Executive director: Tom Mulhern, MBA, CASC
Nurse manager: Kay Beaudett, RN, BSN, CNOR
Head nurse: Helenann McCloskey, RN, BSN
Types of surgeries: General, colonoscopy, endoscopy, laparoscopy, podiatric, orthopedic, ophthalmology, urology, pain management, plastic, ENT, GYN, cystoscopy
Staff: 38 - 27 RNs; 2 LPNs; 1 OR tech; 3 nurse assistants; 5 office.
Procedure rooms: 1
ORs: 4
Operating surgeons: about 30
Monthly case volume: 700
Years in operation: 15
Ownership: 30-physician group

When the nursing staff at Limestone Medical Center's ASC talks, Tom Mulhern, MBA, CASC, listens. "I do what I'm told," says the executive director, only half-kidding. "The nicer way to say it is that we run the company upside down. They're in the trenches - they see what's going right and what can be improved. [The administration] listens and we implement."

You could write his management philosophy on the blade of a scalpel: "Good idea. Done." An example: When Nurse Manager Kay Beaudett, RN, BSN, CNOR, and her staff petitioned Mr. Mulhern for a staff lounge, the vacant doctor's office across the hall wasn't vacant for long.

Another example: When patients were ready to be released, often their rides would still be at the nearby mall running errands. So the reception staff would spend time trying to call the person to come back to the surgery center, tying up the front desk, slowing down recovery room turnover and, ultimately, making patients in reception wait. So an RN proposed that patients' rides should not be allowed to leave the ASC until the patient is ready to go home. Three days later, it was policy.

"It's our policy as of today," says Mr. Mulhern. "With an ASC, there's no red tape and there are quick decisions, because the [physicians] who make the decisions work here."

Long haul
One of the reasons Mr. Mulhern has confidence in his staff's problem-solving abilities is the fact so many nurses have been there several years, and six have been there at least 10 years. "I don't even have to ask staff to pitch in; they just see a job that needs to be done and they do it," says Ms. Beaudett. "I just have to troubleshoot and make sure things go smoothly."

But getting and retaining good nurses has been a challenge. "They've got to be a fit for us," says Mr. Mulhern. "But we have to strive to be a good fit for them, too. It's incredible, the needs people have, and you have to find creative ways to meet those needs and the organization's needs. That's what keeps people here even though, on balance, the hospitals pay more."

There's flex-time, and if a staffer needs to cut down to part time, Mr. Mulhern will help arrange it. "A lot of us are working moms," says Helenann McCloskey, RN, BSN, Limestone ASC's head nurse. "And I don't think we sacrifice either home or work. I could never have had three kids when I worked in the hospital."

Being first
When Limestone Medical Center was built in Wilmington, Del., in 1985, it was a veritable cornucopia of medical services, with physicians' offices, a medical aid department, a blood draw lab and an X-ray and imaging lab all in one place. A couple years later, Limestone's physician owners moved to add an ambulatory surgery center to the mix - the first ASC in Delaware.

"We were the first heavy political struggle," says Ms. Beaudett, who has been with the facility since it opened in 1988. "There were ASCs [nationally], but Delaware had never experienced one before."

Limestone ASC has been through three significant expansions to meet the ever-growing demand for outpatient surgery services. And recently, along with Delaware Surgery Center (Dover, Del.) and Glasgow Surgery Center (Newark, Del.), Limestone started the Delaware Surgery Center Association (DSCA).

"The state is getting used to it now," says Ms. Beaudett. "All the hospitals have their own ASCs because they're more efficient and better for the patient. They probably still look at us as competition, but they're starting to see there's enough business to go around."

A purchasing group
Part of the goal of forming the DSCA was to find a group purchasing organization (GPO) for member centers. The three member ASCs auditioned four buying groups, according to Mr. Mulhern, and conferred on each GPO. The idea is to find a "surrogate purchasing manager," says Mr. Mulhern. "I want to relieve some of the clinical staff of inventory management, and instead of bringing someone in-house, we're going to outsource it." Limestone chose Purnet and HPPI to barcode all medications and supplies at Limestone ASC and to take care of purchasing agreements, respectively.

"It will cost us a flat fee every month, but purchasing is a big headache," says Mr. Mulhern.

Right now, as the barcoding system is being implemented, there is some chaos, but Ms. Beaudett expects that this will be the best move for the long term. "Soon, we'll just make one call to Purnet, and everything will be taken care of," she says.

- Stephanie Wasek