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November/December 2006
In this month's issue:
Developing a State-of-the-Art Ambulatory
Surgery Center
Whether you decide to lease and modify an existing facility
or build from the ground up, developing your center will involve
several months of planning, design, and construction. Creating
an efficient, code compliant, and esthetically pleasing facility
entails many hours of work by a knowledgeable team.
The first and perhaps most important step is to hire a project
manager qualified to take on the multi-faceted job of coordinating
and checking the ongoing project down to its last detail. The
role requires someone who is savvy, resourceful, and determined
because the success of the project will ride on his or her shoulders.
The project manager will need to foresee and handle every eventuality—which
requires experience as well as knowledge. Full-time project managers
are accustomed to the complexities of the job, know how to overcome
obstacles, troubleshoot problems, stay on schedule, and deal with
the wide range of people involved in building an ambulatory surgery
center.
Once the project's feasibility has been established and licensing
applications are underway, the project manager will need to
identify a realtor who can find suitable buildings or lots
in areas convenient for the physicians and their patients. The
decision whether to build from scratch or lease and adapt an existing
structure will depend upon the availability of a suitable building—and
whether or not it is economically feasible to bring it up to state
occupancy standards. The project manager will probably need
to review as many as 14 or 15 sites before finding
one that addresses the requirements of the physician partners.
After the location has been selected, bids must be solicited from
architects and construction firms. It is wise
to consider only architects who are well
qualified and experienced in designing medical buildings. An
architect who usually works on standard commercial buildings
may not be familiar with the many codes and regulations, such
as correct hallway widths and two-hour firewalls, that apply
to an ambulatory health center.
The architect must develop a schematic floor plan that makes sense
in relation to the building itself, but also considers the way
you and your partners, staff, and patients will use it on a daily
basis.
Many buildings will ultimately work best when gutted to a shell,
giving the architect free range to design a space that best meet
your purposes. Whether or not interior walls are retained, every
detail of their functionality will have to be carefully assessed
for the most convenient working environment and a smooth flow for
staff and patients.
After a bid has been accepted, you will need to begin forming
a construction team. You will want a contractor/construction
firm that has first-class recommendations and a roster of skilled
and diligent subcontractors, such as plumbers, electricians, decorators,
and other craftsmen. The project manager will be responsible for
doing due diligence on history and references, and visiting some
of the firms' previous projects. Ideally, your architect has previously
worked with the contractor and subcontractors. When working with
a management partner, you will find the company often uses only
contractors that have proven to be trustworthy and have experience
building health care facilities to everyone's satisfaction.
Communication is key to saving both time and cost. The
project manager should be constantly in touch with you, the contractor,
the architect, the city and state authorities, as well as vendors.
This flow of information and questioning is a vital energy that
keeps the project running smoothly.
Surgery Center Partners has project managers and other experienced
team members ready to handle all aspects of developing and managing
your center. We provide the worry-free solution to center ownership.
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Staffing for Maximum Productivity
Staffing is perhaps the most critical aspect of a well-run
ambulatory surgery center. Employees represent a center's largest
non-fixed operating cost, so it is extremely important to keep
them busy and working at maximum efficiency. Having the right number
and type of staff is the key.
When you plan the staffing of your center, you first must decide
how many hours' care your facility will provide. This obviously
will depend upon the size of the facility and the number of physicians
who use it. Consideration also must be given to the average time
required to perform procedures and the time required for pre- and
post-operative care.
While staffing will vary depending on these factors, these staff
members will be essential:
The lead nurse is central to running the facility. This
individual, who should be experienced in many aspects of staff
management, is in charge of patient care as well as the the day-to-day
functioning, development and training of other facility staff.
A proportion of the lead nurse's time also is spent on administrative
issues, such as quality control, environment checks, and chart
audits.
The unit coordinator is the first and last person the
patient sees and although s/he need not have a healthcare background,
experience in the field is useful. The coordinator greets and registers
patients; ensures forms are signed; finds charts; obtains insurance
verification, authorization and co-payments, and schedules appointments
The job involves large amounts of paperwork, requiring accuracy
and good organization.
Registered nurses or licensed vocational practical nurses
(LVNs) assess patients, take medical histories and physicals,
and place a pre-procedure call to go through medical history, and
perform a final screening immediately prior to the procedure. They
assist physicians and administer medications, as well as oxygen or
IV fluids as needed. They monitor the patient throughout the procedure
and chart and document vital signs. If tests or biopsies are necessary,
the nurses will assist in the collection of tissue, and prepare slides.
They also transport the patient from the preoperative area, to the
procedure room and on to the recovery room (where the patient usually
remains for 20 to 30 minutes). A nurse also must discharge the patient
to the care of a responsible adult.
Technicians may assist doctors with a procedure,
clean up afterwards, restock supplies, and disinfect equipment.
They also may assist in preparing biopsies.
A staff coordinator is essential for keeping a center
running smoothly A procedure should never have to be canceled because
of understaffing. Staffing levels need to remain stable, yet flexible
enough to accommodate the inevitable changes in schedules due to
sickness, leave, vacations, emergencies, etc. A variety of staffing
options will be required so that when one person drops out temporarily
or permanently, someone else can quickly fill his or her place.
For this reason, a pool of per diem staff and registry nurses should
be maintained to fill in on occasion. Fluctuations in the number
of procedures need not result in wasted staff time. Staff can sometimes
use their paid time off (vacation and sick leave) on days when
they are not needed. Detailed planning can help avoid the cost
of staff overtime.
Surgery Center Partners handles all aspects of hiring, training,
and managing well- qualified center employees, freeing you to
focus on caring for patients.
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