orm_november-2023 - 23

Finances
Takeaways
* Clinical hours per case is a simple, yet effective, productivity metric.
* Analysis of productivity measures can include benchmarking against external and internal data.
* A positive work culture will improve staff productivity.
Productivity, Saver
Continued from page 1
and payers on measure development
projects impacting the ASC industry.
" Productivity measures can help you
assess processes that impact center
operations and help pinpoint and focus
efforts on what needs attention. " For
example, a leader who identifies underutilized
block time might learn that the
problem is not lack of volume from the
surgeon, but rather that the surgeon's
office staff finds it cumbersome to
schedule cases with the ASC. Smoothing
the process could increase volume.
But productivity measurement is not
without its challenges, as indicated by
results from the 2023 OR Manager Salary/Career
Survey. In response to an
open-ended question, respondents cited
issues such as difficulty in obtaining
data and lack of time. (For more information,
see the September 2023 article
" Survey: ASC volumes continue to rise
amid staffing challenges, " pp 30-33.)
To overcome these challenges, ASC
leaders need to establish a measurement
process that is both effective and
efficient, and they need to closely analyze
and communicate results.
Productivity process
A recurring productivity theme from ASC
leaders is to " keep it simple. " Start
by looking at the big picture, then drill
down as needed. " The more complex
you make the information gathering, the
more likely an error is going to creep
into it, " says John Goehle, MBA, CASC,
CPA, chief operating officer for Ambulatory
Healthcare Strategies, Inc, in Rochester,
New York, and host of The ASC
Podcast. Kirchner agrees, adding, " If
you ask staff to track every time they
pick up the phone to make a preop call
www.ormanager.com
Calculating hours per case
John Goehle, MBA, CASC, CPA, chief operating
officer for Ambulatory Healthcare
Strategies, Inc, recommends ASC leaders
determine productivity by calculating clinical
hours per case:
➤ Find the total paid hours of the clinical
staff in a given time frame (eg, week,
month, quarter). This information is easily
found in the ASC's payroll record. (Using
paid hours of the clinical staff takes into
consideration all the costs associated with
employees, including vacation and sick
time.)
to a patient and the end
time, you'll never get accurate
numbers. "
Ziegler-Otis says ASC
leaders should realize
that they do not have to
be looking at multiple
metrics all the time. " If
you've been tracking a
lot of metrics, it's easy
to get data analysis pa➤
Find the total number of OR cases.
➤ Divide total paid hours by total number
of cases to obtain clinical hours per
case.
The results can be used to track productivity
over time. In addition, ASC leaders
also can choose to break down clinical
hours per case by role, such as RN or surgical
technologist.
Beverly Kirchner, BSN, RN, CNOR, CASC,
chief compliance officer for SurgeryDirect,
LLC, also uses hours per case but includes
nonclinical staff.
Becky ZieglerOtis,
MHA,
CASC, RHIA,
CPHQ, CHC
ralysis, " she says. She recommends focusing
efforts and working on improving
a few key measures at a time. ZieglerOtis
says this approach aligns productivity
metrics with continuous quality
improvement principles.
Kirchner adds that productivity goals,
quality goals, and patient satisfaction
are all linked. " When we look at productivity,
we want to make sure we don't
cut staffing so short that we're not delivering
quality care, or that the patient
feels they didn't receive individualized
care that met their needs, " she says.
What to measure
" The most important productivity measure
for ASCs is nurse staffing, " Goehle
says. " How do we staff efficiently? " To
answer that question, he recommends
ASC leaders use a simple measure:
clinical hours per case. " It is one of
the most useful tools and one of the
easiest to calculate, but it can be very
powerful, " he says (sidebar, Calculating
hours per case).
This simple calculation has several
advantages. First, it does not require
obtaining information from an electronic
health record (EHR), which many ASCs
still lack. Second, it avoids more complicated
calculations that ASCs may
not have the resources to perform. And
third, ASC leaders can use historical
data to make the calculation and establish
trends. " Every surgical center in
the country can use clinical hours per
case, " Goehle says.
Kirchner also uses hours per case
as the primary productivity measure,
but she includes nonclinical staff in
the calculation. She tracks productivity
daily but primarily focuses on monthly
results. " If we keep our staff hours per
case at 12 or less, we are profitable
that month, our patients don't complain,
and our staff have gotten their hours, "
she says. The data are kept in an Excel
sheet for easy reference, and an iris
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