Susan Kizirian, chief operating officer for ASCOA, shares three ways ASCs can reduce their payroll costs without negatively impacting the quality of care provided.
1. Hirer with understanding that hours are not guaranteed and send staff home or call off when cases are done. The biggest perceived obstacles to doing this is the sense that staff morale is severely impacted by not guaranteeing hours and that you won't be able to hire qualified personnel. Certainly there are outliers that we hear about anecdotally and it is important to remember that they are the exceptions.
In our experience, this protocol works well when communicated and implemented fairly and compassionately. Those two values are critical to bring to the implementation of the task as they work in tandem to achieve the successful execution of this protocol.
Also, the staff will most definitely go to the surgeons with their perspective and the surgeons heart strings will respond; however, we have done employee satisfaction surveys with outside human resources consults and the employees are overall more satisfied with their work environment even with no guaranteed hours and call-offs when compared to employees in like work settings.
So if you make the change, bring on fairness and compassion and ask your surgeons to stay the course with you as you go through the changes.
2. Compress your ASC's schedule by rescheduling cases to another OR day on days that don't have six or more cases scheduled; call staff off for the day. This protocol requires the buy-in of your surgeons, so it is important to show cost savings and get the surgeons buy-in prior to implementation. The biggest obstacle is getting your surgeons to be flexible between their office hours and hospital hours and routines. Once the change is made, the payroll savings is a quantum experience.
3. Combine pre-op and PACU areas so you can staff with less RNs and still provide the quality of care needed in both areas.
Frequently, it is what we are "used to" that leads us to think that is the way it "has to be done." I have had many a PACU nurse tell me that preop and PACU patients cannot be in the same nursing area and that it's a "law." It's human nature to think in terms of absolutes and in healthcare what we have done routinely with positive outcomes is our comfort zone.
Of importance to setting up the use of preop or PACU for both types of ASC nursing care is patient flow and what is visual. So look at your physical layout and choose the area that allows for both functions on days of low census and/or the need to both preop and recover patients in the same area. Some facilities use rolling dividers to delineate space. Type of case also needs to be reviewed in terms of flow and what is visual.
Some states require separation of pediatrics from adults. And it's important to adhere to any regulatory or accreditation standard. However, the facility could designate a pediatric day and still have preop and recover in the same area or separate the adults to one area and pediatric patients to the other area as long as both preop and PACU are set up with gases and suction.
It's extremely doable. It's all in the planning.
Learn more about ASCOA.
Read more guidance from the leadership of ASCOA:
- 3 Critical ASC Benchmarks Not Routinely Tracked
- 6 Ways the Recession has Affected Lending for ASC Start-Ups
- Acquiring Struggling Surgery Centers: Q&A with Jeff Péo of ASCOA