Reinventing the box: We are doing it, you can too

By Stephen W. Earnhart, MS, CEO, Earnhart & Associates Houston, TX

I will ease you into this topic. While it has me excited, I will contain that excitement as I will lose you if I don’t.

We are building our largest and most demanding facility to date! Well, I couldn’t contain myself.

The surgical facility in question is neither a hospital surgery center, nor a joint-ventured center, nor a physician-owned center. It is a surgical hospital outpatient department (HOPD) about three miles from the parent hospital. It will, gloriously, have hospital reimbursement and no physician owners!

Most of the surgeons who will operate out of the facility are employees of the hospital (which is quickly a coming trend), although we will allow non-employed surgeons privileges but no equity. They will use it because of the location and services it will provide.

This is our 12th such facility. The others are all successful, as this one will be. The difference with this facility is that everything will be re-engineered, from the physical design, to staffing mix, to job descriptions, to ambience, to the roles of the staff, and many other changes. This facility has been in the works for over two years, but we are finally throwing dirt and anticipate opening Q1 2014.

We have designed the layout differently from any we have ever done. It is designed 100% for efficiency in operations and staffing economics. It includes an open floor plan and lots of built-ins.

Every job description we have ever used has been torn up and redone, word for word. Nothing will be standard. Every staff member will be hand-picked for skills, professionalism, and ability to work and play well with others. Wherever possible, staff members will be cross-trained and incentivized to maximize patient safety and satisfaction while reducing cost in every area of operations.

I like how the computer industry — Apple, Google, and the like — treat their staff and allow for creativity. It works for them, and it will work in healthcare. Many of those practices will be incorporated into the center. Because all of the employees at the facility will be employees of my company, and we will manage the facility, we can make this happen. Nothing will be the “norm.”

Every efficient and effective service and industry technology will be used and maximized. If it works, it will be incorporated into operations. I have always believed in technology and know that the cost of technology always goes down. We plan to negotiate religiously for the best of the best.

Is this going to be the surgical facility of the future? In some ways, yes. I have been in this industry a long time, and I plan to incorporate what I have learned over the years.

Now, you’re thinking, “Who cares? Do what you want, and stop blowing your own horn already.” Valid, but with the exception of the physical layout and organizational structure, everything we will do, you can do at your facility! It makes no difference if you are working in a hospital or a freestanding ASC.

As an industry, we don’t staff our facilities well. We need to recognize that with fewer and fewer nurses around and available, we need to start looking at how we staff and how we assign responsibilities in our facilities. We all once had cars that we had no idea what the gas mileage was or what was in a hot dog. (I still don’t want to know. It’s one of my favorite foods.) It stands to reason we need to start looking at our processes differently, just as we do everyday occurrences in our day-to-day lives.

With 10,000 patients per day turning 65, and every day after for the next 20 years, we need to change our payer mix to new opportunities and start capitalizing on specialties and services that come with that growing market share. Most of us are shunning Medicare while our competitors are expanding their specialties in ophthalmology, auditory, and urology. Many in this age bracket are losing their vision and hearing, and they are leaking. Why not get into those areas?!

Why are we still doing our own billing when the professional companies out there do it so much better? Figure it out: You almost certainly are losing money billing internally. No time to detail it here. (For information, see my column on “The big question: To bill, or not to bill?” Same-Day Surgery, September 2012, p. 100.)

Everything you need to do with your patient on the day of surgery can be done in 45 minutes before surgery. Airlines “on-time” schedules are listed in newspapers, on TV, and in social media, but yet we still make our patients work around our schedules. That preoperative time will change going forward as patient satisfaction and outcomes play a greater role in reimbursement. No long will we be able to hide those facts that we grossly inconvenience our patients to cover up our own inefficiencies.

How many members of your staff have a financial incentive to add to your bottom line? I spoke to a group of professionals a couple of months ago, and no facility represented in the room had a profit-sharing plan for staff. You want to crosstrain staff and demand efficiency? You’d better cough up some dough. Also, it is the right thing to do. The benefits are immense. Look at the Googles, Apples, and Yahoos of the world. Every employee at those companies are tied to the bottom line.

Refresh your facility as you would your house if you were selling it. Look at the colors of your walls. Ninety-five percent of every center I go into looks like something out of a psychiatric hospital movie. Get some color! Patients and staff respond to visual stimulation!

Put in Wi-Fi. Tell your IT people that they work for you when they cry about “violating their network.” Do it for your patient’s families. I get Wi-Fi in airport bathrooms, for heaven sake!

Get EMR. If you cannot afford it, I can refer you to people that will not charge anything upfront. Patients like being in high-tech places. (Actually, I just made that up; but I do, so therefore I assume others do as well.)

Use as much per diem staff as you can. Full-time staff members tend to get stagnant, complacent, and set in their ways (with the exception of those reading this, of course. You rock!) New faces in the right place can add a new sense of excitement and ideas in an otherwise bureaucratic workplace.

Start having free lunch again once a week, once a month, or once a year for your staff. Have a door prize for something — anything. Jazz it up!

Make a “family wall” in the lounge where people can put pictures of their kids or families or pets. Make a facility “wall.” Light things up!

Get with social media. It offers so much!

Don’t make your patients spend 20 minutes registering when they are tired, caffeine-depleted, scared, and hungry. Let them register, sign their paperwork, and cover their co-pays online in their favorite chair. Get with it, or you won’t be around much longer. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates’ address is 238 S. Egret Bay Blvd., Suite 285, Houston, TX 77573-2682. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: Web:]