ASC boards focus on the big picture of a surgery center’s staffing, services, and financing. But they also might pay closer attention to some of the operational details that can help or hinder an organization’s efficiency.
“I’ve got a list of the top things that anyone on the board of an ASC should be queued in on,” says Neil Brodsky, MD, AGAF, medical director at Queens Endoscopy Center in Fresh Meadows, NY. Brodsky speaks about common operational pitfalls at national ASC conferences.
The following is Brodsky’s list:
• Credentialing. “All physicians on staff are credentialed and privileged for procedures they want to do, including new procedures they want to bring in to the surgery center,” Brodsky says.
Physicians also must have delineated privileges, as described in the medical staff bylaws. Medical staff must maintain a list of surgical procedures that are appropriate for the surgery center.
• Peer review. “We review cases quarterly,” Brodsky says. “We have a committee of physicians, a nursing administrator, and physician volunteers who have an interest in doing a quality review.”
The reviews involve looking at whether the appropriate procedures are performed and what new procedures might work for the center.
“If a physician wants to introduce a new procedure, we have to make sure we have appropriate due diligence,” he says.
The procedure must be appropriate, and the surgeon must be trained on performing the procedure.
• Board composition. “We have to make sure the composition of the board represents physicians,” Brodsky says.
Physicians can rotate on and off the board annually. The board also must assume full legal responsibility for determining, implementing, and monitoring policies governing the ASC’s total operation as well as for oversight and accountability of quality assurance programs.
• Discrimination issues. The ASC must create a culture in which discrimination is not permitted. Larger surgery centers might need a human resources manager. Smaller organizations could contract for these services.
“If you don’t have human resources as part of your skill set, then send people out for training,” Brodsky offers. “The law firm we use for most legal matters also has done presentations for us on human resources, and we use the firm for HR advice.”
Handling staff issues, particularly as they might relate to federal laws and regulations, is not a simple task.
“I would urge people to not put this on the back burner because it can come back to bite you in a big way,” Brodsky says.
• Sexual harassment. Sexual harassment issues have made major headlines in recent months, and for a very good reason: This is an issue that can cause major problems in a workplace.
Inappropriate touching, conversations, and other examples of sexual harassment can result in lawsuits and regulatory complaints. This type of behavior also can negatively affect staff morale and lead to high turnover.
“If someone makes a complaint against another employee, then deal with it, investigate it,” Brodsky stresses.
• Formal warnings. When it involves work effort, tardiness, or absenteeism, an ASC should be consistent, fair, and equal with staff, Brodsky says.
“We say, ‘three strikes and you’re out,’ and keep a formal warning on the employee’s file,” he says.
For instance, Brodsky recalls the case of an employee whose skills were excellent, but who had difficulty arriving to work on time. After three strikes and warnings, the surgery center fired the employee.
• Infection control. “We’re an endoscopy center, so we make sure we’re cleaning scopes appropriately and monitoring for any infection,” Brodsky says.
If there are any infections or adverse outcomes related to the surgery, these must be reported to appropriate governmental agencies.
• Monitoring patients. “Patients here receive a phone call the day after the procedure, and they’re asked about pain, etc.,” Brodsky says. “We do random reviews of charts, checking to make sure there was appropriate medication for the procedure and making sure the pathology reports are sent out and received.”
• Following national guidelines. “If you don’t follow national guidelines in terms of appropriate procedures, then the center can be penalized by payers,” Brodsky says. “We have to make sure everyone is doing exactly the right thing.”
• Checks and balances. “I can’t overestimate how important it is to have a quality assurance committee and to make sure you have checks and balances,” Brodsky says. “Usually, a nurse manager runs a QA committee, keeping minutes.”
The committee reviews information, following a checklist concerning case reviews, infection outbreaks, pathology incidents, patient complaints, transfers to hospitals, and other issues.
“It becomes very rote, and you don’t want to miss anything,” Brodsky says.