ASC management: 9 lessons I’ve learned
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
There was a time when management of a surgical department was a full-time job. There were always problems with maintaining inventory, making sure staff picked everything on the preference cards for each case, and ensuring the physician lounge was stocked with food. Staffing was typically a challenge, and dealing with budgets and capital equipment requests could drive you nuts.
Although most of us didn’t realize it at the time, life was pretty good and uncomplicated. Today, I work with many people involved in the day-to-day management of busy surgical departments and surgery centers, and I nod knowingly. Most of these people could have done my job in the past before their first coffee break! Surgical management is complex, sophisticated, challenging, and just downright backbreaking. And that is on a good day.
If you can master the basics, the rest will fall into place. Here are many of the basics:
1. Delegation is key to success. "No man [or woman] is an island." If you cannot delegate and relinquish some control, you will fail. The product is just too large to handle alone.
2. Only hire people smarter than you. I do this ALL the time. It is remarkably easy! You should learn something from the people you hire, or you are wasting a valuable opportunity. Hiring someone with your skills and knowledge base is counterproductive. You want to learn from each person you hire. When you interview people, ask yourself if they can bring new knowledge to your department.
3. There are only three important line items on your budget. They are net revenue, personnel cost, and supply cost. Do not be concerned with profits. If you can appropriately manage these three, the profits will be there. Delegate the other line items to someone you don’t like.
4. You will be judged not on facts, but on perceptions. Perceptions are reality; accept that or move on. If your physicians think your turnaround time is 40 minutes, it is! Convince them it is 10 minutes by showering them with charts and graphs and endorsements by other "friendly-to-the-cause" physicians. Immediately distract your surgeon with something he or she wants if you see the room turnover is going bad. This might be a good time to discuss his capital equipment request.
5. Keep your staff happy. Nothing is more destructive to management than poor morale and staff turnover. Don’t lose sight of No. 3 (above), but be creative in keeping good staff. Always cull out and get rid of the passive-aggressive staff. They are not worth keeping or trying to convert. They are happy by disrupting others. Ax them!
6. Walk around. Always wear scrubs when you can so you can walk through the department. You need to be seen (see item 4) by the staff, patients, and surgeons. Consider wearing a name badge that says "the buck stops here." Don’t, however, wear it if it doesn’t. Point your finger a lot; it looks impressive unless you point it at a person. (You lose points for that.)
7. Always take the phone call from your boss. This is one of those areas we don’t always agree on. Assuming your boss is not a "What-are-you-doing-this-minute" person, it is always good to have your supervisor think you are in control, yet available.
8. A good idea is always the surgeon’s idea.
If you want to get something done, make the surgeon, or your supervisor, believe it was his or her idea. Very basic management tool.
9. Be happy in your position, or make a lot of money. Why do these two rarely go together? The good news is that with all the new same-day surgery centers going up each year, there are more and more opportunities for strong managers. This growth helps raise the pay. If you are not happy in your job but are making lots of money, well, that is a personal decision.
(Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web: www.earnhart.com.)
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