We step inside many ASCs and hospitals in our daily course of business. It just dawned on me last month that there is something that I have not noticed in the past, but I finally figured it out. It was not what I was missing; rather, it was what I could not see: clear space.

Somehow, we have lost sight of the clutter and the sheer hoarding of stuff. Look around your hospital or ASC. If you focus hard enough you will see what I’m talking about. You should be able to look down your sterile corridor and see the other end unobstructed.

Rare is the facility where one can do that without seeing a linen cart, suture cart, piece of equipment, stretcher, X-ray rack, or other obstacles taking up space. Our patients also see this, and it is disarming to those who consider hospitals and surgery facilities to be like they see on TV: neat and spotless.

This bloat is not limited to the operating area, but can metastasize to the waiting room, which is embarrassing in most centers. It spreads to the exposed front desk and the patient registration areas, all fully in view of our patients and their more focused family members. Would you go to a doctor if there was a dead plant in their waiting room?

If you are in the position to look at your budget, really study it — you can see bloat there, too. When an ASC spends money on completely unnecessary items or services that are no longer needed simply because the facility has always done it that way, that is bloat. Does no one have the time to investigate further what a facility is wasting money on? In most cases, no.

Preference cards are, for the most part, antiquated and need to be updated after the first six months the surgeon performs that procedure. If no one is updating these cards, then it is because no one is looking at them or checking with the surgeon.

Visit your supply rooms, janitor closets, locker rooms, waiting room, and lounge. Try to tell yourself these areas look neat, organized, and professional. Most just cannot do it.

In defense of all of this bloat, I agree when one says, “There is not enough storage area in this facility.” For the most part, surgery centers allocate more space to income areas such as the number of operating rooms vs. storage space. Regulations dictate how much space per operating room a facility needs, but that is the minimum. Rarely does anyone offer more than the minimum because of the cost, but the minimum just is not enough. Everyone wants to cram another operating room into the smallest space available and not allocate enough for storage. You have to play the hand you were dealt and make do.

Everyone is busy. Everyone is short-staffed (or has convinced themselves they are). No one has the time to deal with it. But what is the solution? Pick a staff member to “police the area.” That person is responsible for roaming the halls and identifying what needs to go and what needs to stay.

Eventually, the person in charge of this task also will lose sight of what is clutter and what is not, so it is important to rotate this duty among the staff. After taking stock of the clutter, leaders decide where the objects go (we have “just in time” inventory available to us with most vendors).

If nothing else, install some prefab cabinets to store material so clutter does not clog corridors or patient areas. One also can rent outside storage bins adjacent to the facility for larger items there. Make sure everyone knows what inventory is stored where for easy access.

If you have not touched it in a year, you do not need it. If you can see it, hide it. If you cannot remember why you own it, then store it or lose it. n

(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: searnhart@earnhart.com. Web: www.earnhart.com.)