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ASC Leadership Archives - Page 2 of 4 - Pinnacle III

Dec 28
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The Ripple Effect of Reducing Data Entry Errors

The Ripple Effect of Reducing Data Entry Errors

By ASC Management, Leadership, Revenue Cycle Management No Comments

When claims are denied due to data entry errors made during patient registration, a ripple effect occurs. Payments are delayed, increasing accounts receivable days. Back office billing personnel must work with front desk staff to obtain corrected data, then resubmit claims, wasting precious time. Staff may blame one another for the errors, damaging employee morale and creating an unpleasant work environment. If denied claims build up, the potential to miss important follow up grows and valuable revenue can go uncollected. Profit margins decrease and ownership distributions suffer.

These were all concerns of mine when I faced my ASC’s data entry error rate of nearly 11% in January. I knew we could do better. We had to. So, I set a goal for our front desk staff: to reduce their data entry error rate to below 1%.

In August, we achieved that goal. Our error rate is currently 0.69%. Staff want to further reduce their errors. Given their determination and effort to achieve what they have, I believe they can accomplish any goal they set for themselves.

Here are some of the steps we took to achieve this impressive turnaround.

Review and Analyze Data Entry Error Log

Accountability is critical when striving to improve. To ensure we maintained momentum, we implemented weekly reviews of our data entry error logs. During these reviews, we evaluated each error to identify the cause. We then discussed what staff needed to do to avoid making similar errors in the future.

For example, we noticed our team made similar insurance errors month after month. Some of the errors related to not clearly identifying payers. Others were steeped in confusion around different plan types offered by a single payer. To reduce these errors, we printed examples of our most common insurance cards, highlighting key details needed by registration staff on the front and back of those cards. Laminating these examples provided staff with “cheat sheets” that helped improve accurate entry of insurance details.

Data Entry Double Check

Each morning, an assigned member of the front desk team printed out the schedule of the previous day’s cases. This individual then double-checked that patient data in our registration system to ensure accuracy. To minimize interruptions and distractions, this review was performed in a private office.

Staff also sought out opportunities to perform data checks during the registration process, particularly concerning error-prone areas. For example, the subscriber date of birth was a troublesome data set. When the patient is not the subscriber, both dates of birth (patient and subscriber) need to be recorded. These repetitive reviews helped our team increase data entry accuracy.

Front Desk Staff Input

To help further secure performance improvement, we frequently asked front desk personnel to share their ideas. After all, working these accounts every day gave them insight into areas leadership did not have. We carved out time during our meetings for staff to share thoughts and let us know where help was needed. We worked on fostering an environment where they felt free to express themselves and ask questions.

These meetings and conversations allowed leadership and staff to develop a closer relationship. I maintain an open-door policy. Staff are comfortable speaking with me outside of meetings which allows us to quickly respond to opportunities to make positive change.

To help our front desk team members succeed, we regularly ask if they have the tools they need to perform their jobs effectively. We are happy to honor requests when we understand how doing so will bring about improvements

Ongoing Front Desk Staff Meetings

Once our front desk staff achieved the data error entry rate goal and demonstrated an ability to maintain it, we didn’t stop our meetings. Rather, we decreased meeting frequency from weekly to monthly. Our monthly meetings provide us with time to review and discuss a summary of the previous month’s data entry error reports. Error trends are now a rarity. Our vigilance ensures new trends aren’t developing and significant time isn’t passing without detection of potential troublesome areas.

Eye on the Prize

Ongoing updates on performance is the primary reason our front desk team members were so successful in lowering their data entry error rate. As we instituted improvements, they anxiously awaited delivery of the next data entry error log. They wanted to gauge their performance and find out if their hard work was achieving the desired results. Disappointment set in when the error rate did not decline or drop as much as they hoped. Fortunately, they used their disappointment as motivation to be proactive and seek additional opportunities for improvement.

I see tremendous value in providing our front desk staff with achievable, measurable goals. This team is now working on a new objective – capturing information about patients’ primary employers. Because this is a new process for them, team members occasionally fail to capture this information. We evaluate staff performance in this area monthly and work to determine reasons why our capture rate is not 100%. That’s our goal, and we know it’s obtainable. Why? Because it is a figure achieved by other Pinnacle III managed facilities, and our staff knows it. Now there’s some friendly competition between facilities.

The Ripple Effect

The positive ripple effect our ASC experienced when our front desk team reduced their data entry error rate to less than 1% was significant.

  • In January, when our error rate was 11%, our average accounts receivable (A/R) days was 28. When we reduced the error rate to 0.69% in August, our average A/R days decreased to 20.
  • Our claims-to-payment days declined – from 34 days in the first quarter of 2017 to 31 days in the third quarter.
  • We experienced a reduction in bad debt – from 4% at the end of 3rd quarter 2016 to 3% during the same timeframe in 2017. While the drop in bad debt is attributable to the improved efforts around upfront collections, it underscores how focusing on troublesome performance indicators can produce meaningful change.

Financial improvements have not been the sole byproduct, however. A transformation has occurred among our front desk personnel.

  • They are more engaged and eager to learn about their performance.
  • They more fully understand how their efforts affect our facility which motivates them to continuously strive for excellence.
  • Their relationship with leadership is truly collaborative.
  • Our governing board, which reviews the financial data, has expressed pride in and appreciation of front desk staff performance.

My concern with the damaging ripple effect that could have occurred when our data entry error rate was 11% subsided as progress was made by our front desk team. Our focus on, and improvement in, this area has made a difference. Our ASC operations were positively transformed in a sustainable way.

Michaela Halcomb, Director of Operations

Dec 13
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Responding Appropriately to a Disruptive Employee

Responding Appropriately to a Disruptive Employee

By ASC Management, Leadership No Comments

A thriving ASC runs like a well-oiled machine. However, even the gears of a well-oiled machine can slip creating minor issues that disrupt performance or major issues that can bring performance to a halt.

Some of the gears in your ASC are your employees. When they follow outlined procedures and fulfill their job responsibilities, operations typically run smoothly. However, when an employee becomes disruptive, like a malfunctioning gear, significant problems can occur. Disruptions can –

  • Undermine the culture of safety,
  • Distract staff from attending to their responsibilities which can affect safety, financial performance, and regulatory compliance,
  • Contribute to a decline in staff morale,
  • Increase staff turnover,
  • Weaken staff confidence in management/leadership, or
  • Create legal issues (e.g., patient negligence, physical or verbal abuse).

While there are common steps taken in response to any disruptive employee, different types of disruptive employees require different approaches.

Long-Term Well-Performing Employee Who Suddenly Becomes Disruptive

Good employees are hard to find. Well-performing, experienced employees are difficult to replace. But even the best employees can become disruptive. An employee may act out due to an internal conflict or an external issue that carries into the workplace.

Make time to have a one-on-one discussion with this employee. Be honest and direct about why you are engaging in the conversation. Provide the employee with a description of the disruptive behavior and share personal observations. Straightforwardly pose the question, “What’s going on?” That may be all it takes to obtain an explanation. Provide assistance, when it’s appropriate to do so.

If this conversation fails to bring about a resolution, turn to your human resources policies. If you are dealing with a safety and/or behavior issue, and a policy speaks to these matters, review the applicable language with the disruptive employee. Share a copy of the policy with the employee. Then provide a performance improvement plan outlining expected behavioral changes. Identify a specific timeframe to demonstrate improved performance. Clearly explain the consequences of failure to comply with the plan.

New Hire

You’ve put in the time to find, interview, hire, and orient a new employee. When you learn this individual is disruptive, take a deep breath. Before you stress about having to go through the hiring process all over again, understand that new hires often struggle during their initial employment period.

But don’t stop there! Immediately sit down with the employee and discuss the disruptive behavior. Share your observations. Explain why the employee’s actions are not acceptable. Review your employee handbook with the employee, specifically focusing on pertinent areas – your code of professional conduct and disciplinary procedures, for example. Outline what the employee needs to do to avoid discipline and possible loss of position.

Note: The hiring and training process is time-consuming. Losing a new employee, while easier to handle than losing a senior employee, is not optimal. Ensure you employ a sound interview process that affords you the best chance of hiring the right people the first time around. Ask appropriate questions and dig below the surface to gain insight into your candidates’ answers. Develop a comprehensive onboarding process and sound competency training program. Hiring smart and clearly establishing expectations at the outset positions new employees for success.

Well-Performing Employee in Their Department, Disruptive Employee Elsewhere

You have an employee who is great at their job. They fulfill their responsibilities and receive high marks from managers and co-workers within their department. But when they step outside of their work area, they become disruptive. It’s an unfortunate development that requires action.

Investigate the situation. Speak with the individuals affected by the employee’s disruptive behavior to learn as much as you can about the employee’s actions. Sit down with the employee and explain how his or her actions may be indirectly affecting the performance of their own department and the ASC’s ability to deliver the best possible patient experience. Sometimes, these employees need to be reminded they are expected to maintain the high level of professionalism and excellence they demonstrate in their department throughout the entire facility.

Long-Term Disruptive Employee Who Was Never Disciplined

A new ASC manager learns of an employee whose disruptive actions and/or behavior were ignored by previous leadership. Unfortunately, this is not an ideal start to a new position. If the new leader wants to earn the respect of all ASC staff, action is imperative.

Review the employee’s personnel file to find out if previous managers spoke to the individual or took any action. Speak with affected staff members to learn all you can, documenting any information not included in the file.

Again, sitting down with the employee is necessary. Make it clear the disruptive actions were never acceptable and must now stop. Establish clear expectations regarding future behavior. Provide the employee an opportunity to share their perspective and address whether they believe they can meet your expectations.

While a new manager will not know this employee well, a respectful discussion is vital. Avoid a confrontational tone and negative expressions. The employee may not have realized their behavior was disruptive or understood the harm caused by their actions. A supportive manager who provides positive guidance may be all that is necessary to resolve even a long-term problem.

Rely on Your Policies

Managers faced with any type of disruptive employee behaviors are well-served when they follow their ASC’s policies and procedures. Doing so helps ensure consistency in addressing behavioral incidents and maintaining regulatory compliance.

Managers should prepare to follow through on outlined consequences even if it means firing a valued employees. A disruptive employee can place significant strain on your well-oiled ASC; but a manager who does not respond appropriately may cause irreparable damage.

Jennifer Arellano, Director of Operations

Nov 13
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What’s Your ASC’s Leverage Point in Payer Negotiations?

What’s Your ASC’s Leverage Point in Payer Negotiations?

By Leadership, Payor Contracting No Comments

When it comes to payer negotiations, your ASC leverage point is the weight you bring to the game. What do you lean on to produce results? What card(s) do you play to change the game?

What we’re talking about here is simple physics – matter, motion, energy, and force. Or put more simply, influence. Influence equals change. And no influence equals no change. If what you’re leveraging weighs on you as much as it does your opponent, it’s not leverage. Think of a teeter-totter on a playground with two evenly weighted people on it. It doesn’t move much! You need force applied to one side to create influence and shift the situation.

Your ASC leverage point is achieving the most gain while exercising the least amount of loss. It is important to know what you can concede and what you must gain before your walk into any negotiation. Apply this to all parts of your ASC business operations, especially negotiation with payers.

Optimal leverage enables you to impact change that multiplies your efforts and preserves the utilization of your resources.

Let’s look at an ASC leverage point example.

Is achieving a slight increase in your ASC’s procedure reimbursement at the cost of surrendering payment for implants a leverage point? No, because it costs your ASC as much as it gains. Again, think of the teeter-totter example with two evenly weighted parties attempting to move it. You must work to concede less while still achieving positive results. If your ASC can gain a decent increase without giving up anything other than perhaps the time and energy necessary to make its case, then a true leverage point is exercised.

For a leverage point to work in your favor, it must be sensible, perceived as credible by the payer, and not merely a perceived threat. If perceived as a threat, it will not have the power to influence the other side to move closer to a negotiating position. In either case, an ASC leverage point has potential to bestow gains or impose losses on the other side. However, a genuine leverage point is not overstated or punitive; it’s consequential and practical. It’s the prime force you exert to get what you need and goes beyond strong negotiating skills. Negotiation skills cannot replace a genuine leverage point.

Consider another ASC leverage point example.

Say a payer bundles implant payment and is not offering adequate reimbursement to cover your ASC’s costs plus a reasonable profit. Does your ASC threaten to terminate its contract with the payer because the procedure pays poorly? (This is probably a threat some payers hear often but providers rarely follow-through on.) This tactic would likely amount to a lose-lose proposition for both parties.

An alternate option is to inform the payer your ASC can no longer accept these cases on their members and must divert the cases to a higher paid (facility perspective) and higher cost (payer perspective) center to make your case. The former is not a perceived leverage point unless your ASC truly intends to carry out the termination. But the latter is not only grounded, it will demonstrate to the payer how much they will lose by not administering a reasonable procedure reimbursement that covers your costs and nets a reasonable profit.

Let’s face it, your facility needs the payer to pay more, but the payer has little incentive to pay your facility more. Payers hold significant leverage. To make your case, your ASC must find and exercise its leverage point and change the equation.

A change in the equation can be a payer gaining more information and an increased understanding and willingness to adapt to your ASC’s thinking. Your ASC is offering a cost-containment solution to the payer. Rather than simply asking for greater reimbursement, your ASC must negotiate rates that allow you and your payers to stay in business in a competitive health care market.

Dan Connolly, VP of Payer Relations & Contracting

Nov 02
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Improving Clinical Staff Efficiency with ASC Business Education

By ASC Management, Leadership No Comments

Gradually moving up the ASC job ladder provided me with opportunities to learn a great many things. One of the most significant lessons arose not long after I moved into a management position.

As a nurse, my focus was on delivering the best care possible to every patient that crossed my path. When we delivered great outcomes, I felt successful. Because there were always patients for me to care for, I assumed the ASCs I worked in were also successful businesses.

My outlook changed when I became a manager. My effectiveness as a manager requires focusing on the bigger picture. A significant part of that picture still includes the delivery of safe, compliant care. However, another sizable part involves the financial side of running an ASC. I felt very comfortable with the former and completely unprepared for the latter.

In a clinical position with no management duties, I didn’t stop to consider the ASC business. I didn’t know the reimbursement we receive for a case covers everything we do for patients, from the moment they walk in the door until they go home. It also covers the ASC’s expenses, including our surgical supplies, utilities, rent, and, of course, salaries. I did not receive any relevant ASC business education until I assumed a management position.

Receiving an ASC business education changed my perspective on the delivery of care. Now, every time I see an unused towel or suture in the trash, I equate it to money – money that could go toward better equipment, new technology, and pay raises. I quickly surmised conveying some ASC business education basics to my clinical staff would likely go a long way toward cutting our costs.

Here are some of the ways I approach providing ASC business education to clinical staff.

Allocate time. During our monthly staff meetings, I commit time to discuss our business. I gauge what staff members do and do not understand. I provide clarification when they have specific questions. Once a quarter, I dedicate most of a meeting to ASC business education. This allows me to dive more deeply into specific topics. Since much of what I cover is new, I spread out education to avoid overwhelming staff. I want to teach, not scare them.

Keep it simple. Clinical staff don’t need to know every little detail about the ASC business. When I explain concepts like reimbursement, inventory management, just-in-time ordering, and case costing, I take a “101” rather than a “301” approach. I define concepts using basic terms and outline how they affect the ASC’s bottom line. I focus on how improvements in our ASC business performance benefit patients, staff, and facility.

Break down costs. Sometimes providing a little data can help drive a point home. Our ASC uses Project C.U.R.E. bins to gather medical supplies and equipment for donation. Staff discard unused items from surgical packs into these bins. After these bins fill up, I take pictures of the items inside and put a cost to them. I show these pictures and share the financial breakdown with staff. I also share data comparing the cost of “red” medical waste versus regular waste and disposable versus reusable supplies. Talk about eye-opening experiences!

Challenge staff. Once staff gain a better appreciation of waste costs, we attack our surgical packs. I ask staff to look at the packs to determine what is actually needed in them. At times, staff indicate rarely used items are included in the pack per physician request. In these instances, I speak with the physician. We typically remove the item from the pack but make sure it is available in the room during surgery. That’s a win-win!

New isn’t always necessary. On one occasion, an influx of non-ambulatory nurses joined our ASC. The facility they previously worked in purchased everything new. I educated them about refurbished equipment. I emphasized our use of this equipment did not jeopardize the delivery of high-quality care they were used to providing but did save us money.

Focus on safety. When speaking about cutting costs with your clinical staff, expect some looks of concern. Staff may translate “cutting costs” to mean “cutting resources” and, therefore, “cutting corners” on safety. Convey to staff the ASC will not authorize cuts that could jeopardize safety.

For example, we were using a lot of sterile towels during non-sterile cases. When I addressed how the use of non-sterile towels during these cases would benefit the ASC business, I also explained why doing so wouldn’t increase risk.

Engage Staff, Grow the ASC Business

As my clinical staff gained a better understanding of our ASC business model, they embraced the challenge of finding and implementing cost-cutting changes. With this mindset, we achieved significant savings in a short amount of time.

I know we can always do better. That’s why I try to ensure our clinical staff always have the business education of our ASC operations in the back of their minds. It’s easy, even for leadership, to become complacent when things seem to be going well. But in a health care environment where every dollar really does matter, there’s no room for complacency, and no reason not to empower all staff to make a difference in the bottom line.

Tara Demuth-Fenton, Director of Operations

Aug 11
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Leadership Defined – Best Qualities of an ASC Leader

Leadership Defined – Best Qualities of an ASC Leader

By ASC Management, Leadership No Comments

Jennifer Post’s article, 11 Ways to Define Leadership, published in the leadership section of Business News Daily on March 29, 2017, listed qualities of highly effective leaders alongside relevant quotes from current leaders and business founders. I found many of the viewpoints on the definition of leadership useful for the ambulatory surgery center (ASC) industry. The author’s main point also struck a chord. She maintains leadership is subjective, but its foundation is formed from one thing – the ability to build consensus and establish a following among individuals and teams.

I have been fortunate to learn from highly effective ASC leaders. Those I admire possess a variety of styles, but at the core, they all build momentum around common clinical and business-related goals.

In evaluating the day-to-day behaviors of these effective surgery center leaders, I identified the things they did that were most inspiring to me. I paired each tenet of a good leader with relevant quotes on leadership from Ms. Post’s article. I created the following as a guide for myself in hopes I can integrate these leadership traits into my daily interactions with my surgery center teams.

Step 1: Care

Leadership is about people serving people, inspiring people, and caring about people. You must show you care through your daily actions.

Our surgery centers often lean on staff to be excellent in a fast-paced environment, which is what we are known for. However, this can leave staff feeling the pressure to keep up. It is important to provide our presence, support, education, and creative tools so staff feel equipped to deal with the day-to-day operations of their departments.

“Leadership is serving the people that work for you by giving them the tools they need to succeed . . . [Team members] should be looking forward to the customer and not backwards, over their shoulders, at you . . . [Give] genuine praise for what goes well and lead by sharing in the responsibility early and immediately if things go bad.” –Jordan French, founding CMO, BeeHex, Inc. 3D Food Printing

Step 2: Communicate

When a leader does not communicate well, team members don’t feel valued. Good communication involves listening, truly understanding, and respecting others’ opinions. ASC staff members must be critical thinkers and doers. Impromptu conversations with staff member about problems in the center can result in some of the best ideas to resolve them. This requires leaders to have conversations, ask for input, listen, and think before throwing out an idea.

“Any time you work with a group you should expect disagreement. You should embrace dissent. Teamwork isn’t about going along. It’s about hearing all views, admitting mistakes, and sharing risks and rewards jointly.” – Gary Kelly, CEO, Southwest Airlines

“In my experience, leadership is about three things: to listen, to inspire and to empower. Over the years, I’ve tried to learn to do a much better job of listening actively making sure I really understand the other person’s point of view, learning from them, and using that basis of trust and collaboration to inspire and empower.” –Larry Garfield, president, Garfield Group

Step 3: Have Character

Over-prepare, admit weaknesses, and allow others to assist you. This builds a culture where team members feel valued and fulfilled.

“Adversity does not build character, it reveals it.” –James Lane Allen, novelist

“Leadership is the ability to see a problem and be the solution. So many people are willing to talk about problems or can even empathize, but not many can see the problem or challenge and rise to it. It takes a leader to truly see a problem as a challenge and want to drive toward it.” –Andrea Walker-Leidy, owner, Walker Publicity Consulting

Step 4: Be Competent

Effective leaders know their business and their team. A competent leader is reflected in a competent team. Encourage and help your team gain certifications or specialized training that will make your facility better by providing staff members with gratification and betterment of themselves. Promote from within your organization to your leadership roles. Create your own OR nurses using peri-op 101. Hire clinical directors with the intent of nurturing them in ways that will allows them to assume administrator roles.

“To me, leadership is about playing to strengths and addressing weaknesses in the most productive and efficient way possible. It’s about knowing your team and yourself, and doing your best job to set both up for success.” –Samantha Cohen, co-founder, Neon Bandits

Step 5: Have Courage

As many times as things go right, they go wrong. Leaders need to be the ones sitting in front of a board owning up to mistakes made. However, if a leader can take the situation, apply corrections, and discuss that process, blame is removed so the problem can be fully dissected. If we look at every issue as a potential opportunity to prevent its recurrence, people stop avoiding the issues.

“A leader is someone who has the clarity to know the right things to do, the confidence to know when she’s wrong, and the courage to do the right things even when they’re hard.” –Darcy Eikenberg, founder, RedCapeRevolution.com

Every leader has his or her own style and strategy, and every company its unique challenges. Recruiting and retaining talent in healthcare is a financial and intellectual investment. Effective leadership helps ensure we get the most out of the time and money we spend finding and training team members, because effective leaders build and retain top talent.

“There is no one-size-fits-all approach, answer key or formula to leadership. Leadership should be the humble, authentic expression of your unique personality in pursuit of bettering whatever environment you are in.” –Katie Christy, founder, Activate Your Talent

Jovanna Grissom, Vice President of Operations

1Business News Daily article March 29, 2017 11 Ways to Define Leadership

Aug 03
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Managing difficult employee behavior

Help! My Employees are Keeping Me Awake at Night!

By ASC Management, Leadership No Comments

Lately, when faced with a work situation that taxes my emotional reserve and keeps me awake at night, I turn it on its head. I view the issue from a different perspective; change the tape that’s repeatedly playing in my brain by altering the order of the words.

For example, when I hear, “I’ve got a difficult employee and I don’t have a clue what to do,” I reframe the problem and respond with, “Let’s talk about the difficult behavior this person is exhibiting that is creating frustration for you in the workplace.” Shifting our dialogue to focus on the behavior rather than the person, creates a much-needed level of objectivity that allows for more effective problem solving.

Let’s face it, as leaders, we are bound to encounter employees who exhibit behaviors that are difficult to manage. An employee who simply fails to show up to work on time can create havoc in a facility. Being met with resistance when asked to perform a task in a specific way can derail a surgery center team’s attempts to ensure patient safety.

If you’re like most people, you don’t enjoy confrontation. So, you chalk the behavior up to “a bad day” or, when the behavior rears its ugly head consistently, excuse it with, “That’s just how Marianne operates. She’s not interested in hearing feedback.” But, it’s your job to deal with these behaviors effectively to minimize the ripple effects. The harsh reality is, if you don’t deal with difficult behaviors, the problems will only get worse. And, if you don’t document your actions, it is as if you never responded.

When you find yourself wondering why an employee is being so difficult, avoid succumbing to “stinkin’ thinkin’.” In other words, avoid personalizing the behavior.

Here’s an example. Tom, your receptionist/registrar, reports to the surgery center 10 to 15 minutes late every morning. He is responsible for checking patients in promptly. If he’s not there, patients either end up waiting for him to arrive or his co-workers must stop what they’re doing to perform his job. This is annoying enough on its own. But he has the nerve to saunter in with a Starbucks coffee in hand, jovially greeting everyone on the way to his workstation. The patients love him. They have no idea he’s the one who created the tension they sensed upon their arrival. As he settles into work, capably completing the tasks his co-workers have started for him, you overhear a steady stream of employees filing past your office muttering, “Really? He does this every day. Why does he insist on making everyone miserable? I’m tired of doing his job. Doesn’t he recognize we’ve got our own tasks to perform to ensure surgeries start on time?”

Tom, contrary to what is now popular belief, likely does not wake up every morning planning to upset everyone. He’s laid back – a strong suit when it comes to interacting with patients nervously anticipating their planned procedure – and approaches everything in stride, including sleeping through his alarm, a long line at Starbucks, and having to circle the parking lot three times to find an empty spot.

To deal effectively with Tom’s tardiness, it’s important to accurately identify the problem behavior. On the surface, it might appear the problem is slacking – showing up late because Tom wants others to perform his job. After all, that’s what his co-workers have surmised. However, after talking with Tom, you realize he is on a completely different wavelength. He truly is unaware his behavior negatively impacts the start of everyone else’s day.

Now that you’ve identified the true difficulty, you can effectively manage Tom’s future behavior by having a conversation with him. People who are on a different wavelength, need clearly defined communication that outlines expected results.

Your conversation may proceed along these lines. “Tom, I need you to be at your workstation ready to check in our first patient on time each morning. I expect you to clock in at 5:45, then immediately report to your desk to ensure you are prepared for 6:00 a.m. arrivals. Adhering to this regimen will serve our patients well. The value you bring to our organization will be enhanced when your co-workers realize they can rely on you to greet patients and get them checked in promptly. Our physicians will recognize a change in how quickly they are able to get started each morning. I’m going to document our conversation today as a coaching session. Now that you recognize how important it is for you to be on time to perform an essential requirement of your job, I’m confident you will figure out how to report to work promptly every day.”

I recognize this is only one example of dealing with a difficult behavior. And, more importantly, I’ve assumed the conversation went well. You talked to Tom, he saw the light, he altered his behavior, and being late to work is not something that occurs anymore. I’m aware, however, that’s not always the case.

My point is this: when you separate the person from the behavior, accurately identify the problem, and promptly address with the employee how their behavior impacts the organization, you have a much greater chance of achieving a successful outcome. Those successful outcomes will not only lead to a happier, more united facility, they will allow you to sleep much better at night!

Kim Woodruff, VP of Corporate Finance & Compliance

Jul 20
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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

1 https://hbr.org/2017/05/how-to-improve-your-sales-skills-even-if-youre-not-a-salesperson

Jul 06
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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

Jun 29
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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

Jun 09
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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