Today's SurgiCenter - The Development Demands

The Development Demands a Team Approach

By Molly M. Kientzle, RN

he development of a new ambulatory surgery center (ASC) is an exciting opportunity filled with potential surprises which requires the coordination of multiple activities and resources. It is our goal to provide a fully licensed and accredited surgery center for our physician partners that is poised for long-term operational success.

Our development philosophy at Surgis Inc. is focused on a comprehensive team approach. Instead of a separate development team whose primary responsibility is to develop new ASCs for the company and simply transfer all responsibilities to a different operations team at the end of the development process, Surgis utilizes all of our resources within the company in the development of each new surgery center. Experts in design and construction, legal, finance, operations, clinical operations, information technology, and managed care are involved throughout the development process. This overall team approach results in building strong relationships with our physician partners. As a result, the transition from the development/construction phases to full operations of the center is a smooth and seamless process.

We have clearly defined six major phases of the development process: project definition, pre-construction, equipment, construction build-out, pre-operational, and governance/regulatory licensure.

Each new ASC project begins with the definition phase. Physician input and feasibility studies are completed to determine the scope and specific needs of the project. Ownership structure, facility design requirements, and regulatory approvals are identified and syndication is completed. This phase is directed by a dedicated development team member with input from multiple expert resources within the company.

The pre-construction phase involves all activities necessary prior to actual construction of the new center. Site selection, architectural and engineering plans, financing options, and state review for permitting are coordinated by a dedicated team with extensive experience in facility design and construction management. Simultaneously, the equipment planning phase begins to take place. This phase includes identifying equipment specifications based on physician needs and scope of services. Budgeting and financing packets are also completed for owner approval. Information system requirements are identified and incorporated into the overall project design. The construction phase varies depending on whether the project involves new construction or build-out in an existing building. Throughout this phase, the project is managed by our team to insure code compliance, construction, and budgeting oversight. Finishing selections and equipment installations are completed during this phase of the process. The construction phase is completed once the certificate of occupancy is obtained for the new center.

The fifth phase consists of all pre-operational activities. Staffing needs are finalized, interviews and selection of the staff are completed, and training/orientation is provided prior to opening. Managed-care contract negotiations commence and continue through opening operations of the center. All professional and clinical services are identified and selected including anesthesia providers. This phase actually begins during the construction phase of the development process and continues through to opening day and future operations of the center.

The final major phase involves all governance, regulatory and licensure needs of the ASC. Establishing the center’s governing board, adopting bylaws, approving policies and procedures, completing licensing applications, preparing for inspections and surveys, and credentialing of the medical staff are just a few of the activities that are included in this phase of the center’s development. Although this is the sixth phase of the development process, the governance phase actually begins during the pre-construction phase of the project.

Opening day of the new ASC typically signals the end of the development process, but Surgis’ approach extends development beyond opening day to include the initial daily operations of the center, compliance audits, and accreditation of the new center. The result is an invisible transition from the development phase to the actual operations phase of the new ASC.

Organization and coordination of all project activities is essential to any successful development process. Surgis has created Project Tracking, a proprietary tool to specifically assist our team throughout this labor-intensive process. Project Tracking is a Web-based program which provides real-time sharing of information to all team members from anywhere in the country.

Each project is created based on the targeted opening date of the new ASC. Project Tracking identifies more than 250 physician-led activities to be completed throughout the entire development process and continuing through to the future operations of the new ASC. The project begins with the initial signing of the letter of intent to develop a new center and continues 90 days after the opening date with completion of a full facility compliance audit. Each activity specifically defines the target date of completion and the team member responsible for each task. The process allows team members to attach documents (agreements, budget projections, meeting minutes) and add updates to each activity. This information can be accessed by any team member, allowing for real time communications between all team members. The Project Tracking tool assists team members in planning and executing specific activities in a timely manner and sharing expertise from other team members.

A successful ASC project is predicated on communication with the partnering physicians. Meetings with our physician partners are scheduled regularly throughout the project to insure their input and approval on all aspects of the development process. Standardized agendas have been developed to address specific activities based on the project completion date. Strong communication assists team members in keeping all tasks on track and coordinated with all phases of the process resulting in minimal delays or potential conflicts.

By utilizing our expert resources in a team approach, we have been able to shape the development process to better meet the needs of our physician partners and the future success of our surgery centers. Envisioning operations from the first day of the development process is the key to success in developing an efficient and successful surgery center in which physicians enjoy doing surgery, patients are comfortable, quality is excellent, and economic returns are strong. ` Molly M. Kientzle, RN, is senior vice president of clinical operations for Surgis, Inc.