Day surgery program thrives through attention to detail

Skilled staff and patient satisfaction are key

The 26 surgery centers that make up Pasadena, CA-based ASC Network Corp. have been successful in the face of an initially skeptical public and medical profession — and despite the ongoing challenges of the changing health care environment — by minimizing bureaucracy and delivering a consistent product, says Beth Derby, RN, MBA, corporate vice president for clinical administration.

ASC Network — formed from the recent merger of Sun Surgery in West Hartford, CT, and Premier Ambulatory Systems in Pasadena — is the largest privately held surgery center company in the country. The company’s first facility, Hartford Surgical Center, recently celebrated its 20-year anniversary.

"Having a surgical procedure in an entity that was not called a hospital was a concept that was very hard for people to receive and digest quickly," Derby notes. "The historical challenge has been to provide good care, maintain standards, and gain community acceptance in order to survive.

"It’s rather remarkable to see that an industry which began in 1970 with a handful of committed practitioners has turned into an acceptable way for 50% to 60% of surgery to be performed."

Consistency in the product — having state-of-the-art technology and equipment physicians were familiar with, for example, even in the start-up phase — contributed heavily to the company’s success over the years, says Derby, who is immediate past president of the Federated Ambulatory Surgery Association in Alexandria, VA.

The organization has met the more recent demands of managed care — and the accompanying cost pressures — by controlling administrative costs and building physical plants that are only as large as they need to be, she says.

"We build surgical centers to provide just surgeries, we use them to maximum capacity, and we emphasize materials management," Derby says. "That makes us more efficient."

Allen D. Hecht, MBA, ASC Network’s executive vice president and chief operating officer, lists 10 factors he believes have been key to the company’s success:

1. Identify the unique clinical and administrative characteristics that reflect the attitude of the medical community you serve.

Have a clinical program that reflects local interests and preferences when it comes to such issues as the types of procedures that can be performed on an outpatient basis and the kind of personnel you employ, Hecht advises. For example, some communities prefer that only anesthesiologists be involved, while others would use nurse anesthetists, he adds.

2. Obtain the active participation of a focused, diverse surgical advisory group or committee. That group should include committed individuals on the cutting edge who are interested in maintaining specific standards, whether medical rules and bylaws or facility standards, Hecht notes. Its duties should include review of medical records and standards of care, as well as strategic and community issues, he adds. If the center is multispecialty, then the committee should reflect that multispecialty focus.

3. Secure the participation of the most highly qualified anesthesiologists. ASC Network likes to have an anesthesiologist as medical director, Hecht says, primarily because he or she works at the center full time, immersed in the facility’s day-to-day activities.

"That model has worked well for us all over the country," he adds. "It helps to establish clinical integrity and continuity."

4. Hire the most highly qualified administrator possible — a person that will be a leader, promoting teamwork and effective communication.

That individual should be someone who understands the dynamics of patient care and physician care, who can meet the objectives of the facility while maintaining a focused staff, Hecht explains. "[The administrator] should have a proven track record in maintaining staff with minimal turnover, should be a good listener and an effective delegator — someone who leads by example."

5. Emphasize the recruitment, selection, and orientation of a qualified, dedicated staff — particularly operating room (OR) and recovery room nurses. For example, ASC Network uses only degreed operating and recovery nurses and surgical technicians, Hecht says. "We invest very heavily in RNs," he says.

6. Make sure the management and governance infrastructure — the board of directors and the executive committee — is effective and minimizes bureaucracy.

"When a new service or specialty is being added and an active group of physicians wants to see that occur, don’t let it take several months," Hecht advises. "And if someone comes in with a capital request for equipment, move quickly to get a consensus."

7. Put an appropriate financial infrastructure in place. This includes establishing the appropriate debt or lines of credit a facility will have for capital expansion, as well as monthly reporting and analysis, maintaining the budgeted volume of cases, and adhering to the expense budget.

8. Have a facility design that promotes a good relationship between patient and staff.

Make sure the flow allows for patient privacy: Don’t commingle patients who are being admitted with those being discharged, or pediatric patients with adult patients, Hecht suggests. "Privacy results in patient satisfaction."

9. Design a program that’s adequate to meet the demands associated with expansion. That means that if your state allows it, for example, have space for four ORs, even though you only have staff and equipment for two at present, so you are in a position to expand when the time is right.

Ideally, Hecht says, facilities are designed so they "mature" into their final stage within four or five years. It’s much more efficient to have the groundwork laid for that maturation rather than incur additional costs later due to restructuring and re-engineering, he says.

10. Promote a friendly, patient-oriented environment. Decorating with pleasing colors, conducting preoperative tours, and giving pediatric patients coloring books that describe the surgical process can make patients feel more comfortable, Hecht says. t