Teambuilding is a term that often provokes mixed reactions. Some professionals picture “forced fun” activities that foster more awkwardness than cohesion. Others embrace these events with enthusiasm as chances to get to know their coworkers. Escape room outings, free lunch days, and social events do have their place; they can break the ice, boost morale, and help people connect on a personal level.

For the leaders of 2 ophthalmic ambulatory surgery centers (ASCs)—one a physician-owned facility in the Midwest, the other a high-volume, corporate-owned center in Texas—truly effective team building requires going deeper. They see it as a daily discipline woven into their leadership structure, onboarding, communication, and shared values.

“I think we fail by thinking that 1 outing a year, 2 outings a year, is where you're going to build your team,” said Martin Ramirez, assistant administrator of Key-Whitman Eye Center in Dallas. “You build your team day-to-day.”

Communication and Trust: Vital to Effective Team Building

Kris Pugh, MD, an ophthalmic surgeon at Dr. Black’s Eye Associates in Jeffersonville, IN, describes 2 eras in the ASC’s 25-year history. For most of that time, Dr. Pugh said, the director of nursing (DON) worked in a “vacuum”— tasked with executing clinical and operational decisions without full access to the financial data and strategic planning initiatives, or direct involvement in executive meetings. This lack of transparency, he said, limited effective operation.

That all changed 5 years ago, when Dr. Black’s ASC undertook a total restructuring. The DON now sits on the board, leads the ASC portion of monthly executive meetings, participates in financial reviews, and helps shape the budget and long-term strategic plan. According to Dr. Pugh, the transformation was profound, resulting in better anticipation of problems, richer external networking, clearer vendor management, and more cohesive decision-making around consumables, MIGS devices, lenses, and staffing issues.

“I've seen in our organization these two different models, and there’s no doubt the latter one works the best for us,” Dr. Pugh said. “It’s completely changed. In fact, I wonder how a director of nursing can even execute without all the puzzle pieces. They’re the ones best positioned to make frontline decisions.”

Amanda VanHoose, RN, the ASC’s current director of nursing, agrees. She said the bedrock of a culture of collaboration is “constant, transparent communication” that begins with clinical and administration leaders who share the same information, the same meetings, and the same mission. This back-and-forth, she said, includes the collective voice of the staff. In addition to daily meetings with her CEO and COO, and monthly meetings with the board, Ms. VanHoose huddles daily with her staff to go over schedules, patient needs, workflows, and other issues.

“I can’t meet everybody’s needs, but I try to involve [the input] of as many people as I can because it shows them [their thoughts are] valued,” she said. “I’m always going to have their back and always give them a voice. I think they know that I’m going to be speaking on their behalf.”

Getting Into the Trenches

In Ms. VanHoose’s view, the importance of communication in building a strong team also extends, unsurprisingly, to the surgical suite. She said surgeons set the tone in the daily operations of an ASC more than they realize. Their ability to make space for questions, concerns, and clinical insights from nurses, scrub techs, and anesthesia providers builds trust and reinforces that the entire team—not just the surgeon—is responsible for patient care and efficiency.

Dr. Pugh agrees, adding that trust is further strengthened when the DON helps surgeons confront issues that might otherwise go unaddressed.

“Sometimes surgeons…don't want to bring up conflict, and yet what the staff really wants is to do a great job for the patient, for their team, and for the surgeon,” he said. A strong DON bridges that gap, helping physicians articulate their needs while ensuring staff feel respected, not criticized.

Another critical aspect of daily team building is for clinical leaders to get down into the trenches alongside the staff and surgeons, said Nikki Hurley, director of nursing at Key-Whitman.

“I have always worked day-to-day with my staff. I have never sat down on the job, not been in surgery, unless the schedule allows for me to catch up on things,” she said.

Mr. Ramirez adds that being out and about in the ASC, rather than cocooned in offices all day, fosters respectful working relationships with fewer misunderstandings, more psychological safety, and effective cross-disciplinary collaboration.

“Everyone knows I’m listening and watching how we treat patients,” he said. “Respect is non-negotiable.”

Team Building for the Long Term

Leaders at both organizations recognize that chronic turnover can kill efficiency and destroy morale; they view hiring, onboarding, and professional development as a collective long-term investment in staff retention.

Ms. Hurley said that nursing candidates with promise are brought in for a “working interview” so they can be observed for initiative, temperament, and interpersonal ease—qualities she believes are more predictive of job performance than résumé bullet points. She once bypassed this step for a friend-of-a-friend, with poor results. “That was a mistake,” she said.

Consistent, fair enforcement of ASC policies also matters. The leaders at both ASCs agree that the rules should apply evenly, praise should be public, and reprimands should be private. Toxic individuals, meanwhile, should be promptly and firmly addressed because their negativity can spread throughout the organization.

“You have to be even-handed with everyone. If it applies to him, then it applies to her,” Mr. Ramirez said. “You will have some ‘cancerous’ employees. Get rid of them. We see that as soon as they leave, the whole vibe changes for the better.”

With respect to performance reviews, he keeps detailed notes year-round—compliments and concerns alike—to ensure his evaluations are fair and reflect actual performance. “It’s a little bit like having a camera. They know I’m going to take notes throughout the year. Some even joke about it,” Mr. Ramirez said.

Benefits That Go Beyond Salary

Offering competitive salaries is obviously a given, but Mr. Ramirez argues that money alone doesn’t do as much for retention and team building as might be expected.

“Even a raise, the moment that you get the raise, it feels good the first paycheck, the second paycheck. But it only goes so far. That’s not a long-term solution,” he said. What does count just as much, if not more, he said, are opportunities for advancement.

Key-Whitman institutionalizes competency-building through a novel pathway created in collaboration with the International Joint Commission on Allied Health Personnel in Ophthalmology. Ms. Hurley helped establish a certification route that allows individuals with only a high school diploma to join the ASC, become certified as sterile processing technicians, and then advance to certified ophthalmic scrub assistants.

“Anyone can come in with no clinical background and eventually work up to a scrub tech position with excellent pay,” she said. “Our staff take pride in that achievement.”

Key-Whitman also offers opportunities for cross-training. For instance, every technician rotates through every role: scrubbing, sterile processing, postoperative care, and others.

“First of all, it decreases the boredom; it brings a little change on the day-to-day. But also, it makes them realize how just a little bit of help will really make a difference [in their working relationships],” Mr. Ramirez said.

The practice also pays for continuing education and attendance at national conferences to foster professional growth among their nurses.“I think anytime that we can take them to a conference and give them more education, they like it. They like to feel part of this bigger machine,” said Ms. Hurley. The result of their efforts: Ms. Hurley proudly boasts that their surgical technicians average 6.25 years of tenure, while nurses average 12.7 years.

According to Mr. Ramirez, retention rates like these arise out of authenticity and genuine care for others, which start at and spread from the top. He recommends making it a priority to know and understand not just their staff, but also their staff’s families, struggles, and aspirations. At one point, when a newly married staff member needed to work overtime for an extended period, Mr. Ramirez said he sent flowers and a dinner gift certificate to his spouse as a gesture of thanks.

“She [said], ‘Oh my gosh, this is so nice!’ It didn't cost us that much, but I immediately saw a change in him because he got some support at home.”

Happy Staff, Happy Patients

Both ASCs conduct ongoing reviews of patient feedback, share comments with staff, and use them as platforms for recognizing excellence and discussing ways to improve performance. 

According to Ms. Hurley, Key-Whitman’s Press-Ganey patient satisfaction scores for “personal treatment during the surgical process” is 97%. She and Mr. Ramirez attribute that high level to staff satisfaction, which leads to individual and organizational excellence.

“If you have happy staff, they’re going to convey that happiness to everyone else. If you have some that are not, they’re going to be sure to convey that they are not happy,” Mr. Ramirez said.

Strong Values, Strong Teams

All 4 ASC leaders stress that, unlike annual holiday parties and other activities, building a strong team isn’t just a one-off event that comes and goes once a year. It’s about building an ecosystem based on a shared mission and values; a system that relies on its administrators, clinicians, and staff to work together closely and easily for the benefit of its patients.

“At the end of the day, you just have to show your team that they’re more than just a body on the floor,” Ms. VanHoose said. 

“Show you care,” Ms. Hurley agrees—to which Mr. Ramirez adds, “And if you don’t care, find someone who does.”