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By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates, Dallas
As a company that manages hospital operating departments and ambulatory surgery centers (ASCs), we are seeing some interesting trends developing. We began noticing difficulties in finding experienced operating room staff about 24 months ago. The challenge was mostly in selected geographic pockets, i.e. rural areas where the staffing pool is shallow or highly urbanized union areas where it is difficult to draw staff away from lucrative benefit plans. However, now at the end of 2000, we are seeing a more widely dispersed challenge. What we are finding is very interesting and worthy of comment.
The first and probably most dramatic change is at the highest level of leadership in the facilities, i.e. the center administrator or department head. At this writing, my firm, Earnhart & Associates, is advertising for five new surgery center administrators and nurse managers. Normally, we would use word of mouth to find qualified individuals and fill these positions within a few weeks. Lately, we are advertising for a minimum of two months in addition to our normal efforts! Other firms that own and manage surgery centers report they are experiencing similar recruitment problems. If you find yourself in this situation, our experience is going back to the "old method" of advertising in the newspaper. We have not had much success in advertising via the Internet.
While that is a new wrinkle, what is even more interesting is who is applying for these top spots. In the past (going back almost two decades), the vast majority of applicants for key management roles in the operating room environment has been female registered nurses. They typically had a minimum of 10 years direct operating room experience, of which half was in a management role and a strong mix of not-for-profit and for-profit exposure. Training and transition were relatively easy and smooth for a firm such as mine. That has changed considerably in the past two years.
The applicant for these top spots is showing a different profile than ever before. First, the majority of the applicants overwhelmingly are male — 80% at least. Further, they do not have direct operating room management experience. Unlike the past where the applicant would usually come out of the hospital or ASC marketplace, these individuals are coming out of the physician management companies or — this is surprising — the health care insurance environment. A number of individuals applying for these positions are past (or current) hospital administrators. Prepare yourself for a lot of hand-holding, training, and educating should you elect to go this route. With the right person it can work, especially on contracting, business negotiations, and cash management. But the individual has to be a rapid study and understand that the clinical input is the first priority.
The challenge for staffing is not just touching the management positions. More of the individuals applying for staffing positions in the ASC industry are coming out of the hospitals. It makes sense. According to SMG Marketing Group in Chicago, roughly 200 new ASCs are opening each year. The operating room environment requires highly skilled personnel with years of experience. But there are only so many people to go around. Hospitals have long been the proving ground for training OR personnel. (The "brain drain" of operating room personnel leaving to go to the for-profit companies is a constant frustration to hospitals.)
While these personnel are usually very well-trained in their areas, the transition from the not-for-profit, highly structured hospital environment to the more rapid pace of a highly time-efficient, cross-trained ASC has been a management challenge for all. These personnel (like many of us!) are older. Lifestyle and, most importantly, retirement plans are becoming a key factor in their decision to shift alliances. Also, they are very attuned to the conditions in which they wish to work. For example, most are more willing to work in a hospital/physician-joint ventured ASC than a physician-only center. Some will even chose where they work based upon the makeup of the physician partnership. The typical applicant is a savvy, cognizant individual who knows what he or she wants. The ability to cross-train these individuals is high, and they are usually agreeable to variable hours. Spend extra time explaining the internal resources available to them. It can be disarming for them to know that they might have to do it themselves and not have the ability to pick up the phone and call for someone else to do it.
The front-office staff also are facing challenges. This area is very susceptible to inexperienced personnel who have little billing and collection experience. The advent of ambulatory payment classifications and the sophistication required to handle the new systems, to say nothing of juggling cash management and dealing with the public, has put this front line of the surgical business in the spotlight. Pick your candidate well, and test them to see how they handle tricky situations such as accounts receivable.
How you deal with these challenges will directly effect your programs success as we go into the next century.
I want to make this column more interactive. So, here is my challenge to you. I will share with you some innovative ways of dealing with these challenges, both from our experience and yours, but only if you vote to request it via e-mail. If the majority of my e-mail responders ask me to expand upon this topic, I will do it next month.
At the same time, if you want to add your suggestions or experiences to the column, please include that in your e-mail as well (although not necessary to vote). If you would like a different topic researched and written about, include that information as well. Please be sure to include your name as it appears on your Same-Day Surgery mailing label so that the newsletter can e-mail any future news bulletins to you. Send your vote to me directly at: email@example.com. (Sorry. No recounts will be allowed!)
(Editor’s note: Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: firstname.lastname@example.org. Web: www.earnhart.com.)