orm_november-2023 - 25

Finances
may indicate that the center was properly
staffed before the decline. " The
beauty of this is that you can sell it to
the doctors, " Goehle says. For instance,
the ASC leader could say, " We've never
been as low as 7 and staff and patients
are complaining; it may be time for us to
staff up a bit more. "
Clinical hours per case can serve
as an early warning sign for other problems.
If, for instance, the number of
hours increases from 10 to 13 and staff
satisfaction has not changed, an ASC
leader would want to examine other possible
reasons, such as an increase in
delays in first case on-time starts as a
result of adding a new surgeon.
A key factor to consider when analyzing
data is knowing when to dive deeper
into the data. " You have to understand
the whole picture, " Kirchner says. " When
you break processes down too much, you
lose focus of what your end goal is. " For
example, if the first case is 15 minutes
late, but the time is made up by the end
of the day, a leader would not want to
criticize staff for the late start.
On the other hand, if overall productivity
measures are declining, the ASC
leader should look at the process in
more detail to identify problem areas.
Kirchner cites the example of focusing
on preoperative patient preparation.
" The preop process drives the ASC's
efficiency, " she says. The centers she
works with spend time educating patients
and families to improve time to
discharge and establish parameters
for what is needed before each case.
For instance, patients who will undergo
complex spine procedures must have a
full history and physical at least 7 days
pre-surgery, or the case gets cancelled.
After making a change, Ziegler-Otis
says ASC leaders should continue monitoring
to ensure the change had the
desired impact. For example, a leader
might implement 10-hour shifts as a
staff satisfier and to improve productivity,
only to discover that staff do not
support the change and productivity
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One ASC's experience with maximizing
productivity
Sometimes a simple change can yield results
that exceed expectations. Bob Winandy,
MSN, MBA, RN, chief executive officer
for Brightside Surgical in Bismark,
North Dakota, says the ASC saved half a
million dollars in staffing over one year by
adjusting the schedule. " Our efficiency skyrocketed
when we stopped doing cases on
Fridays, " he says.
All cases are done Monday through
Thursday. Staff go home once their work
is done, even if they have not worked their
full shift; they are paid only for the time
worked. Two nurses receive a $10 per hour
differential to work the night shift when occasionally
there are patients who are not
discharged during the day; those types of
cases are only scheduled on Monday or
does not improve; unintended staff turnover
could occur as a result. In addition,
solutions should be tailored to the
ASC's need. " What works at one center
doesn't necessarily work at another, "
she says. " Each ASC is unique, so you
might have to tweak things based on
your needs. "
Communicating effectively
The results of productivity measures
should be shared with the ASC's board
and staff. Kirchner says boards usually
comprise mostly surgeons (who also
may be owners), often making communication
easier for ASC leaders compared
to their hospital counterparts. " Surgeons
understand productivity because
it hits them in the wallet, " she says.
" The more productive we are, the more
money they make. "
When meeting with owners and
boards, Ziegler-Otis recommends ASC
leaders always include labor and supply
costs as a percentage of revenue.
Discussing these and other productivity
measures regularly helps foster buyin
when the leader needs additional
Tuesday. If there are not overnight cases,
the nurses work the day shift.
The ASC lost a few staff members who
needed a 40-hour workweek, but most
are happy with the shorter week and appreciate
their work/life balance. In addition,
compensation and benefits (including
profit sharing) are competitive with other
ASCs in the area.
" We aren't over-staffed or under-staffed,
we're 'staffed,' " Winandy says. The center,
which has three ORs and a GI suite, does
1,500 cases and 4,000 GI procedures annually.
" We have strict admission criteria,
so we can do a high volume. " Winandy
finds that measuring case volume and
staffing expenses is sufficient for him to assess
productivity.
staff or to make changes to improve
efficiency. One example is when labor
costs go up, but block time utilization
goes down (the target is usually 75%).
" A leader could then work with surgeons
to compress the schedule and use
block time more effectively to ensure
cases flow as efficiently as possible, "
Ziegler-Otis says.
Communicating productivity results
can help with planning for the future.
Courtay keeps a spreadsheet that includes
daily case volume and staff for
the preoperative area, OR, and PACU
in each ASC in the Duke Health System
and uses this simple tool to show
senior leadership the scope of what is
needed. " I can explain it to the CEO of
the hospital, and he gets it, " she says.
Courtay recently used the spreadsheet
to help her obtain approval for needed
positions. " We were able to show that
we are already below where we are supposed
to be for staffing, " she says.
Leaders at each ASC setting also use
the tool to help determine daily staffing
needs. " It holds them accountable for
maximizing productivity. "
OR Manager | Nov/Dec 2023 25
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