The Secret of Success?

The Secret of Success?
Building Lasting Relationships

By Robert McDavitt, RN, BBA, CASC

When we were contacted about this story, we were at a loss for words to describe what we do differently; for information that would benefit another center; a magic bullet. We decided there isn’t one. When it comes down to it, we have been successful because of the relationships we have worked hard to build with our employees, physicians, patients, vendors and payors. Everyone has got to figure a way to manage their costs around the revenue they have. As stewards of the system, we cannot neglect any of our shareholders long-term.

Physician and Employee Satisfaction

There are many physician surveys out there, but the best one we’ve found is our case volume. Whether you are big or small, volume speaks louder than any other indicator of satisfaction. Sure there are reasons why one physician’s volume might go down: retirement, vacation, etc. From a macro level, trended volume reductions with no explanation are typically satisfaction issues. From a purely philosophical standpoint, would we really care about satisfaction if it were not to protect our volume?

The second thing that we watch is our employees. We don’t spend a lot of time with the individual aspects, but rather communicating expectations and troubleshooting the systems they work within. The best thing you can do for your staff is to give them worthwhile work in an environment that is efficient. Take our pre-op area; our nurses were having trouble keeping up with the pace and morale was low. When we took a look at the system, we identified a problem — the patient board was not in plain sight for the nurse to see from the immediate work area. The expectation for pre-op was for every doctor working, two patients had to be prepared. In order for a nurse to see which doctor’s patient they needed to bring back, they had to walk all the way to the end of the work area and around a corner. We moved the board and had instant nurse satisfaction. The point of this example is not that we moved the patient boards; it is the focusing on the system the employee is working in vs. the employee’s reaction to the work environment. If you do not take care of your employees, your competition will.

Patient Satisfaction

In addition to physician and employee satisfaction, we focus on patient satisfaction. Many centers spend thousands of hours/dollars trying to keep patients safe. However, patient safety is not a lofty goal for American consumers; it is the bare minimum expectation. We took all of our employees on a “Scentsational” tour of our facility. They looked, smelled, and experienced our center from a patient’s perspective (although limited by their own subjectivity). We identified that our patients were cold, getting naked and putting on a gown. One staff member had an idea, “What if we put their gowns in the blanket warmer as well?” Bingo, that’s satisfaction. One staff member chimed in, “The patients wait a long time on Friday afternoons. What if we gave them a portable DVD player and movies to watch in pre-op?” Portable DVD player and 50 movies — $150.00 — zero patient complaints on Friday afternoons: priceless.

Oftentimes all we focus on is the patient’s experience when the families are part of the service we provide. Through actual situations, we identified that the patients’ family was largely in the dark in the waiting room, with no idea what was going on with the patient. We purchased pagers that display messages to alert the family when the patient is going into the procedure, coming out of the procedure, and when it is time for them to go see the patient. This has a two-fold effect in that it decreases the family’s stress and ensures the family is in our waiting room when we need to bring them back. We also cut down on the number of visits to the front desk to ask “When do you think they will be ready?”

Communication

Two-way radios for all staff and anesthesia enable constant, real-time, hands-free communication. We identified early on in our center that working as a team was critical to our success. My experience as a registered nurse on the hospital side taught me that being able to communicate with the team was critical to working as a team. We do not allow patient names to be used on the air so confidentiality is not an issue. It enables us for example to “call for a bed” in recovery. Before the radios we had several instances where three patients came out of procedures simultaneously, creating quite a traffic situation. It is virtually non-existent now.

Vendor and Competitor Relations

We made an agreement with a small number of vendors, early on, that we would deal with them with integrity and honesty. The representatives who call on us are like family; we don’t always get along, but we are committed to helping them be successful. If a rep is at the end of their fiscal year and needs a large order to help them personally, if we can adjust the timing to help them, we do. The difference to us between ordering six cases of IV fluids on Friday vs. Monday is insignificant, but to a rep it could make the difference between them getting raises or money for their Christmas. I wouldn’t want anyone to get hung up on the practice, but I think what has made us successful is the attitude of partnership with our vendors.

Right down the hall, less than 20 steps away, is a full service multi-specialty surgery center. We are committed to helping them whenever they need it. When you clear away all the smoke, it all comes down to the patients or physicians that suffer from senseless competition. If we help the center down the hall there is always a physician, fellow clinician, or patient that will reap the benefit. The results of this cooperative attitude is they help us when we need it and on our end, patients, clinicians, and physicians have all benefited from this spirit.

We focus on operational efficiency as much as the next center, but we also try to balance short-term gains with long-term costs and with what any action will do to our relationships.