Sometimes I think the doors to my ORs should be revolving instead of hinged. As the nurse manager of ambulatory surgery at the Medical University of South Carolina in Charleston, I deal with nearly 40 different surgeons - including at least one or two new docs - each month.
I am not an expert in hospital-physician relations, but I feel that strong people skills are essential in the heavy volume setting of a hospital outpatient department. Whether they're familiar faces or infrequent visitors, surgeons are VIPs in your hospital. Your ability to cater to their needs will go a long way to securing cases that might otherwise be performed at the local ASC.
Let's face it: Making every surgeon happy is as likely as your day going exactly as planned. But here are some tips and tricks I've collected over my many years of HOPD management to help ensure that the doctors who bring cases to your facility keep coming back for more.
Play the match game.
Some personalities just don't mix and others mesh really well. It takes a certain amount of finesse to recognize this fact when making your daily surgical assignments. I guarantee that you can immediately name combinations of surgeons and nurses who pose more of a combustion threat than your OR's electrosurgical unit. So can I. When I look at the surgical schedule, I avoid putting a nurse in the same room with a surgeon I know she'll clash with. On the other hand, I'm aware of nurses who have the personalities to calm uptight physicians. Take a few minutes every evening to ensure the next day's OR pairings are set up for personality matches. I also talk to the hospital's main OR manager several times a day. If he tells me a surgeon had a rough time on the day before he's due to operate in my HOPD, I make sure the nurses I schedule for his room are able to handle a potentially cranky physician. The same goes for the relationships between surgeons and anesthesiologists. I spend time with my medical director to gain insight on the relationships between these two groups. By making an effort to communicate with the various departments of your hospital, you'll ensure that surgeons are paired with a surgical team that will work with, instead of against, their personality.
Meet and greet.
Get to know surgeons as soon as they enter your facility. This will not only make them feel welcome in new surroundings, it will also let you establish an open line of communication. Ask them ice-breaking questions. Where were they trained? Where are they practicing? Open up your instrument trays and show them to the new surgeons. Do they include items he uses? Rolling out the informal welcome mat will likely be done at the scrub sink or in the hallway, so get out from behind your desk and be ready to shake some hands. Meeting and greeting is a great way to gauge a physician's personality, but it will also let you observe how surgeons interact with the rest of your staff. Watch a surgeon first thing in the morning. Did he show up on time? Does he have a cup of coffee with the staff or does he keep to himself? How does he interact with your nurses and anesthesia team at the scrub sink? One more thing: Take note of how a surgeon is dressed. If he's in scrubs and a white lab coat, as is our hospital policy, then I know he'll play by the hospital's rules.
Be readily available.
If a surgeon tells me he's having a hard time getting his cases booked in my department, I hand him a business card that contains my beeper number and e-mail address. Even though you work in an ambulatory surgery setting, consider yourself on call 24/7 to answer surgeons' questions and to help get their cases on the schedule. I've received calls at 8 p.m. from docs asking me if they could bring a case in the next day. I try to say yes every time, but even if I can't accommodate their wishes, surgeons appreciate the fact that I make myself readily available and easily reached.
I open up our department every morning at 5:30 a.m. And by opening, I don't mean I sit behind my desk with a coffee and the newspaper. Arrive early and use the time wisely. I check the day's procedure list and my experience lets me recognize potential problem areas in the schedule. If I realize a surgeon won't finish his scheduled cases on time, I'll work with my director of anesthesia to start the day's cases as soon as the first of my surgical staff arrives at 7:00 a.m., instead of a normal 7:30 a.m. start time. I can't tell you how appreciative surgeons are when we take the initiative to recognize a potential problem, and then take the steps as a team to solve the issue before it happens.
Help the main OR.
Consider offering your staff's services to the hospital's main OR. Our department handles emergency ophthalmology cases for the entire hospital. We started handling the cases when the nurses in the main OR didn't want to learn about ophthalmology and my staff didn't have a huge urge to teach them.
Except for a few cases - detached retinas or inflammation of the iris - most ophthalmology emergencies can be dealt with the next morning in our surgery center. When emergencies that can wait until the morning come into the main OR, patients are kept in an observation unit overnight. A surgical resident alerts me at home and I'll coordinate with the on-call staff to perform the cases at 6:30 a.m. the next day - an hour before our regular procedures are scheduled to begin.
Pitching in to help the main OR does wonders for my department's standing in the eyes of our hospital's physicians. The ophthalmologists are thrilled because they work with the same staff in the same room for emergency cases; our hospital's anesthesiologists also love the policy because patients are NPO for at least six hours and they don't have to deal with emergencies throughout the night. My staff also likes the policy because instead of performing procedures after hours, they're able to get a good night's sleep and come to work refreshed in the morning.
Pad your schedule.
One of the biggest power plays I encounter with surgeons is over H&Ps and surgical consents. These pre-admin essentials are especially important in a hospital setting because patients may be placed on different medications or doctor's orders during a separate visit. The problem I encounter, however, is that physicians don't like to waste office hours on getting these done, but instead want to perform them the day of surgery.
Since I am aware of this all too common practice, I have a policy of getting patients in a half-hour earlier than normal on the day of surgery. During that time cushion, patients meet with the anesthesiologist, lab work is done if needed and my nurses piece the elements of an H&P together. By giving myself an extra half hour on the front end of every case, I save my department countless headaches and delays on the back end, and do so without directly confronting a surgeon.
The secret to success
Dealing with some surgeons is like dealing with a stubborn teenager who is set in his ways. I spend a lot of time with my charge nurses when issues arise. We ask ourselves whether we want to fight this battle. In most cases we attempt to work with, rather than against, a surgeon.
Your primary focus is of course on patient care, but ensuring your hospital's ambulatory surgery department is set up to please surgeons will ultimately determine its success in the ultra competitive outpatient surgery market.