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Everyone Sells

Everyone Sells

By ASC Management, Leadership No Comments

I have been in sales nearly my whole life. As a kid during the summer, my friends and I sold lemonade, snow cones, or our old toys from a stand in the neighborhood. From the ages of twelve to fifteen, I rented a table at comic book conventions to buy and sell to other collectors. At the age of sixteen, I had to sell myself in a job interview. When I graduated from college with a degree in physical therapy, I “sold” patients on my ability to assist them in recovering from a variety of physical ailments. To ensure the most optimal outcome, I needed them to “buy” into how important it was for them to be actively involved in their own recovery process. As I moved into formal management and leadership positions, my sales challenge progressed. I was charged with getting my teams or clients to buy into the vision or direction I was “selling.” And, as a business owner, I’ve sold my company’s services to prospects.

Yes, I’ve been selling a long time. That’s what got me excited about a recent Harvard Business Review article by Rebecca Knight titled “How to Improve Your Sales Skills, Even If You’re Not a Salesperson.”1 In it, she quotes Thomas Steenburgh, professor at the University of Virginia Darden School of Business, who states, “Selling is moving somebody else to action.” As managers and leaders, that’s what we do every day. Ms. Knight then proceeds to provide fantastic advice regarding how to think about sales and make oneself more comfortable with the thought of selling.

Although Ms. Knight’s article was focused on actual sales, I viewed it from the aspect of managing and leading people. The principles are the same. Effectively selling your team or clients on your vision and implementation strategy requires the same four tools Ms. Knight identifies as those required to effectively sell products or services.

Reflect.  Look back on the great leaders you’ve worked with in your career. How did they inspire you or your team to achieve more? I always say, management is getting people to do what they are supposed to do, but leadership is helping them achieve more than they thought they could. I had a boss who was great at providing what I needed. He broke down bureaucratic obstacles in the organization that kept me from being successful. Once he paved a path for me, I understood he expected me to deliver results. I’ve tried to adopt a similar leadership style.

On the flip side, reflecting back to poor leaders allows us to learn what not to do as well as what types of behaviors to avoid. I had another boss who was ruthless. She actively sought out weaknesses. The more vulnerable the victim the better, especially if that person reported directly to one of her subordinates. My takeaway from that experience was to make sure my team members were always prepared. Furthermore, I made it clear I would always stand with them.

Put yourself in your counterpart’s shoes. I appreciate the old saying, “To truly know someone, you need to walk a mile in their shoes.” Empathy is the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings and thoughts of another. A leader may be able to fake empathy once or twice. However, the people you are leading will quickly identify whether you are truly empathetic or just paying them lip service.

Understand what motivates your group. Tie the motivations of individuals to your vision to accomplish your goals. I once worked for a senior VP who desperately wanted to expand his territory. He asked what my goals were. I told him I wanted to become an area manager. He replied with, “Then build an area.” He proceeded to provide me the resources, encouragement, and, when necessary, the interference, to build an area. The result was both visions were realized.

Plan, prepare, and practice. You only have one chance to make a first impression. If you’re trying to sell your team on a shared vision for success, obtain buy-in by preparing an initial “pitch” to get them on board. Not being successful the first time doesn’t doom the plan or idea for the future. However, being ill-prepared during the initial roll-out seriously reduces the chance of success going forward.

  • Plan: Identify objections you may encounter ahead of time. Know the people you are preparing to lead or motivate.
  • Prepare: Know your facts. Understand your data. Do your research.
  • Practice: Find a friend or family member with whom to practice your presentation. Or, at the very least, pitch it to yourself in front of a mirror.

Stay calm and don’t brag. Staying calm is especially important if you don’t receive the response you expected. If there is resistance to your plan when initially presenting it to your team, keep your wits about you. You may find additional research is required. Sometimes, you need to work through the plan with your team gradually. Generally speaking, losing your temper or panicking will make things worse.

Bragging or making the project or vision about you is a sure path to difficulty. I have seen managers try to motivate staff or physicians to get behind a vision but these individuals were so ego-centric it was clear to their audience the plan was really about the manager, not the team. Generally, “me” based managers fail.

Again Ms. Knight quotes Thomas Steenburgh, “Very few parents say they want their kids to grow up to be a salesperson.” If these parents truly understood the versatility of the sales skill set, they would appreciate that a sales career can prepare their kids for a life of leadership.

Robert Carrera, President/CEO

asc leadership

ASC Leadership Comes in All Forms

By Leadership No Comments

I ran across an excellent article, “The Seven Secrets of Great Team Captains” by Sam Walker in the Saturday/Sunday May 13-14, 2017 review section of the Wall Street Journal.

In the article, Mr. Walker identifies seven Olympic and professional athletes whose leadership impacted their teams in a positive way. Some of Mr. Walker’s examples are popular individuals – Boston Celtic great Bill Russell and New York Yankee legend Yogi Berra. However, he also cites more obscure athletes, such as Cuban Olympic volleyballer Mireya Luis and French National Team hand ball player Jerome Fernandez.

The article was a great reminder about how, when, and where leadership manifests itself in an organization. In many of the situations described by Mr. Walker, the individual who stepped up wasn’t the captain of the team, but took action that motivated and inspired others. Sometimes we forget that leadership can originate from any place or position in an organization. And no member of a team should discount how their role can impact results.

Another concept illustrated in the article was that of a leader knowing their team well and understanding when they needed a boost. Leaders should not only understand when a motivational bump will be of assistance, but what type of assistance is needed and when providing that help will be optimal. Executing this well is contingent upon a leader’s emotional intelligence and knowledge of the personalities of each team member. Armed with this information, a leader can adjust the team’s mindset and get them back on track.

I have seen business leaders use admonishment to motivate and re-center a team. And I have observed those same leaders use humor and playful perks (ice cream anyone?) to create the necessary adjustments. The results are always dependent on the leader’s knowledge of the team and what action will best suit the situation. When a leader does not know their team well, the attempt at motivation could very well garner a negative impact.

The article also underscored that it isn’t always the team’s star who emerges as the leader. In many cases, the true leader was a “grinder” – someone who may not have possessed the most innate talent, but still achieved optimal results through hard/smart work. They are usually the individuals who don’t mind performing the mundane or difficult daily tasks with little to no recognition. They complete these tasks simply because they know the work needs to be done. These are the indispensable people on a team. Oftentimes, they are the unofficial leaders. In ASCs, I typically find these people in front office roles. In this environment, the focus is usually on the surgeons, administrator, or nursing staff. However, it is often apparent the unofficial leader is the front office team member who knows every nuance of the facility and is a resource to everyone.

Lastly, the article reminded me how I’ve developed my own leadership style and encouraged others to follow suit. The article cited numerous examples of leadership traits to emulate as well as ones to avoid. New leaders, think back to former teachers, coaches, managers, and your parents to identify leadership traits and qualities to emulate and avoid. The people you meet in life can serve as two things: a shining example or a cautionary tale. Leadership is shaped by knowing who to follow.

Robert Carrera – President/CEO

Taking Care of Your “Second Victims” After an ASC Adverse Event

Taking Care of Your “Second Victims” After an ASC Adverse Event

By ASC Management, Leadership No Comments

Life is full of unexpected events. Despite our best efforts, bad things happen. If you work in clinical settings like ASCs long enough, it is likely you will encounter an unexpected event where the outcome is not optimal. Hopefully the resultant harm is minimal, but sometimes it’s not. Adverse events can lead to painful infections, injuries that require surgery, permanent damage, and death. Research shows medical errors are the number three cause of death in the United States.

When an adverse event occurs in a surgery center, the primary concern is the well-being of the patient and their family. With patient needs tended to, leadership works to prevent the mistake from occurring again.

While all of this is happening, potentially overlooked or underappreciated are the needs of your staff. Most ASC physicians and clinical staff pursue a career in medicine because they enjoy taking care of people. Many will establish emotional connections to patients. Surgery center caregivers often use possessive phrases – “these are my patients.” With such strong connections formed, caregivers may suffer significant distress if an adverse event results in patient harm. Given the nature of care provided in ASCs, staff rarely deal with emergencies or surprises. This can magnify the shocking effects of an adverse event.

The term “second victims” describes health care providers involved in an adverse event and traumatized by the incident. They often feel responsible for the outcome. The weight of the experience can have short- and long-term effects. These can include:

  • feelings of guilt, sadness, and shame,
  • distraction, both at and outside of work,
  • second-guessing of knowledge and skills, and
  • personal harm, even suicide.

Here are some recommendations that may help provide support to caregiver “second victims” following an adverse event.

1. Determine affected staff and evaluate.

Identify who served on the clinical team caring for the harmed patient. Clinical ASC supervisors and the administrator should then work to evaluate the impact of the event on involved staff. The administrator and medical director should evaluate the impact on physicians. These evaluations can include one-on-one conversations with team members about their response to the incident. They can help determine if staff are experiencing any emotional trauma.

Do your best to make staff feel comfortable about sharing their thoughts and feelings. While some team members may not open up to you, simply reaching out can help. Doing so conveys you are genuinely concerned about staff well-being and not just determining the cause of the incident.

2. Address patient ratios.

It is difficult to predict how team members will cope with an adverse event, even one that inflicts minimal harm. From a staffing perspective, it may behoove you to assume the worst. Expect involved caregivers to require time to process the situation — time that may keep them out of the ASC or lead to reduced shifts. Immediately address patient ratios and redistribute patient loads to allow for coping and account for reduced staff. You do not want someone treating patients not emotionally or physically prepared to deliver quality care.

3. Provide support.

Offer your support to those team members who indicate some form of trauma. Discuss how they are feeling. Ask if there is anything the surgery center can do for them. This may include providing longer breaks or shorter shifts (if possible). Let them know they can speak to leadership at any time if they find themselves distracted or struggling with emotions.

Note: Not everyone on your team will feel comfortable sharing their emotions or requesting assistance. Keep an eye on team members for signs of struggling. If your gut tells you someone is having a difficult time or you notice changes in behavior (e.g., crying), speak with this team member. Work to obtain an honest answer on their state of mind; it can impact your risk management.

4. Offer professional counseling.

As helpful as it can be for ASC leadership to provide support, some caregivers may require or want outside professional counseling. Have the ability to offer such counseling, even if no one takes advantage of it. Some caregivers may initially dismiss the offer only to take advantage of it later. What’s important is to have counseling available and for caregivers to know how to secure an appointment.

Preparation is Critical

An adverse event can occur at any time. When it does, what matters most is how you respond. Ensure your response plan takes into consideration potential second victims. When caregivers do not receive the necessary attention and support following an adverse event, the likelihood of another incident occurring increases. While you can’t undo a mistake, you can work diligently to prevent another one from happening.

Jebby Mathew – Regional Director of Operations

ASC's 10-year anniversary

Turn Your ASC’s 10-Year Anniversary into an Improvement Opportunity

By ASC Management, Leadership No Comments

Your ASC has reached its 10-year anniversary.  Congratulations!  Reaching this milestone is no small feat.  Take stock of all you have accomplished, reflect on the adversity you have overcome, and then celebrate with your team.  You’ve earned it!

When your surgery center hits a significant milestone such as a 10-year anniversary, it’s important to recognize the achievement.  A celebration is a great opportunity to boost staff satisfaction.  Announcing an anniversary to your community is an effective way to market your ASC to patients and physicians.  People are naturally drawn to and have confidence in organizations with a successful track record.

A noteworthy anniversary is also an opportune time to perform a complete assessment of your surgery center and its operations.  Your ASC has likely undergone significant internal changes during the past decade.  An assessment can help ensure your ASC stays on a path toward celebration in another 10 years.

Include the following areas in your assessment:

ASC Aesthetics

  • Determine if places in your facility need remodeling to ensure it does not look outdated.
  • Examine wall coverings, furniture, fixtures, flooring, and carpet.

ASC Workflow

  • Determine if process and efficiency changes occurring over the past 10 years will benefit from physical or operational improvements. For example, if case volume increased, would adding a patient registration check-in station help handle the growth and improve efficiency?
  • Walk through your ASC with a critical eye on space utilization. As a surgery center “grows out of its space,” optimization of space helps keep areas organized, uncluttered, and efficient.  Consider inventory management, for example.  Could consolidating manufacturers reduce par levels of supplies in some categories?

ASC Information Technology (IT)

  • Work with your in-house IT specialist(s) and IT vendors to determine the age of all your technology. Assess whether any equipment needs replacing. This is especially important for servers that manage your programs and battery backup systems that provide supplemental power.
  • Make sure IT security, such as a firewall, is current and performing adequately.
  • As with any technology, computer workstations gradually slow down and become susceptible to problems that can affect functionality. If you do not already have a schedule to replace your workstations, put one together. Plan your budget to spread the expense out if you want to avoid the financial hit all at once.

ASC Medical Equipment

  • Determine which equipment may be nearing the end of its lifecycle. Many items are not designed to function properly for more than 10 years.
  • Assess the following high-expense items – some of which can exceed $100,000 in cost – and develop a plan for repairs or replacement:
  • Main sterilizer in sterile processing
  • Washer/disinfector in sterile processing
  • Smaller sterilizer units in sub-sterile rooms
  • Scope processors
  • C-arms (x-ray tube and image intensifier usually last 7-10 years)
  • Power equipment (e.g., drills, saws, reamers)
  • Surgical and procedure room tables
  • Ultrasound and transducer for anesthesia pain blocks
  • Patient monitors
  • Defibrillator
  • Anesthesia machines and gas modules
  • Video towers for endoscopy (e.g., video equipment, including cameras, monitors, and shaver boxes)
  • If you purchased any refurbished equipment, keep in mind that its lifespan is likely shorter than new units.

ASC Equipment

  • Ask your maintenance/service vendors to assess facility/plant-related equipment for estimated end of life. If these machines fail, the surgery center will likely need to shut down until completion of repairs or replacement.  Examples include:
  • Generator/transfer switches
  • Boiler and steam system, steam traps, and valves
  • HVAC system/rooftop units
  • Electrical isolation monitors/panels in ORs and procedure rooms
  • A completed assessment should include vendor predictions of how much longer equipment will last. Obtain price quotes and estimates to budget for replacements accordingly.
  • Even if replacements are not needed or recommended for another several years, plan to increase your budget for maintenance and repairs. Expenses will increase with the aging of the units.

Ongoing Exercise

While a 10-year anniversary marks a fitting time in your ASC’s history to perform these evaluations, a mature ASC is best served by performing routine assessments.  More frequent assessments will help minimize surprises and provide ample time to develop plans to address anticipated issues.  If substantial improvements are needed, provide your governing board with project details and solicit their feedback.  Then, appropriately budget for the work.

Your 20-year anniversary may not be right around the corner, but there is plenty of work you can do now to position your ASC for continued prosperity.

Diane Lampron – Director of Operations

ASC scheduling efficiencies

How ASC Scheduling Efficiencies Impact Your Facility’s Revenue

By ASC Management, Leadership, Revenue Cycle Management No Comments

Efficiencies in scheduling can be crucial to positively impacting revenue at your ambulatory surgery center.  Maximizing scheduling efficiency creates room for more procedures.  Even if you gain only one or two procedures each day, these marginal gains can easily increase your bottom line.  Therefore, taking steps to cultivate efficiency is an essential strategic initiative. 

Here are seven ways to create efficiency in your ASC’s scheduling process.

1.  Encourage your physicians’ offices to schedule cases as far in advance as possible.  Cases scheduled well in advance of surgery dates allow surgery           center personnel adequate time to prepare for patients.  Obtaining pre-authorizations from some insurance companies can take several days to complete.  Surgery center staff must call patients in advance of their procedure to review their medical history and discuss financial obligations.  Managers staff the center based on the number and types of cases on the schedule.  At times, center personnel need to pre-order special equipment, medical supplies, or patient-specific implants.  If your physicians’ offices encounter changes in their surgeons’ schedules – cancellations, add-ons, time changes, or order changes, for example – encourage them to communicate those changes to you as quickly as possible.  Discuss ahead of time the preferred form of communication for your center – phone, email, fax – to create efficiencies for their team and yours.

2. Establish a strong working relationship with your physicians’ offices to obtain accurate information. Coordinating patient care requires teamwork.  When your ASC serves as an extension of each physician’s practice, the care continuum is virtually seamless.  It is crucial to obtain scheduling forms from your physicians’ offices with comprehensive patient information and up-to-date copies of both sides of the patients’ insurance cards.  This information assists in determining if patients are viable candidates for surgery at your facility from both a clinical and third-party payor coverage standpoint.  If the surgery or procedure falls under workers’ compensation, ask your physicians’ offices to include adjustors’ names and phone numbers.

3. Schedule patients with special needs and your more extensive/high acuity cases at the beginning of the day. Include small children and patients with chronic illnesses, such as diabetes and sleep apnea, in this classification. Scheduling these cases first allows lengthier recovery times to be more easily accommodated.  Additionally, caring for these patients during usual working hours prevents staff from having to stay late or accumulate costly overtime hours.

4. Schedule specialties in the same room whenever possible. This prevents staff from spending valuable time moving equipment from room to room, leading to shorter turnover times. 

5. Schedule similar surgical sites consecutively (i.e., right vs. left, shoulder vs. knee). As an example, for orthopaedic arthroscopy cases, you may prefer to keep all the shoulder cases in line and then move to knee arthroscopies.   This will reduce the need to change positioning devices and room set up between cases.   Speeding up room turnover, anesthesia set up, and the overall flow of surgery, typically yields happier surgeons!  

6. Know what you have to work with. Larger facilities may have the ability to set up rooms by specialty.  Smaller facilities will need to focus on how to best move and position equipment. Train your staff to think strategically about these types of things based on your center’s unique characteristics.

7. Communicate your ASC’s patient criteria to your surgeons and their staff. Patient safety is a priority.  When your physicians and their office staff understand the contraindications and anesthesia requirements at your center, they can schedule their patients at the appropriate facility.   

After you determine the best efficiency workflow processes for booking procedures at your facility, educate physicians, their scheduling staff, and your facility personnel on how they work and why they are set up that way.  Scheduling efficiencies go a long way toward creating higher satisfaction for your team and physicians.  More importantly, scheduling efficiencies create opportunities to add more cases and increase your ASC’s revenue.

Kelli McMahan – VP of Operations

asc political landscape

Preparing Your ASC for Political Battle

By ASC Governance, Leadership No Comments

There’s an old saying, “Laws are like sausages, no one wants to see them being made.”  When I was younger, I was fully on board with that analogy.  The last thing I wanted to do was participate in the political process.  Then, about 15 years ago, I was thrust into a position that forced me to get directly involved.

Within the same year, pieces of legislation were introduced in Colorado and Minnesota that would have severely negatively impacted the ambulatory surgery center (ASC) industries in those states.  Neither state had an active or robust state association.

Consequently, neither state was prepared to deal with the threat.  Through a herculean effort, disaster was averted in both instances.   Those of us involved in those fights learned a valuable lesson – the best time to prepare for a disaster is before it occurs.

Fast forward to 2017.  The landscape has changed in many ways.   After a five-year battle, the Wisconsin state association, WISCA, under the leadership of Eric Osterman and the association’s board, narrowly missed getting the state’s gross receipts ASC tax rescinded.  In Oregon, the state association recently pushed forward House Bill 2664, allowing 16 ASCs to introduce an “extended stay” license to committee.  In Colorado, CASCA is fervently addressing yet another attempt to negatively impact our state’s convalescent center license for ASCs.

At the federal level, the Ambulatory Surgery Center Association (ASCA) supported the Ambulatory Surgical Center Quality and Access Act of 2017. This act addresses a flaw in current law that allows the Centers for Medicare & Medicaid Services (CMS) to use different measures of inflation for ASCs and hospital outpatient departments (HOPDs) when setting reimbursement rates.

As demonstrated by that short list of activities in 2017, the ASC industry, both on the state and federal level, is far more equipped to deal with threats.  It is also more proactive than ever before.  That by no measure means every state or individual center should sit back and consider the battle won.  Rather, continual preparation and reform is necessary to avert the next crisis.

Some problems that still exist and are keeping ASCs from being formidable political players include:

  • Lack of organized state response to business threats
  • Embryonic, unsophisticated, or paralyzed state organizations
  • Unaware, unable, unwilling, or disinterested physicians
  • Insufficient funding
  • Nonexistent, minimal, or inconsistent education of key elected officials
  • Failure to engage ASCA on a state level
  • Lack of experience, robust understanding, or discomfort with politics, government, and public policy on the part of surgeons, administrators, and staff
  • Ineffective recruitment of hospital support by ASCs and physicians in joint venture arrangements

To set up your ASC for political survival:

  • Join or work to revitalize your state association.
  • Contribute to political fundraising at the state level.
  • Solicit contributions from facility investors for political fundraising.
  • Encourage key stakeholders in your ASC to join a committee in your state association.
  • Involve your physician investors, leadership team, and staff members in state association activities.
  • Engage ASC hospital partners as an ally with your state association.
  • Utilize the ASC’s staff or investors’ political connections.
  • Access key political players on federal and state levels.
  • Engage ASCA on a state level.
  • Contribute, and secure contributions from key stakeholders, to ASCAPAC.
  • Have key ASC personnel and physicians participate in the ASCA Washington DC Fly In.

The above suggestions are some ways every ASC can improve their own political standing along with the political standing of the industry.

To summarize, let me leave you with three quotes to consider when preparing for your ASC’s political survival.

“All politics is local.” – Tip O’Neil

“Never let a third party define your issues or your identity.” – Steven Covey

“It’s not the size of the dog in the fight that counts, it’s the size of the fight in the dog.” – Dwight D. Eisenhower

Robert Carrera – President/CEO

How Marginal Gains are Crucial for Surgery Center Growth

By ASC Governance, ASC Management, Leadership No Comments

Over the course of many years, Pinnacle III has been tasked with the evaluation and turnaround of numerous failing or drastically underperforming surgery centers.  In each situation, it was relatively easy to identify the pain points and devise solutions to create marked improvement in the ASC’s performance.  

There are many centers, however, that already operate at an elevated level.  Their investors often ask us if it is possible for these facilities to improve.  

To answer this question, I am reminded of a story from the 2012 Tour de France and London Olympics. In 2010, Sir Dave Brailsford was tasked with improving the performance of the professional cycling team, Team Sky.  Eventually, he was asked to do the same for the British National Cycling Team.  At that time, Britain hadn’t had a Tour de France champion nor had they performed well in Olympic Cycling. Brailsford realized major gains in the realm of world class athletics were difficult to achieve.  Therefore, he focused on the concept of marginal gains aggregation.  He explained this concept as a one percent margin for improvement in everything.  He believed if you improved every area related to cycling by just one percent, those small gains would add up to remarkable improvement overall.

Initially, Brailsford and his team focused on the obvious – tire weight, seat ergonomics, and athlete nutrition.  Then they turned their focus on the far less obvious.  This included pillow choice and its impact on sleep quality, personal grooming habits and their impact on propensity to develop saddle sores, and hand hygiene to avoid illness.  Essentially, they searched for a one percent improvement in every area where they could create impact.  The results, despite some recent controversies, speak for themselves.  Britain’s Team Sky was victorious in the Tour de France in 2012, 2013, 2015, and 2016.  The British National Cycling Team also won 70% of the gold medals at the 2012 games.

I realize Team Sky is not the first or only organization to espouse the benefits of such an approach.  However, as a cyclist and a geek for human performance improvement, I gravitated to this example to illustrate my point.  Other examples that have paid dividends to the concept of marginal gain include David Cameron’s Behavioral Insight Team which improved the wording of tax demands to increase responsiveness.  Or Google testing 41 shades of blue for its advertising hyperlinks, which they claimed netted an extra $200 million in annual revenue.  The examples are endless.

So, how does a successful ASC ensure continuous growth?  We believe the best get better by consistently reassessing where there are opportunities to aggregate marginal gains.  I have written a great deal about culture.  This is another cultural characteristic which we work to ingrain in our partnered centers.

Every member of an ASC’s team can look for ways to identify marginal gains in their day-to-day activities.  Materials management can move more items to consignment.  Nursing staff can suggest the removal of unneeded items from custom packs.  The revenue cycle management (RCM) team can suggest changes to a dictation template to reduce the need for payors to request additional medical records.  Or, they may suggest implementing online bill pay to create an easier medium for patients to submit payments thereby expediting the receipt of receivables.  These are just a few examples of marginal gains that can be achieved through diligent management.  

It’s also important to keep in mind the reverse can be true as well.  A one percent decline in aggregated overtime can have significant impact on a facility’s operation.  The diagram below, adapted from James Clear, as referenced in “The Slight Edge” by Jeff Olson, effectively illustrates this point.

In closing, it’s easy to get caught up chasing the “large whales” – implementing bundled payments, a total joint program, or a re-syndication – to enhance facility prosperity.  But don’t forget to attend to the “small fish” by creating a culture around aggregating marginal gains.  The valleys in an ASC’s growth can be filled by marginal gains.  Doing so ensures the declines aren’t as sharp which leads to a steadier upward slope.  Overall, marginal gains are crucial to an ASC’s continuous growth.

Robert Carrera – President/CEO

Management page header image

A Clinical Approach to Healthcare Business Management & Problem Solving

By ASC Governance, ASC Management, Leadership No Comments

I am a physical therapist (PT) by education and training.  I graduated from Wayne State University in Detroit, Michigan with a Bachelor of Science in PT. Go Warriors!

For over ten years, I practiced in a variety of settings, including my time spent as a clinical faculty member at the University.  After that, I moved full time into the world of management.  I like to think I could still earn an honest living as a clinician if I needed to.

As my career moved away from clinical practice, I retained my clinical approach when dealing with issues related to business practices.

The American Physical Therapy Association uses the following statement to describe what a physical therapist does:

“PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.  In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness and wellness-oriented programs for healthier and more active lifestyles.”[1]

Essentially, PTs evaluate the situation and assess findings to develop a treatment plan.  Our goal is to return patients to their previous or higher level of function.  In some cases, we develop a plan to prevent or forestall further disability.  Sound familiar?

As is the case with many healthcare disciplines, we learned to evaluate someone and then document our findings in a format called the SOAP note.

Here is what the SOAP note entails:

Subjective – Detailed notes regarding what the patient relays about their status in terms of function, disability, symptoms, and history.

Objective – This is derived from the clinician’s objective observations.  It can include visual observations such as posture and swelling, actual measurements such as range of motion or strength, and hands-on techniques such as palpation.

Assessment – The clinician’s analysis of the various subjective and objective findings yields an assessment.  It explains the reasoning behind the decisions made and clarifies the analytical thinking behind the problem-solving process.

Plan – Conveys how the clinician develops treatment to reach goals or objectives.

As a business leader, I use the clinical approach I learned and practiced to solve management problems.  Here is how:

Subjective – Years ago I read the difference between clinicians heralded at the top of their profession and those considered more average was based on the quality and thoroughness of the clinician’s ability to subjectively capture a patient’s history.  I believe the same is true in business problem solving.

In business, it is important to seek information directly from the source when issues arise.  For instance, I prefer to meet stakeholders in person to obtain the history of the situation and gain an understanding of how it developed.  What areas have been impacted?  What actions have been taken to resolve the issue?  What, if any, impact have those efforts had?  Lastly, I like to ask the stakeholders for their suggestions on resolving the situation.

Objective – When appropriate, I begin the objective portion of my evaluation visually, just like when I treated patients.  This can entail simply walking through the facility or office.  Many times, it involves taking subjective “histories” from stakeholders.  The measurement and hands-on review, in many cases, involves evaluating existing data and reports.  When necessary, and possible, it includes asking for additional information.  This provides me with a complete view of the situation.

Assessment – Again, the assessment is where the expertise and experience of the “clinician” shines through.  Taking all information gleaned from the subjective and objective portions of my evaluation, I can generate a list of problems.  Next, I can prioritize the items on my list.

Plan – Lastly, just as in a clinical setting, I develop a “treatment” plan for the problems in my facility.  The plan addresses not only the symptoms but also their underlying causes.

The business side of healthcare is made up of many clinicians who have transcended their clinical roles into business management and leadership.  I am one of those individuals.  The skills we learned as clinicians allow us to be effective problem solvers in the operational management side of the business as well.

Robert Carrera – President/CEO


manager rounding

ASC Manager Rounding: Maximizing the Benefits

By ASC Management, Leadership No Comments

Manager rounding is the process of visiting patients and families.  It affords surgery center leadership an opportunity to monitor progress, provide education, and identify areas for improvement.  While rounding benefits an ASC’s leadership team and facility personnel, the most important byproduct is the impact it can have on patients and their families.  There are a number of ways to maximize those benefits and achieve short- and long-term improvements in a surgery center.  Here are some helpful steps to consider.

1. Be consistent.

Perform rounds every day, without fail.  The goal is to round multiple times a day, and do so in a purposeful, productive manner.  This may sound cliché, but it’s the only way to develop an effective process.

Maintaining this consistency requires planning.  Consider in advance how you will perform rounding, when you will do it, and the way you will evaluate the information you pick up along the way.

Be consistent with where you go.  Most rounding occurs in the center’s lobby, but it is worthwhile to add the pre-op area to your walkthrough.  This isn’t something most administrators do.  But you might be surprised how much you can learn from a quick visit to patients before their procedure.

2. Keep it a management responsibility.

Rounding is best performed by an ASC’s managers. They’re in an optimal position to represent the facility then take what they learn and turn it into actionable information.

The task should not be delegated to staff even if management is busy.  It is up to other members of the facility’s leadership team to step up if a round cannot be completed by the manager who was originally assigned the task.

3. Educate on processes.

Effective rounding is not improvised.  Education is vital and may need to be tailored to each individual.  Some types of education to consider follow:

  • What to say to start conversations
  • What questions to ask (i.e., a script)
  • How to respond to different comments and questions from family members and patients
  • How to approach strangers and speak with them (and do so confidently)
  • How to read people
  • How to document what is learned (see #4 below)
  • When to elevate an issue and involve other managers or physicians

The goal with rounding is to move through the lobby or pre-op, meet people, make connections, gain information, provide information, and move onto the next person.  Upfront and ongoing education will help make rounding an efficient and productive process.

4. Make the documentation easy.

The quality of the documentation can make rounding a success or failure.  To achieve the former, develop a standardized form those conducting rounds can fill out quickly and legibly.  Include the specific questions you are likely to ask and spaces for notes.

Also, include a checklist of topics on which you are likely to receive feedback. Topics could include wait times, requests for information, communication, and case delays.  Again, leave spaces for notes.

5. Use what you learn.

What you ultimately do with the feedback gleaned during rounding is as important as the rounding itself.  Establish processes for how feedback will be presented in meetings, how to determine what to focus on, and how changes or issues will be addressed.  Develop an organized way for your team to consider any problems you discovered, figure out solutions, and disseminate information to staff.

The benefits of rounding may not be noticeable immediately.  It’s not a process you can conduct for a day or week and expect significant changes.  It may take a few business weeks of consistent rounding to deliver results.

6. Hold your team accountable.

There is a reason the first step highlighted above is the need for consistency.  If a round is skipped one day and there is no ramification, soon there will be a day where two rounds are skipped. Then three. When this occurs, rounding will start to feel optional.  Managers, with their very busy schedules, may find other pressing tasks to fill the time once allocated for rounds.

That’s why it is not only important to plan who will perform rounds and when, but also ensure anyone who does not perform an assigned round is held accountable.   

7. Give rewards and recognition.

Rounding is intended to help bring about improvements.  When improvements are made, rewarding and recognizing team members who made them happen can be an effective way to bring attention to the ongoing importance and value of rounding.

Rewards and recognition can occur when a rounding manager connects with a patient or family member and receives a great suggestion or a staff member takes on greater responsibility to help implement a change.  Rewards can take the form of small gift cards or entries into drawings for more valuable gift cards. Recognition may take the form of singling out specific team members for praise at staff meetings.

8. Focus on engagement.

If a rounding program is the passion project of a single manager, it is doomed to fail.  Rounding must be ingrained in all managers and staff as a critical component of your ASC’s operations. Your team must believe in its purpose and not merely view rounding as yet another task to complete.

In the early stages of a rounding program, emphasize the objectives of rounding: to bring about operational improvements that will make everyone’s job easier and better while making sure patients and their families are safe and comfortable.  When managers are enthusiastic about performing rounds and staff are eagerly awaiting new feedback to drive improvements, you will know your rounding program has established a strong foundation for success.

Jebby Mathew – Director of Operations


Achieve Meaningful Change in Your ASC With a Plan

By ASC Management, Leadership No Comments

Viable contributors to our healthcare system consistently demonstrate the ability to implement effective changes.  Being flexible and able to adapt quickly to patient, provider, and payer developments in your market is critical to your ASC’s success.

Typically, change is not comfortable for most of the workforce including leaders. That’s where having a plan comes in handy.

Here are some key plan components that will help you effectively engage your team and adhere to a path for successful implementation of change.


Communication concerning the change is vital – but it cannot just be communication from the top down.  Communication must occur between leadership and staff, not from leadership to staff.  Make sure input is solicited from everyone involved in making the change as well as those persons affected by the change.

Convey the reason(s) for making the change.  If your team members understand why the change is necessary, they are more likely to buy into the change and actively participate in the process.

Lay out a timeline for the change process.  Although the timeline may need to be adjusted throughout the process, providing a general outline of the plan provides your ASC team an opportunity to envision the path ahead.  They can prepare for what is going to happen and when, and contribute to the end result.


Training may be a crucial component of your plan.  Many changes in ASCs today encompass new technologies – implementing electronic health records and patient portals, upgrading phone systems, or adding new surgical/clinical procedures, for example.

To ensure staff become comfortable using, and maximizing the benefits of, new technologies, extensive hands-on training may be necessary.  While it may be tempting to provide this education in the fastest and least expensive way possible, doing so may end up costing more in the long run.

One of our ASCs recently went through a software system transition.  The vendor offered off-site training for super-users.  We invested the time and money to send three members of the ASC’s team to receive that upfront training.  Upon their return to the ASC, these super-users were extremely valuable in educating and supporting their fellow staff members and physicians during the onsite training process. The team required less intensive training from the vendor, which ultimately saved time and money and promoted a smooth “go live” environment.

It is important to note that people learn at different paces.  When training team members, make sure individual needs are addressed.  More training may be required for some, while less training is necessary for others.


It is not likely everyone will be on the same page the moment you start moving forward with implementing a change.  Some members of your team may embrace the change from the beginning and easily move through the process. Others may exhibit various levels of resistance.

Team members who are hesitant or actively pushing back against a change will require additional attention.  Engage them in conversations to learn about their reservations.  Answer questions about why the change is necessary.  Provide emotional support.  You may not be able to eliminate all their concerns but taking the time to listen and actively support them throughout the process will elicit more positive engagement.

Individuals providing support and engaging in these conversations do not necessarily need to be formal leaders. In fact, peers who have bought into the change may better understand a fellow team member’s struggle and more effectively facilitate their colleague’s buy-in.


For a plan to be successful, leadership must be 100% on board throughout the change process.  They are the change champions.  This is true even if leaders are uncertain about the change or the approved approach to making the change.

In times of uncertainty, leadership must come to terms with the situation, put feelings of doubt aside, and figure out a way to stay positive.  This can be difficult, but the emotions leadership project — whether intentional or not — are inevitably picked up by staff.


An effective plan for change should take the ASC through completion of the process.  Ensure the plan spells out how you will monitor if the change achieves its intended short and long-term goals. 

If the change does not deliver the benefits you were hoping for, additional improvements and other changes may be required.

It is also important to evaluate if the change has any unintended effects on your facility’s operations.  For example, changes can affect customer service and the organization’s culture. Sometimes these changes are positive.  However, if a big change affects these or any other processes negatively, you will want to go back to the drawing board and work to right the ship.

Catherine Sayers – Director of Operations