In the 20 years that I've managed surgical facilities, I've dealt firsthand with the difficulties administrators face when they make the move from a hospital (usually the OR or PACU) to a freestanding ambulatory surgery center.

At first, there's a brief honeymoon period. Weekends off. Holidays off. No shift work. Piece of cake, right? Wrong. The transition can be much more difficult than meets the eye. Just as your staff with hospital experience must embrace the "ASC mentality," so, too, must new surgery center administrators.

The hospital mentality
Hospitals are often bureaucratic and multi-disciplinary. From an administrative standpoint, virtually everything you need is at your disposal. If a computer isn't working, you call the IT department. If OR equipment goes down, there is a bio-medical staff at the ready.

Just as importantly, entire departments are devoted to handling such key administrative functions as budgeting and scheduling. Human resources does the hiring. The accounting or finance office dictates the budget. Need relief staffing? You have floaters from other departments, second- and third-shift personnel and on-call staff available.

In the hospital, the name of the game is clinical or technical competence in your own area. Many newly hired ASC administrators have never actually managed a practice from top-to-bottom. It's a whole new ballgame.

The ASC mentality
In the ASC, the manager is responsible for all aspects of the facility's operations. The lack of a backup is the single biggest challenge. You won't find a biomed staff, infection control department or human resources office. Those tasks are now your responsibility. Staffing is on you - and your available personnel for meeting your core requirements is a lot more limited.

Moreover, you may also be the business manager. The buck may stop with you in terms of determining the budget. You'll be the one marketing the facility to surgeons, trying to convince them to bring their cases to your center.

Success in the ASC depends in large part on your approach to customer service. That's what really sets the two care settings apart, because there is comparable clinical competence in both. In the ASC, however, the patient always comes first.

As administrator, you will be telling staff that they cannot leave as "scheduled" at 3 p.m. because there is a family still waiting for a loved one to come out of PACU, another case is running long in an OR and there is no one to "take over." Moreover, no task is beneath any employee, including the manager. The administrator could be mopping floors, making coffee, taking a patient's blood pressure, filling in at reception and accepting a late add-on case - all within the course of an especially hectic day.

You also need an extraordinary amount of flexibility and tact to determine the surgical schedule, juggling requests for time off, capital equipment requests from your docs, and managing part-time and full-time staff. You're also the one who cajoles your higher-ups to accept the investment of time and capital needed to cross-train staff to cover other areas of the facility.

Sharpening ASC managerial skills
As you go along, you'll get used to the frenetic pace of managing an ASC. Experience is always the greatest teacher. However, networking and continuing education are also indispensable tools. There are many others out there who share these common experiences and can provide you with the benefit of their wisdom. Reach out to them.

A marvelous way to improve as an ASC administrator is to become active in your state's ASC association and attend national meetings such as AAASC and FASA. There are also many things you can do that don't cost a cent. Talk with your fellow administrators and don't be afraid to admit you don't have all the answers to the various problems that arise at your facility. Commiserate with colleagues on list serves such as AORN: Membertalk. Many of us have also come to the ASC via the hospital and have dealt with the same adaptation issues you have. We're all in this together.