Efficient Staffing for an ASC

One of the most difficult aspects of running an efficient ambulatory surgery center (ASC) is maintaining appropriate staffing levels. I cannot think of any other business where the staffing needs change so dramatically from day-to-day. In addition to the dramatic fluctuations in staffing needs, the cost of staff is very high leading to reduced margins and in some cases the difference between profit and loss. Can you imagine staffing for 30 cases today and then adjusting to staff requirements for 10 cases the next day? Of course, you have what we all refer to as fixed staff which would include reception, billing, management, materials, etc., just to make the already difficult problem harder to manage.

In order to make sense of all this — and manage it effectively — you need to start with staffing standards or appropriate units of service for each service in your facility. This is a critical step to make sure the standard is an appropriate measure of the staffing demands of the service. In the preoperative area it is safe to assume that each patient requires a similar amount of time for the preoperative nurse to complete the required documentation and examination. A good unit of measure in this service would be the number of cases.

In the operating room (OR) this measure will not work. The reason for this is that a simple ENT procedure could be as short as 15 minutes and a plastic surgery procedure could last three hours. A better unit of measure in this area would be minutes in surgery.

Once you have determined an appropriate measure for each service you can begin to set a standard for each area. This would be a formula that states the number of units for each fulltime equivalent (FTE). A FTE is the number of hours worked by a full-time employee, usually 40 hours per week or eight hours per day. You can track the efficiency of each service by calculating the number of units, which equals the service measurement times the FTE per service unit and comparing to the actual number of FTEs for the service. To make this process even more effective you can calculate the earned hours by determining the units of service projected off the surgery schedule and calculate the staffing in advance of the day making appropriate changes when necessary.

In addition to the unit of service staffing model you need to be aware of necessary adjustments to what we all call fixed staff. When you are busy you may need to hire temporary staff to assist your fixed staff in order to maintain service levels. When your case volume is down you will need to flex this staff in order to maintain efficiency and profitability. Proper staffing is a difficult and yet critical function of an effective surgery center administrator. 

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