The ambulatory surgery center industry is dynamic and fast-paced. Not everyone will be comfortable in that environment and all too often there is a perception that working in an ASC is less stressful and less demanding than working in a hospital environment. While it is true that the hours and overtime are more conducive to most employees, the belief that working in an ASC will be less demanding is of course quite untrue.

ASC leaders positions are no different. Managing an ASC is much more complex than running an equivalent size hospital department of physician practice. ASC leaders (Administrators and Nursing Directors) require skills in a wide range of areas, including regulatory compliance, personnel administration, finance, clinical care and legal affairs. Accordingly, turnover in ASC leadership is all too common.

When a leadership vacancy occurs, ASC owners and governing body members are faced with an daunting challenge. Selecting an ASC leader requires a thorough understanding of the responsibilities of the position. Owners and governing body members frequently, however, have a very general knowledge of what is required of an ASC leader except as it relates to the activities that they are directly involved in.

Ideally, when recruiting new ASC leaders, owners and governing body members need look for leaders with the following minimum traits:

• ASC leaders can’t be afraid to confront the Surgeons. As a director of the organization, they are tasked with enforcing the organization’s policies and assuring compliance with regulatory requirements. This will periodically put them in conflict with the surgeons.
• Thorough knowledge of Licensure, Certification and Accreditation regulations and standards.
• Knowledge of personnel regulations and the ability to lead and motivate staff to achieve the organization’s goals and objectives
• Knowledge of the legal issues that face ASC, including knowledge of fraud and abuse, anti-kickback and medical-legal issues. Even nurse managers need to understand these issues
• Enough financial management knowledge to interact with contracted or employed financial professionals and maintain appropriate financial stewardship for the organization.
• Knowledge of the Quality Assurance and Performance Improvement process and development and management of appropriate monitoring tools.
• Knowledge of risk management program development, including incident management, OSHA and OSHA Bloodborne Pathogens requirements.

I am well aware that the list is quite daunting and the it will be difficult to hire someone with all of the skills listed. Often, organizations will find it necessary to have an administrator and a nurse manager share these leadership responsibilities. Smaller centers might also find that out-sourcing some of these responsibilities are more cost effective. Companies like Ambulatory Healthcare Strategies for example specialize in such outsourced services.

Don’t forget to listen to the ASC Podcast with John Goehle, Episode 12 for the Week of March 19, 2018 for more discussion of this topic.