1. Hire good staff and give them the tools to do their job. It's important for the administrator to hire good staff members and trust them to do their jobs. "During the hiring process, I ask current staff members to meet potential new hires. This gives current full time employees a chance to give their input in the process. Build a friendly atmosphere with a very open dialogue," says Ms. Reiter. "I encourage strict standards with a relaxed atmosphere. Everyone wants to do the right thing, but sometimes you need gentle reminders. An administrator has to stay connected with the staff on a personal level. Stay positive and recognize the staff strengths as well as support improvements."
DISC holds staff meetings weekly and allows all staff members to have input on important decisions. "I call it ruling by democracy so everyone gets a say and is vested in the process," says Ms. Reiter. "You need to speak up if you notice something wrong rather than ignore it. When a problem does arise, handle it quickly."
2. Consistency for the surgeon and patient. Each surgeon is unique and staff members must be adaptable to different operative techniques. If possible, assign the same staff members to work with surgeons on a regular basis, however every staff member should be able to do every case and clean the room happily in between.
"Staff members should know the surgeon's style, operative technique and postoperative care preferences and make sure it happens every time," says Ms. Reiter. "Keep preference cards for each surgeon and that are case specific for preop, PACU as well as the OR so all staff know and respect the surgeon's preferences. High quality and consistency is repeatable no matter who is working. Everybody should be invested to go the extra distance to make sure what the surgeon wants, happens."
When a new surgeon comes onboard at DISC, they are encouraged to hold an in-service for the staff to share their preferences and meet the staff in person. On occasion the manager for preop, PACU and OR can follow the surgeon during clinic for a few patients to understand what he is telling his patients so we can give the same information in the ASC consistently.
"We try to capture that information before the new surgeon starts," says Ms. Reiter. "Doing that upfront and early is a good time to make sure the surgeon doesn’t get frustrated."
3. All physicians must feel equally important. When administrators communicate with physicians each conversation should be managed with your full attention. "You don't want to just run your facility for the high volume producers," says Ms. Reiter. "You can cater to them, but it's always that higher-hanging fruit that you need to cultivate because they are typically the ones that have choices on where to do their cases. Often they are looking for a place to land."
4. Keep an open dialogue with surgeons. Take every opportunity possible to talk with each surgeon at the center and keep open dialogue. Touch base with them in the staff lounge before and after cases on a regular basis, not just in a time of crisis. "If a surgeon feels they have a say operationally, they are more vested in the facility," says Ms. Reiter. "You want them all to feel special and that they matter."
5. During a crisis. When a crisis arises, approach everybody immediately and with respect. "You have to touch base with them personally and respectfully because they all have differences in how much attention they require," says Ms. Reiter. "If they discussed anything with you, circle back with them and close the loop. If they respect you and you treat them respectfully, you can work things out. In a time of crisis, they need to feel like they have your support and that you handle it quickly, so they are not left struggling." Bring up issues privately in a non-threatening environment."
6. Managing the bottom line. Administrators must know the relative cost for every case, and what cases are on the schedule to ensure they are managing the bottom line. This includes the cost of supplies, particularly high cost and high frequency supplies, along with contracted, non-contracted and expected reimbursement.
"In our spine/ortho ASC, I need to know the cost of every implant and biologic," says Ms. Reiter. "I raise awareness of the prices with the staff and physicians. Because the field of spine is very innovative and challenging, we want to be a facility where we allow new things because that's why many surgeons choose an ASC over a hospital."
Instead, work with device companies to bring the price of new technology down for the ASC setting. "Talk with your vendors instead of just letting them come in and put their supplies on the shelf," says Ms. Reiter. "Surgeons are now more involved with pricing. I see more variability with implant companies on how they can deliver the product to us, more competitively."
7. Familiarize yourself with the marketplace. Every market is different in healthcare and these trends and changes will impact the success of your ASC. Physician groups are growing larger through mergers and acquisitions, and more surgeons are becoming hospital employed.
"As the administrator, you need to know what's out there and be open minded to change," says Ms. Reiter. "The landscape is not the same from one day to the next. You have to be well-read and stay involved with regulatory changes."
8. Strategically plan for a progressive practice model. Stay on the cutting edge of healthcare trends with a flexible strategic plan. Build a progressive practice around the ASC and stay open minded about adding new services.
With DISC's multidisciplinary model, patients have several options for care when they arrive at the office instead of being referred out if they aren't surgical candidates. DISC also includes imaging technology and other specialties to help patients devise a treatment plan and have that care delivered here.
"Keeping patients in-house makes them happy and they will bring more business to you," says Ms. Reiter. "It's an old-fashioned mindset to think that diverse specialists won't be able to practice side by side. They work together now and respect each other's specialties more than ever."
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