Same-Day Surgery Manager

What doctors are saying and why they are leaving

Hospitals have been slow to respond to surgeons

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

Like the rest of the operating room world, I began my career in the not-for-profit hospital environment. I was around in the early days of surgery centers; and for a number of reasons, I made the switch to the for-profit world of surgery centers. I have learned much.

In my role now, I have had the opportunity to visit with many of the movers and shakers in this industry. Some are quite colorful and included some prima donna staff, some self-serving directors and management, dedicated nurses and techs, Generation X newbies (they’re fun to work with, aren’t they?), highly motivated administrators, and about 5,200 surgeons.

When we are putting together a new surgery center, we need to get a feel for what the local surgeons are looking for in the new entity, hence, the surgeon interviews. You should hear what they have to say about the hospital they are considering leaving for their own surgery center.

I will be as polite as I can, but some of this stuff you cannot sugarcoat (or should). We, the hospitals, have a perception problem with our surgical staff. About 90% of Earnhart clients are hospital/physician joint ventures, so I do consider myself to be an authority on this matter and thus able to address the issues forthright.

The outpatient surgery industry exists because hospital operating rooms have missed their target market: the surgeon. We are all tired of hearing that, but it just doesn’t seem like it is sinking in.

Even in the past few weeks, we have interviewed another 38 surgeons, and their biggest complaint (again and again) is the (seemingly) lack of respect they receive from the hospital. It ranges from the administrative "top-down bureaucracy" to slow turnover of rooms, inattentive staff members, "clock-watching" personnel, and just plain "it-is-only-a-job" attitude.

We (the hospitals) have a perception problem that just will not go away with our surgeons. It is broad-based and cuts across all generations of surgeons. The younger ones want more time efficiency and the older, close to retirement, surgeons want to be free of the hassles of fighting for time, space, and equipment.

I really have thought about a solution to the situation and have only come up with one.

The surgeons generally are tolerant about the restrains on inpatient and overnight stay patients, but they are incensed that their outpatient cases get caught up in the quagmire of the overnight, nonelective foray. Probably the greatest reason for this tolerance for the inpatients is the fact that they really do not have other options for this class of patients — yet! They do, however, draw the line with outpatient cases. Why? They have a multitude of other options. There seemingly are surgery centers on every street corner and cash available to build their own if they wish. Why do we continue to hold the door open for them by ignoring their wishes?

Why most hospitals continue to integrate inpatient and outpatient cases surprises me. Most hospitals have options available to segregate these two class of patients (yes, they are different classes), but that old mentality just keeps on hanging on. By ignoring their needs, hospitals eventually will lose these surgeons.

So what options are available? Most hospitals are expanding their operating rooms as surgery is up just about everywhere in the country. If you are looking at new construction, start planning to split inpatient vs. outpatient cases. These patients’ needs are different, and the pressure on the surgeons to perform these cases promptly is an issue.

The people having outpatient surgery are expecting to be treated differently. They know what is going on in the industry, and they are tired of working around the needs of the hospital. You need to learn to work around their needs by dedicating staff that are outgoing, customer service-oriented, time-efficient, and attentive to the needs of the surgeons who brought the patients to you to begin with.

While you can share much of the physical OR environment with both classes, you never should share or mix staffing as the two need to be separate in form and function. The outpatient staff have to quickly establish a positive encounter with the patient (and family) and be attuned to getting the case started on time, having a quick turnover, and impressing the surgeons that this is where they need to be. Rarely can one team of staff handle the needs of these radically different customers.

Also, where is the waiting room for these outpatient cases? Few hospitals ever anticipated 70% of their surgery patients coming through the doors the morning of surgery and never planned on having a place for them to wait. Speaking of waiting, shame on you if you require an 11 a.m. outpatient case to be at the hospital by 7 a.m. If you can’t adjust the registration process and patient flow to accommodate these patients, they shouldn’t be in your facility.

There are ways you can make it happen. Ask your surgeons who are doing cases in a freestanding center what your hospital can do to emulate what that center does. It is not as difficult to change that mentality as you think.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.)