Surgical Symphony

Vantage Surgery Center’s well-honed efficiency, experience and collaborative culture keep its orthopedic service lines flowing ... and growing.

On a sun-splashed June morning, Outpatient Surgery Magazine Editor-in-Chief Jared Bilski and I, along with our photographer for the day, Manager of Audience Engagement & Digital Media David Comdico, pulled up to Vantage Surgery Center in Moorestown, N.J. Strategically situated amid the vast suburban South Jersey sprawl of the Philadelphia area, parking at Vantage was, not surprisingly, ample and free of charge. Patients entering the ASC face no substantial challenges accessing the surgery center’s ground (and only) floor.

That’s important because, every Monday through Friday, many of Vantage’s patients arrive for outpatient surgery with mobility issues. The orthopedic ASC, a 51-49 joint venture between Virtua Health and its physician-owners, performs a lot of robotic-assisted total joints, spine and a large amount of sports medicine procedures in three of its four ORs (a smaller OR is reserved for hand, wrist, foot, ankle and pain management procedures).

Entering the facility, the vibe is more “upscale hangout” than cold, sterile medical facility. The naturally lit lobby and waiting area is large, comfortable and calming.

The facility, which opened in 2019 to replace a smaller two-OR location, still looks brand-new and spotless, from the public areas to, as we soon found, the perioperative core. Even the locker room where we donned scrubs for a backstage tour was clean enough to eat a meal off the floor.

Consistent vision, high standards

JOINT ASSEMBLY LINE Vantage surgeons perform 80 to 85 total joints cases per month, with robotic assistance on most of them.  |  David Comdico

Upon arrival, we were greeted by the two people who make this center go on the daily: Director of Nursing Patricia MacMaster, RN, BSN, and Administrator Kathy Pritchard, RN, CASC.

Entering Ms. Pritchard’s office, we were met with our only indication of clutter — a byproduct of the seemingly unending stream of tasks that flows her way.

“I start each week with about 20 Post-its,” she says, pointing at a wall of yellow sticky notes and then more on her desk. “This was last week, and that’s how many are still on my desk from last week. I’m almost there.”

Ms. Pritchard’s pragmatic task orientation is deeply ingrained after nearly two decades running Vantage. “When Dr. John Gray started this, people including management companies told him, ‘Well, your administrator needs to do this, and your administrator needs to do that.’ He said, ‘I want my administrator to be wherever there’s a problem. If there’s a disgruntled family member in the lobby, I want her in the lobby. If somebody’s unhappy on the phone, I want her on the phone. If there’s a crisis back in the OR, I want her back in the OR. I want her to be a person who every physician or employee can feel they can come in and say, ‘I’m struggling today for this reason.’ That’s how he saw my position. So I just kind of evolved to that.”

Dr. Gray, who served as Vantage’s medical director until his retirement in 2022, approached Ms. Pritchard about running the center four years before the original facility eventually opened in 2006. “He wanted to build a center where patients would come back and say it was the nicest place they’ve ever been, and he wanted me to run it,” she says.

Although Ms. Pritchard had worked in orthopedics at a hospital for 25 years, she didn’t believe she had the necessary experience to run an ASC. “But Dr. Gray said, ‘We’re going to do it together. We’re either going to fail together or we’re going to succeed together. We don’t need to make a lot of money. I just want physicians to be able to come in and know they have a highly qualified, expert orthopedic staff.’” That convinced her to leave the hospital and dive into the unknown of starting, and then running, an orthopedic ASC. Ms. MacMaster then joined the team in 2008.

Ms. Pritchard is entering her 20th and final year at Vantage as she heads into a well-earned retirement. Given her strong sense of responsibility and affection for the center, she is doing everything she can to leave it in good hands for her successor. She’ll still worry about the center though, simply because that’s her nature. “I said, ‘If I come back here 10 years from now, this better be still going,’” she says.

Secret sauce

NERVE CENTER Administrator Kathy Pritchard speaks with OSM editors in her office, where stakeholders regularly come together to quickly and collectively solve problems when issues arise.  |  David Comdico

Ms. Pritchard says 21 surgeons operate at Vantage. They’re supported by a staff of nearly 60 full-timers and per diems, a flexible mix that Ms. MacMaster notes has been key to Vantage’s success.

Approximately 300 procedures are performed monthly at the ASC. Ms. Pritchard says that roughly breaks down to 80 to 85 joint replacement cases, five to 10 spine cases, 100 hand cases, 35 podiatry cases, 65 sports medicine cases and 35 to 40 pain management cases each month.

Patient satisfaction surveys confirm the center’s efficacy, with a 96.3% positive rate that is well above the national average and that has generated year upon year of awards. Outfitted in the requisite PPE, we saw the awards ourselves in the sterile core, along with a stack of copies of the most recent issue of this magazine and all kinds of performance improvement posters and reminders.

Ms. Pritchard attributes the rave patient reviews to steadfast adherence to Dr. Gray’s founding model, which encouraged the establishment of a well-oiled, motivated, skilled, dedicated team of professionals. “We have extremely little clinical turnover,” she says. “My clinical staff usually will choose who they want in their departments, but I interview everyone we hire and tell them I walk around and make sure people are living up to the mission and the vision we started this center with.”

Leadership at all levels is valued, and the team-focused approach to care is foundational to the success of Vantage. “It starts with really good leadership, and I’m not just talking about myself,” says Ms. Pritchard, lauding the team she has assembled on both the clinical and business sides of the center. “It’s the physicians wanting the team approach and echoing that to the staff, and leadership wanting that too. Everybody works together.

“We don’t always agree, so we’ll all come together, sit in this office and just kind of work a problem out and come out with a solution,” she says. “I think one of my gifts is the ability to pivot. If you ask me what I do every day, I have no idea. I just come in and I know I have tasks to do, but whatever walks through that door is what we handle for the day.

“I also see myself as very chameleon-like,” she says. “Physicians are very different. I have one who likes to come in and steal my candy because he’s diabetic, so I fill my candy jars up and he comes in here and takes all my candy. Some are very serious, so you need to have your ‘serious’ head on. One is extremely sarcastic and likes to leave little notes all over my board for me to find later. You just have to change with each person. I think that’s maybe what my secret sauce is.

“We live it every single day,” she says. “Everything is about quality. We don’t have a difficult surgeon here, and with orthopedic surgeons, that’s something. An orthopedic surgeon is a little different than a general surgeon from my perspective. There are so many tools and instruments and other things they need. They want to walk in and go, ‘I see Pat, I know everything’s here, I don’t have to worry.’ They don’t get that at multispecialty centers, necessarily. They don’t get that at the hospital. We’re very implant-driven. When they go in, they want to know they have all the components they need to do that total knee. They have so much confidence in this staff. I am very intense about the way people are trained.

“A lot of young people work for me, especially in pre-op and PACU,” says Ms. Pritchard. “Our hospital partner Virtua sent somebody from human resources here and she said, ‘How many people did you lose when everybody was paying so much money for travelers?’ We lost one person who had only been here for a couple months. We didn’t lose anybody else. She said, ‘Why do you think that is?’ Two of my younger nurses were there, and one said, ‘We call this our forever center, our forever job.’ So you just keep that going.”

Ms. Pritchard emphasizes the patient experience because she puts herself in their shoes, especially those with high deductibles. “I had an analogy told to me years ago that if you go into McDonald’s for dinner and it’s not good, you think, ‘Well, I only paid $15 for my dinner.’ But if you’re paying $200 for your dinner, everything better be perfect. I tell my staff that people are paying $3,000, $4,000, $5,000 deductibles to come in here, so they want everything to be like they’re at a five-star restaurant.

“I talk to every patient who comes in every morning,” she says. “They call me the Walmart greeter.”

Hi, robot

MASTERFUL LEADER Director of Nursing Patricia MacMaster has kept clinical operations humming safely and efficiently at Vantage Surgery Center since 2008.  |  David Comdico

Vantage acquired its first robot in 2017. It now has two.

“We run joints three to four times a week, six joints a day, depending on the week,” says Ms. Pritchard. “We bounce back and forth between two rooms.” She says use of the robots has become the standard of care over the last eight years, with only a handful of total joints cases performed each month without one.

We observed a few robotic total joints procedures during our visit. A lasting image is the ballet of efficiency, teamwork and coordination that occurred after each. As the patient was wheeled out of the OR, turnover teams of at least a half-dozen staff worked comprehensively, quickly and in perfect collaborative balance to clean and disinfect every surface without getting in each other’s way while equipment and instrumentation was transported in and out of the OR for the next case.

“What’s unique here is we have two core techs who help with room turnover and pick cases for us,” says Ms. MacMaster. “That was all done by nurses and techs in the past, but it was just too much to do. We also bring in one or two extra people to do breaks and lunches. We probably are overstaffed, but when you’re trying to turn over ortho cases, you need extra people or it would take twice as long to get the case in the room.”

Anesthesia Director Frank Iula, MD, chatted with us briefly between cases. Dr. Iula is a huge reason why Vantage’s service line runs so smoothly for both patients and providers. “He does great post-op pain blocks,” says Ms. Pritchard. “I’ve been doing this for a very long time, and I am still amazed to see our joints patients walking out almost pain-free because the blocks are so good.”

Filling big shoes

Shoulder and elbow specialist Raymond Ropiak, MD, has served as Vantage’s medical director since Dr. Gray’s retirement. The use of robotics for hips and knees at the center is still a bit mind-blowing to him. “Joint surgery has changed a lot since I was in training,” he says. “The robot wasn’t a thing. What my partners did with the robot is kind of a mystery to me.”

His more traditional training, like that of many of the surgeons at Vantage, serves him well when the robot is in use. “We still need to know how to get out of trouble if the robot can’t,” he says. “You still need that foundation of conventional surgery too, but what our surgeons can do with the robot and minimally invasive techniques is incredible.”

He feels similarly about his patients’ experiences at the ASC. “This place is definitely a patient satisfier,” says Dr. Ropiak. “We have a good team from check-in to recovery. The process from the moment they check in to the moment they leave is much more streamlined than any hospital. Everybody who works here is happy to work here, which says a lot. You’re much more visible here than at a hospital. You can’t be anonymous. People know who their providers are in a surgery center versus a hospital. The nurses are that patient’s nurse, from check-in to check-out, and they remember the staff.

“Our staff retention here is pretty remarkable,” says Dr. Ropiak. “We strive to make this a nice place to work, and people want to stay here.

“When I see patients post-op, I’ll ask them, ‘How was your experience in the surgery center?’ and it’s always positive, always thumbs up,” says Dr. Ropiak. “Sometimes they have some constructive criticism, but more often than not, it’s seamless from start to finish.

“That’s the beauty of this place,” says Dr. Ropiak. “This is the shining star where I still get to practice medicine. We get to pick our staff, pick our team, and it just makes it all so much nicer. When I’m comfortable with who’s scrubbing with me and I can just focus on what I need to do, it changes the game. I’m not knocking the hospital because I perform inpatient procedures too, but we have less control there, and when I have less control, there’s more that I need to worry about. I’d rather just worry about the surgery part, and not if this person next to me knows my steps or my surgery.”

He says the center’s performance has outpaced initial projections. “We got up to speed quicker than was projected, and we’ve almost outgrown it already, which is a testament to what our people have done,” says Dr. Ropiak. “We are selective, not only with our staff, but the docs. We’ll tell some docs, “Your patients maybe aren’t a good fit for us.’”

Adaptable spaces

Vantage’s “new” facility is now six years old, although to a visitor it looks like it opened yesterday. Dr. Ropiak says room for growth was baked into the original design, with rooms large enough to accommodate C-arms and robots for total joints and spine procedures, and a sterile processing area whose size and equipment anticipated high volumes. “And we’ve exceeded it,” he says. “As good as it is, we could use more storage space. The more cases we do, the more processing. It’s good growing pains.”

Dr. Ropiak says the center’s initial vision included private rooms for overnight patient stays. Due to the surgeons’ skill and Dr. Iula’s blocks, however, they’ve never been used for that purpose. “It was a good safety net at the beginning to say we can potentially keep people overnight if needed, but if you’re selecting the patients properly, they don’t want to be in the surgery center overnight,” he says.

Vantage has adapted its available space as needed. The original pre-op area largely sits idle, as pre-op was merged into what was originally only the PACU area during the pandemic, and the idea stuck. “We didn’t want to need to keep cleaning the original pre-op space over and over and over again,” says Ms. MacMaster. “When the pandemic was done, nobody wanted to go back to the old way, so we still do pre-op and PACU in the same area. Unless we’re super busy, the original pre-op side doesn’t get used very often, unless there’s a pediatric patient who needs to be segregated.”

When we toured these areas, we saw more cleanliness, organization and forethought. In pre-op/PACU, nurses had already set up for the next day’s cases. “This is all ready to go, so it’s one less thing to do in the morning,” Ms. MacMaster noted. Color-coded signs at each bay make it easy for individual surgeons to know where their patients will be. “The doc comes in and says, ‘Oh, here’s my first patient right here,’” says Ms. MacMaster.

We saw a restricted-access medications room and a physical therapy room with equipment for patients to practice walking up and down steps. When patients are ready to ambulate, they are led around the facility’s square configuration of hallways.

Notably, there are no beds in pre-op/PACU. “Patients come in and out of the OR on a stretcher,” says Ms. MacMaster. “We used to have beds, but we didn’t even use them, so we sold them. When patients start feeling their legs from the spinal and are ready to get up, we get them in a chair, and they have their own bathroom. All patients who have spinals need to void first. Then we walk them around the square to make sure they’re able to walk and that their walker is adjusted properly.”

Career opportunities

Many facilities are having a tough time finding sterile processing technicians. Vantage provides a good example of what’s possible in that search.

In the reprocessing area, among the wrapped sterilized trays and other gear, we encountered the facility’s hard-at-work materials manager, Colin Maher, who is also SPD-certified and helps out occasionally in that regard.

In the “clean” room, we encountered sterile processing technician Kevin Beza. “Kevin is a success story here,” says Ms. MacMaster. “He was working at a pizza place, and had worked with Colin there. We had a core tech position open and Kevin came in and interviewed for it.”

Leadership liked Kevin but ended up hiring someone else due to his lack of experience. But Kevin kept in touch with Colin, asking if there was anything he could do at the facility. He ended up coming in to learn the sterile processing trade from the facility’s existing techs.

“They showed him how to do everything,” says Ms. MacMaster. “After about six months, he took his SPD certification test and passed on the first try.”

What’s Mr. Beza’s favorite part of the job?

“It’s always busy, always moving,” he says. “There’s always something to do and I like to keep it going. It’s always something different too. We get a lot of loaner trays.”

Family affair

As we returned to the locker room to change back into our civvies, we encountered a per-diem staffer. He said he also works at hospitals, but this was his favorite place to work because of the inclusive and collaborative family vibe and the focus on the patient experience and safety.

His words, largely unprompted, were no surprise. They just reinforced what we saw all day. OSM