Behind Closed Doors: Baptism by Fire — and Paperwork

The diary of a new, oh-so-unprepared ASC leader.

When I took the job as clinical director of an ASC, I imagined myself as a visionary leader who ensured patients and staff would thrive in a perfectly coordinated dance of healthcare excellence.

Truth is, I had no idea what I was doing.

For all my grand thoughts about visionary leadership, I actually spent my first week as an administrator trying to figure out how to change the toner in the copier and work the coffee maker.

Nowhere in the job description did it state that by accepting the position, I would automatically become part CEO, part therapist, part IT support, part janitor, and an HVAC and generator technician.

I’ve learned that this job is a unique mix of responsibilities. One minute you’re reviewing compliance protocols. The next, you’re plunging a clogged toilet because, apparently, no one else is willing to do it.

My first meeting with the surgeons was terrifying. They greeted me with expressions ranging from mild skepticism to outright amusement, as if they were betting on how long I’d last. When they would ask me questions, I’d think, “I have no idea” or “How the h$ll am I supposed to know that?” The surgeons would always follow up their questions with “Well, you’re the expert...” This made me cringe inside because I felt like a fraud. I wasn’t an expert; I was just a nurse who took a job bigger than I was prepared for.

I will say this, though: The blind confidence our surgeons had in my abilities motivated me to immerse myself in learning everything I possibly could about running a surgery center so I could become the type of leader who didn’t cringe at the “You’re the expert” refrain.

No one fully appreciates how much paperwork an ASC generates until they’re buried under it. I need to plant some trees to pay Mother Earth back. Between state regulations, federal guidelines, insurance requirements and credentialing documents, “death by regulations” should be an approved diagnosis code.

Speaking of regulations, nothing spikes your heart rate like a surprise visit from an accrediting body. One moment I’m laughing with my nurses about the items I incorrectly ordered, blissfully unaware of the impending doom. The next, I’m speedwalking through the facility, frantically whispering, “Where are the logs? Where are the logs?!” like a lunatic.

ASC leadership is an exercise in constant crisis management. Equipment failure? “No problem, we have a back-up plan.” Staff member calls out at the last minute? “We’ll adjust the schedule; this is why we cross-train staff.” A patient insists they were supposed to have their left eye operated on when the chart clearly says right? “Let’s triple-check before rolling to the OR.”

During crisis moments, I’ve learned to stay calm and collected on the outside, while on the inside I’m crying, praying and contemplating my life choices. The art of it is that nobody knows this but me, and maybe my primary care provider who checks my blood pressure.

Despite the chaos — and occasional tears — there are always exhilarating moments that make it all worthwhile. The time we shaved three minutes off room turnover due to a process improvement? Score! Winning a patient safety and financial management award? Gold star! (Although my husband still doesn’t believe the part about financial management!) Seeing a patient walk out smiling, pain-free and with improved vision just a few minutes after surgery? That’s my Stanley Cup.

Sure, there are days when I fantasize about becoming a lifeguard on a beach in the Caribbean, gazing at crystal-clear aquamarine water while perfecting my tan and achieving a Zen-like state of relaxed bliss, but who doesn’t? Despite the stress, paperwork and occasional plumbing emergency, I love this place. If I survived my first year as an ASC administrator, I can survive anything. OSM