Same-Day Surgery Manager: Staff and physician woes, plus question on OR size
Staff and physician woes, plus question on OR size
By Stephen W. Earnhart, MS
CEO
Earnhart & Associates
Austin, TX
Question: Many of our surgeons pledged a certain number of cases they would do when we built our ambulatory surgery center last year. Wisely, I saved that list. I have been comparing it to what they are actually doing, and most of them are not even close! I don't want to rock the boat, but I think they should live up to what they said they were going to do. Our numbers are not even close to what they should be by now, and I am getting heat about it. Suggestions?
Answer: You need to individually approach each of the 11 surgeons. Review the numbers with them, and see what the problem is. Further, at your upcoming board meeting, demonstrate on a computer graphic the number of cases per month by investor, and compare that number to the number of cases they pledged. Speaking with them before that meeting will give you an opportunity to give the board the surgeons' feedback on why they are missing the numbers.
Question: As the head of human resources at our hospital, I am awash in our operating room staff resignations as a result of two new large surgery centers opening up within a mile of our campus. As a not-for-profit hospital, there is no way we can compete with what these centers are offering our staff. Any suggestions?
Answer: This is a very common complaint from our hospital clients. There is much you can do. I suggest that you have a more detailed exit interview with your departing staff and find out what the surgery center is offering that is so attractive to them. I can assure you that it is not salary. What you probably will find out is that your departing staff will not have "call" or weekends, no holidays, and they probably will have an opportunity for profit-sharing. Your institution can offer the same to your staff. You just need to be creative in how you structure it.
Question: We are building a new hospital and have the opportunity to look at the new size of our operating rooms. Currently they are 320 square feet. We know that they need to be closer to 400 or even 500 square feet. What are you finding in the industry?
Answer: So much of our operating room floor space is taken up with anesthesia machines, wires, poles, and other specialty equipment that walking around can become hazardous to our health. I would not consider anything fewer than 500 square feet and would recommend that you shoot for 700 to 800 square feet. We actually have surgery centers out there that have 800 square feet operating rooms that feel there is a need for that size.
Question: Members of our anesthesia department keep complaining that they need to start our surgical cases on time in the morning or they are not going to be able to provide us service. I admit that often our 7 a.m. cases do not get started until 7:45 or later on a routine basis. The reasons are varied, I am sure, but we have never had a chance to actually document where the problems lie. Any experience with this and how can we solve it?
Answer: First, join the club. Almost 100% of our hospital clients have cases that start on time less than 50% of the time. You can improve it by finding out where the problems lie. I can tell you right now — without even meeting you — that the bulk of your delays are paperwork. The staff needs to have a completed chart, but the history and physical or lab work is usually late or missing. The solution is as simple as requesting that the info needs to be at the operating room two days before surgery instead of the day of surgery. It's sort of like telling a chronically late friend to meet you at 6:30 instead of the real time of 7. Then they show up on time. You also will find that about 30% of your late starts are because anesthesia is late. But you need to have this info for your own institution. Have someone audit your late cases for two weeks and get the bigger picture. You will find that you usually can get back on track.
(Editor's note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 3112 Windsor Road, Suite A-242, Austin, TX 78703. E-mail: [email protected]. Web: www.earnhart.com.)
Question: Many of our surgeons pledged a certain number of cases they would do when we built our ambulatory surgery center last year.Subscribe Now for Access
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