Developing Top-tier Surgical Teams

You depend on your team. Help them excel with these winning strategies from successful ASCs.

By Erin Murphy, Contributing Editor

If you were asked to describe a good surgical team, you might say it’s one that helps to deliver a seamless schedule, calm patients and smooth surgeries. Or you might say a good surgical team provides quality care in a personalized, compassionate environment. It deftly handles unforeseen events. With a good team, patients are satisfied and the surgeon’s job is easier.

But how do you create a strong, cohesive team? The effort involves many players, including administrators, nursing managers and surgical coordinators. And similar to the formation of any good team, the team-building process is very thorough, consistent and goal-driven.

Strategic Hiring

In building a good surgical team, a thoughtful approach to hiring is one of your most important tools. Perhaps you want traits you value in your current employees, or maybe you need to fill a gap in skills or personality. You’re probably leaning toward someone with a positive disposition who wants to work hard. By creating a desirable workplace and working with a wish list of skills and traits that fits the practice, ASCs can ensure that they have excellent team members.

As business administrator for Surgisite Boston/West Suburban Eye Surgery Center, Pam Major, CASC, wants to attract the best candidates for the site’s surgical teams. She understands that before an ASC advertises a job or holds an interview, it has to be a place where people want to work.

“We offer a great work environment and excellent benefits, including fully paid health care and 4 weeks vacation to start,” she explains. “That allows us to attract people with an asset we consider very important — experience.”

For the past 8 years, Major and her colleagues have hired only circulating and OR nurses who have ophthalmology experience in either ASCs or hospitals. For pre- and post-op care, they hire new graduates or people with experience in other specialties, and then train them in ASC protocol.

“It makes for a great team,” Major says. “Experienced employees bring so much to the practice. The right people set the tone for everyone else. Good team members are our greatest assets.”

Surgical coordinator Vickey Ford and her colleagues take a different approach at Cataract and Laser Center, the ASC associated with Eye Centers of Tennessee. Ford explains that the ASC’s medical director, Larry E. Patterson, MD, is very clear about his priorities for new team members.

“We tend to hire based on intelligence and personality. We would rather have a great personality than a well-trained person with a bad disposition and no smiling face,” Ford says. She also carefully considers the mix of people that she and her colleagues put together on a team. “We have to have some people who are very driven and some people who want to work 9 to 5. Both kinds of employees are important to giving us a good balance of leadership and stability.” The key is to create a balance among the staff of people who want to move ahead and others who’ll be happy holding the same position for the next 20 years.

Training and Trust

Once you have good people, how do help them develop into a great team? Training is a start. In Ford’s experience, that means not only training individual staff members in their job tasks, but also training the team as a unit with an eye toward enhancing the patient experience.

“Training revolves around the individual patient experience, with the team working as a single educational unit.”

— Vickey Ford, Surgical coordinator at Eye Centers of Tennessee

“In our clinic, we used to teach every member of the team to discuss refractive lenses, for example. Rather than limit the discussion to good refractive candidates, we threw a good deal of potentially irrelevant ideas at every patient,” she says. “Today, as patients move through the office, they’re educated on the basic concept of premium lenses and laser cataract surgery, but the surgeon discusses the specific lens option he determines is best suited to each patient. So now, the closer patients get to the doctor, the more knowledge the team member has about refractive lenses. The training revolves around the individual patient experience, with the team working as a single educational unit.”

Another important role of training, according to Ford, is the creation of an ongoing, team-building discussion. “We meet once a week for 30 minutes and review new information and programs,” she says. “We talk about what happened in the past week, as well. Each technician is required to discuss any instances when he or she was corrected during the week. It’s not punitive. It’s a chance for us to learn from each other’s mistakes, and we grow closer by having that open discussion.”

When good training and communication are combined with time and practice, Ford says the result is trust. “There has to be a level of trust among members of a team. In a practice setting, we have to trust each other to get the patient the right eyeglasses, but when the end goal is surgery, the trust level has to be even higher. If we can trust each person on the team to do his part, then surgery goes beautifully,” she explains. “It’s hard to have faith in people, but our doctor trusts us with anything. He knows that we have all of our tasks completed, we think through the process and we support and check each other. That’s important.”

The Compassion Factor

New team members hear a great deal about the intellectual side of their work, from highly skilled clinical work to instructions on how to use the electronic health records system. But they play a compassionate role in the patient experience as well, and that role requires training, too.

Your surgical team should know what your patients are going through and what kind of experience you want them to have in the ASC.

If an atmosphere of respect, caring and personal attention is your goal, then your team needs to know how to make it a reality.

According to Major, the team’s compassionate role begins with the pre-op phone call. “A patient liaison calls and tells the patient what to expect, when to come, what to bring and asks about any special arrangements,” she says. “The patient hears a friendly person who answers his questions, so they already have an established relationship before the patient walks in the door. That helps allay their fears.”

Most patients in Major’s ASC are between 65 and 90 years old. They’re coming into an ASC with 70 surgeons, and they’re nervous about eye surgery. “That’s why I consider our wonderful front office staff to be part of the surgical team,” she says. “Judy is often the first person patients see, and she makes them feel at ease, even when 20 people are in the waiting room. When the very first encounter puts them at ease, they don’t feel stress when they get to the back.”

The front desk is one example of how Major and her colleagues carefully assign the right person to the right job. They used to have younger staff members at the front desk, but found that their senior patients were more at ease meeting a friendly person in her 50s. Major points out, “If patients were greeted with a snippy ‘Go sit over there’, that would be stressful for them. A compassionate person makes all the difference.”

Major says she and her colleagues train the staff to show respect and courtesy as well. “Patients noted on their surveys that they were offended when a 20-year-old orderly called them by their first names,” she explains. “The staff didn’t mean to be disrespectful, they just grew up in a different time. We train everyone from the front desk to the surgeon to address patients as Mr. or Mrs. Smith, or sir or ma’am. It’s a good general rule, but seniors particularly appreciate that dignity when they’re feeling uncertain or vulnerable.”

The final step in creating a compassionate experience, according to Major, is to reduce or eliminate the thing patients despise most — waiting. When patient surveys showed some dissatisfaction with wait time, Major and her colleagues recalibrated the scheduled arrival times based on how long it takes each surgeon to perform a procedure. Rather than assigning a standard arrival time of 1 hour before surgery, they created a grid of arrival times that varied based on whether the patient was scheduled to see a doctor whose cataract procedures generally take 10 minutes or one who takes 30 minutes.

“Patients were waiting longer for surgeons who take longer, and the wait time was distressing for patients. Now, we have an arrival time based on data, not an arbitrary standard,” Major says. “We also set ourselves up to succeed. When we tell patients how long they should expect to be in the ASC, we add a half hour. If we tell a cataract patient to expect to spend 2½ hours, he’s thrilled to go home in just 2. Now our patient surveys are glowing.”

Keeping Things Consistent

A well-trained surgical team supports many of the ASC’s key goals, such as a smooth schedule, a positive patient experience and good clinical outcomes. According to Ford, that kind of “well-oiled machine” effect doesn’t come from hiring and training alone. Practice — and a few checklists — makes perfect.

“We’re perfectionists. We want to provide continuity to the experience for our patients and our surgeons. That means laying out the process we want to follow and ensuring that we stick to it,” Ford says. “When you do everything the exact same way every single time, it’s easy to get good at it.”

As one of two surgical coordinators in her ASC, Ford meets with patients in their preoperative visits to the clinic, performs the IOLMaster (Carl Zeiss Meditec) and does IOL calculations. The doctor begins the IOL consultation, then Ford answers any additional questions. She schedules the patients for surgery and reviews their instructions. She calls patients before and after surgery and sees them at their follow-up visits.

In a cataract workup and surgery day that requires a number of handoffs, Ford remains a familiar face to about 1,000 patients per year.

“I believe that they feel like the experience is personal,” she says. “Patients are often afraid to call the doctor, so I tell them they can call me or our other surgical coordinator if they have any questions, and we’ll get the answers.”

“The final step in creating a compassionate experience is to reduce or eliminate the thing patients despise most — waiting.”

— Pam Major, business administrator for Surgisite Boston/West Suburban Eye Surgery Center

Ford has created checklists for her own role and other members of the team. Not only do the checklists ensure that nothing is overlooked, but they also promote improvement through repetition. All of the checklists merge into the patient’s file for reference.

Growth and Renewal

Once you have a good surgical team trained and working in your ASC, that team will benefit from constant improvement and renewal, says Major. She finds that good teams get better over time.

“Our team has worked together for years, and we’re better for it. We’re always focused on completing cases and taking care of our patients, and that focus gets us through very tough, busy days. To succeed, we all have to work together, and no individual team member can slow us down,” Major explains. “There’s definitely a feeling of satisfaction. We know that we’re trusted to do the best work in a very efficient, profitable way.”

Even if your team becomes a model for others, there’s always room to learn. Because Dr. Patterson publishes articles and speaks at major meetings, his ASC has drawn visitors to view new technologies, as well as to see how the surgical team works. Ford says that about once a month, a surgeon and a half dozen staff members from other practices come to look at their patient flow, scheduling and surgery. “They learn from us, and we’ve picked up interesting details from them as well,” Ford says. “It gets us out of our own bubble, which I think is another healthy habit for a good team. There is always room for improvement and new ideas.” I’m happy to provide all of our forms and email their staff anything we use.

“We’ve tried different cataract work-up schedules in the clinic based on outside ideas, and Dr. Patterson has tried different techniques in surgery from time to time,” says Ford. She says that sharing with these practices also helps create a network of contacts in ophthalmic ASCs across the country that they can use to get answers when they get stumped on something. “For example, if we can’t find a distributor for a medication or piece of equipment, we have many ASC administrators or directors of nursing that we can call,” Fors says, “That’s kind of nice!” ◊