Creating a welcoming, patient-friendly environment during the COVID-19 pandemic is a challenge for any organization, including surgery centers, which rely (in part) on smiles and exceptional people skills.

This challenging high-wire act hit home for one perioperative nurse when she found herself in the role of an eye surgery center patient after some elective procedures resumed over the summer.

“Even though I am a perioperative nurse, and I know what to expect and had COVID-19, you still get a little nervous and are not fully relaxed when having a procedure,” says Kay Ball, RN, PhD, CNOR, FAAN, a perioperative consultant, certified medical laser safety officer, and adjunct professor at Otterbein University in Westerville, OH. Ball also serves as the nurse planner for this publication. “My first procedure was canceled in April. Then, I had my first eye procedure in June.”

Ball underwent cataract surgery in both eyes one month apart at the Columbus Eye Surgery Center in Ohio. She was impressed with how well the surgery center maintained friendly customer service despite following strict infection prevention guidelines.

Good customer service begins at the top, notes Janie Norman, RN, director of the Columbus Eye Surgery Center. “I set high expectations for all of my staff, and they know that,” Norman says. “We focus a lot on patient satisfaction surveys.”

Staff review patients’ comments, looking for any issues they can fix. “We fix it so patients have a great experience here at the center,” Norman says. “Everyone at the center likes what they do ... and they like taking care of patients, which gives the patient a great experience.”

Building rapport between surgery center staff and patients can be a little more challenging at a time when patients mostly are not permitted to bring family or friends, they are required to wear masks at all times, and are required to stay six feet apart from other patients.

Norman and Ball describe a few ways a surgery center can provide a patient-friendly environment in the backdrop of the COVID-19 pandemic:

Set expectations for staff. The week before Columbus Eye Surgery Center reopened and restarted performing elective procedures, staff attended a mandatory meeting to review all new protocols, Norman says.“We wanted to make sure staff, physicians, and patients were safe,” Norman reports. “We put in place additional protocols to encourage employees that they could feel comfortable coming back to work.”

Leaders spoke with every employee, asking whether they were comfortable with returning to work. Every person answered was comfortable returning to work. “At the end of each week, we touched base and asked, ‘What’s working? What’s not working? How is it going?’” Norman says. “There were some things we had to adjust as things went on.”

The surgery center moved slowly with its new infection prevention measures because they placed additional burdens on staff. For example, there is more paperwork now. There are additional cleaning protocols in place, from the lobby up to and around the receptionist’s desk, back through pre-op, and into the recovery room.

“It did slow down our efficiency in the beginning, but as our staff adjusted to the protocols, we were able to be more efficient and take great care of our patients,” Norman says.

Provide warm welcome. Smiling remains important, even behind a mask, Norman notes. “I think you can really see someone smile through their eyes,” she says.

When Ball arrived at the surgery center, an employee took her temperature and asked her driver to wait in the car. The center’s staff reminded Ball to take off her jewelry and verified her insurance.

“The pleasantness of everybody felt very welcome. They smile a lot and joke with patients, and patients feel very much at ease,” Ball recalls. “You can tell when someone is smiling when they have a mask on. It gives you a warm feeling when you hear them talking to you and treating you like you are family. They asked me if I was comfortable so many times and asked me if I had any questions so many times.”

That is part of perioperative nurses’ and surgeons’ caring attitude. “With COVID, there’s that stress of ‘I don’t want to get this disease,’ and everyone is there by themselves,” Ball explains. “The nurses and surgeons are more alert to the patient’s discomfort.”

Make new infection prevention rules clear. One challenging change was requiring family members and friends to wait outside the facility instead of the waiting room.

“We’d call and say, ‘Mrs. Smith, your mother is ready; bring the car down,’ but they might be at [lunch] or the store,” Norman explains. “That backed up our recovery room because the family wasn’t there.”

The surgery center changed its rules to direct visitors to agree to return at a specific time, waiting for the staff’s call to pick up the patient. “We always told them a time that is a little before the surgery was done so they could be there on time,” Norman says.

Another new rule was requiring everyone in the center to wear a mask, including during the procedure. So far, every patient has been pleasant and understanding about wearing their mask, Norman reports.

Emphasize teamwork. “You create a family atmosphere by having employees who believe in teamwork and have positive attitudes,” Norman offers. “When you have a group of nurses and employees who will help each other, that creates teamwork and positive energy that you need to have a successful surgery center.”

Creating an optimal team environment starts with hiring the right people, which is not always easy, Norman admits.

“Sometimes, it’s hard to judge a person in a 20-minute interview. You have to hope they’re being honest with you,” she says. “When you have someone who is creating negative energy in a group, you have to address it by pulling that person aside and having a conversation with them, letting them know they’re creating that negative environment and [how] it affects everyone.”

In Ball’s experience at the surgery center, it was not just the assigned team that made her feel valued. Other employees were friendly, too.

The surgery center’s leadership contributes to teamwork by chipping in wherever needed, Norman says. “Our operating room [OR] supervisor is circulating every day,” she says. “I help wherever they need me, whether it’s turnover in the OR, cleaning instruments — just not sitting in my office.”

Everyone works hard to provide a positive patient experience, according to Norman. Helping in all areas of a surgery center gives managers a better understanding of problems that arise.

“If you have an employee who comes to you with a complaint about a certain responsibility, and you’ve done that responsibility, then you can relate better and help form a solution that is doable,” Norman explains. “This works better than if someone comes to me complaining about something I’ve never done before. It’s hard for me to come up with a solution if I don’t know that job.”

Keep communication flowing. When Ball was rolled into the OR, everyone introduced themselves, including the nurse anesthetist. Staff offered Ball medication to help relax her, but Ball said she preferred to be awake.

The OR team made sure Ball was comfortable, turned on some background music, and instructed her to let them know if she needed to cough or sneeze so they could stop everything and be prepared. “You have to be very still for 10 to 15 minutes,” Ball notes.

The team reviewed her information to confirm they were working on the correct eye and putting in a certain lens. During this process, the nurses are social, engaging patients in conversations as everyone prepares for surgery, Norman says.

“It’s very natural, and it’s something we can continue to do because they have their mask on,” she says. “That builds rapport with the patient.”