How to keep physicians from leaving your program
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
We all know about the explosive growth of ambulatory surgery centers (ASC). We understand the reasons behind it: lower cost provider, increased efficiencies, ability to joint venture with physicians, ambulatory payment classifications (APCs), etc. But for many, the option of going out and constructing a new surgery center is not an option.
Your surgeons say they can live without a for-profit joint venture, but they are threatening to join the local surgery center because that facility is efficient and you are not. You explain that you are a trauma center and that ambulatory cases sometimes get "bumped" for emergencies — sorry.
Try as you might, you just cannot get the room turnaround time under 30 or 40 minutes. The surgeons scream that the for-profits centers can turn the rooms in under 10 minutes. What do you do?
First, some background. Earnhart & Associates probably has a larger and more extensive data bank on physician satisfaction and other issues related to ambulatory surgery joint ventures than any other organization in the country. When we interview physicians, the overwhelming reason physicians cite for wanting to develop (or join) a for-profit ASC is efficiency of operations. They want cases to start on time and turnaround on time, so they can get out of the hospital as quickly as possible. The surgeons plead to the director, VP, or CEO: "Why can’t you do that?" Is it really that difficult to be efficient?
Efficiency of a physician’s time is a sign of respect for the job they do. It is a way of the facility saying, "Hey, I understand. Let’s get your cases going so you don’t have to spend your morning in the doctors’ lounge between doing $200 and $300 professional fee reimbursable procedures." That is complete, uncompensated down time for surgeons. They get nothing for the time or the waste of effort. Is it any wonder why they are so disagreeable or unwilling to assist you in cost control or another committee position? Show respect — get respect.
Consider the following approach:
• Step one.
Sit down with your staff and find out what you do best. Jot them down. Things such as state-of-the-art equipment, three shifts of operations, full anesthesia coverage, evening hours, Saturday operations, etc., are significant.
• Step two.
Write down the things that you might want to improve upon. These usually include turnaround time (find your average time) and start times. (I know, not your fault; it’s anesthesia or admitting or someone else, but you are going to have to take the hit for it.) The average number of items in this list is usually 10.
• Step three.
Do an honest appraisal of how you can fix or improve items in step two.
• Step four.
Interview as many of your surgical staff as possible. Try to get an unbiased person to interview them. Ask things like, "If you were in charge, what would you change around here?" Get their perception of what it is they think you do best. Ask what they think you need to improve. Don’t try to argue or debate them. Just write down their comments. Be a very active listener. Don’t try to defend yourself or the facility.
• Step five.
Go back to steps one and two and compare. I guarantee your list will not be in sync with your surgeons. Perception is reality — face it. If they think your turnaround time is 60 minutes — it is! Live with it, but try to change it.
• Step six.
You had better make changes fast. You have now set expectations in the minds of the surgical staff that you are going to do something. If you do not, you are going to be in worse shape than you are now.
Each facility has different issues, but let’s assume that your biggest issues in step four are turnaround and start times.
• Step seven.
Start acting on the issues. Analysis your OR staff. If you don’t have changes to make in staffing, you aren’t being honest with yourself. This is the time to rock the boat! Make changes in management. Put everyone’s positions on the line. You have a great deal of money that is going to leave your hospital if your surgeons walk. This exercise is not for the faint of heart.
Tell everyone what you’re going to do. Have a definable plan with goals and benchmarks. Start making charts and bar grafts. Have two or three staff meetings per week if necessary (it usually is) to review the goal and redefine where you are. Kick butt!
Some things you might need to consider include time clocks, cross-training, multiple shifts, etc. You are going to lose some of your staff. They are not going to tolerate some of the changes you are going to have to make. So be it.
Next month we will expand this area and discuss ways to fix late start times.
Editor’s note: Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. World Wide Web: http://www.earnhart.com.
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