Organizing Staff to Improve Efficiency

By Maureen Layne Waddle, MBA

A constant challenge for ASC managers is the establishment of a staffing structure that maximizes efficiency. Like all ASCs, ophthalmic ASCs have a unique challenge in determining appropriate staffing levels due to the fact that surgical schedules vary greatly. Staff members and doctors struggle when volumes are high and, conversely, are underutilized in weeks when there is minimal surgical volume.

An ASC business manager looks to create staffing models that will ensure the best possible patient experience while keeping expenses in line with owner expectations. Surgical case mix and volume both play major roles in determining staffing requirements, and each center is different. Below are some steps that administrators have found useful in customizing their staffing structure for maximum efficiency.

Methods commonly employed for improving staff efficiency:

1. Clearly define responsibilities and create job descriptions. Every individual performs better when expectations are clear. ASCs may combine job descriptions depending on need, but below is a list of the most common job titles found in ophthalmic ASCs:

• Director/manager/administrator
• Director of nursing
• Medical director
• Admissions/discharge clerk
• OR circulating nurse
• Orderly/expeditor
• Preop/PACU nurse
• Scheduler/receptionist
• Instrument technician
• Surgical technician (scrub tech)
• Patient service/business office manager
• Billing clerk
• Infection control coordinator

2. Create a pool of qualified per-diem staff. It's very common to use per-diem staffing in the healthcare industry. From a financial perspective, it's logical to only staff the center on surgical case days. The challenge is finding people who are efficient at assisting with eye surgery if they don't regularly perform these duties. In addition, there is paperwork, tracking, reporting, maintenance and various other administrative duties that need completion on nonsurgical days. Also, per-diem staff members will look for other opportunities if not provided a minimum number of days per month to meet their financial needs. Most centers use per-diem RNs for pre/postop coverage or even to serve as circulators. However, you can also create a pool for other non-nursing positions. Healthcare temp agencies can provide reception/admission help on extraordinarily busy days, and local health care certification schools may keep lists of recent grads (e.g., surgical techs, etc.) willing to work per diem. But the best resources for “as needed” help may be within the practices of the surgeons who use the center.

3. Utilize staff members from surgeons' practices. There are many advantages to coordinating with ophthalmic practices to provide staffing coverage for the ASC. The practice, like the ASC, is looking for more efficient use of their staff members. When the doctor is out of the office in surgery, there are often several staff members that aren't being fully utilized. Because of this, the practice generally appreciates the benefit of leasing staff members to the surgery center and having that expense covered for the day. Furthermore, from the ASC perspective, the staff member already has ophthalmic terminology knowledge, knows the surgeon's preferences, and is a familiar face to the patients, thus enhancing continuity of care. Some certified ophthalmic assistants/technicians will even make the effort to become certified surgical technicians (CSTs) to enable them to assist the doctor in the OR. Working with the practice to encourage this type of certification and continuing education is of benefit to the practice and the ASC. Some of the most cost-efficient practices and ASCs are those who have an established track record of these types of staff-leasing programs.

4. Establish clear processes and communication between the practices and the ASC. As government regulations continue to increase and decreasing reimbursement necessitates improvement in efficiencies, effective managers of ASCs have worked with the practices they serve to reduce duplication of services while ensuring seamless care for patients. This might include dropping off patient admission packets at practices so the surgical counselors can distribute patient rights documents and other forms required to meet Medicare's conditions for coverage. Clear communication between the practice and the ASC for scheduling coordination and patient information also reduces staff time in the ASC. In addition to improving efficiency, all of these measures help reduce the likelihood of errors.

5. Work with surgeons to gain cooperation for more efficient schedules. When trying to predict staffing needs and improve overall efficiency, productivity experts have proven time and again that batching “like work” is the best method for increasing productivity and reducing errors. Rather than performing five cataract surgeries on Tuesday every week, a center can reduce expenses by performing 10 cataract surgeries every other Tuesday. Even if a center is not operating at full capacity and therefore has open days for surgery, it is still dollars ahead to group cases onto fewer days and offer consistent per-diem hours to external staff members for those days. This may be a little challenging as the surgery center's schedule impacts the practice's schedule and vice versa. Arranging for a mutually agreeable schedule is often a delicate negotiation.

6. Use nursing extenders. As the health-care industry strives for maximizing physician efficiency through the use of physician extenders such as nurse practitioners and physician assistants, the ASC can be more efficient with meeting patient demand through the use of nursing extenders. Though size isn't a barrier for implementing this tip, use of nursing extenders is more commonly found in busier ASCs (those performing more than 2,000 cataract cases per year). Although there are certain responsibilities that only a registered nurse can handle, providing orderly support and/or administrative support for the nursing staff can reduce the number of RNs required. Any support that makes our most expensive staff members more productive, by having them perform only the tasks they are credentialed to perform, improves the overall efficiency of the center.

Quantifying Efficiency Improvement

While many centers conduct regular clinical studies, business measures should also be part of quality assurance programs. Staffing efficiency measures are reported through organizations such as the ASC Association and the Outpatient Ophthalmic Surgery Society (OOSS) in order to provide benchmarks.

Ideally, before implementing one or more of the previously mentioned tips, a manager will establish baseline measures to determine the impact of implementing a new program. Above is a table with some common staffing measures, the formula for calculation, and a “normal range.”

Efficiency & Proper Staffing Are Key

ASC managers can use tips from other managers to help customize a staffing program for the unique needs of the ASC. Establishment of efficiency measures for staffing will help managers quantify how implementing operational and staffing changes can improve staffing effectiveness in an ASC. ■