1. Teach staff to multitask. Successful ambulatory surgery centers are able to optimize profitability by keeping a lean staff. However, the ASC must still be efficient with the small team available. Teach employees to multitask so they are able to help where needed on a daily basis.
"We hire the minimum necessary full-time staff and all are expected to multitask," says Evalyn Cole, CEO and administrator of Spine Surgery Center of Eugene (Ore.). "Then we fill in with per diem staff when there isn't enough full time staff to cover the cases."
The staff at Central Main Orthopaedics ASC in Auburn are also cross-trained and agree to flexible responsibilities when they join the team. This process also allows existing staff members to cover for others who are on vacation and stay productive when their usual surgeon takes time off.
"Our OR efficiencies are based on a staff that is flexible with cross training so there aren't any hard lines between the roles," says Anne Marie Kayashima of Central Maine Orthopaedics ASC. "It keeps the patients flowing through the system. There is a whole lot of preparation that goes into our days, and we want to make sure every responsibility is filled. We also see that when staff members are well versed in different parts of the process they can help us improve those processes in the clinic for patients who will eventually need surgery."
2. Add a washer and dryer. Ms. Cole added a washer and dryer to her surgery center so the nurses could launder scrubs in between cases. This way a sterile environment is maintained at the ASC and nurses can quickly begin their cases when they arrive at the center.
"We have added a washer and dryer and our CNAs launder the scrubs between cases," says Ms. Cole. "This reduces laundry costs and extends the life of the scrubs, since they are not washed in the harsh chemicals used by commercial laundry."
3. Purchase surgeon lunches. When surgeons are bringing several cases in a row, or performing cases over the lunch hour, ASC administrators can keep things running on schedule by catering in lunch. Surgeons also appreciate the gesture, which can raise surgeon satisfaction for both investors and non-investors.
"We provide lunch for surgeons and staff in our center on busy surgery days when they can't get away to buy lunch," says Ms. Cole. "We contracted with a local private lady caterer, who sets up the menu for a month in advance. The staff can bring their lunch on days they don't prefer what's on the menu and this has alleviated a daily scramble to order lunches and reduced our costs."
4. Organize case information the day before. Central Maine Orthopaedics has a strict schedule of preparing patient charts 24 hours before the scheduled surgery time and the secretary gives patients calls to gather patient histories and other imperative preoperative information.
"We want to do all of the prep work ahead of time so they hear all the information three or four times," says Ms. Kayashima. "That way they are prepared for their day of surgery. They will arrive on time and then the staff can work together to make sure the case runs smoothly. We also discuss the discharge process ahead of time, which affords us a staffing matrix that is lean but highly skilled."
Staff should also review physician preference cards ahead of time so everything is present before the case begins. "Preference cards should be correct so there isn't anything you have to run and get at the last minute," says Shiela Stone, a surgery consultant at Soyring Consulting. "Train your team so everyone is working at the same time."
5. Ask for staff ideas. Staff members who are cross trained and familiar with the snags in the everyday processes can develop ideas to make the surgery center more efficient — whether it be scheduling cases in a new way or working the pre- and postoperative rooms from a different angle.
"Ask the staff members about what things have happened recently to slow down the patient care process and what problems they see in the system," says Ms. Stone. "Then you can ask about their ideas to make the process better. I think they will buy into their role as a team member if you incentivize them to come up with good ideas."
Administrators and physician leaders can coordinate a profit sharing system to incentivize their employees, which would bolster their pay if they meet certain perimeters. However, bonuses don't have to be financial; you can give them an extra day off if they meet their goals.
"It's all about education," says Ms. Stone. "Your employees should understand why changes are being made and how they can help make patient care more efficient."
6. Inform everyone on case particulars. Every staff member involved with the case should know the particulars before the case begins. All equipment or supplies should be noted and if there are conflicts — such as two cases schedule to use the same arthroscopy equipment at the same time — they should be noted and fixed before the day of surgery.
"If you don't get patients worked through the postoperative area and through the door you can start to get a backup in the OR," says Ms. Stone. "You need to schedule well so you don't get behind. I think it's important for everyone to be educated on how long the process should take so they understand there should be a cataract surgery patient ready to go every 10 minutes or hernia patents ready every hour."
The operating room staff should communicate with the preoperative staff if cases are taking longer than expected or surgeons encounter an issue that will take extra time.
"The postoperative area should also stay in communication with the operating room staff and let them know there is a delay," says Ms. Stone. "The more important thing is to have a person in charge who circulates through the area and carries forward these communications as well as helps things move along more quickly wherever possible."
7. Allow surgeons two rooms if possible. If your surgery center has the ability to coordinate two rooms for a single surgeon so they can go back and forth on short cases such as cataracts and arthroscopies. This system allows staff members to prepare one room while surgeons are performing cases in the other, and then vice versa.
"If you can't have two rooms for one surgeon, you have to turnover cases in the same room," says Ms. Stone. "In that situation, standardizing the process streamlines the surgeries to make things quicker. You should only open the supplies for cases you really need, and have the surgical tech help clean the room after the cases. Whoever is free should also jump in; nobody is too good to mop the floor."
8. Bring physicians on board with efficiency. Surgeons who regularly perform cases at the hospital are familiar with their schedule, which is often longer and more drawn out than the ASC. Surgeons must understand that to keep the ASC running, moving patients through quickly is imperative, but the care must also be high quality.
"Surgeons must make sure the patients are ready and well educated about the surgery center," says Ms. Stone. "They should have had their EKG or any other tests before coming to the surgery center as well as informed consent so the patients really understand what happens."
Surgeons can also have a set pathway of moving between patients and cases so staff members always know where they are and don't have to go searching for surgeons in between cases.
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Here are eight steps for ambulatory surgery center administrators to improve efficiency in their operating rooms.
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