Q I'm an RN in a hospital outpatient surgery unit. Our hospital has just built a freestanding ASC in partnership with 30 physicians in a 51-49 agreement. We're being urged to apply and transfer to the new ASC if we want to be assured a job. It's projected that half of the hospital's outpatient volume (about 600 cases per month) will go to the new center. What's been your observation of the effect new ambulatory centers have on staffing of hospital outpatient surgical units? We want to make an informed decision but this concept is new to us.

A I'd probably move to the ASC, which is a very different environment from the hospital. Even though you do outpatient surgery now, you're still in the hospital. In an ASC, you usually cross-train to lots of areas, and that will give you a new focus on nursing. You can also get involved in CQI, safety, infection control and risk management.

An ASC's hours are usually good, with no call and no weekends. The salary might be slightly lower than a hospital's, but the working environment is usually much better. Keep in mind that the new ASC likely won't have an immediate effect on the volume of cases at the hospital because the doctors might not want to split their time between the two sites. This usually complicates their schedule - unless the ASC gives them very good block times.

Before you make your decision, I'd get answers to these two questions:

• If you move and you don't like it, will the hospital let you come back?
• Will you lose your accrued benefits and seniority if you move?

When to Hire Staff

Q We're building an ASC and were wondering when we should we hire the staff.

A Assuming you're using an operational development, here's the timeframe for hiring staff:

Benchmarking's Magic Number

Q How many cases should I include from our center in a benchmarking study on a specific procedure?

A The answer depends on several things. How long is the study going to be conducted? How many cases of that procedure do you perform, on average, during that time frame? How many other centers are involved in the benchmarking study, and how many cases will they perform during this period? Most experts agree that at least 30 cases are needed before you can achieve reliable results. However, the more cases you can realistically include (depending on your resources), the more meaningful the results.

Reward the Team or the Individual?

Q Should our incentive plan reward the entire staff or individual employees?

A I recommend a two-tier bonus plan that measures the overall performance of the center as well as the individual performance of the employee. The idea is to create a plan whereby the entire staff is rewarded if the center meets certain performance targets such as meeting or exceeding budget for the period. Further, the plan also should evaluate the performance of the individual employee on the basis of certain key attributes such as attitude, communication skills, technical skills, teamwork and patient and physician satisfaction. In other words, the plan rewards employees and aligns their incentives with the policies and culture of the center. If the bonus plan is set up properly, it will assist in retention of key employees as well as reward the staff for center performance as well as individual performance and serve to?align the?staff with the owners and management of the center (see "An Incentive Plan Where Everyone Gains" on page 16).