My Turn: The Many Hats You'll Wear in an ASC

If you're like most surgery center administrators, you started out as a hospital OR circulator, an apprenticeship that didn't come close to preparing you for all the hats you'd wear and balls you'd juggle as the chief cook and bottle washer at a freestanding ASC. You're probably still trying to wrap your head around the impossibly long list of clinical and administrative responsibilities. We don't have space to name them all, but you have to know a little bit about a lot — from procurement to phlebotomy, risk management to medical records, credentialing to accreditation, infection prevention to preventative maintenance, education to equipment coordinator, QI to QA, and HR to HIPAA. And when you've got a second to spare, they could use a hand in pre-op and PACU.

I've been at this probably longer than you have. When I left the hospital and started my ASC career in the late 1970s, there wasn't an ASC in every strip mall. Alternative-site outpatient surgery was just an up-and-coming novelty. I thought I was hired to be an OR circulating nurse, but suddenly I was responsible for about 20 different tasks. It was sink-or-swim, multi-tasking time.

You can have all the titles and responsibilities in the world, but you must be given the time to do them. It is difficult to serve two masters, clinical and administrative, but it can be done. There are no how-to books for some of your duties — you'll just have to learn on the run. Others require some background training or certification, such as administering conscious sedation or serving as infection prevention officer. Earning a CIC (Certified Infection Control) certificate is a plus, and in some states is required.

Create algorithms to meet and track deadlines. Some websites will send email reminders about upcoming inspections and equipment preventive maintenance. Business card files are an absolute must to maintain contacts with vendors and biomedical companies.

It's not unusual for ASC administrators to fall behind keeping up with the regulatory issues, especially when there is an upcoming accreditation inspection at an ASC that hasn't been compliant for years, especially with all the biomedical inspections and certifications, such as the UPS (uninterrupted power supply), air exchange devices, plumbing, monitors and anesthesia machines. You must have proof that all devices are within compliance guidelines, and it can be costly to keep them there.

Hope you like to teach, because you'll need to conduct monthly in-services for all clinical personnel on such infection control topics as bloodborne pathogens, tuberculosis and hand sanitizing. Hope you enjoy QI/QA programs, because you must conduct quarterly projects that have the 10-step guide that meets the CMS certification standard. And hope you like to post warning and reminder signs throughout your facility, because that also falls on your plate. You'll also have to find time to admit patients, recover patients or circulate in the OR.

Why does an ASC administrator have to wear so many hats? One, because you're that rare breed of expert clinician who possesses business acumen, and two, you're a lot less expensive than a dozen consultants. You are the ASC's savior. And as they say, uneasy lies the head that wears a crown. OSM