Administrator: Frank Shobe
Physician Executive: Larry Teuber, MD
Types of surgeries: neurosurgical, orthopedic, general, gynecological, ENT, podiatric, plastics
Staff: 230 - 98 nurses; 16 surgical techs; 3 radiological techs; 7 CT/MR techs; 2 orderlies; 18 inventory/support; 29 business office; 3 transcriptionists; 2 schedulers; and 10 receptionists
Procedure rooms: one (includes pain clinic)
ORs: 8
Operating surgeons: 52
Monthly case volume: 500 to 600
Years in operation: 6
Ownership structure: LLP

The allure of Black Hills Surgery Center, a surgical hospital in Rapid City, S.D., is in its wide range of healthcare services - and long list of lavish non-healthcare amenities.

There are on-site hospitalists, open MRI, an e-signature system surgeons use to sign dictation with an on-site computer system and high-field imaging. The imaging center provides reports that are read, transcribed and faxed to physicians in less than two hours. OR turnaround time is between seven and 10 minutes, and the RN-to-patient ratio is 1-to-3.

The list of extras for patients is long, too: Catered meals come on silver platters accompanied by a rose and gourmet chocolates; overnight rooms are private suites and include DVD players, high-speed Internet connections and pull-down beds for family; and cappuccino, espresso, beer, wine, comfortable bathrobes, fresh flowers and limousine or courier service are available.

"To succeed in an area that had been dominated by [the regional hospital], we found it necessary to become innovators, to provide a host of firsts to the area," says patient-relations director Debbie Mertes.

"What we did was identify two areas of focus: everything neutral or positive the hospital did, and everything the hospital did that upset its customers," says physician executive Larry Teuber, MD. "We identified problems and solved them with good execution, and we have good, loyal customers - patients and physicians."

Taking all comers
If you listen to the hospital lobby in Washington D.C., you might think specialty surgical hospitals only cherry-pick profitable cases, leaving community hospitals to foot the bill for patients who can't pay.

But it's not always the case.
"We have never turned away a case because of inability to pay," says Ms. Mertes. "We provide the same pampering to all patients, including Medicare and Medicaid patients."

The reason Black Hills can do this is simply efficiency, says Dr. Teuber. Because the facility bargains hard on equipment prices, keeps turnover times to a minimum and patient satisfaction to a maximum, it can serve "everybody who walks in our doors."

"It's like a grocery store," says Dr. Teuber. "If you manage one, you know products will go beyond shelf-life, people will break or steal items, and checks will bounce - it's part of any business, and we manage accordingly. What makes anyone think that simply being in healthcare entitles you to get paid for everything you do?

"Hospitals waste money on board retreats, huge boardroom tables, unproductive middle- and upper-level management and forming committees, and that's why they lose money."

Cross-pollinated healthcare
The philosophy that underlies all Black Hills' operations is based in service industries.

"We cross-pollinate with the best of other industries," says Dr. Teuber. "And we have just one pre-requisite in hiring officer-level staff: They can have no experience in healthcare. We hire people with hospitality, food-service and financial-services experience. We send our senior managers to the Ritz Carlton program."

This culture manifests in the amenities and healthcare services - but those stem from Dr. Teuber's constantly encouraging staff to devise ways to change the facility and service.

"We'll brainstorm only to see what we can change," he says. "What about uniforms - why don't we do something different? Can we change colors, textures, smells, tastes of food, sounds of hallways? A lot of what we do is philosophical, but you just put it into experiences you can touch and feel. If we do execute a bad idea, we identify it and drop it."

Staff excellence
Finding good clinical staff is "so easy, you can't believe it," says Dr. Teuber. Instead of spending thousands to advertise for open positions, then hire and train clinical staff - only to find they're not a good fit - Dr. Teuber simply asks current employees who they'd like to see come from the hospital. The current staff member gets a finder's fee, and the new staff member gets a sign-on bonus.

"You can spend $3,000 to $5,000 recruiting and training," says Dr. Teuber. "Or you can be sure you're getting quality players and spend it in a bonus. It's like professional sports; we cannibalize the hospital. That's where we get our best staff."

On top of competitive salaries and benefits, RNs are offered the state's best RN-to-patient ratio. Physicians are strictly reviewed in-facility, and any of their medical errors at another facility must be reported within 24 hours.

- Stephanie Wasek