By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates, Dallas
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The volume of surgery, inpatient and outpatient, is booming across the United States. Centers that we developed just three and four years ago already are at capacity, and they are chopping into the adjacent space for more operating rooms. The fastest growing segment of our company is not what you might think. It is hospitals building ambulatory surgery centers (ASCs) as an extension of their surgical services departments to accommodate the glut of new patients. Don’t you just love the job security that brings to us all? However, it is a double-edged sword. Many surgeons are leaving the hospital environment, and it’s not necessarily because the hospital is inefficient (a frequent cry). Now they are leaving because they cannot get their cases scheduled in a "reasonable time." Many of our hospital clients are citing weeks out for elective procedures, which infuriates patients and surgeons alike. You really have to be sympathetic to the institutions with this new wrinkle.
We have spent a lot of time working with a couple of dozen hospital clients on this issue alone. While there are some relatively quick fixes for some, the problem is more complex that it might seem. I want to share some solutions that might help you if you are in the predicament that your peers are in.
As we have noted in previous columns, sometimes building new space is not the answer. First, it takes years to develop a new building or surgical wing, and for many, the problem is reaching a critical stage today. Building new facilities that are properly designed (which is another column topic) usually is a long-term solution. You may not have time for that.
First, obtain input from all your staff. Find out what the problems are, and prioritize them. It is rarely a case of too many patients and not enough operating rooms. Identify bottlenecks in your system. If you are losing 15 minutes per patient because of a bottleneck somewhere, and you are performing 8,000 cases per year, that adds up quickly. Assuming your average surgical minutes per case are 60, freeing up that bottleneck could allow you to perform an additional 2,000 cases per year! You would be surprised what bottlenecks we discover.
Expand your hours of operation. Most hospitals only operate seven to eight hours per day. Expanding your surgical hours by one hour per operating room can add another couple of thousand cases. Pay staff to work through their lunch hour. I know, you all hate me, but eating at noon everyday is not a requirement for life. Some staff will say "No way!" However, others will be delighted to pick up extra money to delay lunch or be willing to leave early in lieu of a lunch break.
Pay staff NOT to take vacation days. This used to be a bigger option than it is now. I remember many times getting vacation pay and regular pay by working my vacation time. It’s not as if I was going anywhere special anyway. Again, I will get lots of hate mail on this, but it is true that not everyone needs to use all their vacation time going away.
Strongly consider Saturday morning elective cases. For hospitals that do it, the staff enjoy it. Avoid making it mandatory. Do not ignore the fact that surgery is going to continue to increase this country, and these are only bandages I am talking about. You still need a long-term plan. The reason? Once you have done all of the above, you really are backed into a corner if you have no other alternatives for the long-term fix.
Your greatest challenge in the implementation of the above will not come from your staff; it will be from anesthesia. Across the country, anesthesia is being stretched thinner and thinner. The fact is that in many areas, anesthetists are in short supply, and most are not going to be willing to expand into their leisure time to accommodate your surgeons. You have to work with them and include them in your solution planning. Make sure that you do not come up with a plan and present it to the surgical staff before discussing it with anesthesia. I made that mistake once years ago. It wasn’t pretty. I am still bleeding.
(If you have suggestions for addressing bottlenecks, please contact Earnhart at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web: www.earnhart.com/benchmarks.htm. Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.)
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