Basic Guidelines for ASC Staffing

You must execute on four key priorities.

BY RAY MAYS

For the past 6 years, we at Eye Centers of Tennessee have hosted surgeons and their staffs from across the country at our practice and ambulatory surgery center (ASC). The following article is based upon the most common questions and issues relating to staffing an ASC. I am not a human resources expert or a consultant, but a practice administrator who is here in the trenches every day having to live with the decisions that are made and not made.

Those of you who have been through our 2-day course or have read my other articles know that I disagree with most of the information put out by management consultants and other "experts" who are not involved in the day-to-day operation of an ophthalmic business. It has been my experience that consultants are more interested in the day-to-day operation of their business. What follows is the distillation of 22 years of management experience, with the last 10 of those years in the ophthalmic industry. My guidelines for ASC staffing are relatively simple but it is important that the practice place a high priority on such staffing, using all the resources at its disposal to attract and retain the best people for these positions.

The Stakes in ASC Staffing

Let me say at the outset that the guidelines for selecting staff for an ASC are about the same as the guidelines for staffing an office practice — only with far less margin for error. A bad hire in an office setting can usually be corrected fairly quickly without too much damage to the practice. Problems such as incompetence, lateness, chronic absenteeism, too much time spent on personal calls and/or rudeness are certainly annoying in the office environment, but employees who exhibit these traits can be rooted out fairly quickly, with positions filled by better workers.

In the ASC environment, we are looking to build a cohesive, competent and smoothly functioning team that can stay together for years. One of the major reasons that ophthalmic surgeons prefer to perform procedures in their own ASC is because having your own facility allows you to develop a team concept that pays off in quicker, more efficient and safer procedures. In a smoothly functioning ASC, nurses and techs routinely anticipate the surgeon's needs and can be relied upon to have the right instruments and the right supplies available at the moment when they are needed. A first-rate ASC staff is invaluable to a surgeon. They are able to react quickly and appropriately when a procedure doesn't go as planned, allowing the surgeon to work confidently.

In contrast, a member of the ASC staff who is chronically late or absent, who does not function at maximum capability, or who does not give a total effort, can undermine the work of all the other team members, especially the surgeon. Allowing a bad employee to remain on an ASC team negates the basic justification for even having your own ASC.

With that said, we also must recognize that there are business considerations in operating an ASC. The goal is to staff the facility appropriately — but not to overstaff. At our ASC, we strive for a staffing balance that enables our surgeons to perform procedures safely and efficiently but with no wasted resources or extraneous personnel. We achieve this balance by working to excel in four key areas: productivity, recruitment, retention and termination.

■ Productivity. Why hire anyone to do anything? It's so much easier to do something yourself. The answer is found in a single word — productivity. The ability to leverage the time of others to achieve greater productivity is why a business can do what it is supposed to do, which is to serve customers while achieving an acceptable profit.

For an ASC, the state will usually require a minimum number of people to be present while surgery is in progress, but it is up to the owners to decide how many full-time and how many part-time employees to hire.

I consider the addition of an employee an investment. As with any investment, a return must be calculated based upon the level of risk. I am a firm believer that an investment in one's own business is the best investment that can be made. I think a suitable return on the investment into an employee is 20%, or approximately four times more than a risk-free United States Treasury yield and two times more than the historic annual return of the Standard and Poor's stock market index.

For example, if a new employee's salary is $30,000 per year, then that addition should produce $36,000 in new revenue. How the $36,000 is computed is up to the owners, but it could be that the new employee enables an additional 36 cataract surgeries per year, or brings skills that reduce OR time from 2 days per week to 1.5 or 1 day per week, or adds the ability for the owners to add an additional week of vacation per year without impacting cash flow.

■ Recruitment. We have resorted to ethical bribery to recruit staff. We offer a bonus to anyone who refers a qualified person to us — if the new person stays through the 90-day probation period.

After a referral has been made, we schedule an interview with the prospect. The first step is to administer the Wonderlic aptitude test. It takes 12 minutes for the applicant to perform the test and about 2 minutes to score.

Within 15 minutes we know if this person has the appropriate scholastic aptitude to do the job. If the person scores well on the test, we schedule a meeting with our nurse administrator. Our nurse administrator runs the day-to-day nuts and bolts of our ASC. She is the one who must deal with employees on a daily basis, so I allow her a chance to get to know this person.

When we are down to the final two candidates, we schedule a time for the surgeons to meet with them. This is usually a quick 10-minute meeting to allow the surgeons to get a feel for the candidates' surgical experience. Does she know the "language" of surgery? Does she know the instruments? Does she know her way around the OR?

Within a day or so, we have a meeting with the nurse administrator, the surgeons and myself to review the candidates and make our decision. It has been my experience that by this stage one of the candidates is clearly number one. We call our first candidate in and have the nurse administrator present the compensation package, the benefit package and the job specifics. Usually, the new employee must give her present employer 2- to 3-weeks notice. During this time we order uniforms, fill out new employee paperwork, get any initial training and documentation taken care of (OSHA, state, credentialing), and if possible have the new employee come to a day or surgery to get a feel for how we operate and begin the process of meeting the staff.

■ Retention. Retention is a key to the success of any business. We have been fortunate that we have had the same key employees together for more than 5 years, allowing the team-building and continuity that is so critical to the smooth operation of an ASC.

To achieve this continuity, we offer flexible hours and a generous bonus package. I believe that flexible hours are the most important thing that we do to retain our staff. It is our goal to hire the best and most qualified person for every job in our practice but the reality is that the great majority of people who make up the staffs of ophthalmology practices are going to be women. I have learned over the past 10 years of working with women that they generally have a greater variety of non-workplace responsibilities than men do. Most of the women that we hire go to work and then go home to another job, that of homemaker. Recognizing this as a fact of life in the 21st Century, we try to work with our staff to allow them as much flexibility as we possibly can.

■ Termination. I have been surprised at the number of doctors and administrators who have problems with staff. When every effort has been made to deal with a disruptive or disrespectful employee, it is time for them to go.

State laws differ, but for the most part the refusal to do a job as instructed or gross insubordination are always grounds for termination. Properly documented discussions with the employee by their supervisor should be maintained, but people who are continually a problem simply need to be let go.

In any organization there will be those who are at the top of the list and those who are at the bottom. Hopefully the differences between the best employee and the worst employee are very small.

The Exemplary ASC

Clearly, having an excellent, cohesive staff is the key to operating an exemplary ophthalmic ASC. Just ask any surgeon. It is my belief that practices should put the highest priority in ASC staffing, recruiting the best people and proving them with competitive base pay, benefits, incentives and working conditions that make them want to stay. Scrimping on staffing an ASC can have all kinds of unhappy and unintended consequences. The goal is to have a staff that has every motivation to contribute to the overall success of the ASC. The result of a motivated, high-functioning ASC staff is patients who are happy with their outcomes, surgeons who are confident and relaxed, along with financial returns that justify the operation of the facility. OM