Same-day surgery experts look into their crystal balls
The same-day surgery field will continue to expand in coming years. Some of the biggest changes will include expansion of the freestanding market and an internal focus on teamwork and customer service, same-day surgery experts predict.
Less state regulation will increase the demand for ambulatory surgery, predicts Tony Carr, president of Fresno, CA-based Health Pacific International, advisors in surgical services and women’s health services. Carr opened the Fresno Surgery Center in 1984 and the Fresno Surgery and Recovery Care Center in 1988.
The number of freestanding surgery centers, including those developed by hospitals, will continue to rise, Carr predicts. In addition, surgery center chains and health systems will continue to acquire independent centers, he says.
Same-day surgery will increase in physicians’ offices, predicts Wallace Reed, MD, who in 1970 co-founded Surgicenter of Phoenix, the first multispecialty ambulatory surgery facility in the country that was not based at a hospital. "That will require more monitoring and more means of accrediting those offices as suitable for outpatient surgery," he says.
More single-specialty surgery centers will develop, Carr predicts. In Fresno, for example, surgery centers are being developed in specialties including urology and gynecology.
"What’s happening in California, and a lot of other states, is that because managed care is putting pressures on doctors to come together and work as groups, one of the consequences of the group formation is surgeons recognize that by working together, they can support the development of a single-specialty surgery center," Carr says.
More surgery centers will seek licenses as hospitals, Carr predicts. Carr’s Fresno Surgery and Recovery Care Center converted to hospital licensure in 1991 and became the nation’s first surgical hospital.
Surgical hospitals that keep patients for two to three days will be developed by large corporate chains, hospital systems, and physician groups, particularly as states continue to repeal their certificate of need laws, he predicts.
"It depends on the state, but the doors are being opened, and you’ll see less regulation controlling expansion," Carr says.
Providers who offer shorter stays will focus on their role in the continuum of care, Dykstra predicts. As same-day surgery programs tackle more complex procedures, they will need to offer transitional care, such as home care or extended recovery care, she says.
Furthermore, care of patients in same-day surgery settings will be more individualized, Reed predicts.
"More and more we’re going to see procedures tailor-made for patients a customized, designer type of surgery and anesthesia management of patients," he says. "We’ll tailor patients’ services to their needs. There will be more talking with patients and less lab testing with patients who are otherwise healthy," he says, referring to physical status Class I patients.
One internal area of change will be educating and training staff to focus on customer service and teamwork.
"Managed care companies are beginning to listen more to their members in terms of customer satisfaction," says Penny Dykstra, RN, director for emergency, observation, and outpatient surgical services at St. Joseph’s Hospital of Atlanta. If customers aren’t receiving services at the level they want, the managed care company is going to pull out, Dykstra warns.
Same-day surgery managers should focus on the continuous improvement of themselves and their staffs in terms of customer service, Carr advises.
"Surgery centers have been successful because they have done such a great job of bringing together people who fit together in the same culture of providing exceptional customer service," he says. "Customer service is one of keys to success in the future."
Dykstra agrees. When St. Joseph’s began to make changes that were reducing outpatient lengths of stay, some of the staff felt their jobs might be threatened, and they didn’t see how to improve customer service, Dykstra says. At that time, St. Joseph’s initiated a customer service training program for all employees that explained the important role employees play in providing cost-efficient care.
"They know now they can make that kind of a change with a positive outcome not just with dollars, but with their involvement," Dykstra says.
Helping different departments learn to work as a team is key, she says. Staff need to be taught that "courting" physicians and making the surgery experience more pleasant for patients are ways to make your outpatient surgery program stand out in a competitive field.
"Managed care makes it equal," Dykstra says. "What do you have to make it more attractive?"
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