Ophthalmology Business

MAY 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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A s the administrator of an ambulatory surgery center (ASC) and executive director of a five-location professional practice, increasing efficiency is a top focus for me, as it is for our doctors. In our ASC, we have identified a number of ways to keep things running as smoothly as possible. 1. Optimized scheduling With the recent addition of a femtosecond laser to our ASC, we have shifted the emphasis away from how many cases per hour we are able to complete. The femtosecond allows us to actually slow down a little bit, while still maintaining a good level of productivity. At the same time, we have looked at ways that we can schedule procedures most efficiently and predictably for our surgeons. We now have a goal of a 50% conversion rate for the femtosecond laser, which allows us to float the surgeons in a pattern in which they always know where they're going. With this pattern, surgeons transition back and forth consistently between performing traditional phaco and femtoassisted phaco. 2. Team flexibility Our ASC used to be very rigid in the way we scheduled patients and the processes we used to check them in and care for them through their surgery. We assigned a preop nurse, a postop nurse, and a floater each day, who had their own defined responsibilities. While this system meant that each nurse knew exactly who was responsible for which duties, it also occasionally led to what we called "Lucy moments," which refers to the classic episode of I Love Lucy in which Lucy and Ethel couldn't quite keep up with the chocolate conveyor belt. With this system, a hiccup in one part of our "conveyor belt" could disrupt our processes both downstream and upstream. Now, we have transitioned to a much more flexible and fluid schedule, and have trained our staff to work accordingly in order to avoid those "Lucy moments." We still have three nurses on staff each day, but each nurse is cross-trained for any necessary duties and can help patients at any point in the process. Using this approach, if a patient changes his mind about a lens or a procedure on the day of surgery, we are better able to make changes swiftly and keep the process moving. We ask our staff members to think on their feet, communicate among themselves, and work as a team in order to meet the challenges of the day. When problems occur, the nurses are able to step in to help their teammates, as opposed to being tied to one single assignment. This system functions well in our two-OR practice. We still assign scrubs for each day, and we also have assigned nurses in each of the ORs, but the other nurses know that their job is simply to clock in at the beginning of the day and provide patientcentered care, wherever it is needed. 3. Streamlined paperwork We ask our doctors to bring a "cheat sheet" on each patient having surgery, which includes all of the basic information that OR staff need to quickly access on surgery days. This cheat sheet is hung on the base of each bed, where it is easily accessible for quick reference and time-outs. We find this to be a great timesaver, keeping all of our need-to-know information within easy reach. We also ask each patient to bring a complete health history and physical to the facility, which allows us to simply recheck the information instead of having to fill it out for the first time. There is no more waiting for patients to root through purses looking for pill bottles or to make phone calls for information. 4. Smart outsourcing Every practice likely sees patients who are high risk, have special needs, or are not able to travel far for surgery. It is of course vital to provide these patients with the best possible level of care, which we sometimes determine would be better provided in a hospital setting than in our ASC. When we decide this, we are still able to arrange for our surgeons to have continuity in their technology and to provide the same high level of service we provide in the ASC. We contract with Sightpath Medical (Minneapolis) to provide our surgeons with the same surgical technologies they are accustomed to using in the ASC. Sightpath brings its mobile equipment to the rural hospitals in communities where we serve patients, or to our local hospital to treat high-risk patients, and the service is paid for on a per-case basis. With this arrangement, we are able to treat high-risk or special needs patients in a hospital, which not only better serves their needs, but allows us to keep the ASC running most efficiently with more standard cases. We have seen excellent results using these four approaches to optimizing efficiency. By refining our scheduling, empowering our staff, simplifying paperwork, and taking advantage of outside services, we are able to focus our attention in the ASC on providing the best possible care for patients. OB Dr. Cwiak is executive director, The Vision Companies, Louisville, Ky. She can be contacted at sarahelizabethcwiak @gmail.com. May 2013 • Ophthalmology Business eZine 19

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