Leadership: ASC Jobs Are Amazing, But No Walk in the Park

Setting expectations for new ASC leaders and staff is vital.

Outpatient surgery centers have earned a reputation among healthcare providers for being “easier” places to work because the patients are relatively healthy, the procedures are elective and minimally invasive and, because the work is conducted on weekdays, employees can enjoy their nights, weekends and holidays without the stress of being on call.

A broad job description

While most of this is true, working at a same-day center is no walk in the park. These jobs come with very real stressors and challenges, some of which have almost nothing to do with providing health care.

For example, early in my career as an ASC nurse manager, I had to make sure the building’s elevator and generator worked. I remember thinking, Why does a nurse manager need to perform tasks like this? My plate is already full. How could I possibly be expected to serve as the building superintendent as well? Many ASCs are essentially small independent businesses, and like running any small business, leaders must learn every aspect of the facility’s daily operations. Last month at AORN Expo, I facilitated a meeting of passionate ASC leaders to learn about the most important issues they face. Here are the highlights of that engaging conversation.

Scheduling

ASCs generally promise new employees that they will be home in time for dinner on weekdays and won’t work on weekends or holidays. These undeniable perks come with a tradeoff, however.

For example, there is no next shift to take over for you. Even though your patients are comparatively healthier, and the procedures are less complex than at a hospital, there is no guarantee that a case won’t take longer than expected. At an ASC, you must stay and finish cases that run past the end of your scheduled shift. If you can’t stay, the rest of the team will be forced to cover for you. (The upside is that once you go home, you are rarely asked to come back in an on-call situation.) Many ASCs plan for staffing cases that run past the scheduled ends of shifts with staggered start times, rotating late days and asking for volunteers to stay.

A common misperception is that ASCs do not get add-on cases. Many ASCs located near the offices of their physician-owners accept their last-minute same-day cases. Don’t get me wrong: ASCs offer great flexible schedules. In practice, however, that’s not always the case. To fully enjoy the perks of working “business hours,” employees must be flexible and take turns covering late cases — and cover for each other. If everyone works together, they can get the schedule they prefer while avoiding short-staffed scenarios that can burn out the covering team.

Resources

ASCs have a fraction of the resources that most HOPDs have. They often work with limited supplies, in small spaces, with barebones staff. They often have limited budgets for instruments and other equipment. Only a handful of providers and nurses are on site, many with similar experience. If an emergency occurs, the staff on hand must manage it while calling and awaiting EMS.

The ASC leaders at our AORN Expo meeting explained what working in an ASC with limited resources really looks like. Here’s a snapshot: No turnover team exists, even in some high-volume centers, and environmental services doesn’t arrive until the end of the day to clean common areas and perform terminal cleaning. OR nurses transport each patient to PACU and quickly return to work with the surgical techs to complete room turnover cleaning, including point-of-use cleaning of instruments and equipment. Those same nurses must transport used instruments to the sterile processing department before they can bring case carts and equipment into the OR for the next case. Don’t forget — the expectation for room turnover time can be as little as six minutes, wheels out to wheels in. This cycle repeats multiple times per day. An ASC nurse circulating multiple cases throughout the day will easily rack up 10,000-plus steps, sometimes before lunch. Although the work may appear “easier,” each team member has more responsibilities than they would in a hospital. Room stocking, pulling cases and instrument reprocessing are tasks that often must be completed prior to closing.

Assignments

Making room assignments is challenging. (Full disclosure, I have contributed to poorly assigned surgery schedules in the past.) The key to fair distribution of case assignments: Think from the perspective of the staff, which is a challenge in itself. A growing number of ASC managers have limited experience at working in an OR, so they lack the intricate knowledge of what it takes.

In order to bridge this gap, leaders need to arm themselves with knowledge of the case assignment process while taking into account what the assignment means to the person involved. Remember, rotating assignments promotes teamwork and cross-training. Rounding in the OR and observing staff completing tasks will help leaders develop a better understanding of the team’s workload, and they will appreciate that gesture.

Leaders should also collaborate with staff to determine the best way to evenly distribute the workload and maintain fair assignments.

If you’re considering a new ASC job or hiring someone new to the environment, manage their expectations up front. Team members who know what they are getting into are much more likely to succeed (and stay) than those who anticipated something different. For more information on operational management and leading ASC teams, please visit osmag.net/leadershipasc. OSM