Many visitors have come through the doors of Spectra Eye Institute, located in Sun City, AZ, seeking insight into the facility's processes and procedures. We welcome surgeons to observe surgery and learn new techniques and administrative and clinical staff members to learn about our operations.

Spectra Eye Institute is a freestanding ophthalmicbased outpatient surgery center comprising three operating rooms and one minor procedure room. All procedures are performed under monitored anesthesia care. On average, 7,200 patients per year are treated at Spectra. Of course, patients come first in every procedure and process at our surgery center, and our resources are allocated as such. Achieving the best possible patient care is what drives our human resource management and our recruiting efforts, and it has a profound effect on how we assign staff members. In my role as the administrator of Spectra Eye Institute, I have found that efficiency is critical to success. Further, an efficient staff is one that integrates, accepts, and understands the common goal of exceptional patient care.

A DRIVE TO SUCCEED
As any administrator will tell you, the vast majority of overhead for an ambulatory surgery center (ASC) is spent on staffing and supplies. To remain profitable in these difficult economic times, all staff, from the administrator to the scheduling secretary, must take an active role in the process of managing these resources. At Spectra Eye Institute, we call it the “taking ownership interest in the business” approach. This does not mean that the administrative staff must be knowledgeable about the profitand- loss and balance sheets. Nor does it mean that the clinical staff has a say in salary and benefits information. What is does mean is that all members of the staff take a personal interest in the business and are encouraged and empowered to take steps for the greater good of the facility and its patients. One example is the scheduling secretary who is empowered to manipulate the surgical schedule to make better use of the day. Another is the clinical staff member who reviews the staffing needs for a particular surgical day and helps facilitate scheduling of all staff members. Although many ASCs require a superior to tackle these types of tasks, we do not. Our operations are based on the theory that if everyone is to benefit from the efficiency and productivity of the team, staff members should be actively involved in the process.

MATCH THE STAFF MEMBER WITH THE TASK
A key aspect to profitability and sustainability of an ASC is the efficient and effective use of the staff. This is not to be confused with speed. Efficiency and effectiveness have more to do with the way in which processes and procedures are carried out to give superior patient care. Many strategies can be utilized, starting when a physician's office schedules a case and culminating when the patient receives a postoperative phone call. To follow are some processes that have worked to increase efficiency.

Prior to the day of surgery. All patients receive a preoperative phone call a few days prior to surgery to review and verify information such as demographics, health history, and financial responsibility. This allows the patient to address any questions or concerns in a confidential manner. Issues such as advance directives and financial interest disclosures can be addressed at this time. Concerns regarding payment of coinsurance or deductibles can be discussed and settled in a confidential manner. Questions relating to anesthesia can be addressed by nursing staff or anesthesiologists.

Day of surgery. Upon registration, the administrative assistant greets the patient and requests copies of the insurance cards. All necessary paperwork, including the informed consent, is signed, and the patient is ready for the clinical staff. This whole process takes about 5 minutes from greeting to completion. Many patients remark at how efficient the check-in process is; all tasks are performed in such a way as to alleviate the unnecessary stress on the patient, maintain confidentiality, and prevent bottlenecks in the admissions process.

Once admitted into the surgical suite, a nurse and a patient care technician (PCT) are assigned to the patient and assist him or her to a surgical stretcher where the patient will remain for the duration of the stay. Although appropriate nursing staff is available, the PCT plays a vital role at Spectra Eye Institute. In house, they are often referred to as “patient movers,” and their role is critical to the success of the efficiency model. PCTs are able to handle all aspects of patient care that do not require nursing intervention. This, in turn, allows the nursing staff to better focus on nursing-related needs of the patients. The PCT acts as the patient advocate, spending time assisting in preoperative care, anesthesia administration, and postoperative care.

An important part of efficiency in an ASC is good utilization of OR time. Room turnover must be efficient and it is in this role that the PCT is a critical player. The PCT enters the OR at case completion and assists with everything from disconnecting the patient from the monitor removing the trash from the case to assisting in the transport of the patient to the recovery area. Another PCT prepares the next patient for surgery, transports him into the OR and hooks him up to the monitor. Turnover times for our ASC run 3 minutes for a cataract case and 7 minutes for a retina case. Once in recovery, the PCT hooks the patient to the monitor, offers them a snack, retrieves family members waiting in the lobby, and reviews the postoperative instructions with the patient, all while a nurse is assessing the patient for recovery. After assessment by a member of the nursing staff and the anesthesiologist, the patient is cleared for discharge. The PCT then escorts the patient, and family members to their vehicle.

Evening after surgery. The evening after the surgery day is when the nursing staff attempts to contact patients to check on their progress and condition. A nurse discusses with patients any concerns, comments, or questions they might have prior to their appointment with their surgeon the following day. It is at this time that the nurse will complete the patient record and, if necessary, instruct the patient to contact the surgeon for further evaluation should an untoward situation arise.

EFFICIENCY VS STAFFING COSTS
It is no secret that salary costs, particularly for nurses, can have a profound effect on an ASC's budget. Although care must be exercised to manage and control these costs, it must be done in such a way as not to jeopardize excellence in patient care. One of the ways that Spectra Eye Institute has managed these costs is to assign the right staff members to the right tasks as discussed previously. Additional processes are noted below.

Flex time. The challenge is to better utilize staff during peak hours and decrease staff during nonpeak hours. Many staff members at Spectra, full time and part time, maintain varied hours according to the surgical schedule. For example, a staff member might work a 10-hour-shift on a busy surgery day, and a 6-hour-shift on a lighter day. “Flexing” allows better staff alignment by maintaining adequate head counts, all while reducing nonproductive hours and overtime.

Low census. Low census allows employees to take time off without pay at their discretion in the case of a decrease in staffing requirements. The nursing staff appreciates the increased flexibility.

EFFICIENCY REQUIRES TEAMWORK
To remain profitable, one must always be on the lookout for effective ways to increase revenue and decrease costs. Spectra Eye Institute has become a success story not because of the volume of patients but because of the entire staff's firm commitment to delivering outstanding patient care in an environment of stellar teamwork via an efficient and effective process.

Jan Amator, MBA is CEO/Administrator for Spectra Eye Institute in Sun City, AZ. She can be reached via e-mail at jamator@cox.net.

Pravin U. Dugel, MD, is Managing Partner of Retinal Consultants of Arizona and Founding Member of the Spectra Eye Institute in Sun City, AZ. He is a Retina Today Editorial Board member. He can be reached via e-mail at pdugel@gmail.com.