If you have ownership interest in an ASC, you’re always on the lookout for ways to boost productivity and profits. These ideas come from Donna Giles, RN, BSN, VP Clinical Operations, and Terry Bohlke, CASC, VP Operations, National Surgical Healthcare, who presented at the ASCA Annual Meeting.
1. Simplify your benchmarking. Some ASCs make the mistake of hiring expensive consultants to do complicated metrics based on national data and not necessarily relevant to your ASC, says Giles. The best productivity metrics compare your ASC’s current performance to past performance. “Where were you last year and how can you beat that?” Bohlke asks. That’s the best way to gauge whether the productivity improvements you’ve implemented really work.
And those complicated daily productivity tools companies want to sell you? Save some money and develop your own simple metric that doesn’t require loads of staff time to enter data that’s irrelevant to you, Giles suggests. If you have someone on staff who is good at Excel, you can develop your own simple, customized tool. Bohlke and Giles recommend your ASC look at 3 metrics:
- Total worked surgical staff hours divided by total hours patients are in the OR—“wheels-in to wheels-out.”
- Total worked staff hours in PreOp and PACU divided by total patient hours in PreOp and PACU. Tip: This is where most ASCs have lots of opportunity to improve productivity.
- Total worked staff hours divided by total number of adjusted cases.
2. Make sure your ASC’s managers are having “fierce conversations” with staff about high, medium, and low efficiency. If your ASC has data your managers and staff can look at together, they can have crucial conversations in transparent, non-threatening ways. For example, some PACU staff are really good at moving patients along, says Bohlke. These patients get out the door safely and their satisfaction levels are high. But some PACU staff aren’t as skilled with patient flow. Team up different kinds of PACU staff so they can learn from each other.
3. Cross-train staff. Some ASCs bump up salary each time a staffer builds up a certification in one specialized area. But it’s really important to reward breadth, says Bohlke. An employee who can work in several areas is a “treasure” when it comes to managing staff productivity. If you have a staffer who wants to broaden her skill set, it may well be a good investment for your ASC to reward that.
4. Evaluate your ASC staff’s skill mix. Do you have the proper balance of RNs, LPNs and CNAs? Are your RN’s bogged down in tasks a nurse’s aide might handle just as well?
5. Pay attention to how your time clock works. Your ASC’s managers need to understand how the time clock rounds for time, Bohlke says. Some time clocks record the exact time, but most “round” backward or forward. “Your staff most likely know how that works whether you do or not,” he says. If you’ve got a time clock that rounds in 15-minute increments, it’s possible you have staff who are gaming the system, and that can add up to a lot of money. One ASC found enough money to hire six additional full-time employees once it dug into time clock monitoring, Giles reports.
Eyes Open: ASC productivity is typically great in the mornings, but tapers off in afternoons, Bohlke and Giles note. The tapering happens because managers finally get their late lunches and check their emails and they “tend not to make sure staff clock out when it’s time” during the afternoons.
6. Pay attention to where your time clock is. Position it near clinical and administrative work areas so that employees clock in when they’re actually ready to work. If your ASC’s time clock is in the break room, you will get even well-intentioned employees absent-mindedly clocking in, and then getting a cup of coffee, changing clothes, and doing other non-work activities on the clock.
Eyes Open: There are FSLA regulations governing time clock details, and your state may have rules as well.
7. Monitor overtime. Make sure a manager approves all OT before it’s incurred and that someone monitors overtime patterns. “Two percent of ASC hours should be overtime,” Bohlke says. If overtime is less than 2 percent, that’s a sign your ASC is paying out too much for full-time staff. If overtime is more than 2 percent, it’s a good idea to do a cost benefit analysis to make sure you don’t need more full-time staff.