Today's SurgiCenter - Guiding Principles

By Taylor Morris

Most companies adopt guiding principles that reflect their core values. From its early days, Symbion Healthcare adopted 10 guiding principles that influence our actions and remind us of our mission to provide quality healthcare to the communities we serve. They deal with conduct and character as much as process. By nature, they are a bit inspirational, and they are also broad in their interpretation. Certainly, to be effective, core values should be broad enough to have meaning across all areas of the company: development, operations, accounting/finance, and yes, even the subject of this article: facility development.

Have a Plan

The first principle is perfect for facility development. After all, we deal with plans every day. We’ve found that canned design solutions seldom work. Just as healthcare is provided at the local level, facility-design solutions must be adapted to local needs. Centers can vary in size, case volume, specialty mix, service complement, land configuration, and building footprint. Some are freestanding, while others go in office buildings with unique dimensions, floor-to-floor clearances, and column spacing. While cookie-cutter solutions don’t work, consistency of flow and space adjacencies do produce success. Regardless of project- specific factors, basic flow patterns and processes have to be respected in all designs. Consistency of this kind is a benefit to operations, which likes the fact that when they are handed the keys to the facility, they know what they are getting.

Take Ownership

Who drives the building’s design? The architect? The corporate project manager? The physician investor? The hospital partner? The anesthesiologist? The facility administrator? In fact, all should have input, but none at the expense of the others’ essential needs. Walk into a poorly designed facility and if you look carefully, you can tell who steered the process to the detriment of the others. It would be foolish not to get the advice and input from clinicians, physicians, business office staff, or IS department. The job of the project manager is to direct the process, involve the stakeholders at key decisions points, and not lose sight of the project’s goals. A good project manager will know a key decision from one not requiring input from others.

Focus With Passion

Work with consultants who share your vision and passion. Surgical facilities are challenging enough without hiring architects and builders that do not have a passion for it. Most project managers have received the request to use an architect who is the brother-in-law of one of the partners or a builder that built the physician’s office or home. But ambulatory surgery centers (ASCs) are not the same as medical offices in concept or execution. They are complicated, technically sophisticated buildings that require specific knowledge and expertise. Don’t allow unqualified consultants to jeopardize your project. Some companies prefer to work with a limited number of consultants used on a repeat basis, and we are strong advocates of this approach. Familiarity breeds consistency and efficiency. However, on many of our projects we do not get to use “team” members (the architect is already under contract, the developer has a relationship, the local market has highly qualified consultants). In that case, we are flexible enough to work with a variety of consultants, but we insist they have significant experience with surgery center design and construction.

Act Boldly

There are two views of management: one that believes people are basically incompetent and need close supervision. The other believes people do their best when they are empowered to act with boldness and creativity. We adhere to the latter, and try to create an atmosphere that fosters creativity, open dialogue and communication. Boldness is needed in the environment of change. Technology changes constantly, new equipment is continually introduced, regulations are revised, all resulting in a dynamic environment impacting the size of rooms, ratios of stretcher positions to treatment rooms, sterilization room layouts, etc.; therefore, we don’t hesitate to review assumptions and previously held design ideas. Boldness may also mean challenging a request for the latest whiz-bang technology with limited usefulness in an ASC or questionable cost to benefit ratio.

Show Up and Never Quit

Theoretically speaking, this principle invokes the need for perseverance, determination, and adaptability. On a practical level, it may mean showing up regularly at the job site. Participate in monthly owner architect contractor meeting to evaluate the work in place and construction progress. It is a rare trip that doesn’t result in at least one issue identified and resolved. Provide your design team with another set of eyes. Ask questions, point out areas of concern, and allow the team to benefit from your experience. But don’t interfere or usurp their responsibilities; allow them to do their job. Also, show up at the right time. Translated: the time to decide where you want power outlets is not once the partitions are up.

Do Not Blame or Judge

Nothing is more frustrating and counterproductive than one team member criticizing the efforts of another. It is better to establish a relationship of trust and confidence in your consultants’ abilities as professionals and expect them to act accordingly. We emphasize from the beginning that no one wins at the expense of another, and no one gains from pointing out the failures of another team member. Project managers must sometime light a fire to get results, but save the flamethrower approach for only the direst of circumstances.

Pitch In

As stated above, opening ASCs is a team effort involving architects, engineers, contractors, equipment planners, clinicians, physician partners, and vendors. Each member of the team must know his or her role and do their part. Save us all from the consultant who sets traps for another team member and delights in another’s misfortune. The next principle follows naturally from this one.

Be Big, Not Little

This is a great admonition for every area of life. I’m sure my friends are tired of hearing me say it. But to be relevant to facility design, this principle is more appropriately stated, “Be neither big nor little, but just right.” Overbuild the facility and you have saddled operations with unnecessary overhead and expense. Underbuild it and you have compromised the center’s full growth potential. Never assume the size of the facility without first obtaining objective utilization data. We ask physicians to estimate the number of cases they plan to bring to the center, adjust that number to add a degree of conservatism, and estimate the number of operating rooms based on between 1,000 to 1,250 cases per room per year. Pay special attention to growth projections. Depending on growth projection timeline, future rooms can be un-built but located, shelled-in, or completely constructed but not equipped.

Laugh and Celebrate

It’s one thing to laugh and celebrate at the groundbreaking ceremony, and quite another at the ribbon cutting. Missing a deadline or failing a final inspection guarantees a somber occasion. Many contractors fall into the trap of over-promising on delivery. Many owners fall into the trap of believing what their contractor tells them without first assessing progress themselves. I tell contractors, “Don’t tell me what you think I want to hear; tell the real story because once you give me a completion date, we are going to take action on many fronts (hiring staff, delivering furniture and equipment, etc.) based on that date.” Owners must be careful not to set unrealistic deadlines that result in hurried work and poor quality. Concrete can only cure so fast.

Be Grateful

There are many building types requiring facility development know-how. Educational, commercial, residential, places for worship — all have their fair share of challenge and reward. In my opinion, few are more challenging or produce a higher sense of accomplishment than successfully opening a modern ambulatory surgery center. Contributing to the healthcare delivery system and enhancing the quality of patient care in a community is very satisfying. So to is enabling physician partners to realize their dream of owning their own center and adding to their quality of life. For these reasons, I am grateful to play a part.

In summary:

1. Match the plan to project-specific needs.

2. Get input from the stakeholder-owners.

3. Work with experienced consultants. They have the passion.

4. Constantly revisit assumptions; challenge precedents.

5. Be an active participant and be timely in your participation.

6. Work together as a team. Look out for each other.

7. Do your part and let others do theirs.

8. Match facility size to definitive needs. Plan for growth.

9. The win-win approach allows everyone to celebrate.

10. Remember how fortunate you are.