- Email: [email protected]
Looking Outside to Meet Internal Challenges: The Benefits of Outsourcing
Looking Outside to Meet Internal Challenges: The Benefits of Outsourcing PAM NEIDERER, BSN, RN
ABSTRACT Providing resourceful solutions to common facility management challenges can require many steps, including internal and external research, evaluating potential options, and implementing new protocols. The outpatient surgical services administrator at the Surgical Center of York and the Endoscopy Center of Memorial Hospital, York, Pennsylvania, addressed the challenge of managing and meeting surgeons’ expectations and requests for better equipment and increased patient volume for ophthalmology procedures while maintaining a strict budget. Outsourcing of surgical equipment was identified as a viable option to meet these needs. AORN J 93 (January 2011) 133-135. © AORN, Inc, 2011. doi: 10.1016/ j.aorn.2010.08.015 Key words: outsourcing, facility management, ambulatory surgery, equipment, financing.
A
s the outpatient surgical services administrator for the Surgical Center of York and the Endoscopy Center of Memorial Hospital, York, Pennsylvania, I am responsible for evaluating methods for running a more efficient medical center. Many elements go into running a successful facility:
equipment sourcing, maintenance and inventory; teamwork; staff participation in decision making; staffing flexibility; time management; and budget allocations and constraints.
With each challenge, it is important to research both internal and external factors as well as vari-
ous solutions to meet the facility’s unique needs. Internal factors may include current or previous policies for staffing, purchasing, and budgeting. External factors may include vendor relations, reimbursement policies, and patient preferences. To address challenges, internal surveys of staff members may help to determine how well the current protocols and duties are understood and to gauge employee satisfaction. In addition, conducting equipment trials may help to establish preferences and streamline purchasing. As a dual-facility administrator, I have had to find ways to be resourceful to control costs, provide our surgeons with the best equipment possible, and optimize staff members’ time. I have found new and creative solutions to these issues by tapping into resources, such as my
doi: 10.1016/j.aorn.2010.08.015
© AORN, Inc, 2011
January 2011
Vol 93
No 1 ● AORN Journal
133
January 2011
Vol 93
No 1
NEIDERER
memberships with AORN and the Pennsylvania through the same type of pay-per-procedure Ambulatory Surgery Association, professional agreement. On the additional recommendation of nursing journals and magazines, and opportunities a colleague who used the same ophthalmic outto network with perioperative professionals. sourcing company in her facility, I decided to The Surgical Cenpursue outsourcing ter of York is a mulas an option. tispecialty facility in The next step was I conducted trials of equipment from three which a high volume to perform internal companies with our surgeons so we could of ophthalmic surgievaluations of curmake the most informed decision. Decisions were based not only on the surgeon’s cal procedures, sperent cataract surgery preferences but also the reliability of the cifically cataract and protocols, costs assoretinal procedures are vendor representative, past experience with ciated with equipthe company, ease of equipment use, and performed. When our ment, supplies, staff, availability of necessary training. cataract surgeons and other factors, wanted access to betand to determine our ter equipment and to cost per cataract proincrease their patient volume, I knew this might cedure, as well as the cost of purchasing new require a change in current protocols to meet their equipment based on our own negotiations. I also needs. We had one room dedicated to ophthalmic conducted trials of equipment from three compaprocedures, and it was already divided between nies with our surgeons so we could make the cataract and retinal procedures. To increase our most informed decision and meet their needs. The patient volume, we would not only need a second surgeons completed evaluations of the equipment. ophthalmic room but also new state-of-the-art Decisions were based on not only the surgeon’s equipment. The challenge became meeting our preferences but also reliability of the vendor repsurgeons’ needs while avoiding costly capital resentative, past experience with the company, expenditures. ease of use, and availability of necessary training. Next, I compared the internal findings of our current cost-per-procedure analysis with what the EFFECTIVE RESEARCH ophthalmic outsourcing company could offer, and YIELDS SOLUTIONS To meet this challenge, I first examined current the results were impressive. The ophthalmic outprotocols at both facilities and found a successful sourcing company was able to provide a contract model already in place within both the ambulathat addressed the facility’s needs and challenges, tory surgery and endoscopy center. We have had and offered comprehensive cataract surgical sera long-standing agreement with a medical techvices without the capital investments that we nology company, through which we outsource our would have incurred had we upgraded on our rigid scopes for various arthroscopic procedures, own. as well as flexible scopes for our endoscopy procedures. This company provides access to stateONE SOLUTION FOR of-the-art equipment on a pay-per-procedure baMULTIPLE CHALLENGES sis. I then began researching similar services for The chosen ophthalmic outsourcing company is a ophthalmic procedures and found an ophthalmic vendor-neutral service provider, which not only outsourcing company that provides access to allowed us to provide our surgeons with their prestate-of-the-art cataract and refractive surgery ferred state-of-the-art equipment but also to mainequipment for both fixed and mobile accounts tain our long-standing relationships with our 134
AORN Journal
THE BENEFITS OF OUTSOURCING ophthalmic sales representatives. The company simply acted as the liaison between our facilities and the vendors to negotiate the best pricing possible. Through their services, we were able to obtain two phacoemulsification machines, two flat-screen monitors, and two microscopes, all of which were cutting edge and the highest quality equipment available. Our contract also included the purchase of additional surgical equipment sets, which has eliminated our need to flash sterilize between procedures to stay on schedule. Purchasing this equipment through the outsourcing company’s services has allowed us to pay off the equipment in half the time it would have taken if we had purchased it on our own. With these savings, we were able to extend our ophthalmic services to a second room, which allows us to offer cataract and retinal surgery simultaneously, thereby adding increased flexibility in scheduling and the ability to accommodate higher patient volumes. In addition, our high procedure volume has resulted in a lower cost per procedure, which created additional savings. Beyond the benefits of eliminating capital investments and increasing buying power, our contracts with both outsourcing companies include a service contract in which they cover our maintenance costs and scheduling. The ophthalmic outsourcing company also handles our ophthalmic inventory maintenance. With this added service, I am able to save money on maintaining our inventory by allocating staff members to other tasks, thereby increasing our overall productivity. Although staff members were already fully trained on ophthalmic procedures, the ophthalmic outsourcing company does provide access to ophthalmic-specialized, National Board of Surgi-
www.aornjournal.org
cal Technology and Surgical Assisting certified technicians who can scrub in and assist as needed. CONCLUSION When facing a challenge, such as meeting the needs of surgeons or increasing productivity, one of the greatest risks a perioperative professional can take is not learning about his or her options, especially when the solution potentially involves a high capital investment. Perioperative professionals should do their research and evaluate all of the internal factors and external options. This initial research will help put information gathered from journals and colleague recommendations into perspective for the facility. In addition, when outsourcing a service, perioperative professionals should make sure that it comprehensively fits with the facility’s needs, and they should examine ways that the company can increase other operating efficiencies as well. By researching and understanding the specific needs and issues at a facility as well as all of the available options, perioperative professionals can successfully address any challenge that presents itself. Editor’s note: Publication of this article does not imply AORN endorsement of specific products or services.
Pam Neiderer, BSN, RN, is outpatient surgical services administrator, Surgical Center of York and Endoscopy Center of Memorial Hospital, York, PA. Ms Neiderer has no declared affiliation that may be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal
135
ABSTRACT Providing resourceful solutions to common facility management challenges can require many steps, including internal and external research, evaluating potential options, and implementing new protocols. The outpatient surgical services administrator at the Surgical Center of York and the Endoscopy Center of Memorial Hospital, York, Pennsylvania, addressed the challenge of managing and meeting surgeons’ expectations and requests for better equipment and increased patient volume for ophthalmology procedures while maintaining a strict budget. Outsourcing of surgical equipment was identified as a viable option to meet these needs. AORN J 93 (January 2011) 133-135. © AORN, Inc, 2011. doi: 10.1016/ j.aorn.2010.08.015 Key words: outsourcing, facility management, ambulatory surgery, equipment, financing.
A
s the outpatient surgical services administrator for the Surgical Center of York and the Endoscopy Center of Memorial Hospital, York, Pennsylvania, I am responsible for evaluating methods for running a more efficient medical center. Many elements go into running a successful facility:
equipment sourcing, maintenance and inventory; teamwork; staff participation in decision making; staffing flexibility; time management; and budget allocations and constraints.
With each challenge, it is important to research both internal and external factors as well as vari-
ous solutions to meet the facility’s unique needs. Internal factors may include current or previous policies for staffing, purchasing, and budgeting. External factors may include vendor relations, reimbursement policies, and patient preferences. To address challenges, internal surveys of staff members may help to determine how well the current protocols and duties are understood and to gauge employee satisfaction. In addition, conducting equipment trials may help to establish preferences and streamline purchasing. As a dual-facility administrator, I have had to find ways to be resourceful to control costs, provide our surgeons with the best equipment possible, and optimize staff members’ time. I have found new and creative solutions to these issues by tapping into resources, such as my
doi: 10.1016/j.aorn.2010.08.015
© AORN, Inc, 2011
January 2011
Vol 93
No 1 ● AORN Journal
133
January 2011
Vol 93
No 1
NEIDERER
memberships with AORN and the Pennsylvania through the same type of pay-per-procedure Ambulatory Surgery Association, professional agreement. On the additional recommendation of nursing journals and magazines, and opportunities a colleague who used the same ophthalmic outto network with perioperative professionals. sourcing company in her facility, I decided to The Surgical Cenpursue outsourcing ter of York is a mulas an option. tispecialty facility in The next step was I conducted trials of equipment from three which a high volume to perform internal companies with our surgeons so we could of ophthalmic surgievaluations of curmake the most informed decision. Decisions were based not only on the surgeon’s cal procedures, sperent cataract surgery preferences but also the reliability of the cifically cataract and protocols, costs assoretinal procedures are vendor representative, past experience with ciated with equipthe company, ease of equipment use, and performed. When our ment, supplies, staff, availability of necessary training. cataract surgeons and other factors, wanted access to betand to determine our ter equipment and to cost per cataract proincrease their patient volume, I knew this might cedure, as well as the cost of purchasing new require a change in current protocols to meet their equipment based on our own negotiations. I also needs. We had one room dedicated to ophthalmic conducted trials of equipment from three compaprocedures, and it was already divided between nies with our surgeons so we could make the cataract and retinal procedures. To increase our most informed decision and meet their needs. The patient volume, we would not only need a second surgeons completed evaluations of the equipment. ophthalmic room but also new state-of-the-art Decisions were based on not only the surgeon’s equipment. The challenge became meeting our preferences but also reliability of the vendor repsurgeons’ needs while avoiding costly capital resentative, past experience with the company, expenditures. ease of use, and availability of necessary training. Next, I compared the internal findings of our current cost-per-procedure analysis with what the EFFECTIVE RESEARCH ophthalmic outsourcing company could offer, and YIELDS SOLUTIONS To meet this challenge, I first examined current the results were impressive. The ophthalmic outprotocols at both facilities and found a successful sourcing company was able to provide a contract model already in place within both the ambulathat addressed the facility’s needs and challenges, tory surgery and endoscopy center. We have had and offered comprehensive cataract surgical sera long-standing agreement with a medical techvices without the capital investments that we nology company, through which we outsource our would have incurred had we upgraded on our rigid scopes for various arthroscopic procedures, own. as well as flexible scopes for our endoscopy procedures. This company provides access to stateONE SOLUTION FOR of-the-art equipment on a pay-per-procedure baMULTIPLE CHALLENGES sis. I then began researching similar services for The chosen ophthalmic outsourcing company is a ophthalmic procedures and found an ophthalmic vendor-neutral service provider, which not only outsourcing company that provides access to allowed us to provide our surgeons with their prestate-of-the-art cataract and refractive surgery ferred state-of-the-art equipment but also to mainequipment for both fixed and mobile accounts tain our long-standing relationships with our 134
AORN Journal
THE BENEFITS OF OUTSOURCING ophthalmic sales representatives. The company simply acted as the liaison between our facilities and the vendors to negotiate the best pricing possible. Through their services, we were able to obtain two phacoemulsification machines, two flat-screen monitors, and two microscopes, all of which were cutting edge and the highest quality equipment available. Our contract also included the purchase of additional surgical equipment sets, which has eliminated our need to flash sterilize between procedures to stay on schedule. Purchasing this equipment through the outsourcing company’s services has allowed us to pay off the equipment in half the time it would have taken if we had purchased it on our own. With these savings, we were able to extend our ophthalmic services to a second room, which allows us to offer cataract and retinal surgery simultaneously, thereby adding increased flexibility in scheduling and the ability to accommodate higher patient volumes. In addition, our high procedure volume has resulted in a lower cost per procedure, which created additional savings. Beyond the benefits of eliminating capital investments and increasing buying power, our contracts with both outsourcing companies include a service contract in which they cover our maintenance costs and scheduling. The ophthalmic outsourcing company also handles our ophthalmic inventory maintenance. With this added service, I am able to save money on maintaining our inventory by allocating staff members to other tasks, thereby increasing our overall productivity. Although staff members were already fully trained on ophthalmic procedures, the ophthalmic outsourcing company does provide access to ophthalmic-specialized, National Board of Surgi-
www.aornjournal.org
cal Technology and Surgical Assisting certified technicians who can scrub in and assist as needed. CONCLUSION When facing a challenge, such as meeting the needs of surgeons or increasing productivity, one of the greatest risks a perioperative professional can take is not learning about his or her options, especially when the solution potentially involves a high capital investment. Perioperative professionals should do their research and evaluate all of the internal factors and external options. This initial research will help put information gathered from journals and colleague recommendations into perspective for the facility. In addition, when outsourcing a service, perioperative professionals should make sure that it comprehensively fits with the facility’s needs, and they should examine ways that the company can increase other operating efficiencies as well. By researching and understanding the specific needs and issues at a facility as well as all of the available options, perioperative professionals can successfully address any challenge that presents itself. Editor’s note: Publication of this article does not imply AORN endorsement of specific products or services.
Pam Neiderer, BSN, RN, is outpatient surgical services administrator, Surgical Center of York and Endoscopy Center of Memorial Hospital, York, PA. Ms Neiderer has no declared affiliation that may be perceived as posing a potential conflict of interest in the publication of this article.
AORN Journal
135