Why ASC Administrators Need Great Medical Directors

To succeed clinically, operationally and financially, the position must be more than ceremonial.

As ASC administrators, we feel the heaviness of the many hats we wear. Many of us take on multiple crucial roles within our surgery centers – many of which staff, surgeons, medical directors and owners may not even realize we must perform.

For example, you may not only be the administrator or director of nursing, but also the safety director, the risk management director, the quality improvement coordinator, the radiology coordinator… the list goes on and on. And even if you’re fortunate enough to have other individuals covering each of those roles, as the administrator you’re still responsible for overseeing all of it.

When a center’s medical director is oblivious to what the administrator does, or about what their own position actually means and requires, it’s a bad situation.

‘We are not following any of these rules’

This is particularly the case when it comes to regulations, compliance and other legally required functions of the administrator’s job that are vital to the center’s continued operation.

Many medical directors are woefully unaware of the multiple regulations under which an ASC must operate, including those from the state, CMS and whichever accreditation body your center utilizes. It’s a lot for an administrator to handle, and it becomes even more difficult when the medical director doesn’t appreciate the importance or magnitude of the administrator’s responsibilities in this area, as well as the impact of regulatory matters on staff and daily workflow.

Simply put, some surgeons assume that because they have “Medical Director” behind their name, certain things don’t apply to them. Some may believe the rules, regulations and policies under which your center operates are dumb and shouldn’t apply to them or your other surgeons. I’ve had a medical director look me straight in the eye and say, “We are not following any of these rules,” including their own written policies.

How do medical directors who act this way expect to pass a survey if the example they set with the other surgeons and staff is to not follow rules?

When I have laid this out for certain medical directors, they didn’t like hearing it. I’ve tried, “Hey, have you read our regulations? I’d like to go over them with you so maybe you have a better understanding of what we’re supposed to be doing and following. Let’s talk about this and maybe gain a little bit of education.” I’ve also printed out policies, tied them to regulations and handed it to them.

With some medical directors, however, it’s all been for naught. When somebody already has a bad or questionable attitude, anything I say or provide them generally doesn’t help. It can be incredibly frustrating.

I’m not asking the medical director to study, read or recite all of these regulations or become some sort of regulatory expert. I am, however, asking them to respect my knowledge of these regulations, back me in their enforcement, and be my supportive partner not only in this matter, but overall.

Some subpar medical directors will temporarily straighten up and change their tune when a surveyor walks in the door. Then the surveyor leaves, and we go right back to business as usual.

I’ve talked with administrators who feel powerless operating in this dynamic. They eventually give up trying to effectively engage the medical director and resign themselves to working under the sad umbrella of “it is what it is.” I’ve known administrators who were unaware when they accepted a position that they were stepping into a toxic culture with a bad medical director, quickly became horrified, and immediately started looking for another job.

You don’t want to be that center. And you don’t want to work with that kind of medical director.

What makes a bad medical director?

Some medical directors wear their title proudly and vainly, brandishing it on their scrubs and lab coats, viewing the position simply as a status symbol or perk rather than a serious, vital, collaborative role with an important mission. Not surprisingly, medical directors like these are often, in fact, ineffective and inadequate leaders.

Over 17 years, I’ve worked in virtually every nursing role there is at numerous surgery centers, and as my career has progressed, I have served as the administrator of several, including for the past two years at my current ENT-focused ASC. I’ve worked with four amazing medical directors — including my current one, Perry Poteet, MD, MHA — who have set a high standard in their productive engagement and partnership not only with me but also the other surgeons and the staff. Working with these great medical directors has only made those who held the role mostly for the title and the bragging rights seem even worse. And make no mistake: An ASC with a medical director in title only is not set up to thrive.

At facilities with subpar medical directors, morale suffers. Some engage in facility gossip. Some display a “do as I say, not as I do” attitude. Staff see their poor examples of leadership every day. If the medical director doesn’t support the administrator’s authority and knowledge, staff feels they cannot affect change, so why bother? When your medical director is telling you to blatantly break rules or not follow policies and protocols, why would a staff member not follow their lead? After all, that’s the medical director.

In situations like this, the administrator is essentially rendered voiceless and powerless by the medical director’s lack of support. Like the staff, they feel hamstrung in their ability to affect or enact needed change. They experience difficulties in holding staff or surgeons accountable because the medical director doesn’t back them up. Patient care — especially the quality of patient care — suffers too, with patients unaware that it’s being actively compromised by dysfunction at the surgical center. If you don’t have a medical director who can converse with you and attempt to understand the purpose and impact of regulations, who doesn’t see performance improvement as an imperative, who doesn’t back you up by getting other surgeons in the facility in line with policies, your job is likely very difficult as well as thankless. When the medical director isn’t pulling their weight, the administrator is literally working alone, frantically trying to keep everybody at the center rowing in the same direction.

I’ve never seen any educational or other material that lays out what it means to be a good medical director and how those in the role can best support the administrator. So I thought I’d take a crack at it.

What makes a good medical director?

Several traits are evident in a good medical director and can help them operate masterfully in their role:

• Collaboration, teamwork and leadership skills. They show an ability and willingness to form strong relationships with the administrator, staff and surgeons. They enthusiastically support growth and deftly manage conflict. They have strong communication skills and, together with the administrator, present a unified approach to facility operations, patient care and patient outcomes.

Perhaps most importantly, they accept that they don’t know what they don’t know. They are fully aware when they are entering areas of the business in which they are out of their depth, and are open to relying on the administrator’s knowledge and experience in those areas.

“Make no mistake: An ASC with a medical director in title only is not set up to thrive.”

• Empathy and compassion. A good medical director isn’t just kind and understanding at the patient bedside, but also with the administrator, other leaders, staff and surgeons. They offer and display support for everyone at the center, and actively participate in fostering a positive work environment.

• Adaptability. A good medical director knows how to navigate the evolving world of health care and the changing demands of its workforce. They embrace change. They don’t view “We’ve always done it this way” as an acceptable answer.

• Focus on quality and safety. A good medical director employs industry best practices, views patient safety as top priority, and holds their peers who operate at your center accountable.

As the administrator, I view the medical director as a liaison between me, the governing board and especially the operating surgeons, whose position about administrators is often, “You’re not a surgeon, therefore you’re not on the same level as me.” Your medical director must be willing to have difficult peer-to-peer conversations with surgeons about policies and regulations that must be followed in order to keep your center’s licensure.

A partnership for all to see

A healthy, honest, trusting relationship between an administrator and medical director can have a positive impact far beyond these two individuals. In my experience, this type of productive and positive relationship helps boost team morale, fosters trust in leadership, enhances quality of care and furthers operational efficiency. It signals to staff and operating surgeons that leadership is aligned and communicating. It offers weight to administrative words, actions and policies.

This kind of relationship, however, doesn’t exist by default. It must be nurtured by both parties. The administrator and the medical director must be mutually accepting of open dialogue and constructive criticism, with a willingness to meet in the middle for the betterment of the center. They must demonstrate this partnership in front of staff, surgeons and the governing body, avoid gossip and always maintain professionalism.

Searching for a unicorn?

Medical directors who are just as skilled in communications and teamwork as they are at performing surgeries are not quite unicorns, but they’re a rare breed. While some will just never get the importance of their positions, others who are open-minded can successfully evolve in them.

It’s difficult to define expectations for the medical director position at an ASC. Some just have a natural ability to lead and collaborate that flows authentically. I’ve never met an ASC medical director who received education about what it takes to be a good one. As a result, physicians often take the title and kind of run with it. Either they prove successful at it on their own, or after they flail at the start of their tenure, they are open to the administrator’s guidance and coaching to improve.

One thing is for sure: A surgery center administrator benefits when they work in harmony with their medical director, and so does the center, its staff and its patients. Building a productive administrator-medical director relationship simply requires an honest and consistent effort on both sides. OSM