For quality of care, staff retention and profit, your participation is irreplaceable.

With the ever-rising cost of doing business, physician owners of ambulatory surgery centers (ASCs) can financially help their organizations by being engaged leaders. A 2011 study (tinyurl.com/4wndbp5b ) found that in key metric areas such as financial performance, companies with high-quality leaders were 13 times more likely to surpass their industry competitors. Additionally, organizations with quality leadership have up to three times higher employee retention.

With statistics like those, it makes good business sense as an ASC owner to be involved in operations. However, it can be tricky to stay engaged in facility operations when there are so many moving parts to ASC management.

Below I recommend three focus areas to ensure your active engagement within the ASC and yield a positive impact on the organization’s bottom line.

KNOW YOUR FINANCIALS

I cannot emphasize this enough: The financials of an ASC are different than those of a practice. For instance, they are labor and supply intensive (more on that later), so effective management of both can greatly impact your bottom line. Knowing that, a financial package, which includes a balance sheet, income statement and case volume, along with a dashboard of key performance indicators (KPIs) should be distributed to you and other physician owners monthly.

Additionally, and maybe even more importantly, those financial documents should be discussed and reviewed between you and the ASC management team. All variances in the financials on a month-to-month or year-over-year basis should have an explanation, and the management team should work with you to address any issues. These financials and KPIs provide ASC owners insight into the operational decisions made every day. They also provide the opportunity to set new operational goals for nurse leaders and other key ASC positions to improve the fiscal performance of the center.

When looking for improvements, a key area to focus on is labor cost. An ASC’s highest expense is labor. While this is similar to other organizations, an ASC’s payroll is heavy with nursing personnel — meaning it has a much higher payroll per person than a practice. Managing nursing cost by strategically using ancillary and support staff to expedite patient flow through the ASC can dramatically affect staffing cost. It is also imperative that staffing is driven by the surgery schedule; if there are no cases or a low volume for the day, staff must be called off. This is effectively done with the use of per diem staff instead of an all full-time staff. Properly managing staffing cost is essential to a profitable ASC.

Another key area to focus on is supply cost. As I mentioned earlier, the ASC setting is supply intensive, meaning that every time a patient enters an ASC, a supply cost is associated with that visit. Therefore, all supply costs should be meticulously managed. It is imperative that the cost is known, accurate and scrutinized. When you are clued into seemly small supply decisions, like which blade to use, more strategic decisions that affect the big picture can be made. Even small supply adjustments can have a large — and likely positive — impact on the financial performance of the ASC.

KNOW YOUR QAPI PROGRAM

An ASC’s Quality Assessment and Performance Improvement, or QAPI, program indicates the quality of care the center is providing. As the physician owner, it is imperative that you hold, attend and actively participate in quarterly QAPI meetings. While some items, such as medical record audits, may not seem to directly affect patient care, they do. Your engagement in all facility matters sets the tone for how the ASC is expected to operate. If you are interested in a matter, staff will have the same response. This high level of engagement can trickle down to every aspect of care provided within the center. Quality care leads to satisfied patients who are more likely to recommend both the center and their surgeon. This in turn helps to generate more business for the center.

My experience has also proven that centers with an active QAPI program encounter fewer adverse events. For example, if a medication error is made, having a committee review the cause and adjust the procedure will help to avoid this error in the future. Such an emphasis on safety also results in greater employee satisfaction, since the facility supports what personnel have devoted their lives to: the care of others. Employee satisfaction leads to better staff retention, a savings that should not be underrated. Industry experts estimate that the turnover cost for one nursing position can range from $38,000 to $61,000, depending on the facility’s location (tinyurl.com/5fhxssn2 ). Avoiding that expense can drastically affect the ASC’s bottom line.

KNOW YOUR CULTURE

Another important factor in staff retention is culture. The ASC must have a culture that emphasizes safety, quality and mutual respect. A culture of safety that empowers staff to speak up when something isn’t right creates an environment where active engagement and quality improvement can thrive. This type of environment allows relationships built on mutual trust and integrity to form between staff members and you. Small adjustments to everyday operation, such as saying “thank you” to staff at the end of the day, can further strengthen these relationships. The same is true when you respond to questions in a respectful way and provide education or feedback to staff when warranted.

Having fully engaged staff who have a voice at the table is a key factor in staff satisfaction and retention. This in turn has a positive effect on your payroll (see turnover cost above) and the ASC’s financial health.

RECIPE FOR SUCCESS

As a business owner, your focus is on creating a strong bottom line. As a surgeon, your focus is on maintaining patient safety and good outcomes. Those two goals can coincide.

When you actively engage in facility operations by being involved in financials, participating in the QAPI program and creating a healthy work culture, you have a recipe for success — one where you uphold your fiduciary responsibility to the center and care for those who depend on it — for employees and patients alike. OM

Vanessa Sindell, MSN, RN, is a senior consultant with Progressive Surgical Solutions, a division of BSM Consulting. Prior to joining Progressive Surgical Solutions, she worked for 8 years as the director of nursing for an ophthalmic surgery center.