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February 10, 2015

3 Actionable Strategies for Surgical Growth

Surgery is critical to the financial success of most hospitals and medical centers, so it’s no surprise that growth in surgical volume is a key focus for most facilities. It is important for your facility to have specific, actionable strategies that take into account organization-wide initiatives and goals, rather than just chasing “general growth.” Once you have a growth plan in place, it’s time to figure out how to achieve it.

1. Operational Positioning for Growth

Three major areas need to be reviewed in order to position your facility operationally for growth: first, an analysis of existing capital planning; second, an analysis of staffing availability; and third, a review of these factors against room availability.


Capital Availability

Capital availability is vital to the success of each department. In order for you to know where your department stands, you need to conduct a very specific review of instruments and equipment needs for new surgeons and/or new procedures as they come on board. Capital priorities are particularly important for equipment and instruments that may not be readily available for different specialties.

In order to determine the need for various instruments and equipment, the department must first conduct a review of utilization, as augmenting existing equipment/instrumentation is just as important as reviewing new needs. To do this, a detailed analysis by surgical specialty and specific procedures needs to be compared against the schedule. This comparison will tell you if equipment/instrument utilization is adequate to support different types of procedures during open times. For example, this review might reveal that two blocks of open time on the schedule do not have C-ARM availability. This discloses limitations on growth and capital planning needs to increase existing business and to attract new business.


Staffing Availability

As is necessary with utilization and equipment, an analysis of staffing also needs to be conducted to better understand whether staff—full time or pool—are available to staff open rooms. At a basic level, this review will assist in understanding the staff availability and FTE implications for planning. However, facilities should also examine staffing constraints that exist based on staff skill sets. One particular area of focus should be specialty skills sets of staff scrubbing for cases. This skill set assessment will assist the facility in prioritizing recruitment and educational needs for staff moving forward.

The other facet of staffing is ensuring coverage for anesthesia. Conduct a similar analysis in conjunction with medical staff including a review of the contractual services agreement, if applicable.


2. Strategic Planning for Surgical Growth

In order to achieve the best outcomes for the facility, surgical leadership should develop a detailed strategic plan outlining growth opportunities. An overview of key areas of focus for this plan is outlined below:


Organic Growth

Organic growth represents the proverbial “low hanging fruit” in volume growth. The key to success in growing volume with existing surgeons working at the facility is establishing a positive working relationship with surgeons supported through operational efficiency and excellence. Leadership needs to take the time to meet one-on-one with existing surgeons (both high and low volume) to understand what barriers they think exist to operations at the facility. If surgeons are taking cases to other facilities, determine what actions and priorities would entice them to bring more of their cases back to your organization. These conversations will help inform the performance improvement initiatives and priorities that should exist within your department.


Employed Physicians

To increase case volume from your employed or academically affiliated physicians, it is imperative to develop a clear recruitment strategy with other key stakeholders at the organization. To start, ensure that surgical leadership has effective communication lines with strategy and physician management groups. Surgical leadership needs to assist in recruitment strategies by having both a strong understanding of operational preparedness for growth and analytics focused on volume and revenue drivers. At that point, surgical leadership should be assisting in the decision-making process for specialty recruitment.


Attracting Community Providers

When recruiting new non-employed surgeons, it is important to make sure that they are a good fit for your organization. Use the following information to help you target the right surgeons from your community:

  • Work on your value proposition—Why should they come to your facility over others? Some key focus areas might be:
    • Open time
    • Staff skill levels
    • Outcomes
    • Amenities
    • Patient satisfaction
  • Ensure positive outcomes from trial cases—When a surgeon brings a few cases to your facility to see if it is going to be a good fit, of course you want to make sure it goes smoothly.
    • Notify and prepare organizational leadership and staff members for new physicians. This applies to more than just the staff scrubbing for a case. Because a new physician and his or her office staff may be unfamiliar with the processes at your facility, some handholding must occur. This is to ensure that key interfacing departments provide an excellent experience for the physician as well as his or her staff and patients. This includes scheduling, patient access/registration, anesthesia, materials, sterile processing, etc.


Building Your Referral Network and Improving Referral Rates

While building strong referral networks is most impactful for employed physicians, it is also relevant to community surgeons that perform cases at your facility. A strong primary care network (whether formal or informal) can help drive cases to your facility. Assuming there are independent primary care networks within the hospital community, the health facility should reach out and discuss its capabilities with them on a regular basis.

To begin the process, define the groups your facility wants to work with. Next, as previously discussed, define your value proposition. The proposition is going to be slightly different than the one you would use for recruitment because you are not only talking about your facility, but also about the surgeons who practice there. In some cases, it may even be appropriate for surgeons to be involved in those conversations to discuss their own capabilities.

3. Ensure Access to the Surgical Schedule

Operational preparation and strategic planning help position facilities for growth, but the final factor affecting volume growth is schedule availability. A detailed review of schedule availability using the information on equipment/instrumentation and staffing that were previously analyzed should be completed. Use the following as a checklist to help ensure an appropriately open schedule:

  • Review block scheduling to determine the following:
    • Whether there is adequate open time
    • What utilization your facility currently has (i.e. block utilization by physician and room utilization as a whole)
      • Block scheduling: Where open time could come from if the facility does not have enough availability
      • As a rule, community hospitals typically strive for 70 percent or less block time, while academic medical centers aim for 80 percent or less
  • Make sure open time is truly available
    • Practices like “unofficial” block times, inappropriate gatekeepers, and onerous approval processes can create artificially closed schedules

Next Steps:

If you have additional questions related to growing surgical volume at your facility, or if you would like to engage Soyring Consulting in the development of strategies to improve your Surgery Department, please contact our team today. Click to learn about Soyring Consulting’s Surgery and Strategy services.

About Soyring Consulting:

Soyring Consulting provides clinical and managerial consulting services to healthcare facilities. Our team has worked in more than 35 states across the United States on healthcare system, hospital, and department-specific projects. By combining our experience, proven knowledge, and time-tested skills, we work with your team to identify targeted opportunities along with plan development and implementation.

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