What Can Football Teach Us about Surgery Center Management?

3 Essentials for ASC Improvement From Joe Zasa

By Rachel Fields
This article is reprinted from Becker’s ASC Review

“As I watched Alabama win this year’s national championship in college football as well as the national championship in 2009, it struck me how similar running a surgery center is to coaching a football team,” says Joe Zasa, co-founder of ASD Management. Mr. Zasa grew up in Birmingham and attended the University of Alabama, an institution with an abiding love of football and a storied past in the sport.

“I have had a particularly unique window with respect to the football program, and particularly the head football coaches, from Bear Bryant to the current coach, Nick Saban,” he says. “Over this time, Alabama had three very good coaches and several mediocre coaches. There are similarities between the coaches who succeeded.”

According to Mr. Zasa, the “rule of three” applies to both sports programs and to business. The most successful programs have:

1. A system. Establishing a system of operations is the core of a surgery center and a sports program, Mr. Zasa says. “The next time you watch Monday Night Football, listen to the starting lineup,” he says. “You will find that most of the players did not play on championship teams, or even the historic great college football programs. They were excellent players in mediocre systems.”

He says the system for a surgery center has three components: 1) clinical systems, 2) business office and 3) risk management. Each area of the surgery center must have a strict adherence to center culture and strategic direction in order to succeed. Mr. Zasa says when his company approaches a surgery center in need of a turnaround, the problems often lie with systematic failures. For example, the surgery center may not load their contracts into a computer system to track their accounts receivable. The supply area may look like a McKesson warehouse — full of supplies that will never be used but have already been purchased, effectively throwing money away. Employees don’t have a defined process for doing their jobs, so they end up dropping claims and forgetting to follow up on collections.

The surgery center should have a pervasive culture that touches every area of the facility, Mr. Zasa says. This doesn’t just mean purchasing and printing out generic policies and procedures for a small business; it means truly understanding how each role in the ASC contributes to profitability and advising staff members on how their tasks should be performed. Staff members should know how to answer the phone, how to drop claims and how to audit processes to track progress. Mr. Zasa says the surgery center should also have an employee bonus program in place that provides tangible financial rewards for good work. The bonus program should not be a “guessing game”: Employees should understand they will reap exactly what they sow.

2. Recruitment. According to Mr. Zasa, the Alabama football program has had a top five recruiting class for the last five years — and they have won two national championships. “This is not a coincidence, but it is a mistake to believe that recruiting players is the solution,” Mr. Zasa says. “You must have a superior system and superior execution.”

This doesn’t necessarily mean recruiting “stars” if they won’t work with the other members of the surgery center, Mr. Zasa says. “We spend a lot of time with staff members, and we have pre-screening tests to make sure they’re a good fit for the center,” he says. While a small surgery center can’t necessarily implement full-time training for each employee, Mr. Zasa says it helps to have regular on-site training and presentations about the center’s culture.

Physicians and anesthesia providers should be similarly recruited to work within the “system” of the center, he says. Anesthesia groups should be able to turn rooms quickly, choose appropriate drugs for the surgery center and have a strong interest in the quality aspects of the ASC. “You want anesthesiologists and CRNAs who have an interest in outpatient surgery,” he says. The same is true for physicians: Every physician recruited to the center should fit within the center’s strategic plan, bringing a needed specialty and an eye towards quality improvement. The physician should also get along well with the other providers at the center.

3. Execution. Execution is about completing a series of small tasks that create success in the long run, Mr. Zasa says. A football team can’t win a championship just by thinking about it; the team has to run drills during every practice and concentrate on every individual play in order to succeed. Your surgery center might have a good system and great players but fail because of poor execution, Mr. Zasa says.

He says execution comes down to what your staff does on a daily basis. The big picture is useful to keep in mind, but every staff member should primarily be focused on his or her daily tasks. If a team member is distracted by thinking about their upcoming vacation or a fight with their spouse, they will jeopardize the success of the ASC just as a football player would jeopardize the potential to win. “Every day, your staff should be thinking, ‘This is the job I need to do today,'” he says. “It’s about focusing on what’s important now.” Over time, completing those small daily tasks will add up into long-term success.

Reprinted with permission from Becker’s ASC Review.
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