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ASC staffing Archives - Pinnacle III

Dec 06
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Onboarding a New Department Manager

Onboarding a New Department Manager

By ASC Management, Leadership, Revenue Cycle Management No Comments

For those in ASC leadership, building the right management team is essential to success. This primary objective should not be taken lightly. Once you build an effective team culture with dynamic and engaged individuals, you can expect to make meaningful progress towards organizational goals. Thus, the process for finding and hiring management team members should be a selective one, based on your organizational needs. But what happens once you have selected and hired new management team members? How do you effectively integrate new department managers into your company and cultivate dynamic, engaged team members?

One key to the success of a new manager is a solid onboarding program. Anecdotal evidence shows, properly onboarding an employee can lead to higher job satisfaction, decreased occupational stress, enhanced company commitment, and improved employee retention.

A thoughtful onboarding program eases a new or existing employee’s transition into a new role, ensuring the individual has the tools needed to succeed. Without it, you will likely be performing another employment search soon.

Joining an existing team may be difficult for the new manager and existing team members who have already formed working relationships. So, how do you create an onboarding process that works for all members of your team?

Onboarding takes many shapes and forms, including, but not limited to, meetings, printed materials, one-on-one training, webinars, and corporate retreats. It’s not just training and education – there is also a social aspect to onboarding.

An example of how you may choose to approach employee onboarding for new department managers is outlined below. The process is outlined from a global perspective. As you read, consider how you might incorporate specific actions for your company.

Let’s get the onboarding process started! Day 1:

  • Make the new manager feel welcomed. Ensure their office, computer, phone, etc. are set up and ready for use.
  • Walk through the office and make personal introductions to colleagues.
  • Hand the new manager off to HR for completion of all the necessary employment forms and benefits enrollment.
  • Schedule meetings with other managers and key personnel. Share informative insights on the organizational culture and important team initiatives.
  • Set the tone, framework, and timing for learning. Be open to the process and willing to change timelines based on individual needs.

It is important to be patient during the initial onboarding process. Listen to the feedback and questions from the new manager. Not everyone is comfortable forging ahead or immediately creating relationships in a new company. Many might be hesitant to ask questions. Even new managers with industry experience have much to learn about this unfamiliar environment. It is our job to make sure they are given ample opportunity to absorb all the information and have the tools needed to succeed.

Onboarding checklist guide

It can be helpful to maintain a detailed onboarding checklist to guide you through the manager’s initial employment period. Some of the items you may want to include on your first 90-day checklist follow.

  • Set a 90-day expectation of objectives and performance.
  • Discuss the onboarding checklist in detail – and I mean detail!
  • Be available to mentor and coach daily. Make yourself available to discuss ideas and perceptions with the new manager and how to proceed.
  • Establish regular reporting with the new manager, perhaps weekly. Determine the reporting format and due dates. These reports may provide you with insight about the progress or struggles of the new manager as you move through the onboarding process.
  • Share a company organization chart and make introductions, demonstrating the bench strength and support of the company infrastructure.
  • Schedule regular one-on-one sessions to review the progress of onboarding and performance objectives. Identify tasks/initiatives which need further review and education. Identify initiatives from the orientation checklist which need to be added.
  • Schedule or incorporate the manager into existing management meetings and encourage collaboration from everyone present.
  • Observe, listen, and support. These activities will likely provide additional insight into the manager’s performance and how they are integrating into the company.
  • Complete a 90-day evaluation and thoroughly review the orientation checklist. Ensure any area that has not been adequately covered is addressed.

Following up

Once the new employee has successfully completed the initial employment period, don’t make the mistake of cutting the cord. Continue to offer relevant opportunities for education and development.

Figuratively speaking, it is common for companies to let the manager jump into the pool before they know if there is water in it. This tactic typically does not allow the new manager to get up to speed more quickly. Rather, it will likely delay the successful results you were hoping for from the beginning. Alternatively, giving your new manager adequate training and introduction to the company’s philosophy before overloading them with responsibilities sets them up for the best possibility of success.

Hiring is challenging enough, but once you have done your due diligence and recruited the person you want to your team, your job is not complete. An effective onboarding process requires putting in the time to foster training, provide support, and cultivate positive relationships. You want this to be a long-term win-win for the employee, the company, the clients, and you.

Carol Ciluffo, VP of Revenue Cycle Management

Aug 29
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Launching an ASC Staff Certification Program

Launching an ASC Staff Certification Program

By ASC Management, Leadership No Comments

When members of your staff indicate they want to get better at their jobs, your response is probably enthusiastic support. After all, a more competent, skilled staff is better prepared to achieve improved clinical and financial results and higher patient and surgeon satisfaction. These are some of the reasons ASCs allocate time and resources to staff training and in-service education. They are also compelling reasons for developing a program that supports ASC staff certification.

ASC Staff Certification Program Components

Here are some of the essential components to address when developing your ASC staff certification program guidelines.

Eligibility

Determine certification program eligibility. Is the program limited to full-time employees or are part-time employees also eligible to participate? Are staff required to work at your ASC for a specific amount of time (e.g., one year) before they are eligible for the program? Will you restrict participation to employees in good-standing?

Acceptable Certifications

Specify which certifications your program will cover – preferably, those that are essential to your facility’s success. Examples of certifications you may want to include:

  • Certified Perioperative Nurse (CNOR)
  • Certified Post Anesthesia Nurse (CPAN)
  • Certified Ambulatory PeriAnesthesia Nurse (CAPA)
  • Certified Surgical Tech (CST)
  • Certified Gastroenterology Registered Nurse (CGRN)

It’s important to permit staff to propose certifications not included in your program. You can weigh the merits and applicability of each proposal. While you may add to your original program list, consider including only those certifications awarded by nationally recognized professional organizations.

Covered Expenses

Identify which expenses are eligible for reimbursement upon successful completion of the ASC staff certification. You will likely want to cover the certification exam fee. You may want to reimburse certification renewal fees. Other expenses to consider:

  • Educational resources to support exam preparation (e.g., books, webinars, conferences)
  • Practice exams
  • Transportation to and from an exam center
  • Continuing education required to maintain the certification

Include a qualifier noting that reimbursement only applies to the portion of eligible expenses not already covered by other payment sources, such as scholarships. Put a cap on the amount of reimbursement available for a single certification and/or timeframe (e.g., annually).

Documentation

Require documentation at the beginning and end of the program. Employees seeking certification assistance should submit their application/request in writing. Following certification program completion, ensure employees provide documentation demonstrating they earned the certification. If you are covering other expenses, request itemized receipts.

Secure a Return on Your Investment

An ASC staff certification program is one way for your ASC to invest in staff. Help protect your investment by including a reimbursement qualifier in your guidelines. State how long employees are expected to remain with your surgery center following completion of, and reimbursement for, the certification program. Clearly outline the financial penalty for failing to reach this mark.

For example, you might require employees to repay 70% of their assistance if they do not stay with your ASC for one year after achieving certification. While you cannot require employees to remain at your center, financial penalties encourage them to thoughtfully consider the impact leaving prior to completion of the qualifying term will have on them and your ASC. Financial qualifiers also deter individuals not fully committed to staying with your ASC from applying to the program.

ASC Staff Certification Program Expansion

If you launch a program that is successful, consider additional ways to encourage staff members to participate. One way is to add certifications to your list. Ask staff for their recommendations. Monitor the development of new certifications, such as the recently launched Certified Ambulatory Infection Preventionist (CAIP).

Another way to expand the program is to go beyond certifications. Include courses provided through an accredited educational institution of higher learning (e.g. college, university, trade or vocational school). These offerings may attract individuals already holding certification(s) or those not interested in certification.

Here are some additional considerations if you are going to offer reimbursement for course tuition:

  • Require the primary business of the institution attended is education. Academic or college credit hours should be earned upon successful completion of the class.
  • Ensure course work is applicable to the employee’s current position or tied to a degree related to an employee’s career path with your ASC.
  • Require proof of completion, such as a transcript or grade report.
  • Determine whether to reimburse for books and other supplies mandated for course participation.

Offering reimbursement for certifications and courses is a potentially low-cost, high-reward method to improve staff performance and productivity. This investment can encourage greater staff loyalty and appreciation of leadership support. An ASC staff certification and educational course program promotes an ASC’s mission of providing compassionate, high-quality care. That’s a proposition easy to endorse!

Michaela Halcomb, Director of Operations

Aug 16
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Quick Tips for Managing a Rural ASC

Quick Tips for Managing a Rural ASC

By ASC Management, Leadership No Comments

Managing a rural ambulatory surgery center (ASC) presents unique challenges. In a limited demographic region, staffing, physician recruitment, and patient access can be problematic, especially if a well-formed strategy isn’t in place.

Here are several tips to help manage a rural ASC.

Staffing

In a remote (non-urban) region, there are typically a limited number of skilled professionals available to staff your rural ASC. While professionals in the area may possess the necessary medical credentials, they may not be equipped with firsthand ASC experience. If you require ASC experience as a minimum qualification, you will further limit your applicant pool. Therefore, it’s best to shift your focus to hiring qualified, motivated individuals who are willing to put in the time and effort necessary to achieve competency in the surgery center arena. Be prepared to spend adequate time onboarding and introducing new employees to the ASC model. It differs significantly from the hospital model where available staff may have gained much of their previous experience. A challenge faced by employees new to the ASC model is learning to perform multiple duties they were not likely required to complete in the hospital setting. Patience, consistent check-ins, and open communication with the preceptor are key in getting them up to speed.

Physician Recruitment

Physician recruitment can also be challenging for a rural ASC. Typically, there is only one hospital which employs physicians in the area. The ASC will either need to have a transfer agreement with that hospital or the physicians providing surgical and procedural services will need to have privileges at the local hospital.

If the hospital is not inclined to provide a transfer agreement to the ASC, physicians who only perform outreach medical services in the area may find obtaining medical staff privileges at the hospital burdensome. Because these physicians are not providing services to the rural community daily, they may be unable to meet the hospital’s case threshold requirements.

Take time to understand physicians’ relationships with the hospital prior to onboarding them to your ASC. In turn, ensure physicians you are recruiting to the ASC understand the steps they may have to take to secure the necessary relationship with the local hospital.

Patients

Patient access is limited in a rural area. Some patients may travel for an hour or more to receive medical services. Robust patient scheduling, admission, and discharge criteria are necessary to ensure optimal patient experience. Train your staff to ask your patients the right questions. Nursing staff need to supply patients with detailed post-operative instructions, as well as travel instructions to make sure patients are comfortable on their trip home.

Some patients may require longer recovery times to adequately prepare them for their extended post-op travel. Understanding these needs up front, will save your staff, physicians, and patients valuable time post-surgery. Provide patient satisfaction surveys, monitor the responses, and implement operational changes to enhance customer service.

The challenges encountered in running a rural ASC are different than those you may face in a surgery center located in a metropolitan area. Devise a strategy that considers staff, patients, and physicians. Focus on building and maintaining a high functioning ASC team. Create relationships that extend beyond the rural community. Focusing on these efforts will help you run a more successful rural ASC with the limited market and resources available.

Kelli McMahan, Regional VP of Operations

Aug 01
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ASC Policies, Procedures, and Protocols, Oh My!

ASC Policies, Procedures, and Protocols, Oh My!

By ASC Governance, ASC Management, Leadership No Comments

Policies, procedures, and protocols are the lifeblood of an ASC’s operations. These critical guidelines should be clear, concise, and readily accessible to members of the workforce. Sometimes, despite the importance of these standards, locating a comprehensive listing of policies, procedures, and protocols is not easy. When staff members are unable to easily locate a policy for the guidance they need to complete their job duties, they are hampered in their mission to provide efficient and effective service to patients. Frustration arises when time is wasted working through inefficient processes. And, in a surgery center’s fast-paced environment, timeliness is critical to efficiency.

Policies and procedures are written to provide clear and concise context, which in turn promotes consistent performance across teams. Written policies are the guideposts which represent evidence-based practices to be applied in daily functions. When team members cannot locate a policy, mistakes can happen, and clinical care can falter.

The best policies and procedures are well-researched, carefully crafted documents that contain pertinent references. They should also be stripped of bulky words, keeping content current, consistent, and concise. No matter how well written the policy, it is meaningless if it is never read and applied to practice.

How do you know if your staff is knowledgeable of your surgery center’s policies and procedures?

If your staff asks questions which are addressed in the policies and procedures manual, that can be an indicator that they are unfamiliar with your ASC policies and procedures. For example, do they ask, “What policy addresses cleaning point of care devices between patient use?” or “How often must relative humidity be monitored?” These questions indicate your staff either do not know best practices, or your ASC process, or they are unsure where to locate the information.

To address a lack of awareness of policies and procedures, begin by creating open dialogue with your staff. During this process, you may uncover a need for retraining or identify areas in your onboarding process that are insufficient. On the other hand, if your staff reveals competency in the areas where there were questions and they are solely looking for your center’s specific policy, take a step back to review the accessibility of your policies and procedures and determine if they are user friendly. There may be many reasons why staff members do not establish and maintain policy knowledge with ease; communicate with them to find out why.

Are Policies, Procedures, and Protocols Accessible?

Let’s explore the accessibility factor by looking at the history of policies and procedures. In the past, policies and procedures were paper based – typically housed in several large three ring binders. Often, these policy notebooks were strategically placed in the confines of a manager’s office – the person most often responsible for upkeep of written policies. In this model, the binders are not immediately available to the bedside nurse who may benefit greatly if they were in a more convenient, accessible location.

The communication breakdown here can be explained by competing priorities. A manager of a busy ASC is often overwhelmed by the demands of the day. The ongoing task of refreshing policies quickly can easily slip to a lower priority.

A practicing nurse knows to wipe down the gurney and put clean sheets on the bed before the next patient uses it. He or she did not need to read a policy to know this. However, does this same nurse know why only FDA approved disinfectant is used? How much dwell time is needed to kill microorganisms? Which point of care devices need to be cleaned? The answers to these infection prevention practices are critical to current infection control standards and are addressed in written policy. When the policy is read and executed, best practice is displayed by the entire team.

Poor practice, ineffective communication, and inadequate onboarding occur when the cleaning process is vocalized but not provided in written form during the orientation of a new hire. The orientee does their best to repeat what is heard and observed – but a breakdown in the consistency of the function can easily occur. If the employee does not receive enough guidance or resources, he or she may resort to performing the task in the way he or she knows how, relying on previous experience or observations of others. That performance might not adhere to the latest best practices. Alternatively, proper infection control processes are easily achieved as a repeatable task with initial and continuous education resources available.

Sustainable solutions to sharing protocols, policies, and procedures

As ASC leaders, our responsibilities include consistent, reliable management of information. Effective policies contain information that can be easily shared with members of the workforce. Leaders need sustainable solutions that improve how we share policies with staff members.

Here are four goals to consider:

  • Policies are readily available to end users.
  • Policies are accurate and current.
  • Policies are protected from erroneous editing.
  • Policy updates are communicated clearly and in a timely manner to appropriate personnel.

To select a communication platform designed to achieve these goals and secure utilization among all team members, consider the following questions:

  • Does the platform address your identified goals?
  • Can the facility afford the platform?
  • What training is required to launch and implement the platform?
  • What will be gained from using this platform?
  • How will leadership appropriately administer change management?

Not every ASC will be able to adopt the same method, hence the importance of identifying your own goals. Once goals are established, develop leading questions to identify the best tool or process for your surgery center presently and in the foreseeable future.

Is there a better way?

Pinnacle III’s managed facilities recently adopted a technology-based policy management system. This strategic move allows our ASCs to immediately gain access to our surgery center policy library. Placing a clickable icon on every workstation provides employees immediate access to policies. System administration ensures accurate and current content material, maintaining intellectual ownership. To protect policies from incidental tampering, all editing occurs via permissions and a prescribed work flow process.

To facilitate the change management process, staff training was provided upon implementation. Periodic in-services were scheduled following initial implementation. To progress staff adoption, a series of quizzes were prepared for personnel affording them opportunities to practice locating and reading various policies on the platform.

Implementation of this software has decreased employee frustration with inability to locate policies. The software provides a more efficient way to maintain and update policies. Our leadership team is more confident members of the workforce are following policies. This has enhanced the workforce’s ability to achieve compliance to practice standards and defined business operations. The leadership team’s repetitive message, “Let’s view the policy!” and “Did you read the policy?” makes consistency probable.

A technology-based platform may not be the answer for your ASC. However, it is important to understand the pain points and efficiency issues that occur in your center. These critical components are directly tied to patient care. No matter what your solution, make sure you are addressing your policy, procedure, and protocol goals. After all, the best policy ever written is the policy which is accessed, read, and applied to daily practice!

Jean Day, Director, Clinical Education

Jul 12
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Welcome Aboard: Â Great Reasons to Become an ASC Nurse

Welcome Aboard: Great Reasons to Become an ASC Nurse

By ASC Management, Leadership No Comments

Nursing jobs are aplenty and there are no signs of this changing any time soon. According to data from the U.S. Bureau of Labor Statistics, employment of registered nurses is projected to grow 15% from 2016 to 2026 – much faster than the average for all occupations.[1] Factors contributing to this rosy job outlook include employment growth in the health care sector and the need to replace retiring nurses.

With ample nursing job openings, qualified nurses can be selective about their work environment. A question nurses must answer is: “In what type of care environment do I want to work?” One of the more rewarding and enjoyable opportunities is serving as an ASC nurse.

Advantages of Working as an ASC Nurse

Here are some of the most compelling arguments for why nurses may want to set their sights on landing a position in an ASC.

  1. Better work-life balance. ASC staff do not typically work weekends or holiday hours. Weekday shifts tend to end at a reasonable time – usually, there’s no burning the midnight oil. If you want evenings, weekends, and holidays free, these are typical perks of being an ASC nurse.

There is a trend of ASCs opening on an occasional Saturday to help meet patient scheduling needs. Some ASC nurses jump at the opportunity to work this shift as it often frees up a weekday. An open weekday is a great time to take care of appointments and errands while most people are working. Depending upon your interests, that weekday may be the prime time to pursue recreational activities.

  1. Opportunity for cross-training. Are you interested in expanding your skill set while on the job? The ASC setting is the place for you. ASCs run a lean staff, with team members expected to wear many hats. For an ASC nurse, this may entail assuming roles such as risk manager, quality improvement director, or infection control specialist. Some ASCs ask clinical staff if they are interested in cross-training in what may seem like unusual areas. These can include patient registration, sterile processing, and materials management.

Cross-training affords nurses opportunities to expand their education and skills while still focusing on patient care. Cross-training may also provide an opportunity for nurses to work more hours, if the need arises.

  1. Strong team cohesion. Hospitals, due to their physical and staff sizes, tend to be departmentalized, experience greater staff turnover, and rely upon more temporary staff. ASCs, with their small, cross-trained staff, naturally lend themselves to stronger team cohesiveness and efficiency. It doesn’t take long for a new ASC nurse to meet all coworkers and understand their job roles. By working with the same people day in and out, ASC staff develop powerful, often family-like bonds.

This familiarity helps develop comfort with and confidence in one another. It also improves communication and interaction between team members. The results: greater staff, patient and physician satisfaction; stronger workflow; reduced risks and, typically, better outcomes.

  1. Closer relationships with patients. Patients who seek treatment at an ASC are in generally good health. They lack severe comorbidities. Undergoing surgery in an ASC tends to be less stressful compared to requiring emergent hospital care.

These factors allow ASC nurses to get to know their patients on a more personal level. There’s time for conversations with patients and family members. It’s not unusual for one or more staff members to discover a social connection with patients. As these bonds develop, patients move beyond being a medical record number and diagnosis. It is a rewarding experience to deliver care to someone you know on a more personal level.

  1. Bonus program. In many ASCs, once the facility achieves profitability, leadership will implement a bonus program. This allows staff to take greater ownership of how well the entire business performs. For an ASC nurse, this may include influencing patient satisfaction, room turnover rate, survey performance, and cost containment.
  2. Faster decision-making. In a hospital, change tends to be slow. For example, if clinical staff are unhappy with a type of surgical glove, changing brands usually requires a lengthy approval process. This can include multiple trials and levels of leadership approval, potentially taking many weeks.

In the ASC, the decision-making process is usually linear and quick. Unhappy with a product? It may only take a day or two to switch.

Answer These Questions Before Pursuing an ASC Nurse Job

The pros listed above represent just a portion of the many reasons why serving as an ASC nurse is rewarding. However, working in the ASC environment may not be for everyone. Before you begin applying to ASC job openings, consider these questions:

  • Do you need a guaranteed shift? ASCs tend to staff for the cases on their schedule. When there is not a full schedule, staff are often sent home. At times, there may be opportunities to fill some open schedule time with special projects. Even then, flexible scheduling tends to be a fact of life for an ASC nurse.
  • Are you looking for a rush? ASCs perform scheduled, elective procedures. Surprises are unwanted. If they happen, it usually indicates something has gone wrong, potentially jeopardizing safety. Want the adrenaline surge of coming into work not knowing what will happen or what you will need to do? You won’t find that in a well-run ASC.
  • Do you want to move up the leadership ladder quickly? There are few management roles within an ASC. If your desire is to rapidly advance into a management role, the ASC setting likely won’t lend itself to quick upward mobility. It is important to note, however, if you work in an ASC managed by a larger company, there may be more opportunities for advancement – assuming you’re willing to relocate.
  • Do you work best independently? ASCs thrive on teamwork. Most projects require it. If you tend to work most effectively on your own, an ASC probably isn’t a good fit.

Still unsure about whether you want to work as an ASC nurse? Consider reaching out to a local ASC and speak with its clinical director or director of nursing. Ask this person to tell you what they love about working in a surgery center. Find out if you can visit, tour the facility, and speak with other members of the nursing staff. There’s a good chance that working as an ASC nurse will check many of the boxes on your desired job qualities list.

Lisa Austin, VP of Facility Development

[1] https://www.bls.gov/ooh/healthcare/registered-nurses.htm

Jun 28
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Developing a Successful ASC Staff Onboarding Program

Developing a Successful ASC Staff Onboarding Program

By ASC Management, Leadership No Comments

Onboarding plays a vital role in the success of new hires. An effective ASC staff onboarding program helps new employees acclimate to their role and environment while learning rules and responsibilities. Effective onboarding is also critical to employee retention. Staff are more likely to be satisfied, productive team members when they are provided with the knowledge and training needed to thrive in their positions. Some estimates put the cost of replacing an employee as high as 150 percent of their annual salary.[1] Retaining staff has a direct, positive impact on your bottom line.

ASC Onboarding Best Practices

To help improve the success of your ASC onboarding program, consider these recommendations.

Choose your HR representative carefully. The individual overseeing your human resources (HR) responsibilities is likely the first person new hires will meet on their first day of employment. This meeting sets the tone for the entire ASC onboarding experience. It’s your ASC’s opportunity to make a positive first impression and establish the standard for your positive culture. Your HR representative should be warm and approachable. New employees should come away from their time spent with HR feeling welcomed and valued. They should also understand your ASC’s plan and commitment to helping ensure they excel in their position.

Don’t move too fast. While you may be tempted to put new hires to work right away, refrain from extending too much responsibility too early. Improve the likelihood of job success by allocating appropriate time to cover essential rules and processes. This can include mandatory training, use of your ASC’s patient accounting system, emergency preparedness, and departmental policies and procedures. For new clinical staff members, complete this education and associated paperwork before they begin providing patient care. For new business office staff members, do so before they tackle any business tasks, especially those requiring compliance with HIPAA.

Be consistent. If multiple team members educate new staff, try to ensure training is consistent. Doing so will help you measure training results and efficiently address areas for improvement.

For example, many ASCs assign preceptors to new clinical staff. Each preceptor should know what they need to review to deliver complete, effective training. If you identify shortcomings, it will be easier to train all preceptors on the new information. This will provide confidence that new staff receive this revised education regardless of who fills the preceptor role.

Measure competency progress. As new hires move through your ASC onboarding process, measure their competency progress. One mechanism to consider using is a checklist. As new staff demonstrate proficiency in critical areas, the individuals tasked with overseeing training can indicate on the checklist that competency has been achieved. The checklist can also remind trainers to provide more focus on areas of competency deficits identified during the ASC onboarding process.

Check in periodically. Managers should periodically check in with new staff members throughout their training. While you can make this a formal process, such as scheduling time to speak after 30 and/or 60 days, informal discussions can be beneficial as well. Pull new hires aside at appropriate times to ask about the ASC onboarding process thus far. Are they receiving the training they need? Are questions being answered? How are they getting along with their trainers? Have they encountered any problems?

By asking these types of questions, you may discover opportunities to improve the ASC onboarding experience. After all, you want to make training as successful as possible. Everyone benefits if you can identify worthwhile changes earlier in the process.

Perform formal evaluation. At the end of the onboarding process, schedule a formal evaluation of new hires. Gather notes from trainers and any tools used to measure competency. Ask new hires specific questions about their role and responsibilities. Review competencies, verifying that new hires are adequately prepared to provide services without constant oversight.

If trainers have noted competencies in need of improvement, use this meeting to discuss how to address any limitations. Some areas may simply require reviewing educational materials at the meeting. If that will not suffice, you may need to extend training, focusing on competencies still requiring attention.

Hire Smart to Boost ASC Onboarding Success

The key to a successful ASC onboarding process is a successful hiring process. The onboarding process uses precious time and resources, including the skills and energy of multiple employees. You don’t want to waste these efforts on people who aren’t a good fit and do not remain with your ASC for long.

Here are some quick tips to help improve your hiring process:

  • Don’t hire too quickly. Unfilled job openings may require current staff to work overtime or your ASC to use part-time help. These options are better than rushing to hire people who might lack the qualifications to effectively fill positions.
  • Hire to fit your current culture. It’s important that new hires have the professional skills to fill your job openings. You also need individuals who possess strong interpersonal skills. New hires should contribute to your positive culture and encourage other team members to strive to succeed. Remember, one negative person can seriously damage your facility’s culture.
  • Look for shared vision. The people you hire should possess a vision for the ASC that aligns with that of your facility. For example, if you value compassion and productivity, look for those qualities in candidates.
  • Conduct initial interviews over the phone. Resumes, cover letters, and references only tell part of potential candidates’ stories. Before proceeding with face-to-face interviews, schedule telephone interviews. Go through a set list of questions to help determine whether candidates seem professionally and personally qualified for your openings. If you sense a good potential fit, proceed with in-person interviews. You’ll already have a feel for each candidate’s personality before they arrive, which should help interviews progress efficiently and effectively.

A careful, thoughtful hiring process is more likely to identify candidates who are likely to be successful in your environment. Once they arrive, an onboarding program focused on productivity and satisfaction will increase the likelihood new employees remain with your ASC for many years to come.

Jennifer Arellano, Director of Operations

[1] https://www.inc.com/suzanne-lucas/why-employee-turnover-is-so-costly.html

Jun 20
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Avoiding the Cost of a Bad Hire through Strategic Interviews

Avoiding the Cost of a Bad Hire through Strategic Interviews

By ASC Management, Leadership No Comments

It is undeniable hiring personnel is tough. In the fast-paced, dynamic ASC industry, there is little room, if any, to proactively hire candidates. OR nurses and surgical technicians are scarce with ASCs facing significant competition for those resources with other health care organizations. With these factors at play, we often rush to fill open positions. Current staff may be overextended sapping them of energy required to participate effectively in the hiring process. When everyone is anxious to fill the void or expand the team, we overlook flaws in candidates. We end up hiring people who don’t really meet our job-related needs and end up costing the company more in the long run.

Recognize the True Costs of a Bad Hire

The expenses associated with recruitment and new employee onboarding are more significant than most of us realize. Consider the following:

If you are using a free job posting platform, you may think you aren’t incurring any recruitment fees. However, if you and your staff are preparing and placing open positions on these platforms, that takes time – one of your most precious resources. Screening applicants, conducting strategic interviews, preparing offer letters, and negotiating employment terms all come with a time and energy price tag. Tack on the fees associated with background checks, drug screens, pre-employment physicals, and/or relocation packages and you have a good idea of what it costs to secure the services of a new team member. If you use the services of a professional recruiter, the costs associated with new hire recruitment can increase exponentially.

But it doesn’t stop there. Factor in the costs of onboarding which may include the following:

  • Time spent preparing and processing new hire paperwork
  • Time spent explaining benefit offerings and processing new hire enrollment elections
  • Time spent conducting organizational and departmental orientation
  • Costs associated with compliance training platforms
  • Time spent training and mentoring new team members
  • Time spent conducting competency assessments

And onboarding isn’t a one day, one week, or even one-month process. Onboarding should last for months with scheduled check-ins at one week, 30 days, 60 days, and 90 days. If you and your new team member have chosen well, the costs associated with recruitment and onboarding result in a return on your investment over the course of the employee’s tenure with your organization.

However, if your new employee doesn’t work out, the costs escalate. To calculate the cost of a “bad” hire – we are not passing judgments on people, we’re referring to a poor fit – add these potential outlays to the loss of everything spent on your new hire thus far:

  • Additional recruitment fees and staff time spent securing a replacement
  • Relocation and training for a replacement
  • Negative impact on team performance
  • Disruption to workflow
  • Potential for lost customers
  • Weakened employer brand
  • Job separation and/or litigation fees

To obtain the right person for the job, you need to know what you’re looking for, ask the right questions, and accurately discern candidate responses. This “simple” formula requires forethought, planning, communication, staff training, and a commitment to press on until you identify an “ideal” candidate.

Conduct Strategic Interviews

If your organization doesn’t have a standardized strategic interviewing process, create one. You’ll reduce the odds of making poor selection decisions when your hiring managers are provided with tools to formulate good questions and effectively evaluate candidates.

Standardized interviews ensure the process is consistent for all candidates. Strategic interviews for each vacancy should be conducted by the same set of interviewers for all candidates. Similarly, strategic interview questions should not vary from one candidate to the next. This allows for a better apples-to-apples comparison during your hiring team’s debriefing sessions.

Development of interview questions should be thoughtful, focusing on the competencies – knowledge, skills, and abilities (KSAs) – required to be successful in the job as well as the attributes required to be effective in the position, department, and organization. Well-formulated job descriptions will help you identify the critical success factors for each position. It may also help to consider the attributes of your top-performing personnel.

Here are some KSAs to consider:

  • Time management
  • Communication
  • Problem solving and decision making
  • Strategic thinking
  • Ethical practice
  • Reliability
  • Initiative
  • Credibility and personal effectiveness
  • Collaboration and teamwork orientation
  • Interpersonal skills
  • Customer/client focus
  • Leadership

Strategic interview questions can fit into various categories – general, behavioral, situational, and technical. An often-used general question posed at the outset of many interviews is, “Tell me about yourself.” Behavioral questions focus on the candidate’s past experience as a means of predicting future behavior and performance. An example is, “What was one of the toughest problems you ever solved? What process did you go through to solve it?” Situational questions provide the candidate with a hypothetical scenario and ask how they would respond given the situation described. For example, “You complete a task early. What do you do with your extra time?” Technical questions tend to be specific to a role. You might ask an infection preventionist, “How do you keep employees abreast of the latest developments in infection control? What types of surveillance techniques do you find most effective?” Develop a healthy mix of these types of questions based on KSAs identified as critical success factors for each position. Focusing solely on skills and experience can lead to overlooking an applicant’s true potential or minimize behaviors that are inconsistent with company values.

Strategic interviews aren’t merely about employers posing questions and soliciting information from interviewees. They provide your applicants with an opportunity to get to know you and your organization. Ensure you allot time for candidates to ask you and your team questions. Strive to properly convey your brand and culture to applicants.

Finally, ensure everyone involved in the strategic interviewing process has the tools they need to avoid asking inappropriate questions. Provide them with a list of illegal questions and alternate phrasing to obtain the answers they need. Here are a few examples:

  • Instead of asking “Can you get a babysitter on short notice for overtime or travel?” ask “You’ll be asked to work overtime or travel on short notice. Will this be a problem for you?”
  • Instead of asking “Is English your first language?” or “What is your native tongue?” ask “What languages can you read, write, or speak fluently?”
  • Instead of asking “How old are you?” ask “Are you over the age of 18?”

It’s easy for inexperienced hiring personnel to unwittingly phrase a question inappropriately. Set your team up for success by preparing them ahead of time. Ask them to stick to the script. They can convey their engagement to candidates via a friendly handshake, smile, and thanking them for their time or candor.

Conclusion

A well-formed talent recruitment strategy in the ASC industry is crucial to running a successful organization. Strategic interviews minimize the risk of a bad hire by ensuring you perform due diligence in vetting potential employees’ skills, experiences, capabilities, and cultural fit for your organization. Taking the time to create a strategic interview process positions your interviewing team to ask the right questions. When you gain a deeper understanding of potential new hires, you save time and money in the long run.

Kim Woodruff, VP of Human Resources & Compliance

Apr 26
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ASC Business Office Checkpoints: Improving Your Surgery Center’s Bottom Line

ASC Business Office Checkpoints: Improving Your Surgery Center’s Bottom Line

By ASC Management, Revenue Cycle Management No Comments

If your ASC business office is not meeting their performance metric benchmarks, it may be time to re-evaluate your revenue cycle management policies and procedures. Business office personnel who serve on the front-end (scheduling and insurance verification, for example) and those who serve on the back-end (billing office personnel) must work as a team to achieve your ASC’s key performance indicators.

There are natural checkpoints built in to revenue cycle management. When striving to meet performance benchmarks, you and your staff can take advantage of these natural checkpoints if you know how to use them. For example, both your patient accounting system and clearinghouse have resources available to help identify opportunities for improvement. Additionally, internal tracking processes, including logs and dashboards, allow you to sort through preventable errors and identify staff members who need additional education and training.

Regular evaluation of revenue cycle policies and procedures on the front and back end of your process can assist supervisors, managers, and administrators address weaknesses, improve performance, and enhance your ASC’s bottom line.

Where do you start?

Begin your evaluation at the initial receipt of patient information. Schedulers and insurance verification personnel are at the front end of your financial flow. Accurate data entry is crucial to proper registration, eligibility, and authorization. Data entry errors, including incorrect policy numbers or failure to obtain subscriber date of birth, may create billing delays. To minimize unnecessary rejections and denials, consider developing and using a scheduling checklist.

A scheduling checklist includes guidelines on information your surgery schedulers must collect to ensure there are no omissions or errors when the ASC billing office submits a claim. This tool can reduce time delays in claim filing and eliminate the need to re-work rejected claims. Regular review of clearinghouse rejections can help you create and add to your scheduling checklist by identifying areas in which staff may be prone to making errors.

Monitoring patient benefits

Schedulers and insurance verification personnel also need a solid understanding of patient benefits. Knowing how to determine a patient’s outstanding deductible, predict coinsurance, pre-collect co-payments, and coordinate patient benefits are essential to success. To automate this process, integrate your clearinghouse whenever possible. Insurance websites also provide free tools that assist in determining patient benefits, eligibility, and financial responsibility. Evaluate the accuracy, efficiency, and effectiveness of your scheduling and verification team by running reports from your patient accounting system. Review the total dollars pre-collected each month and challenge your team to break their record the following month. Celebrate their successes! And ensure you educate staff about when and why to use an Advance Beneficiary Notice (ABN).[1]

Establishing self-pay policies for procedures performed at the facility which are not covered by insurance is also important. Ensure your team is familiar with in-network insurance carriers as well as the procedures and implants those carriers reimburse. Insurance carriers regularly publish and update pre-authorization lists. Track and evaluate denials attributable to no authorization, non-coverage due to place of service, and out-of-network write-offs. Set targets for the ASC business office team to increase collections and decrease denials. When target goals are met, reward your team for their efforts. Motivation and direction make a difference when seeking improvements.

What happens after submitting a claim?

Once a case is billed, use denial tracking to identify areas of education for coders and surgeons. Encourage coding staff to take a second look at medical necessity denials. A simple query to the physician can mean the difference between payment and non-payment. Review this information to identify areas for improvement. Denials related to bundling[2] might mean a coder requires additional education on proper modifier use. Medical necessity denials can indicate operative note templates need to be updated or coding staff need additional access to pertinent patient records.

Educate everyone about the cases that can and cannot be performed in your ASC. National Correct Coding Initiative (NCCI) edits and a list of approved ASC procedures can be found on the Centers for Medicare & Medicaid Services (CMS) website or the website for the facility’s Medicare Administrative Contractor (MAC).[3] Centralize front and back end staff access to your approved procedures lists and assign someone to review and update them on a regular basis.

Another checkpoint technique is separating the duties of your charge entry, payment posting, and follow-up teams. This introduces another layer of accountability. As your accounts receivable (follow-up) personnel work their aging reports, they can identify charge entry and payment posting habits that require education or training to improve accuracy and timeliness of account resolution. Payment posters will provide a second set of eyes on write-offs and can supply additional insight into tackling appeals and securing reimbursement. Accounts receivable personnel can also prevent timely filing issues by following up on accounts as soon as 30-45 days after the date of service. Regular reconciliation of unbilled claims in comparison to cases performed prevents missed cases.

Improving the flow in the ASC business office

There are numerous opportunities to tighten the flow of patient information from scheduling to final payment. Cross-checking information at critical points in the ASC revenue cycle reduces billing delays and preventable denials. Separation of duties among ASC billing office staff allows you to build natural checkpoints into your system, preventing costly errors including unnecessary write-offs. Once areas for improvement have been identified, set achievable goals and timelines for your staff, then celebrate their successes.

Bethany Bueno, Director, Billing Operations, Specialty Billing Solutions

[1] An Advance Beneficiary Notice (ABN) is given to patients to forewarn that Medicare may deny payment for their treatment.

[2] A bundling denial occurs when a procedure requires a qualifying procedure be received and covered and the qualifying other procedure has not been performed or adjudicated. A denial related to unbundling occurs when several CPT codes are billed for a service when one inclusive code is available.

[3] A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic area or “jurisdiction” to regionally manage the policies and medical claims for Medicare Part A and Part B Fee-For-Service (FFS) beneficiaries.

Apr 19
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Does Securing a Team Partner Make Sense for Your ASC?

Does Securing a Team Partner Make Sense for Your ASC?

By ASC Development, ASC Management, Leadership No Comments

I recently read a theory about teams in the workplace from a variety of sources including General Stanley McChrystal’s book, “Team of Teams,” which entails a process of employing many small specialized teams to tackle large complicated issues. Hiring teams of individuals in unison to accomplish a goal is not new to many businesses. When college football teams change head coaches, for example, an entire staff of ancillary/associate coaches may accompany the new coach. Thus, a new team is hired.

In other cases, a team of individuals is assembled one at a time. For example, I have a friend in the advertising business who has worked as part of a team which was assembled over the years and hired by different agencies to provide writing and graphic design services. The individuals that make up this advertising team were hired one at a time as the agency grew. In music, there are many famous teams of song writers. In the corporate world, companies purchase other businesses and acquire teams to add a service or function they do not currently possess or offer. Think of Google’s acquisition of Android, Nest, Waze, and YouTube

Hiring teams can also occur via outsourcing. Or as I prefer to call it, by securing a “team partner.” Groups seek out organizations to partner with that specialize in ready-built teams in their respective industry, rather than build a team from scratch.

Outsourcing has at times received a negative reputation. Many business leaders question outsourcing anything. However, health care is morphing and changing daily. If a leader does not take the time to assess opportunities or approaches outside their organization’s usual way of thinking, maintaining the status quo could become detrimental and costly. It is perfectly normal, and oftentimes most beneficial, to ask for help in finding and hiring teams from an industry expert.

Why should an ASC consider hiring a team partner?

  1. Locate and tap into existing expertise. Hiring an industry team partner allows an ASC to quickly access qualified candidates with a history of success. While past success is not a sure sign of future success, it is a much better indicator than no past experience or a history of no success. While there are no guarantees a new internal team will succeed, the proven track record of a team partner is generally worth the price – both in dollars and time.
  2. Time is of the essence. You will rarely hear an organization say, “There are no time constraints to launch this project or fix this issue.” While building expertise from within, or tapping into internal resources may seem safe, it typically isn’t expeditious in our fast-paced health care environment. Learning takes time. Becoming an expert takes even more time. Often, learning on the job is not a luxury we possess. A team partner allows for immediate impact.
  3. No team bonding needed. High performing teams have a proven track record of working extremely well together. New teams, on the other hand, need time to create chemistry and build trust. Selecting experienced individuals with the proper skill-set and culture, then creating a team to elicit results and meet expectations is time consuming. Consider hiring an ASC team partner to access established teams. Bringing on an established team provides more timely dividends.
  4. Internal change is difficult. If change was easy, there would not be a multi-billion dollar industry built around helping individuals or organizations with their change management efforts. Many organizations will hire a single individual or even multiple individuals to create a new service offering. Within a few months or a year, those individuals may begin to think and act like everyone else leaving their original goals unaccomplished. Team partnering allows an organization to tap into an alternative corporate culture to advance a new initiative or gain buy-in to a critical mindset change.
  5. Acquire the crossover effect. Organizations experience a period of plasticity in their identity when there is a large influx of new employees. This period of change is known as the crossover effect. The crossover effect can be viewed as positive disruption. The spread of new ideas and new ways of working bring new life to the host organization. Often a newly hired team can affect other, more established teams within the organization via positive disruption.

Business owners and leaders are all striving for gains and improvement in the performance of their people and organizations. In many cases, changing our perceptions, practices, and personnel will be required to achieve those gains. Thoughtfully consider if hiring team partners might help your ASC acquire the individuals needed to facilitate some of those changes in the most expeditious, beneficial manner possible.

Robert Carrera, President/CEO

Mar 28
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Simple, Effective Ways to Boost ASC Staff Satisfaction

Simple, Effective Ways to Boost ASC Staff Satisfaction

By ASC Management, Leadership No Comments

There is no denying the importance of staff satisfaction in an ASC. When staff are content with their jobs, the positivity permeates throughout the facility. Patients and their families notice. Physicians enjoy coming to the center more and overall care improves.

In a busy ASC, managers may find it challenging to plan activities intended to help boost staff satisfaction. Although it is often difficult to make the time, such activities are critical. And, once you commit to them, they should occur regularly. If you employ good staff, you can be sure other organizations would love to hire them away from you. The moment staff morale starts to dip, the door begins to open for your competition.

ASC administrators and managers who want to boost staff morale have many employee engagement options. Two staff-focused activities commonly implemented at ASCs and other health care facilities designed to improve staff satisfaction and retention are outlined below. They are fun, inexpensive, and easy to administer.

Staff Satisfaction Booster #1: Monthly Birthday Celebrations

Most people enjoy celebrating their birthday with others. That’s why birthday celebrations are an excellent opportunity to show appreciation for staff members. They present an opportunity for ASC staff to gather during work hours, have some fun, and receive a treat.

In a very small ASC, it might be possible to celebrate everyone’s birthday individually. As an ASC grows, that becomes more difficult. For a staff of 50, a birthday celebration could occur every week. This adds up to a lot of time . . . and a lot of cake! Additionally, the celebrations may quickly lose their luster if conducted too frequently. One solution is monthly birthday celebrations.

Once a month, around the same time each month, celebrate the birthday of everyone born that month. Buy a large enough birthday cake to provide all team members with a piece. During the lunch hour, available staff come together in the break room. Anyone with a birthday that month is recognized.

By taking this approach, no birthdays are missed. It doesn’t matter if someone’s birthday falls on a weekend or holiday. During monthly celebrations, everyone is acknowledged equally. With a month between celebrations, excitement builds over the get-together and, of course, free cake.

Staff Satisfaction Booster #2: High-Five Appreciation Program

High-fives between people are a way of acknowledging a job well done. That’s the objective of the high-five appreciation program. Rather than staff giving each other physical high-fives (which they can still do), these high-fives are written and recorded.

The materials needed to launch this program are a bulletin board, thumbtacks, paper, pencil, and scissors. Trace hand figures on paper and cut them out. I recommend streamlining the process by cutting multiple sheets at a time. Repeat this process until you have a large stack of paper hands.

When staff members see another team member doing something they feel is worthy of a high-five, they make a note of the outstanding action on a paper hand and then tack the hand to the bulletin board. Items written on the hand include:

  • recognized staff member’s name;
  • date of the observed activity; and
  • description of the staff member’s action.

Recognized actions should be specific – notable behaviors or achievements that go beyond a person’s job responsibilities or something someone does well consistently.

If staff are actively participating in the program, a good number of hands will be posted to your bulletin board after about a month. Each month, take the hands down, review them, and pick out a few that stand out as exceptional. Bring staff together to acknowledge the great work recognized during the previous month. When is a good time to do this? How about during the monthly birthday celebration?

After singing happy birthday and handing out cake, read the high-fives that you selected. If your budget permits, providing a small gift to these “winners” can be a nice bonus. Take time to hand out all the high-fives to the staff members acknowledged on them. The simple recognition of a job well done – with or without a gift – is sure to bring smiles to the faces of your team.

Note: There may be value in including high-fives in your staff evaluation process. Before distributing the high-fives, note the acknowledged action(s) in staff personnel files.

Keys to Success

While these activities are easy to implement and sustain, they have a profound effect on staff morale – particularly the high-five program.

To ensure your high-five program is successful, take these steps:

  • Educate staff. At an all-staff meeting, explain how the program works and why you are doing it. Build some excitement.
  • Task your managers with ensuring their departments fill out at least a few hands during the first several months. Regular encouragement by managers to team members during department meetings should help do the trick.
  • Actively promote the program. If your high-five celebration happens on a Thursday, send an email to staff on Monday or Tuesday. Remind staff that the celebration is in a few days and encourage them to submit their high-fives. This will help nudge anyone thinking about completing a high-five to get it done before the celebration.
  • Review the high-fives. If you find people are submitting high-fives that are not representative of the types of actions you want to acknowledge, remind staff about the “rules” and objectives.
  • Seek feedback. Not every staff member will want to be recognized in the same fashion. Take time to seek feedback from staff or your managers on how people feel about the program and being recognized. For example, some individuals would rather you send them a personal note than to be publicly recognized. Tailoring your recognitions will go a long way with your staff.

For the monthly birthday celebrations, the most important step is to ensure the events happen every month, without fail. Once you announce the monthly celebrations, most of your team will look forward to their celebration month. If you stop the celebrations before completing 12 months, you are likely to disappoint staff members who were never in the spotlight.

Consistency is critical for the high-five celebrations as well. By putting in the time and effort, and maintaining the excitement surrounding these activities, your ASC will establish valuable ways to boost staff satisfaction.

Jebby Mathew, Regional Director of Operations