OASC | STAFFING

Varying Approaches Help Maximize Staff Hours

It requires some balancing to keep an ASC running smoothly.

By Beth Thomas Hertz, Contributing Editor

Most ophthalmic ASCs have busy days, followed by those that are fairly quiet. How administrators manage staffing to meet their centers’ needs efficiently while keeping employees happy and productive is a balancing act that can be approached in several ways.

For one group, Eye Centers of Tennessee, based in Crossville, Tenn., employing people who desire part-time work is the answer. For others, such as The Center for Sight, in Lufkin, Texas, sharing ASC staff with the clinic and optical shop to create full-time jobs has been the solution.

Using Part-time Staff

Ray Mays, practice administrator at Eye Centers of Tennessee, a group that has six locations and includes four ophthalmologists, six optometrists and one audiologist, says offering flexible work schedules is the key to keeping his staff happy and turnover low.

“We’ve pretty much had the same staff for the past 12 years and they have their work flow down to a science,” he says. “There isn’t much that happens that they don’t know how to handle.”

The ASC only has three full-time staff members — a nurse administrator, a business office manager and a scrub technician.

“The three of them handle everything,” Mays says. “They clean, manage inventory, help with billing and collections — whatever needs to be done. They learned long ago that we can hire someone else for $15 an hour or they can all pitch in and each make $5 more per hour.”

On surgery days, usually Tuesdays, the PRN staff is on duty, usually consisting of two RNs and two LPNs. They’re all women, most have children, and they prefer a flexible part-time schedule over full-time employment, explains Mays.

“We feel our current staffing is very efficient, but we aren’t above tweaking it,” says Mays. An example of this is when they added the femtosecond laser for cataract surgery. “It slowed our pace for a bit until we figured out how to incorporate the technology into our surgical routine,” says Mays.

Preference for Full Time

Richard J. Ruckman, MD, FACS, medical director of The Center for Sight, takes a different approach. He maximizes his staffing efficiency by sharing members across his clinic and ASC, which he opened in 1993.

He has 48 employees, including two ophthalmologists and two optometrists, across two offices, three optical shops and an ASC. Dr. Ruckman accommodates employee desire for full-time jobs through cross-training and by offering what he describes as a good benefits package and a schedule that doesn’t include weekends or evenings.

Finding good RNs to staff the ASC is a challenge in his area, so he works hard to keep his existing staff happy. Only one RN on his staff chooses to work part time.

“We don’t want to let anyone go or cut back their hours,” says Dr. Ruckman. “It’s not good for morale if staff members are worried about their hours. We don’t want them looking for another job.”

Dr. Ruckman says he may be slightly overstaffed, but he’s willing to “ride it out” in the short term because he added a second surgeon 2 years ago who’s still ramping up his volume. Once his volume increases, Dr. Ruckman believes the ASC and clinic will be properly staffed, and he doesn’t want to risk losing quality people in the meantime.

His ASC performs 35 to 40 surgeries a week, usually spread over 2 days. Eleven people are needed on surgery days, plus an independent contractor nurse anesthetist. Only one person works for the ASC full time — the instrument technician who also oversees areas such as inventory and maintenance contracts. Dr. Ruckman estimates that each week, the ASC uses time equal to that of about five or six full-time jobs, and the rest of his staff’s hours are spent on clinic-related issues. For example, one RN who’s the surgical supervisor performs IOL calculations and one conducts preoperative histories and physical exams. Another serves as the practice compliance officer when she’s not in the OR.

“We have very low turnover among our senior staff,” says Dr. Ruckman. He feels this is essential in providing patients continuity and consistency of care. Patients see familiar faces when they come in for their surgery. “It establishes good rapport,” he says, adding that patient satisfaction surveys for the ASC have always shown very good results.

Avoiding Overtime

Both Mays and Dr. Ruckman say their practices don’t rely on much employee overtime. Dr. Ruckman’s center only averages 2 hours per week total, over 13 people. “Occasionally, if we have a very busy surgical day or several people on vacation, it can throw us off. But overall, our staff is very good about watching their hours and leaving once their work is done,” he states.

Mays says that if anyone is close to 10 hours of OT in a month, he has to approve it. “It’s not because we’re cheap. If we need you, you’ll work, but you don’t need to be here 50 hours a week. You have other responsibilities outside of work,” he says.

Of his 80 total employees, 74 are women. “Many women have responsibilities at home and we don’t want them to burn out here. We want them to be in this for the long haul,” he says. In fact, offering schedules that allow staff to balance work with home life is a key part of avoiding costs such as overtime, and the time and expense of recruiting or training new people. “We have a job to do, but if we help each other when others need assistance, in the long run, we decrease turnover,” he says.

On days when school is canceled due to bad weather, the building is full of children. “It’s reality. The healthcare world is dominated by women. They’re wives and mothers and we need to help them integrate their home life with their work.”

Mays notes that he rarely gets calls that the ASC is short on staff. If someone needs a day off, they work it out amongst themselves. “It just happens magically,” he says. “It’s been at least 10 years since I’ve had to deal with that type of scheduling issue.”

Aim for Calm and Control

Dr. Ruckman says achieving proper staffing levels is “a constant battle” but feels he’s fortunate to have a stable staff, especially among his RNs. “You don’t want to be too lean,” he says. “A surgery center is one place where you need every person who is supposed to be there to be there on surgery day.”

Mays says that if the ASC is functioning well, your staffing is probably fine. Don’t push to cut back. “You don’t want everyone rushing around at all times. It doesn’t instill confidence in the patient,” he says. “You want your team to be calm and capable, and good things will happen.” ■