Fatal flaws and how to solve them

HR, revenue problems top list of reasons for failure

(Editor's note: This is the first of a two-part article that looks at key reasons for failure in outpatient surgery programs. This month, we look at human resource issues, and next month we'll evaluate key revenue areas that must be addressed to help a struggling program.)

Physician recruitment, cost containment, staffing, and managed care contracting are all key parts of any outpatient surgery manager's job, but if your program is struggling, how do you decide which area is most important?

"There is a lot of information on how to reduce costs and how to recruit new physicians, but in reality, these are not the areas that have the biggest impact on a surgery program that is not doing well," says Thomas Mallon, chief executive officer of Regent Surgery Health, a Westchester, IL-based developer and manager of ambulatory surgery programs. There are two human resource-related areas and two revenue-related areas that, if addressed by surgery program managers, will resolve 80% of their problems, he suggests.

• Hire the right administrator.

Too many times, a surgery center administrator will come from the office of one of the physicians involved in the surgery center, says Mallon. While this person may have the business skills necessary for running a surgery center, the previous association with one surgeon often leads to accusations of preferential treatment for the surgeon, he says. "It is best to hire a neutral person, someone with no ties to any of the physicians involved in the surgery center," he says.

There are many traits that the "right" administrator should possess, says Mallon. "Find someone who is energetic, creative, organized, and persistent," he suggests. "If you hire the administrator from within the existing staff, make sure the person is well respected," he says.

Excellent conflict resolution and people skills are essential for a good administrator, Mallon says. The administrator must be able to communicate well with physicians, staff members, managed care companies, and patients, so he or she must be able to relate to a wide range of people, he adds. "Although the ideal background for a surgery program administrator is a mix of clinical and management skills, it is more important to hire for attitude then teach the person the skills needed," says Mallon. It is much easier to teach people how to handle a budget or plan a new service than it is to teach them to relate to people, he explains.

• Take steps to avoid low staff morale.

One of the key roles of an outpatient surgery program administrator is to make sure that employees' morale stays high, points out Mallon. If the right administrator is in place, it becomes easier to establish a good working environment that promotes high morale, he adds.

Low staff morale is a major problem for struggling surgery programs, admits Mallon. Poor morale can result in the loss of patients, physicians, and staff, he says. Each of these losses only increases the financial troubles a surgery program may experience, he adds.

If you are having difficulty within your program and you are making a number of changes to address problems, maintaining good staff morale is critical, says Denise Cheek, RN, administrator of Calumet Surgery Center in Munster, IN. Calumet underwent several changes, including a change in administrators, and staff morale was high on the list of priorities throughout all the changes, says Cheek. "I was promoted from within the staff, so I knew everyone and I understood how the anxiety created by change was affecting everyone," she explains. "The most important thing I did was to hold meetings with the staff if I heard about rumors that were spreading or if I heard that one or more people were upset about something specific." By sitting down with the staff and directly addressing rumors or answering questions, Cheek was able to reduce anxiety and squash rumors before they got out of control, she adds.

Because there was a change in administrators, other staff members feared for their jobs, so one of the first steps in the change was to bring the staff's pay scale up to the standard pay scale in the area, points out Cheek. "This was good for our morale because it reassured everyone that their job was important to the success of the center and that we did not plan to cut positions," she says. "Luckily, we had no turnover during our transition and it was a positive experience for everyone."

One of the reasons Cheek was able to keep staff members focused on the positive aspects of their transition was her focus on "we," she says. "It was important to look at all of our changes as important to the whole facility and important to each member of the team," she explains.

Teamwork is essential in an outpatient surgery setting, admits Mallon. For this reason, make sure you hire staff members who like teamwork and don't focus on narrowly defined job responsibilities, he says. "Surgery center staffs are usually small, so it's important that everyone respect and like each other," he adds. "Luckily, outpatient surgery programs are desirable workplaces, so there is a good pool of clinically qualified people from which to choose."