Ambulatory surgery center (ASC) staffing has risen to become one of the biggest challenges for owners. The landscape of surgical procedures changed drastically in 2020, and as a result, ASCs face new challenges of attracting and retaining permanent staff. Burnout among health care professionals was problematic prior to 2020, but the pandemic amplified this problem, and affected outpatient surgical centers in more than one way.
The New England Journal of Medicine (NEJM) describes burnout, or the worker's "moral injury from being unable to provide the care patients need," as a problem that has become almost foundational in our systems of care.1 Electronic medical record (EMR) systems meant to increase efficiency and standardize charting may not be fully integrated with other systems in the ASC, adding to the labor involved with each case. Additionally, documentation has increased to the point that workers spend more time documenting visits than with the patients themselves. These, together with a "chronic underinvestment in public health infrastructure," have culminated in an overworked healthcare community.1
Attract and Retain Employees with a Staff-Centered Workplace
As more procedures are pushed into the outpatient sphere, ASCs are a fast-growing component of the overall healthcare market. Surgical center reimbursement is, by design, a fraction of hospital reimbursement, and third-party payers can reduce their costs by funneling outpatient surgeries to ambulatory centers.2 As hospitals reach farther into the outpatient market to recapture some of their lost inpatient revenue, ASCs will increasingly compete with these larger systems for a shrinking group of talent.
Hiring locum tenens workers is one solution, but we know this solution has its own drawbacks. There are always people coming and going, and professionals are often working with unfamiliar faces. Per diem staff not only demand a higher wage, but every new person has to learn the ropes of your surgical center. While this is not as great a challenge if your facility is already streamlined and efficient, creating this environment is the first step to hiring and retaining permanent staff. A staff-centered working environment can become an ASC's best recruiting tool.
A staff-centered workplace sets clear expectations from day one. It offers written policies and procedures, gives workers the tools they need to complete their roles with accuracy and efficiency, and encourages staff well-being and betterment.
The privately-owned ASC environment is different operationally from a big hospital or health system. Owners have more flexibility in some areas, but staffing needs become amplified in a smaller workplace, when jobs are sometimes shared and one person calling out sick can have a snowball effect on the entire operation. Here are a few ways you can help attract and retain employees and overcome ambulatory surgery center staffing challenges.
Offer High-Value Onboarding
A report published by Glassdoor emphasizes that proper onboarding can increase new employee early productivity and employee retention by up to 82%.3 Human resource professionals suggest the onboarding process include a few important details:
- First, create a checklist, which will be different for each type of job within the ASC. The checklist will provide a new hire with everything they need to get started, including information about completing paperwork, training, and even a list of people to contact for help completing these tasks.
- Second, consider assigning someone to act as a mentor. This will help immediately establish a relationship for the new employee and can be someone they go to with questions.
- Lastly, ensure that new hires understand the practice's culture. Ideally, this begins before the hiring process (and is one of the reasons the employee wants to work for you), but culture is often reinforced by team members in the way they support the business's values and mission.
Streamline Workflows and Prioritize Efficiency
Healthcare leaders are calling for a reduction in paperwork across the healthcare sector as a means of reducing burnout and low job satisfaction, in addition to reducing medical errors. Acknowledging these problems, the National Library of Medicine published a report in 2021 that aims for a 75% reduction in documentation burden by 2025. This report identifies five domains of burden, including reimbursement, regulatory, quality, usability, and self-imposed.4
While some of these domains of burden relate to compliance, and therefore allow little to no flexibility, others can be addressed at the individual business level. If we consider reimbursement, quality, and usability, ASCs benefit from diagnostic machines that help perform clinical tasks with greater accuracy and ease. Machines like the GE HealthCare Venue Fit™ Ultrasound were thoughtfully designed to integrate easily into an ASC. "It is a hospital-grade point-of-care machine with a smaller footprint, that has been redesigned to fit within the system," Mark Vanderhulst, Senior Marketing Manager for GE HealthCare Point of Care Ultrasound shares. With easy-to-use features designed to enable fast patient assessments, confident decisions and improve scan consistency between operators, the Venue Fit™ ensures expedient, meaningful care while reducing administrative burden and the amount of time spent on documentation.
Offer Training and Continuing Education
Meeting your employees' training needs should be integral to your ASC's culture. The best diagnostic machine becomes useless and burdensome if the user hasn't been trained to use it properly and to its technological capacity. Some vendors, such as GE HealthCare, offer connections with third-party trainers across all care segments, to enable employees to stay up to date not just on equipment but also on their continuing education requirements. New employees should be assured your ASC has the technological tools needed to help them provide the best patient care possible.
Emphasize Work-Life Balance
A study published in BMJ Quality and Safety calls the problem of burnout a pandemic in itself. The study found that work-life balance among healthcare workers is lowest among physicians, not only during the professional training period but throughout their careers. Importantly, the authors attribute this widespread issue to more than just increasing workloads. They state this work-life imbalance is learned and ingrained in the culture of medicine.5
To attract and retain top talent while reducing employee turnover, business owners must understand that their employees not only want to have lives outside of work—they need to. Ambulatory surgery centers are schedule-driven, and employees need to know the practice has chosen the appropriate equipment and written policies and procedures that not only increase efficiency, but enable great patient care. Not everyone should be working late every day to complete basic tasks. If they are, the business has an opportunity to make improvements. Building a culture that respects vacations, sick time, and family matters—or even creating flexible scheduling when possible—helps employees feel like valued human beings.
Messaging Matters
Staffing challenges in healthcare may continue to grow, but ambulatory surgery centers can attract candidates by adjusting their messaging. When your values are aligned with a staff-centered workforce, you offer a job on a strong, fulfilled team, carefully built to self-sustain and grow. As an owner with a mind to ambulatory surgery center staffing challenges, your message to prospective employees is that they will have a culture of self-care, a guaranteed income (as opposed to daily work that may or may not be steady), have access to hospital-grade diagnostic equipment and an opportunity to increase their skills through specialized training through partnerships that support your business.
REFERENCES
1. Murthy VH. Confronting health worker burnout and well-being. The New England Journal of Medicine. August 2022;387:577-579. https://www.nejm.org/doi/full/10.1056/NEJMp2207252.
2. Morse S. Ambulatory surgery centers compete with hospitals for outpatient dollars. Healthcare Finance. https://www.healthcarefinancenews.com/news/ambulatory-surgery-centers-compete-hospitals-outpatient-dollars. Accessed March 21, 2023.
3. Laurano M. The true cost of a bad hire. Glassdoor. August 2015. https://b2b-assets.glassdoor.com/the-true-cost-of-a-bad-hire.pdf. Accessed March 22, 2023.
4. Report from the 25 by 5: Symposium series to reduce documentation burden on U.S. clinicians by 75% by 2025. Columbia University. https://www.dbmi.columbia.edu/wp-content/uploads/2021/08/25x5_Executive_Summary_V2.pdf. Accessed March 20, 2023.
5. Schwartz SP, Adair KC, Bae J, et al. Work-life balance behaviors cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis. BMJ Quality & Safety. February 2019;29(2):142-150. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365921/.
