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Running an Effective, Efficient ASC Daily Huddle

Running an Effective, Efficient ASC Daily Huddle

By ASC Management, Leadership

In the fast-paced, team-oriented environment of an ambulatory surgery center, a regular group meeting, also known as an ASC daily huddle, can serve as one of the most important times in an ASC’s day. A daily huddle can help staff get on the same page concerning potential challenges for the upcoming surgical day. Discussing foreseeable issues provides an opportunity to address them and helps ensure safe and productive operations.

In structuring an ASC daily huddle, clinical leaders must be sure to focus on engaging and relevant discussions. Otherwise, if huddles aren’t structured and executed meaningfully, they can quickly lose their value. Staff may start coming to huddles unprepared and disinterested. After a short while, huddles may be viewed as more of a social gathering or an optional meeting. Many may logically determine an unproductive huddle is a huddle not worth holding.

Daily Huddle Best Practices

Here are a few tips to make each ASC daily huddle more effective and productive.

Keep huddles short. A brief daily huddle helps keep people focused and engaged. Staff should come prepared to discuss only the issues and concerns that matter to the upcoming surgical day. A huddle is not an opportunity for staff to ramble or discuss insignificant topics. More serious issues requiring significant time and attention are also not appropriate for a huddle – these should be addressed as soon as they arise.

Consider using a timer to measure how long participants speak and track the huddle’s total time. Use this information to keep the discussion moving along in an efficient manner. A good time limit for an ASC daily huddle is seven minutes or less.

Choose an appropriate time for the huddle, then stick with it. Some ASCs hold their huddles in the morning. Some in the afternoon. But what other ASCs do shouldn’t matter to you. The time to hold your daily huddle should be what’s best for your ASC. If you seem to experience many issues in the morning (e.g., poor workflow, coordination, communication), a meeting every morning to plan out that day may be worthwhile.

If you tend to experience issues with appropriate staffing and instrument availability, for example, consider a mid-afternoon meeting. This can provide the time necessary to resolve such issues before the next day begins.

Once you determine the time that’s best for your ASC, do not deviate from it. This will help establish a routine for your daily huddle and better ensure participating staff do not miss a huddle.

Establish a consistent location. Holding the huddle in the same location can also support consistent participation. Choose a central location to make it as easy as possible for participating staff to attend. The location should be a private area that won’t interfere with operations.

Consider asking staff where they would prefer to hold the ASC daily huddle. This will help secure buy-in and ownership of the huddle.

Limit the number of participants. To maintain focus and avoid distractions, every daily huddle should only involve essential individuals. This typically means a single person from each department – business office, pre-op, operating room (OR), central sterile services department (CSPD) and post-anesthesia care unit (PACU).

Every department should be represented at every huddle. Establish this expectation during the first huddle and then hold staff accountable.

Run huddles in a consistent manner. To keep the ASC daily huddle functional and quick, follow the same direction every meeting. Establish the order for department representatives to speak and always proceed in that manner. Once participants become accustomed to that order, they will know when it’s their turn to speak, eliminating wasted time.

Daily Huddle Topics of Discussion

Representatives should come to each daily huddle prepared to speak about their departments’ specific concerns for the upcoming day. A concern one day may not be a concern the following day. If a matter is not a concern for the upcoming surgical day, it should not be raised during the huddle.

Here are examples of worthwhile topics staff may want to discuss, broken down by department.

Business office:

  • Appropriateness of check-in times
  • Patient comfort upon arrival
  • Staff comfort with patient flow
  • Ability for staff to handle unusual scheduling (e.g., add-on cases)
  • Patient financial issues that could delay the start of a case
  • Patients with similar names that could create safety issues

Pre-op:

  • Assessment concerns
  • Missing paperwork (e.g., history and physicals, consent forms)
  • Noteworthy patient health issues (e.g., fall risks, poor vision or hearing)

OR:

  • Challenging surgeries, surgical approaches, physicians or staff
  • Availability of instrument sets and supplies
  • Availability of required implants
  • Status of vendors expected to participate in procedures

CSPD:

  • Challenging instrument turnovers that could delay cases

PACU:

  • Discharge red flags
  • Appropriate staffing levels for patient flow/timing
  • Potential need for extended shifts

ASC Daily Huddle Success: Final Key Takeaways

When beginning with huddles, the first few might take longer than you desire. That’s to be expected as staff learn about and become comfortable with how you want to approach each daily huddle.

Provide guidance to participants on topics they should and should not discuss. Remind them about the importance of coming to the daily huddle prepared. Help them with timing. If someone starts to ramble, reel them in. While structure is important, strive to keep huddles loose and full of positive energy.

With each passing week, the amount of time a daily huddle takes should decline. After a little while, huddles should rarely – if ever – exceed your maximum time allotted.

Most importantly, every daily huddle must provide value. Participants should share their thoughts about what they believe is necessary to improve operations. Staff should come away from a huddle knowing what must happen to make the upcoming surgical day safe and productive.


Jebby Mathew, Regional Director of Operations

ASC billing office process improvement

ASC Billing Office Process Improvement – Conducting a Quarterly Review

By ASC Management, Leadership, Revenue Cycle Management No Comments

The saying goes, “Old habits die hard.” But in the ASC billing office, repeating the same mistakes costs time, money, and resources. Hence, the process of identifying process inefficiencies and areas of improvement is a constant responsibility for an effective ASC billing office. It is generally good practice to conduct a complete billing office process improvement evaluation and plan implementation at the end of each financial quarter. At the close of a quarter, there is enough data to review, identify, and correct negative trends. The start of a new quarter provides a clean slate for tracking the impact of the changes three months from now.

Where to begin?

Start by identifying your weaknesses by analyzing available data. This data can come from your patient accounting system and/or clearinghouse. Error tracking allows you to quantify mistakes that prevent clean claims. Reviewing clearinghouse rejection reports may identify trends. If you regularly find the same rejections, log the incidence as well as the resolution changes you make to help you identify and correct the issue. It may also be beneficial to review adjustment journal codes and ensure they meet your tracking needs in case you need to analyze payment or adjustment trends. These metrics can help you identify training opportunities for your staff at all stages of your billing cycle.

Collaboration

In an efficient billing office, a system of checks and balances establishes itself when billing tasks are departmentalized. The schedulers provide the patient and billing information, verification confirms the feasibility of the case under the provided circumstances, coders translate the visit for delivery to the insurance carrier, data entry qualifies the billing information, and accounts receivable ensures maximum reimbursement for the team’s efforts. Each subsequent person that handles the information relies on the previous person’s understanding of healthcare billing. Every individual’s work is verified, but not repeated, in the next step in the process. When each of these groups of people are housed in the same location, collaboration is as simple as looking over the cubicle wall. If your ASC billing office is off-site, the frequency and timeliness in which front office errors are communicated may impact the ASC billing office revenue cycle. It is important to have timely and frequent communication in this scenario.

Cross-train

Requests should not be put on hold when someone is out sick! Besides needing backup to cover absences, cross-training allows employees to understand how people in other roles manage their time and contribute to the success of the team. Transparency among departments and roles invites accountability. The quarterly billing office process improvement review is a perfect time to identify areas where cross-training is needed to fill gaps and/or back up a role.

Empower

A billing office’s process improvement plan success is dependent on the team’s commitment to the improvements. Encourage staff to participate and take charge of change. They perform the tasks that bring the money in the door. Policies and procedures sound good on paper, but execution can reveal unexpected roadblocks. Your team has ideas of how to prevent issues and improve the process. Implement the solutions that will work best for your team and your center.

Re-evaluate

CMS guidelines, fee schedules, CPT/ICD-10/HCPCS codes, pre-certification lists, and coverage policies – this information changes monthly, quarterly, annually. Subscribe to insurance company newsletters and follow medical societies, revenue cycle resources, and vendors. Assign someone to distribute beneficial information to affected groups of people. This may include surgeons, their billing office, facility administrators, and insurance verification specialists, in addition to your own revenue cycle team. The information released may force you to take yet another look at your revenue cycle needs and adjust as necessary!

Summary of Tips for ASC Billing Office Process Improvement

Make it regular. ASC billing office process improvement review should take place on a regular basis, whether conducted monthly, quarterly, or on another schedule.

Review the data. Reviewing rejected claims logs and other data allows you to identify trends and billing office inefficiencies.

Promote team collaboration. Billing office roles will naturally back each other up when operating in sync with collaboration.

Incorporate occasional cross-training. A fresh set of eyes can provide valuable insight into simple changes that can increase efficiency or reduce errors.

Don’t leave out clinical roles. They have valuable insights that can affect coding and thus reimbursement. Evaluate the use of expensive implants and supplies to ensure you are billing and collecting as your contracts allow.

Re-evaluate and update regulatory information. It is crucial to the essential function of the ASC billing office to maintain accurate and up-to-date records when it comes to CMS guidelines, fee schedules, CPT/ICD-10/HCPCS codes, pre-certification lists, and coverage policies. This should also be a part of the regular ASC billing office process improvement review.

The only constant in the healthcare industry is change. When so many professionals rely on your office for the financial deliverables of their organization, as in the ASC billing office, it is imperative to stay up-to-date with industry changes. Regular review of your internal processes is the best way to keep up.


Bethany Bueno, Director of Billing Operations

Avoiding the Cost of a Bad Hire through Strategic Interviews

Avoiding the Cost of a Bad Hire through Strategic Interviews

By ASC Management, Leadership No Comments

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

Recognize the True Costs of a Bad Hire

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

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

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

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

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

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

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

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

Conduct Strategic Interviews

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

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

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

Here are some KSAs to consider:

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

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

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

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

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

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

Conclusion

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


Kim Woodruff, VP of Human Resources & Compliance

Simple, Effective Ways to Boost ASC Staff Satisfaction

Simple, Effective Ways to Boost ASC Staff Satisfaction

By ASC Management, Leadership No Comments

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

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

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

Staff Satisfaction Booster #1: Monthly Birthday Celebrations

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

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

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

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

Staff Satisfaction Booster #2: High-Five Appreciation Program

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

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

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

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

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

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

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

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

Keys to Success

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

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

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

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

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


Jebby Mathew, Regional Director of Operations

Teamwork Can Become Your ASC’s Organizational Norm

Teamwork Can Become Your ASC’s Organizational Norm

By ASC Management, Leadership No Comments

Is teamwork the norm in your ambulatory surgery center? If the answer is yes, you are ahead of the curve.

Most organizations struggle to develop and foster an environment in which true teamwork can flourish. However, organizations successful in fostering a team-oriented environment see many benefits in the lives, and output, of their workforce. An organizational norm of teamwork fosters creativity & learning, builds trust, develops conflict resolution skills, blends complementary strengths, promotes a wider sense of ownership, and encourages healthy risk-taking.[1]

In the book, High Five! The Magic of Working Together, the authors assert, “Fostering teamwork is creating a work culture that values collaboration. In a teamwork environment, people understand and believe that thinking, planning, decisions, and actions are better when done cooperatively. People recognize, and even assimilate, the belief that ‘none of us is as good as all of us.'”[2]

Why is developing a culture of teamwork such a struggle?

Our schools, family structures, and many of our pastimes emphasize winning and individual achievement over collaborative accomplishments. Some of us are raised in environments that do not teach or value collaboration. Instead, we learn early to be the first and the best.

As we mature and begin our careers, this pattern continues. It is not uncommon for workplace rewards and promotions to be directly tied to individual performance. The system of rewards at work often reinforces self-reliance. Instead of working collaboratively with colleagues who are specialists in their respective fields, we strive to grow our own breadth of knowledge to increase our ability to do all things by ourselves.

How can you create an environment in which teamwork and collaboration are your norm?

Clearly communicate teamwork and collaboration are expected. Model teamwork in your interactions with each member of your ASC. Talk about and identify the value of a teamwork culture in meetings. Make teamwork a core value of your surgery center. Advertise it in places easily seen and identifiable by all. Emphasize that being a team player is a strength. Hire individuals who are team-oriented.

Maintain a culture of teamwork even when things are going wrong. Resist the temptation to blame individuals. Instead, focus on how the team can resolve issues that arise. This allows your team the freedom to make decisions without fear of making a mistake and being reprimanded.

As you transform your staff into a collaborative team, recognize and reward teamwork actions along the way. Consider how to focus compensation, bonuses, and recognition on collaborative practices as well as individual contribution and achievements. One avenue for teamwork recognition is sharing important stories that emphasize teamwork during regular team meetings. For example, “Remember when our Pre-Op/PACU nursing staff worked together to conduct a pre-survey prior to our most recent state accreditation survey? They found 5 areas where we needed to improve processes to maintain compliance with regulations. But they didn’t stop there. They executed the necessary process improvements. Let’s all applaud our Pre-Op/PACU nursing staff members. They diligently worked together to get ready for that survey and contributed favorably to our success.”

How do you maintain teamwork and collaboration?

As you focus on and implement teamwork, you will recognize the need for team building activities. Traditionally, organizations approached team building as a trip to a resort, playing games, or some other type of break from the workplace. Then they wondered why the sense of teamwork at their one-day outing failed to make its way back to the workplace. To gain the most from your efforts to build teamwork, consider more regular, fun, shared occasions for team building. Potlucks, local sporting events, or even local dinners are all good options.

Consider challenging your staff with a project that requires working together collaboratively to achieve a desired objective. Before doing so, however, provide training and tools to team members on communication and setting team standards. This will allow them to focus most of their energy on the assigned project and less effort on figuring out how to work together as a team.

Use ice breakers and teamwork exercises at meetings. While these activities are short in duration and cost little to implement, they help teams get to know one another and often result in a healthy dose of laughter.

Celebrating Team Culture

Ask ASC leaders to publicly recognize teams for their successes and offer team members opportunities to recognize their peers for major contributions to the team. Receiving recognition makes the feeling of team success even sweeter, and worth repeating.

Effective teamwork not only promotes creativity, learning, and innovation, but also encourages team members to perform at their highest potential. When team members are working together at their highest potential, their efforts are multiplied. Your organization benefits exponentially. Once teamwork is established as an organizational norm, trust amongst colleagues and workplace satisfaction are fostered, contributing to a general sense of good will in your ASC.


Jovanna Grissom, VP of Operations


[1] https://www.sandler.com/blog/6-benefits-of-teamwork-in-the-workplace

[2] High Five! The Magic of Working Together, by Kenneth V. Blanchard, Sheldon Bowles, Others, 2000, New York: HarperCollins Publishers Inc. Copyright (2001) by Blanchard Family Partnership and Ode to Joy limited.

 

Matchmaker, Matchmaker: Finding the "Perfect" Surgery Center Team

Matchmaker, Matchmaker: Finding the “Perfect” Surgery Center Team

By ASC Development, ASC Management, Leadership No Comments

In the classic “Fiddler on the Roof” song “Matchmaker, Matchmaker,” Tevye and Golde’s daughters sing about a matchmaker finding husbands for them. The lyrics include the following line: “Matchmaker, matchmaker, look through your book, and make me a perfect match.” When tasked with building a new surgery center team, I play the matchmaker role.

My “book” is comprised of information on job seekers – a collection of resumes/CVs, interview notes, and insight from the candidates’ references. With this information, the pressure is on me to accomplish what those daughters ask for – perfect matches. I cannot simply choose who I think is the best clinical director, administrator, materials coordinator, operating room nurse, recovery nurse, and business office person on paper. These selections cannot happen in a bubble. Instead, I must do my best to ensure this initial set of team members will work well together. They will jointly create the desired culture for the ASC. And they will instill this culture in the staff members hired and trained after them, helping attract more likeminded individuals.

There’s a lot of pressure to get these initial hires right. I hope they will remain with the ASC for years, forming the foundation for the facility. When building a surgery center team, I focus on the following to increase the likelihood that I make the correct selections.

Ownership Expectations

During meetings with the ASC’s owners, I seek first to understand their expectations of the new facility. What does their optimal surgery center team look like? How do they envision the facility’s culture? What type of employees are they looking for to support that culture?

When PINNACLE III is the manager of the facility, I factor in our culture expectations as well. Defining an ASC’s culture isn’t easy. In my experience, if I take the time to understand expectations, I’ll gain the insight required to create the anticipated culture. In an ASC, it will likely include expectations of delivering the highest quality care via a skilled, efficient team who perform their respective roles with integrity.

Surgery Center Team Interviews

A resume or CV tells me about a prospective employee’s background. That background information is important – I want to hire competent, qualified staff. However, resume review is not the most important step in the hiring process. Candidates can appear quite impressive on paper but fall short of expectations in person. The interview process is the best opportunity to assess whether candidates fit the mold for the new surgery center team.

My interview questions aim to accomplish several objectives. I dig deep to truly understand how an interviewee will work for the ASC. My focus isn’t just be on short-term performance but the candidate’s potential longevity and adaptability as the center grows. What are their values? Do they place importance on honesty and integrity? Are they lifelong learners? How do they envision positively impacting the business? I’m looking for positive signs as well as potential warning signs.

I inquire about their previous employer’s culture. Coming from an organization with a different culture than the new ASC isn’t necessarily problematic. Depending upon the situation, it’s important to recognize that I may need to do a little work to address the effects of that culture, particularly if the candidate was not valued in their previous work setting.

I like to ask interviewees how they would act when faced with difficult situations I’ve witnessed firsthand in ASCs. For example, what would they do if they encountered a disruptive physician? What if the narcotic count was off at day’s end? What if a daily deposit didn’t match the books? I want to obtain an understanding of how they are going to respond during stressful events.

These types of questions serve two purposes, First, I hope their responses give me confidence that they will act responsibly. Second, I learn if they will respond differently than I would in a similar situation. If they turn out to be the right fit for the surgery center team, I have identified an area where this person may require some guidance.

My Presentation

When interviewing job candidates, I am typically the first, personal representation of the ASC. I am the face of its culture or, in the case of a new or developing ASC, its desired culture. I am likely all the candidates know of the surgery center team. If I want the ability to hire the candidates I determine are right for the ASC, I need to ensure these candidates view the ASC as a good fit as well.

With the low unemployment rate, health care professionals typically have at least a few, if not many, job options. Hiring is a two-way street. I need to ensure the way I present during the interview process reflects the way I want the ASC to be perceived. I believe it’s best to be clear and concise when interviewing. If I adopt an overly laid-back approach, I risk alienating individuals looking for structure. More laid-back candidates will still appreciate the professional manner through which I conducted their interview.

Achieving Surgery Center Team “Perfection”

While finding “perfect” matches may prove difficult, I want to come as close as possible with my initial hires. I would rather hold off on filling a position than make a “bad” hire. With bad hires, I often spend extra time and effort bringing them on, only to lose them after a short period. In a worst-case scenario, a bad hire can create untoward results in the ASC’s culture – gossiping, not focusing on personalized service, or not treating physicians as customers, for example.

That’s why the key for me is never to hire out of desperation. There’s no better way to find an imperfect match. Remember: When playing matchmaker for an ASC, the task is finding matches for the owners, other staff, and patients. And like that of a matchmaker, this is a responsibility not to be taken lightly.


Lisa Austin, VP of Facility Development

Running an Effective ASC Board Meeting: Lessons I've Learned

Running an Effective ASC Board Meeting: Lessons I’ve Learned

By ASC Governance, ASC Management, Leadership No Comments

Board meetings are critical to an ASC’s ongoing and long-term success. They designate time to address regulatory issues required to maintain compliance. They serve as an opportunity for leaders to make important financial and strategic planning decisions. An ASC board meeting also allows leadership to address problems or areas in need of improvement.

In my 10-plus years serving as a surgery center administrator, I’ve run my fair share of board meetings. Regardless of how each board meeting turns out, I strive to learn something to help the next meeting go smoother.

Guidance for Conducting a Better ASC Board Meeting

Here are some of the key lessons I’ve learned over the years.

  1. No established rules. There are no firm guidelines for running an ASC board meeting. In fact, board meetings do not need to be formal. What matters is finding a format and approach that allows you to accomplish what’s necessary in the time available.
  2. Get to know your board. Learn about your board members; specifically, what they want to get out of board meetings. Using this information, adapt your approach to cater to these needs.
  3. Be consistent. Once you develop a format that works well for your board meeting, stick with it. This serves several purposes. A template will make developing agendas easier and help ensure you do not omit important topics from one meeting to the next. It will also help focus the meeting – board members will know when certain agenda items are up for discussion. If time is consistently allocated to specific topics, board members are less likely to push for earlier discussion on an issue.
  4. Take command. As the individual running the board meeting, you play a major role in determining the meeting’s effectiveness. Talkative or strongly opinionated board members have the potential to hijack a meeting. Maintain control and keep the meeting on task.
  5. Allow for discussion. Build in time for some discussion of key issues in every board meeting. The key word here is “some.” Most meetings last 60 to 90 minutes. A mere 15-minute discussion will eat up a large percentage of that time. Keep discussions short and focused so you can move through the agenda. If an issue requires lengthy discussion, designate a time following the meeting for interested individuals to continue their conversation.
  6. Focus on key items. Going into an ASC board meeting, know which issues are the most important and make sure to cover them. Good preparation and organization of information will help ensure efficient use of the available time. If you plan to provide details, make sure they are critical to the discussion and any decisions. Do not dive so far into details that you take time away from other key issues.
  7. Keep it high level. When weighing what details to provide, such as financial or quality data, keep in mind that most boards look for a high-level perspective. This would include what’s going right or wrong within the ASC and your recommendation on next steps (more on this below). A high-level perspective typically works well for most topics unless one requires deeper discussion because of its urgency or seriousness.
  8. Come up with solutions. If your agenda includes the sharing of shortfalls or areas of concern, be prepared to outline plans for correction. You want board members to leave the meeting feeling confident that you are already working to address any problems.
  9. Make decisions easier. Agenda items that require board members to vote on an issue or make a decision can quickly derail a meeting. If one board member shares an opinion, others are likely to share their thoughts as well. This can quickly turn into a lengthy, possibly heated, discussion. Avoid this scenario by steering members away from unnecessary confrontations. Rather than asking board members what they think the ASC should do, provide options to choose from. Share your recommendation, with a short explanation of your reasoning. The board may still want to engage in a discussion, but providing a few options rather than presenting an open-ended question should help bring about a faster decision.
  10. Be upfront with bad news. If you have bad news to share or anticipate needing to discuss a difficult subject, don’t shock board members by using the meeting as the first time you present this information. Provide board members with a heads-up that the meeting agenda will include the concerning topic. Make sure the board president is aware of the matter and, when possible, to discuss the issue prior to the meeting. If the matter affects specific board members, hold conversations with them in advance.

Bonus Tips for a Successful ASC Board Meeting

Here are a few additional pieces of advice to help you lead constructive meetings:

  • Efficiency is important, but poor preparation can quickly overshadow its significance. If you don’t present ideas in an organized manner, the board may perceive you as less efficient and knowledgeable.
  • When you don’t know the answer to a question, admit it. You’re better off being transparent than trying to appear knowledgeable about an issue when you simply are not. If the information provided turns out to be incorrect, the board is likely to lose confidence in you. Rather, take the time to research the information and provide a correct response. By taking this approach, when you say you know the answer to a question, board members will trust you.

Considering the infrequency of board meetings – with many ASCs only holding them quarterly – every minute of every meeting is of the utmost importance. To run your next ASC board meeting more effectively and productively, prepare fully and take total advantage of the time allotted.


Diane Lampron, Director of Operations

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

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

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

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