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Jun 09
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ASC scheduling efficiencies

How ASC Scheduling Efficiencies Impact Your Facility’s Revenue

By ASC Management, Leadership, Revenue Cycle Management No Comments

Efficiencies in scheduling can be crucial to positively impacting revenue at your ambulatory surgery center.  Maximizing scheduling efficiency creates room for more procedures.  Even if you gain only one or two procedures each day, these marginal gains can easily increase your bottom line.  Therefore, taking steps to cultivate efficiency is an essential strategic initiative. 

Here are seven ways to create efficiency in your ASC’s scheduling process.

1.  Encourage your physicians’ offices to schedule cases as far in advance as possible.  Cases scheduled well in advance of surgery dates allow surgery           center personnel adequate time to prepare for patients.  Obtaining pre-authorizations from some insurance companies can take several days to complete.  Surgery center staff must call patients in advance of their procedure to review their medical history and discuss financial obligations.  Managers staff the center based on the number and types of cases on the schedule.  At times, center personnel need to pre-order special equipment, medical supplies, or patient-specific implants.  If your physicians’ offices encounter changes in their surgeons’ schedules – cancellations, add-ons, time changes, or order changes, for example – encourage them to communicate those changes to you as quickly as possible.  Discuss ahead of time the preferred form of communication for your center – phone, email, fax – to create efficiencies for their team and yours.

2. Establish a strong working relationship with your physicians’ offices to obtain accurate information. Coordinating patient care requires teamwork.  When your ASC serves as an extension of each physician’s practice, the care continuum is virtually seamless.  It is crucial to obtain scheduling forms from your physicians’ offices with comprehensive patient information and up-to-date copies of both sides of the patients’ insurance cards.  This information assists in determining if patients are viable candidates for surgery at your facility from both a clinical and third-party payor coverage standpoint.  If the surgery or procedure falls under workers’ compensation, ask your physicians’ offices to include adjustors’ names and phone numbers.

3. Schedule patients with special needs and your more extensive/high acuity cases at the beginning of the day. Include small children and patients with chronic illnesses, such as diabetes and sleep apnea, in this classification. Scheduling these cases first allows lengthier recovery times to be more easily accommodated.  Additionally, caring for these patients during usual working hours prevents staff from having to stay late or accumulate costly overtime hours.

4. Schedule specialties in the same room whenever possible. This prevents staff from spending valuable time moving equipment from room to room, leading to shorter turnover times. 

5. Schedule similar surgical sites consecutively (i.e., right vs. left, shoulder vs. knee). As an example, for orthopaedic arthroscopy cases, you may prefer to keep all the shoulder cases in line and then move to knee arthroscopies.   This will reduce the need to change positioning devices and room set up between cases.   Speeding up room turnover, anesthesia set up, and the overall flow of surgery, typically yields happier surgeons!  

6. Know what you have to work with. Larger facilities may have the ability to set up rooms by specialty.  Smaller facilities will need to focus on how to best move and position equipment. Train your staff to think strategically about these types of things based on your center’s unique characteristics.

7. Communicate your ASC’s patient criteria to your surgeons and their staff. Patient safety is a priority.  When your physicians and their office staff understand the contraindications and anesthesia requirements at your center, they can schedule their patients at the appropriate facility.   

After you determine the best efficiency workflow processes for booking procedures at your facility, educate physicians, their scheduling staff, and your facility personnel on how they work and why they are set up that way.  Scheduling efficiencies go a long way toward creating higher satisfaction for your team and physicians.  More importantly, scheduling efficiencies create opportunities to add more cases and increase your ASC’s revenue.

Kelli McMahan – VP of Operations

May 30
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How Marginal Gains are Crucial for Surgery Center Growth

By ASC Governance, ASC Management, Leadership No Comments

Over the course of many years, Pinnacle III has been tasked with the evaluation and turnaround of numerous failing or drastically underperforming surgery centers.  In each situation, it was relatively easy to identify the pain points and devise solutions to create marked improvement in the ASC’s performance.  

There are many centers, however, that already operate at an elevated level.  Their investors often ask us if it is possible for these facilities to improve.  

To answer this question, I am reminded of a story from the 2012 Tour de France and London Olympics. In 2010, Sir Dave Brailsford was tasked with improving the performance of the professional cycling team, Team Sky.  Eventually, he was asked to do the same for the British National Cycling Team.  At that time, Britain hadn’t had a Tour de France champion nor had they performed well in Olympic Cycling. Brailsford realized major gains in the realm of world class athletics were difficult to achieve.  Therefore, he focused on the concept of marginal gains aggregation.  He explained this concept as a one percent margin for improvement in everything.  He believed if you improved every area related to cycling by just one percent, those small gains would add up to remarkable improvement overall.

Initially, Brailsford and his team focused on the obvious – tire weight, seat ergonomics, and athlete nutrition.  Then they turned their focus on the far less obvious.  This included pillow choice and its impact on sleep quality, personal grooming habits and their impact on propensity to develop saddle sores, and hand hygiene to avoid illness.  Essentially, they searched for a one percent improvement in every area where they could create impact.  The results, despite some recent controversies, speak for themselves.  Britain’s Team Sky was victorious in the Tour de France in 2012, 2013, 2015, and 2016.  The British National Cycling Team also won 70% of the gold medals at the 2012 games.

I realize Team Sky is not the first or only organization to espouse the benefits of such an approach.  However, as a cyclist and a geek for human performance improvement, I gravitated to this example to illustrate my point.  Other examples that have paid dividends to the concept of marginal gain include David Cameron’s Behavioral Insight Team which improved the wording of tax demands to increase responsiveness.  Or Google testing 41 shades of blue for its advertising hyperlinks, which they claimed netted an extra $200 million in annual revenue.  The examples are endless.

So, how does a successful ASC ensure continuous growth?  We believe the best get better by consistently reassessing where there are opportunities to aggregate marginal gains.  I have written a great deal about culture.  This is another cultural characteristic which we work to ingrain in our partnered centers.

Every member of an ASC’s team can look for ways to identify marginal gains in their day-to-day activities.  Materials management can move more items to consignment.  Nursing staff can suggest the removal of unneeded items from custom packs.  The revenue cycle management (RCM) team can suggest changes to a dictation template to reduce the need for payors to request additional medical records.  Or, they may suggest implementing online bill pay to create an easier medium for patients to submit payments thereby expediting the receipt of receivables.  These are just a few examples of marginal gains that can be achieved through diligent management.  

It’s also important to keep in mind the reverse can be true as well.  A one percent decline in aggregated overtime can have significant impact on a facility’s operation.  The diagram below, adapted from James Clear, as referenced in “The Slight Edge” by Jeff Olson, effectively illustrates this point.

In closing, it’s easy to get caught up chasing the “large whales” – implementing bundled payments, a total joint program, or a re-syndication – to enhance facility prosperity.  But don’t forget to attend to the “small fish” by creating a culture around aggregating marginal gains.  The valleys in an ASC’s growth can be filled by marginal gains.  Doing so ensures the declines aren’t as sharp which leads to a steadier upward slope.  Overall, marginal gains are crucial to an ASC’s continuous growth.

Robert Carrera – President/CEO

May 17
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IT Checklist

This Checklist Can Help Keep Your ASC’s IT Network Secure and Data Protected

By ASC Management No Comments

It doesn’t take much for cybercriminals to gain access to a network.  A click of a link in an email.  The opening of an attachment.  A visit to a compromised website.  The use of outdated software. A lack of proper security software.  The list goes on.

Once cybercriminals breach your network, immense damage can occur.  At a minimum, you may need to go partially or entirely offline.  In a worse scenario, they may steal sensitive financial and/or clinical data.

Recovering from a breach can be a slow process, and an expensive one at that. Expenses can add up quickly when you take into consideration the cost of:

  • investigation,
  • remediation,
  • patient notification (and coverage for potential identify theft and credit monitoring),
  • legal fees,
  • regulatory fines, and
  • business interruption and associated loss.

To help keep your surgery center’s network secure and cybercriminals at bay, consider performing regular information technology (IT) audits. These audits, which examine your IT systems and software, can help identify security weaknesses.

Here is a checklist of some critical IT security-related questions to answer. Speak with your internal IT director and/or outsourced IT vendor to ensure each audit area is addressed.   

Network Security Protection

  • Do we use anti-spyware software?
  • Do we use anti-malware/malware detection software?
  • Does our security software filter malicious code from websites?
  • Does our security software process emails through anti-spam and anti-virus filtering?
  • Do all servers and workstations have the proper security software installed?
  • Is security software current/updated?
  • Do we have processes to keep security software current/updated?

Firewall

  • Do we have a firewall installed?
  • Is our firewall configured securely? (Note: If the firewall is using factory default settings, it is likely not secure.)
  • Is the firewall functioning as designed?

Network Access

  • Is all remote access to the network authenticated and encrypted?
  • Do we use physical security controls to prevent unauthorized access to computer networks and data?
  • Do we have access controls in place with role-based assignments?

Internet Access

  • Do we have internet access restrictions in place?
  • Do such restrictions block potentially harmful websites?

Wi-Fi Access

  • Is Wi-Fi configured to prevent unauthorized server access?
  • Is Wi-Fi configured to provide public internet access without server access (i.e., a second setup)?

Software Updates and Patches

  • Do we have a process for receiving notices of available security patches and upgrades?
  • Do we have a process for installing and testing critical security patches?
  • Do we have a process for identifying software that stops receiving support?
  • Do we have a process for effectively replacing software, if necessary?

Security Assessment/Testing

  • Do we have a process for performing regular testing of our cybersecurity measures?
  • Do we have a process for performing an annual, full system security assessment?
  • Do we have a process for effectively responding to security incidents (e.g., hacking, viruses, and denial-of-service attacks)?

Be Diligent

Cybercriminals are lurking, waiting for an individual or organization to make a mistake.  While you can’t keep cybercriminals from targeting your ASC, you can make your center a less appealing mark.  Ensure network security is a priority. This will put you in a better position to avoid breaches, catch potential weaknesses early, and make cybercriminals look elsewhere for their next victim.

Diane Lampron – Director of Operations

May 03
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ASC Administrator

Successfully Transitioning into an ASC Administrator Role

By ASC Management No Comments

In the spring of 2016, I was approached by my management company supervisor about accepting an interim administrator position at our ambulatory surgical center.  Interested, yet hesitant, I agreed, as his confidence in me to take on the role was genuine and complimentary.  

With a new boss and role ahead of me, the necessity to decipher what was needed to succeed occupied my thoughts.  As clinical director of the surgery center for three years, I understood the importance of leadership and management.  However, I did not possess a complete understanding of the administrator role.  To gain this understanding and to succeed in my new role, I needed a plan.

Success Requires Knowing the Answers

Initially, I needed to understand the expectations.  Specifically, I wanted to gain knowledge about the following:

  • What was the vision of the ASC’s board of directors?
  • How will the management company assist with executing this vision?
  • What was required of me to meet this vision?

Success Requires Knowing Who Has the Answers

To determine who had the answers I was seeking, I needed to build relationships and identify what resources were available to me.  I found myself asking:

  • Who are the members of the management team and what are their roles?
  • How does each role impact the facility?
  • How is each role impacted by the facility?
  • Which members of the team have experience or expertise in which areas?
  • How can I tap into this experience or expertise to create success in my new role?
  • Who are the points of contact for the daily tasks of conducting business (accounting, banking, business insurance, credentialing, etc.)?

Success Requires Knowing the Deficiencies

As I began gathering responses to my questions and utilizing the educational resources available to me, I recognized the importance of assessing my needs.  I asked:

  • Where can knowledge and information assist me in successfully accomplishing the expectations of my new role?
  • Where can I obtain that knowledge and information?
  • What areas within the facility need immediate attention?
  • Are there resources available to address the areas requiring immediate attention?

In my twenty plus years in healthcare, I discovered relationships are an integral and necessary part of success.  This was true in my new position as well.  It was incumbent upon me to reach out for assistance, build relationships, and successfully integrate into the existing management team.  Within the healthcare industry, or any business for that matter, an open mind, patience, and willingness to visualize the big picture all propel an individual’s efforts forward.  An African Proverb states, “If you want to go fast, go alone.  If you want to go far, go with others.”

My integration into an ASC’s existing management team consisted of the following–

  • Knowing the vision of the stakeholders
  • Aligning the facility with that vision
  • Building relationships within the existing management group
  • Researching and obtaining useful resources
  • Identifying areas of improvement
  • Proactively addressing the identified needs

Later that year, having successfully navigated the interim role, I was offered the administrator position. 

In summary, I found Henry Ford’s statement to be true: “Coming together is a beginning.  Keeping together is progress. Working together is success.”

Tara Demuth Fenton – Facility Administrator, Children’s North Surgery Center

May 01
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ASC Onboarding

ASC Onboarding – Begin with the End in Mind

By ASC Management No Comments

In many ASCs, a new employee’s initial day on the job consists of filling out new hire paperwork, reviewing pertinent portions of the employee handbook, being introduced to other employees, quickly touring the facility, and, well, getting to work.  ASCs are small businesses – no frills, limited time, tightly managed resources, one big happy family.  Showing a new employee the ropes is typically a crash course consisting of several employees disseminating lots of information in a short period of time.    

It’s no wonder new employees experience frustration and dissatisfaction early on.  We’ve thrown them into the pool.  It should be no surprise when new employees struggle – often in many little ways.  Sure, they knew how to swim and made it to the other side safe and sound.  But it certainly wasn’t a pleasant experience. 

This is why many management articles focus on the importance of onboarding.  Onboarding is, essentially, organizational socialization.  It is the process through which new employees acquire the knowledge, skills, and behaviors necessary to integrate effectively into an existing organization.  If you do not currently have a formal onboarding program in your facility, implementing one will go a long way toward increasing employee satisfaction and retention. 

When creating your onboarding process, begin with the end in mind.  Typically, the end goal is to retain highly qualified employees who synergistically enhance your team.  What tasks do you need to undertake to achieve your desired goal?   

Establish onboarding program objectives. 

Here are some objectives to consider:

  • Teach new hires about your facility’s mission, vision, and core values. Avoid having them read about these workplace tenets.  Have your medical director, team leads, and personnel from every department explain how these principles translate into employee behaviors and mindsets.
  • Provide socialization opportunities in the workplace. Arrange for multiple employees to conduct the facility tour.  Let a PACU employee provide them with a tour of post-op.  Allow front office personnel an opportunity to explain the scheduling, verification, pre-authorization, and registration processes.  They will garner valuable insights during these interactions.  Host a welcome breakfast or lunch. Ensure every member of the team has a chance to participate in this informal gathering.  Help new employees feel good about the role they fulfill and who they work alongside. 
  • Educate new hires about the company culture. Review the unspoken “rules.”  Provide insight into facility nuances.
  • Discuss performance standards and expectations. Outline your expectations, how you measure performance, and what it will take to succeed.
  • Teach them how to do the work. Let them know where they can obtain the necessary materials to perform their job.  Identify who they should go to when a problem arises.  Clearly convey whose approval they need before altering a process or changing plans.

Structure your onboarding process with strategic forethought. 

It includes a written plan/checklist tailored for each position.  Some elements of that plan will apply consistently across all positions.  Other plan elements will require a deep dive into position specifics.  Ensure each plan incorporates input from key team members.  Their unique perspectives about what needs to be covered during the first few days, weeks, and months of a new employee’s tenure will lend itself to a comprehensive process.

Take care of logistics prior to your new employee’s first day. 

Expend the time and energy necessary to create user names and passwords to essential software programs.  If scrubs are provided, make certain the correct size is on hand.  Have a locker available to store valuables during their workday.  Provide them with their name tag.  Order supplies for their workstation, when applicable.  Let them know how to obtain additional items they will need to be efficient and effective.

Ensure the process is interactive; not an information dump. 

Intersperse reading materials in small chunks throughout their initial days on the job.  Ask new hires about their preferred learning style and do what it takes to accommodate those style needs.  Allow ample time for them to observe, while still providing frequent opportunities for hands-on practice.

Avoid rushing the process. 

Spread it out over several months.  Plan on spending the initial employment period (30-90 days) focusing on your new hire.  Recognize onboarding takes time which, if executed well, yields a high return on your investment.  Consider assigning a mentor to extend the orientation process in the 6-9 months following the initial employment period.  Finally, follow-up at regular intervals – 30 days, 60 days, 90 days, 6 months, 9 months, and annually.  Use these follow-ups to assess progress and check in with the employee to determine ongoing needs. 

A well-crafted onboarding program leads you to desired results.  In fact, it can serve as an amazing recruitment tool.  So much so that applicants might be queuing up at the door hoping to fill your next vacant position.

Kim Woodruff – Vice President of Corporate Finance & Compliance

Apr 27
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ASC Cybersecurity

Why Good Enough is Not Good for ASC Cybersecurity

By ASC Management No Comments

There’s good news and bad news when it comes to cybersecurity and ASCs.  The good news is healthcare organizations saw fewer records compromised by cyberattacks in 2016.[1]  In 2016, “only” 12 million records were compromised, down from nearly 100 million compromised records in 2015.

The bad news is two-fold.  First, cybercriminals compromised millions of records.  And second, they focused on smaller targets, which likely includes ambulatory surgery centers.

Cybersecurity must be a high priority for ASCs.  In fact, ASCs should treat cybersecurity with the same care and attention as they extend to their patients. Cybercriminals are looking to exploit even the smallest mistake or shortcoming. You cannot afford to give them such an opportunity.

Consider this scenario 

An ASC performs a top-level information technology (IT) assessment.  It finds frequent communications and discussions are occurring with the surgery center’s IT vendor. A monthly activity log indicates the servers are routinely checked for viruses, unusual activities in event logs, and overall IT performance. Basic server maintenance is ongoing.  When the IT vendor installed a new server, they implemented appropriate security measures (e.g., anti-virus and anti-spyware protection, firewall, backup system).

Sounds pretty good, right?  The basics seem to be in place.  Unfortunately, pretty good does not mean great, nor does it indicate perfection.  And when there are imperfections, there are open doors for possible cybercriminal intrusion.

Potential risks and concerns

Here are some potential risks and concerns a top-level assessment like the one above may overlook.

1. Anti-virus software installed on some computers and servers. If even a single computer connected to the network or server is missed, this creates a vulnerability.

2. Like most software, antivirus and antispyware programs must undergo regular updates. When a security software update is missed, the wall of protection is weakened.

3. Servers must also undergo updates. Updates often address security gaps identified by the server’s operating system developer (e.g., Microsoft).  Once again, if an update is missed, security could be compromised.

4. The use of a backup system is critical. It can allow you to restore data in the event of data loss due to viruses, accidents, or disasters.  However, that’s only the case if the backup system is configured properly to backup data correctly, efficiently, and with the right amount of data retention.  Simply “having” a backup system does not mean proper backups occur.

5. An ASC should use a firewall to protect against possible outside threats and intrusions. Think of a firewall as filling the role of disease prevention while antivirus software is more for infection control. A firewall will maximize its effectiveness when configured properly.  But as with disease prevention, problems may develop if the ASC neglects anything. 

Although installing a firewall is an important security step, additional steps must follow.  A firewall without content filtering that prevents users from visiting any website could open your surgery center to security problems.  It also reduces staff productivity.  Firewalls can filter out identified, malicious, virus-infected websites, but only with the proper configuration.

Some firewalls can provide an “intrusion prevention system.”  This functionality is designed to detect and block attempts to exploit network vulnerabilities for taking control of a computer or network.  Enable and configure this functionality to better protect the network.

6. Conversations with an IT vendor are nice, but what happens if you need hands-on expertise on short notice? This is where the use of a remote monitoring and management system comes into play.

When installed, the system permits the IT vendor to keep an eye on what is happening with an ASC’s network.  The vendor can monitor the server, network, and workstation health.  When an issue is identified, the vendor may be able to address it before cybercriminals exploit the problem.

If your IT looks fine on the surface, such a system may seem unnecessary . . . until it becomes very necessary.  By then, it may be too late to use the system effectively.

Be proactive  

When it comes to cybersecurity, you cannot afford to be reactive.  There is a good chance a cybercriminal will be faster at reacting than you.

Work with your IT vendor to ensure your ASC is doing everything possible to identify and address potential risks and concerns.  Put processes in place to help maintain the highest level of cybersecurity and keep cybercriminals at bay.

Diane Lampron – Director of Operations

[1]According to the 2017 IBM X-Force Threat Intelligence Index

Apr 25
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Management page header image

A Clinical Approach to Healthcare Business Management & Problem Solving

By ASC Governance, ASC Management, Leadership No Comments

I am a physical therapist (PT) by education and training.  I graduated from Wayne State University in Detroit, Michigan with a Bachelor of Science in PT. Go Warriors!

For over ten years, I practiced in a variety of settings, including my time spent as a clinical faculty member at the University.  After that, I moved full time into the world of management.  I like to think I could still earn an honest living as a clinician if I needed to.

As my career moved away from clinical practice, I retained my clinical approach when dealing with issues related to business practices.

The American Physical Therapy Association uses the following statement to describe what a physical therapist does:

“PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.  In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles.”[1]

Essentially, PTs evaluate the situation and assess findings to develop a treatment plan.  Our goal is to return patients to their previous or higher level of function.  In some cases, we develop a plan to prevent or forestall further disability.  Sound familiar?

As is the case with many healthcare disciplines, we learned to evaluate someone and then document our findings in a format called the SOAP note.

Here is what the SOAP note entails:

Subjective – Detailed notes regarding what the patient relays about their status in terms of function, disability, symptoms, and history.

Objective – This is derived from the clinician’s objective observations.  It can include visual observations such as posture and swelling, actual measurements such as range of motion or strength, and hands-on techniques such as palpation.

Assessment – The clinician’s analysis of the various subjective and objective findings yields an assessment.  It explains the reasoning behind the decisions made and clarifies the analytical thinking behind the problem-solving process.

Plan – Conveys how the clinician develops treatment to reach goals or objectives.

As a business leader, I use the clinical approach I learned and practiced to solve management problems.  Here is how:

Subjective – Years ago I read the difference between clinicians heralded at the top of their profession and those considered more average was based on the quality and thoroughness of the clinician’s ability to subjectively capture a patient’s history.  I believe the same is true in business problem solving.

In business, it is important to seek information directly from the source when issues arise.  For instance, I prefer to meet stakeholders in person to obtain the history of the situation and gain an understanding of how it developed.  What areas have been impacted?  What actions have been taken to resolve the issue?  What, if any, impact have those efforts had?  Lastly, I like to ask the stakeholders for their suggestions on resolving the situation.

Objective – When appropriate, I begin the objective portion of my evaluation visually, just like when I treated patients.  This can entail simply walking through the facility or office.  Many times, it involves taking subjective “histories” from stakeholders.  The measurement and hands-on review, in many cases, involves evaluating existing data and reports.  When necessary, and possible, it includes asking for additional information.  This provides me with a complete view of the situation.

Assessment – Again, the assessment is where the expertise and experience of the “clinician” shines through.  Taking all information gleaned from the subjective and objective portions of my evaluation, I can generate a list of problems.  Next, I can prioritize the items on my list.

Plan – Lastly, just as in a clinical setting, I develop a “treatment” plan for the problems in my facility.  The plan addresses not only the symptoms but also their underlying causes.

The business side of healthcare is made up of many clinicians who have transcended their clinical roles into business management and leadership.  I am one of those individuals.  The skills we learned as clinicians allow us to be effective problem solvers in the operational management side of the business as well.

Robert Carrera – President/CEO

[1] http://www.apta.org/PTCareers/RoleofaPT/

Apr 14
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manager rounding

ASC Manager Rounding: Maximizing the Benefits

By ASC Management, Leadership No Comments

Manager rounding is the process of visiting patients and families.  It affords surgery center leadership an opportunity to monitor progress, provide education, and identify areas for improvement.  While rounding benefits an ASC’s leadership team and facility personnel, the most important byproduct is the impact it can have on patients and their families.  There are a number of ways to maximize those benefits and achieve short- and long-term improvements in a surgery center.  Here are some helpful steps to consider.

1. Be consistent.

Perform rounds every day, without fail.  The goal is to round multiple times a day, and do so in a purposeful, productive manner.  This may sound cliché, but it’s the only way to develop an effective process.

Maintaining this consistency requires planning.  Consider in advance how you will perform rounding, when you will do it, and the way you will evaluate the information you pick up along the way.

Be consistent with where you go.  Most rounding occurs in the center’s lobby, but it is worthwhile to add the pre-op area to your walkthrough.  This isn’t something most administrators do.  But you might be surprised how much you can learn from a quick visit to patients before their procedure.

2. Keep it a management responsibility.

Rounding is best performed by an ASC’s managers. They’re in an optimal position to represent the facility then take what they learn and turn it into actionable information.

The task should not be delegated to staff even if management is busy.  It is up to other members of the facility’s leadership team to step up if a round cannot be completed by the manager who was originally assigned the task.

3. Educate on processes.

Effective rounding is not improvised.  Education is vital and may need to be tailored to each individual.  Some types of education to consider follow:

  • What to say to start conversations
  • What questions to ask (i.e., a script)
  • How to respond to different comments and questions from family members and patients
  • How to approach strangers and speak with them (and do so confidently)
  • How to read people
  • How to document what is learned (see #4 below)
  • When to elevate an issue and involve other managers or physicians

The goal with rounding is to move through the lobby or pre-op, meet people, make connections, gain information, provide information, and move onto the next person.  Upfront and ongoing education will help make rounding an efficient and productive process.

4. Make the documentation easy.

The quality of the documentation can make rounding a success or failure.  To achieve the former, develop a standardized form those conducting rounds can fill out quickly and legibly.  Include the specific questions you are likely to ask and spaces for notes.

Also, include a checklist of topics on which you are likely to receive feedback. Topics could include wait times, requests for information, communication, and case delays.  Again, leave spaces for notes.

5. Use what you learn.

What you ultimately do with the feedback gleaned during rounding is as important as the rounding itself.  Establish processes for how feedback will be presented in meetings, how to determine what to focus on, and how changes or issues will be addressed.  Develop an organized way for your team to consider any problems you discovered, figure out solutions, and disseminate information to staff.

The benefits of rounding may not be noticeable immediately.  It’s not a process you can conduct for a day or week and expect significant changes.  It may take a few business weeks of consistent rounding to deliver results.

6. Hold your team accountable.

There is a reason the first step highlighted above is the need for consistency.  If a round is skipped one day and there is no ramification, soon there will be a day where two rounds are skipped. Then three. When this occurs, rounding will start to feel optional.  Managers, with their very busy schedules, may find other pressing tasks to fill the time once allocated for rounds.

That’s why it is not only important to plan who will perform rounds and when, but also ensure anyone who does not perform an assigned round is held accountable.   

7. Give rewards and recognition.

Rounding is intended to help bring about improvements.  When improvements are made, rewarding and recognizing team members who made them happen can be an effective way to bring attention to the ongoing importance and value of rounding.

Rewards and recognition can occur when a rounding manager connects with a patient or family member and receives a great suggestion or a staff member takes on greater responsibility to help implement a change.  Rewards can take the form of small gift cards or entries into drawings for more valuable gift cards. Recognition may take the form of singling out specific team members for praise at staff meetings.

8. Focus on engagement.

If a rounding program is the passion project of a single manager, it is doomed to fail.  Rounding must be ingrained in all managers and staff as a critical component of your ASC’s operations. Your team must believe in its purpose and not merely view rounding as yet another task to complete.

In the early stages of a rounding program, emphasize the objectives of rounding: to bring about operational improvements that will make everyone’s job easier and better while making sure patients and their families are safe and comfortable.  When managers are enthusiastic about performing rounds and staff are eagerly awaiting new feedback to drive improvements, you will know your rounding program has established a strong foundation for success.

Jebby Mathew – Director of Operations

Apr 12
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change

Achieve Meaningful Change in Your ASC With a Plan

By ASC Management, Leadership No Comments

Viable contributors to our healthcare system consistently demonstrate the ability to implement effective changes.  Being flexible and able to adapt quickly to patient, provider, and payer developments in your market is critical to your ASC’s success.

Typically, change is not comfortable for most of the workforce including leaders. That’s where having a plan comes in handy.

Here are some key plan components that will help you effectively engage your team and adhere to a path for successful implementation of change.

Communication

Communication concerning the change is vital – but it cannot just be communication from the top down.  Communication must occur between leadership and staff, not from leadership to staff.  Make sure input is solicited from everyone involved in making the change as well as those persons affected by the change.

Convey the reason(s) for making the change.  If your team members understand why the change is necessary, they are more likely to buy into the change and actively participate in the process.

Lay out a timeline for the change process.  Although the timeline may need to be adjusted throughout the process, providing a general outline of the plan provides your ASC team an opportunity to envision the path ahead.  They can prepare for what is going to happen and when, and contribute to the end result.

Training

Training may be a crucial component of your plan.  Many changes in ASCs today encompass new technologies – implementing electronic health records and patient portals, upgrading phone systems, or adding new surgical/clinical procedures, for example.

To ensure staff become comfortable using, and maximizing the benefits of, new technologies, extensive hands-on training may be necessary.  While it may be tempting to provide this education in the fastest and least expensive way possible, doing so may end up costing more in the long run.

One of our ASCs recently went through a software system transition.  The vendor offered off-site training for super-users.  We invested the time and money to send three members of the ASC’s team to receive that upfront training.  Upon their return to the ASC, these super-users were extremely valuable in educating and supporting their fellow staff members and physicians during the onsite training process. The team required less intensive training from the vendor, which ultimately saved time and money and promoted a smooth “go live” environment.

It is important to note that people learn at different paces.  When training team members, make sure individual needs are addressed.  More training may be required for some, while less training is necessary for others.

Counseling

It is not likely everyone will be on the same page the moment you start moving forward with implementing a change.  Some members of your team may embrace the change from the beginning and easily move through the process. Others may exhibit various levels of resistance.

Team members who are hesitant or actively pushing back against a change will require additional attention.  Engage them in conversations to learn about their reservations.  Answer questions about why the change is necessary.  Provide emotional support.  You may not be able to eliminate all their concerns but taking the time to listen and actively support them throughout the process will elicit more positive engagement.

Individuals providing support and engaging in these conversations do not necessarily need to be formal leaders. In fact, peers who have bought into the change may better understand a fellow team member’s struggle and more effectively facilitate their colleague’s buy-in.

Leadership

For a plan to be successful, leadership must be 100% on board throughout the change process.  They are the change champions.  This is true even if leaders are uncertain about the change or the approved approach to making the change.

In times of uncertainty, leadership must come to terms with the situation, put feelings of doubt aside, and figure out a way to stay positive.  This can be difficult, but the emotions leadership project — whether intentional or not — are inevitably picked up by staff.

Monitoring

An effective plan for change should take the ASC through completion of the process.  Ensure the plan spells out how you will monitor if the change achieves its intended short and long-term goals. 

If the change does not deliver the benefits you were hoping for, additional improvements and other changes may be required.

It is also important to evaluate if the change has any unintended effects on your facility’s operations.  For example, changes can affect customer service and the organization’s culture. Sometimes these changes are positive.  However, if a big change affects these or any other processes negatively, you will want to go back to the drawing board and work to right the ship.

Catherine Sayers – Director of Operations

Apr 06
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ASC Team

Harnessing the Power of Your ASC Team

By ASC Governance, ASC Management, Leadership No Comments

Organizations who harness the power of teamwork thrive.  You can sense their vibrant energy the minute you step through their front door.  Positive momentum permeates every aspect of their business.  Their collaborative spirit is infectious.        

Teamwork in your ASC can easily make the difference between your place of business being merely another place to work or a workplace of choice.  It can also make the difference between your ASC being yet another place to receive care or the preferred patient option for ambulatory surgical services. 

ASC leaders who understand who makes up their team and what allows for a dynamic work environment are better equipped to harness the power of their team.

The diagram above is a visual representation of an ASC’s stakeholders.  Let’s explore how to engage individual team members to create a vibrant team.

What is Important to the team?

Whether an ASC is in the planning stages, has recently opened, or is in its tenth year of operation, the organization’s mission statement is critical to developing and maintaining its goals.   It serves as the cornerstone of the ASC’s culture. 

A properly crafted mission statement –

  • Communicates the purpose of the organization
  • Serves as a filter to separate what is, and is not, important to the organization
  • Clearly states which markets the organization will serve and how
  • Communicates a sense of intended direction to the entire organization

The mission statement guides the actions of the ASC, articulates its overall goals, provides a path to achieve those goals, and ensures decision-making is in keeping with those goals.  It provides the framework to develop the company’s strategies.

When crafting a mission statement, consider –

  • Quality and consistency
  • Customer service
  • Diversity and individuality
  • Professionalism
  • Specific ideals of a sponsoring or partnering health system or organization

Although it is not uncommon for a mission statement to remain the same over time, it should not remain static due to inattention or apathy.  Markets, goals, leadership, and organizations change and evolve.  Review your mission statement on a regular basis to ensure it reflects any substantial changes.

The Team

Physicians

As I have discussed in other posts, physicians become members of ASCs for a variety of reasons. Ensure you recruit physicians based on how they will function as part of your team. Careful selection is the key to success. If physicians participate for the right reasons and their previous track record demonstrates they are “team players,” integrating them into your team should not be difficult.

Because physicians interact daily with your patients and staff, it is critical for them to buy into, and actively support, the ASC’s mission and culture.  There is no quicker way to undermine the effectiveness of your workplace than to work with physicians who do not respect your organization’s purpose.

Board of Managers

Ideally, the ASC’s Board of Managers (BOM) should create the facility’s mission statement, be involved in its regular review, and develop any revisions.  By setting the facility’s policies and procedures, hiring its medical director and management team, and crafting the mission statement, the BOM is the de facto owner of the ASC’s culture.

BOMs facilitate team dynamics when they are comprised of a diverse group of investors, representing different physician groups and specialties.  When the facility is joint ventured, it is important to include hospital executive representation on the BOM.

Ultimately, the most important characteristic for board members to possess is a willingness to participate and devote the time necessary to enthusiastically engage in facility-related discussions. Board members who stay informed about facility performance and operations and consider the perspectives of all stakeholders regarding ASC topics make sound business decisions.

Medical Director

The medical director is selected by the BOM.  As with physicians, this selection needs to be based on the individual’s track record of being a “team player.” Initially, the medical director will be involved in developing the ASC’s policies and procedures.

Most importantly, the medical director is charged with supporting clinical and administrative staff, enforcing policies and procedures (along with the BOM), and effectively maintaining the facility’s culture.  This will include addressing professional issues related to physicians and staff that are averse to the desired team environment.  The medical director will also function as a team member in multiple operational areas including scheduling, staffing, inventory, operating room utilization, etc.

Clinical and Administrative Staff

A popular saying is, “Hire the right people and get out of their way.”  This holds true not only for employee skill sets and work ethic, but also for their ability to effectively function as members of a team.  Educating staff about the ASC’s mission and the BOM’s commitment to that mission sets the stage for a well-informed team ready to fulfill the desired expectations.

It is critical to support and empower clinical and administrative staff to take action and make the decisions necessary to fulfill the ASC’s mission.  For example, they must feel comfortable reaching out to ASC leadership when quality of care or customer service issues are being compromised.

As new team members are added through growth or attrition, ensure a consistent message is relayed by the physician owners, BOM, medical director, and the facility’s management team. This will ensure the desired team dynamic is preserved.

Management

Management is comprised of the ASC’s administrator and their team of program leaders.  The role of management is to own the ASC’s mission and consistently promote that message to all team members in the facility.  This is the responsibility the BOM entrusts to the center’s management. Management accomplishes this by expecting, promoting, and modeling excellent working interactions among all stakeholders.  Recognizing the contributions of all team members in pursuit of the ASC’s goals and carrying out its mission allows a team atmosphere to flourish.  

Finally, management is responsible for ensuring team members who are not bought into the organization’s mission, or do not have the skill set to contribute to that mission, are appropriately removed from the mix.  Jim Collins, renowned management consultant and author, said, “The only way to deliver to the people who are achieving is to not burden them with the people who are not achieving.” [1]

Conclusion

In conclusion, I am reminded of a speech given by legendary University of Michigan football coach Bo Schembechler.  It is simply referred to as “The Team! The Team! The Team!”  There are numerous YouTube versions of the speech.  My personal favorite is one pulled from a news clip (approximately 2 minutes long).  In his speech, Bo reminds us there is nothing in life we will achieve as an individual that will provide us more personal satisfaction than what we will achieve as a member of a team.  The team can be defined in many ways – your family, your place of worship, your work place – the list goes on.  The underlying message is this:  leaders need to provide the unwavering vision, mission, and culture necessary to make sure all stakeholders have a chance to experience the sense of team accomplishment described so powerfully in Bo’s speech.

Robert Carrera – President/CEO

[1] Good to Great:  Why Some Companies Make the Leap & Others Don’t, James C. Collins, 2001