secure an appointment.

Preparation is Critical

An adverse event can occur at any time. When it does, what matters most is how you respond. Ensure your response plan takes into consideration potential second victims. When caregivers do not receive the necessary attention and support following an adverse event, the likelihood of another incident occurring increases. While you can’t undo a mistake, you can work diligently to prevent another one from happening.

Jebby Mathew – Regional Director of Operations

Jun 27
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Your Surgery Center Safety Tools May Not Be Enough for Patient Safety

Your Surgery Center Safety Tools May Not Be Enough for Patient Safety

By ASC Management No Comments

ASCs use a myriad of safety tools – hand off protocols, checklists, computerized order entry systems, automated medication dispensing systems, and other similar solutions – to prevent unintentional slips and errors. These protocols are essential. But what happens when a clinician does not speak up when a safety tool identifies a risk?

When a clinician knows of a risk and does not speak up, the communication break-down can appear intentional. Someone knows, or strongly suspects, something is wrong, but chooses to ignore or avoid it. They may attempt to speak up, but back down when faced with resistance. This is not a slip or an error. This is a calculated decision to not engage in a conversation that may be uncomfortable, elicit a negative response, or result in no response at all.

The American Association of Critical-Care Nurses and VitaSmarts documented in their research, Silence Kills: The Seven Crucial Conversations for Healthcare (Maxfield D, 2005), clinicians identify three concerns which are often left undiscussed because they are emotionally and politically risky topics. These topics are dangerous shortcuts, incompetence, and disrespect.

The data from this study presents a convincing case:

1. More than one half of the clinicians who participated in the study reported shortcuts led to near misses or patient harm;
2. More than one third said incompetence led to near misses or harm to a patient; and,
3. More than half indicated disrespect (not listening to their ideas or valuing their professional opinion) experienced in previous scenarios prevented them from speaking up.

The data also shows clinicians are more likely to take their concerns to managers rather than speak to the person they are concerned about. Since organizations often assume working through the hierarchy is the correct way to address a problem, it is important to examine if this system actually works.

A better solution may be to tackle these issues using a multifaceted approach to create a culture where people feel safe to speak up when they have concerns. Try the following:

Establish a Team.

Start by assembling a small team made up of leaders, including physicians. Work to identify crucial moments and vital behaviors in the center or department.

Identify Crucial Moments.

There is a handful of “perfect storm moments” when circumstances, people, and activities combine to make safety tools ineffective. The team needs to identify these moments so people recognize when they occur. One example is when the facility pushes the surgery schedule into the evening and people are in a rush to get home.

Define Vital Behaviors.

When clinicians are in a crucial moment they need to know what to do or say. This is where vital behaviors come in. Here are two examples:

1. Encourage 200 percent accountability. Each staff member is 100 percent accountable for following safe practices and 100 percent accountable for making sure others follow safe practices.
2. Create the “thank you” program. Establish a safe and respectful environment where staff members can hold each other accountable. When someone reminds them of safety practices, they thank the other person and redouble their efforts to keep patients safe.

Develop a Playbook.

Create a list of situations (crucial moments) and plans (vital behaviors) staff can refer to. They may modify these and invent new strategies on their own. You can use this as a training tool and assist in performance improvement.

Most safety tools work by warning a clinician of potential problems. However, warnings only create safety when clinicians can speak up and get others to act.

Jovanna Grissom – Director of Operations

Jun 21
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Dos and Don’ts When Developing a Surgery Center Project Budget

Dos and Don’ts When Developing a Surgery Center Project Budget

By ASC Management No Comments

“The best-laid plans of mice and men often go awry.” This quote is an adaptation of a line from the Robert Burns poem, “To a Mouse.” It essentially means, no matter how carefully one plans, something may still go wrong.

This can be true when developing a budget for an ASC project. The smallest of oversights can derail budget accuracy. I’ve seen it happen and witnessed the ramifications. Suffice it to say, when the cost of a surgery center project exceeds its budget, management is usually displeased. And justifiably so. Unexpected expenses can place financial strain on owners who may be forced to make up the difference on short notice.

Here are some dos and don’ts that can help you develop a more accurate project budget.

Do use a work breakdown structure (WBS)

A WBS identifies the individual tasks necessary to complete the project. The tool is typically arranged in a hierarchy. It is intended for practical groupings, such as by activities or deliverables.

When assembled correctly, a WBS provides a comprehensive list of tasks needed to complete the project. With this information, you can better determine:

  • what personnel you will need to complete each activity,
  • what types of vendors/service providers are necessary,
  • what materials are necessary,
  • what approvals (e.g., city, state, fire, accreditation, Medicare, etc.) are necessary,
  • how long completion of each activity is likely to take, and
  • potential risks to take into account (more on this later).

You will want to carefully consider these factors when determining the cost of each activity. Your final budget reflects the sum of the costs of all activities.
Without the use of such a planning tool, you are more likely to omit important financial considerations.

Don’t guess

Resist the temptation to guess about any element of your ASC project and its budget. Doing so can create a harmful ripple effect.

Let’s say your project requires a service such as painting. If you required painting services last year, you may feel confident about guessing the cost. However, many factors could cause your guess to come in low. The painting company you used last year may no longer be in business or available for your project. You may need a more expensive paint. The ASC space you need to paint this year may be larger than last year’s space.

Perhaps a manager asks how long a project will take and you guess a month. The manager may use this information to make plans for a new project after the month has passed. If your project takes longer than a month, you now have two projects overlapping. If these projects require use of the same space and/or personnel, there may be delays in completion of one or start of the other, potentially resulting in increased expenses.

Take the time to conduct the due diligence necessary to secure accurate estimates. Avoid succumbing to pressure to begin a project or provide on-the-spot answers. Maintain the integrity of the project by refusing to cut corners on research. The potential negative effects of guessing on your ASC project components and its budget likely outweigh any potential positives.

Do budget for risk

No matter how great you are at surgery center project planning, try to budget for the unexpected. Most projects inevitably experience unexpected and uncontrollable hiccups that will increase costs.

For example, if a project involves new construction, you may learn of surprises underground or during visits by inspectors. If a project involves an existing space, there may be pipe or wiring surprises behind the walls. Other causes of unexpected challenges can include weather interruptions, personnel sickness, subcontractor delays, and shipping/supply delays.

As the size, scope, and timeline for an ASC project grows, so do the risk considerations. It’s better to come in under-budget than need to request additional funding once the project is underway.

Don’t overextend personnel

When assembling a team to work on a project, take staff members’ skill sets into careful consideration. An effective manager of a department may not necessarily serve as an equally effective project manager. While some responsibilities may be similar, differences in the roles, including management of an extended timeline, could lead to costly problems and delays. Ensure skill sets align with the tasks you need accomplished.

Take personnel availability into consideration. If a project requires staff to take time out of their normal job schedule, who will fill these open hours? Does it make sense to pay overtime or bring in PRN (as needed) staff to complete a project faster? Should you spread out hours over a longer period of time to avoid extra staffing expenses?

Do the best you can

Surgery center project budgeting is not a perfect science. You can put together what you believe is an accurate budget that accounts for risk and still exceed established parameters. If you encounter obstacles likely to cause you to go over budget or allotted timeframe, be transparent. Inform leadership as soon as possible so they can make plans to account for the change.

What’s most important is to be diligent in your planning. Try to limit surprises and ultimately come as close to your budget as possible. If you accomplish these objectives, consider your project budget planning a success!

Jebby Mathew – Regional Director of Operations

Jun 19
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Running a Successful Endoscopy Center is all about Patient Access

Running a Successful Endoscopy Center is all about Patient Access

By ASC Management No Comments

In ASCs, where surgical procedures are performed, volume is typically driven by surgeons. ASC leadership is responsible for making it easy for physicians/surgeons to bring their procedures to the facility.

Most adults need to undergo a routine colonoscopy when they turn 50. In an endoscopy center, the volume is driven by patients or their referring primary care physicians (PCPs). Therefore, an endoscopy center’s leadership must make it easy for patients to come to the center for their procedures. Without ease of access, patients are likely to look elsewhere for care and PCPs are likely to refer elsewhere.

Eight steps endoscopy centers can take to improve patient access and grow their volume in the process follow.

1. Be easy to find.

Make sure patients and PCPs can find your center without much effort. These days, that means developing and maintaining a strong internet presence. Keep your website current. Make sure it’s mobile friendly by incorporating a responsive design. When patients search for a place to receive a colonoscopy, you want your center showing up on the first page of results and as close to the top of that page as possible.

2. Provide direct access.

Give patients the ability to call and schedule their procedure directly with you. Make this as simple a process as possible – you don’t want to give patients a reason to hang up.

3. Conduct community outreach.

The internet is a valuable tool to connect with patients but don’t underestimate the power of human contact. Participate in outreach programs. Encourage your physicians to give talks at community centers. Attend senior expos and other events that are likely to attract your target demographics.

4. Streamline the referral process.

Provide local PCPs with packets of information about your endoscopy center and colonoscopy scheduling process. These packets should include everything a patient needs – health history form, consent form, preparatory instructions, directions to your facility, contact information, etc. PCPs will appreciate your efforts to help their patients receive care. This is an effective way to directly market to patients and PCPs.

5. Network with PCPs.

Focus on building strong relationships with PCPs and their offices to encourage referrals. Schedule lunch meetings where you can talk about your center and the services you offer. Discuss any barriers to access and what you can do to help remove them. Whenever possible, involve your physicians in these efforts which will help develop peer-to-peer connections with PCPs.

6. Analyze referral patterns.

Keep a close watch on your referring physicians’ case volumes. If you witness a noticeable decline, determine the cause and try to fix it. If volume is flat, find out if there is anything else you can do to encourage more referrals. When volume increases, express appreciation and make sure you maintain a high quality of service.

7. Monitor physician activity.

Make sure you are on top of the movement of physicians in your market, especially those who are high referral sources. When a referring physician changes practices, make sure the new practice receives your patient packets. Schedule time to meet with this physician to reestablish your connection, if necessary. You can also use this as an opportunity to speak with this physician’s new partners about becoming referral sources. If a new PCP comes into the market, be the first one to welcome him or her. Reach out and schedule a meeting. A positive first impression can go a long way toward securing referrals.

8. Stay current.

Be on the lookout for new gastroenterology and endoscopy procedures and technology. For example, new means for treating fecal incontinence are gaining greater acceptance. As word spreads about such advancements, you may want to offer these services. Doing so can add case volume while elevating your center’s profile, bringing attention to the other services your endoscopy center provides. Keep an open mind to what you can do in your center. Developments coming down the pipeline may be worth considering.

Remain Proactive

There’s a lot of competition for patients and referrals. To maintain ease of patient access and remain a primary referral destination, vigilance is required. Establish processes for monitoring your internet presence. Ensure continuous communication with your referral sources. Do whatever is necessary to establish your endoscopy center as the provider of choice for patients and PCPs – then don’t let up! The moment you take your ease of patient access and referral sources for granted, another facility may seize the opening.

Catherine Sayers – Director of Operations

Jun 15
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outpatient total joint replacement program

Starting an Outpatient Total Joint Replacement Program at Your ASC: 5 Key Questions

By ASC Development, ASC Governance, ASC Management No Comments

Advances to minimally invasive surgical techniques, blood loss management, and anesthetics have led to a rise in total joint arthroplasties (TJA) being performed at ambulatory surgery centers (ASCs). Orthopaedic specialists and patients nationwide are increasingly well-served with the same-day model, in which patients receive their total joint replacement and return home for recovery within 24 hours, typically on the same day as surgery. Many orthopaedic-focused and multidisciplinary ASCs are preparing to offer a same-day TJA program, if they do not already. For ASCs working to initiate a credible total joint program, there are key clinical, business, and marketing elements of a well-developed program to consider.

Five questions ASC board members and investors will want to ask before approving a TJA program follow.

1. How does the ASC determine TJA patient selection criteria?

Well-formed patient selection criteria are important components of a successful TJA program. Key stakeholders will likely query, is there a national standard for outpatient TJA patient selection criteria? Unfortunately, the current answer is no. Outpatient total joints do not have as much history as that of outpatient surgery in general. And few professional societies have yet to publish specific criteria for outpatient total joint replacements. However, publications from institutions doing TJA successfully on an outpatient basis are available.

To form a TJA patient selection criteria that is safe for your patients, lean on your clinical leaders. This includes your clinical nurse manager and head anesthesiologist. Begin with your center’s current patient selection criteria for all patients. Then, consider American College of Surgeons National Surgical Quality Improvement Program (NSQIP) standards and American Society of Anesthesiologists (ASA) standards. Do this before reviewing accepted standards from peer-reviewed publications and other ASCs with successful TJA programs.

2. What is the ASC’s clinical plan for performing total joints?

A thorough clinical plan includes patient selection criteria, pre-operative screening protocols, anesthesia plans (pre-operative, intra-operative, and post-operative), clinical guidelines, discharge guidelines/criteria, and follow-up guidelines. Once again, rely on your clinical leaders to formulate the guidelines. If you are having trouble determining some of the clinical plan components, contact a qualified total joint program consultant and/or your ASC association. You can also perform an internet search to look at what other ASCs are doing. Finally, the clinical plan should also incorporate physical therapy, which many ASCs are arranging for patients to complete at the ASC both pre-operatively and post-operatively on the day of surgery.

3. Is the ASC’s nursing staff prepared for the first TJA case?

The beauty of working with skilled nurses in an ASC is their wide-ranging experience. Their experience often includes total and partial joint surgeries at hospitals and other surgery centers. Still, you will want to work with your Clinical Nurse Manager to prepare your ASC’s nursing staff for the TJA program. Identify individuals on your team with the most experience in orthopaedic surgery and in performing total joint surgeries. If you are lucky, you may even have nurses on staff who have worked on TJA cases with the physicians who will be performing them at your center. Rely on these individuals to serve as your skilled TJA nurses and teachers for the other nurses.

In advance of your first patients, prepare your operating room nurses. Arrange for a TJA walk-through with your device representatives. Prepare your pre-op/PACU recovery nurses by arranging for a lesson with a physical therapist who can teach them safe post-surgery movement and ambulation techniques that will prepare TJA patients for discharge. If overnight patient stays are part of your clinical plan, ensure nursing staff members understand patient care expectations during this extended recovery time.

4. What will be the fiscal impact on the ASC?

If you are projecting a certain number of total joint cases in your first year, identify the market and physicians who you expect will deliver these cases. For example, is there a patient population you are not treating because an outpatient total joint program isn’t currently in place? Or, will your physicians be moving a sector of their current patient population to your ASC? Is there another way to capture market share? Combine projected case counts with information on reimbursements and costs to identify the potential fiscal impact on your ASC.

5. What is the marketing strategy and plan for your TJA program?

To answer this question, one must first gain direction from the ASC’s governing body. Determine their interest in working collaboratively with key stakeholders such as the hospital partner to market a comprehensive total joint program. In some cases, collaborative marketing may be a strong desire of your board. Regardless, it will behoove you to create a marketing plan that divides marketing efforts into consecutive stages.

For example, the initial stage might aim to maintain the current customer base. This can include efforts like marketing to referral sources and direct-to-consumers through patient education, media/public relations, and website enhancements. The next stage could then focus on expanding the customer base by exploring new market areas and referral sources. At each stage, marketing efforts and metrics should be evaluated to determine if program goals are being met. This analysis will help determine future growth opportunities and identify further initiatives for enhancing the TJA program.

One of the key components of a successful outpatient total joint replacement program is early preparation. Completing a clear and concise clinical, business, and marketing plan will not only demonstrate to surgery center board members the ASC is ready for total joint approval, it will also deliver a safe environment for total joint replacements performed in your facility.

Jack Mast – Physician Liaison

Jun 13
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ASC's 10-year anniversary

Turn Your ASC’s 10-Year Anniversary into an Improvement Opportunity

By ASC Management, Leadership No Comments

Your ASC has reached its 10-year anniversary.  Congratulations!  Reaching this milestone is no small feat.  Take stock of all you have accomplished, reflect on the adversity you have overcome, and then celebrate with your team.  You’ve earned it!

When your surgery center hits a significant milestone such as a 10-year anniversary, it’s important to recognize the achievement.  A celebration is a great opportunity to boost staff satisfaction.  Announcing an anniversary to your community is an effective way to market your ASC to patients and physicians.  People are naturally drawn to and have confidence in organizations with a successful track record.

A noteworthy anniversary is also an opportune time to perform a complete assessment of your surgery center and its operations.  Your ASC has likely undergone significant internal changes during the past decade.  An assessment can help ensure your ASC stays on a path toward celebration in another 10 years.

Include the following areas in your assessment:

ASC Aesthetics

  • Determine if places in your facility need remodeling to ensure it does not look outdated.
  • Examine wall coverings, furniture, fixtures, flooring, and carpet.

ASC Workflow

  • Determine if process and efficiency changes occurring over the past 10 years will benefit from physical or operational improvements. For example, if case volume increased, would adding a patient registration check-in station help handle the growth and improve efficiency?
  • Walk through your ASC with a critical eye on space utilization. As a surgery center “grows out of its space,” optimization of space helps keep areas organized, uncluttered, and efficient.  Consider inventory management, for example.  Could consolidating manufacturers reduce par levels of supplies in some categories?

ASC Information Technology (IT)

  • Work with your in-house IT specialist(s) and IT vendors to determine the age of all your technology. Assess whether any equipment needs replacing. This is especially important for servers that manage your programs and battery backup systems that provide supplemental power.
  • Make sure IT security, such as a firewall, is current and performing adequately.
  • As with any technology, computer workstations gradually slow down and become susceptible to problems that can affect functionality. If you do not already have a schedule to replace your workstations, put one together. Plan your budget to spread the expense out if you want to avoid the financial hit all at once.

ASC Medical Equipment

  • Determine which equipment may be nearing the end of its lifecycle. Many items are not designed to function properly for more than 10 years.
  • Assess the following high-expense items – some of which can exceed $100,000 in cost – and develop a plan for repairs or replacement:
  • Main sterilizer in sterile processing
  • Washer/disinfector in sterile processing
  • Smaller sterilizer units in sub-sterile rooms
  • Scope processors
  • C-arms (x-ray tube and image intensifier usually last 7-10 years)
  • Power equipment (e.g., drills, saws, reamers)
  • Surgical and procedure room tables
  • Ultrasound and transducer for anesthesia pain blocks
  • Patient monitors
  • Defibrillator
  • Anesthesia machines and gas modules
  • Video towers for endoscopy (e.g., video equipment, including cameras, monitors, and shaver boxes)
  • If you purchased any refurbished equipment, keep in mind that its lifespan is likely shorter than new units.

ASC Equipment

  • Ask your maintenance/service vendors to assess facility/plant-related equipment for estimated end of life. If these machines fail, the surgery center will likely need to shut down until completion of repairs or replacement.  Examples include:
  • Generator/transfer switches
  • Boiler and steam system, steam traps, and valves
  • HVAC system/rooftop units
  • Electrical isolation monitors/panels in ORs and procedure rooms
  • A completed assessment should include vendor predictions of how much longer equipment will last. Obtain price quotes and estimates to budget for replacements accordingly.
  • Even if replacements are not needed or recommended for another several years, plan to increase your budget for maintenance and repairs. Expenses will increase with the aging of the units.

Ongoing Exercise

While a 10-year anniversary marks a fitting time in your ASC’s history to perform these evaluations, a mature ASC is best served by performing routine assessments.  More frequent assessments will help minimize surprises and provide ample time to develop plans to address anticipated issues.  If substantial improvements are needed, provide your governing board with project details and solicit their feedback.  Then, appropriately budget for the work.

Your 20-year anniversary may not be right around the corner, but there is plenty of work you can do now to position your ASC for continued prosperity.

Diane Lampron – Director of Operations