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Staffing: Building a Sustainable Culture
71 Plays20 days ago
Last week, we explored how to choose the best staffing agency with Mayte Rechani. This week, we’re continuing our staffing series with Mark Henderson Leary to discuss what it takes to build a sustainable culture at your ASC.
Mark shares practical strategies to help you:
- Define what your culture really is
- Identify team members who may not be the right fit
- Attract and retain people who align with your values
In our news recap, we cover:
- The ongoing anesthesia staffing crisis
- Concerns from ASC leaders about proposed HHS policy changes
- National Colorectal Cancer Awareness Month
- A feel-good story from this year’s National Resident Matching Program
Resources Mentioned:
- Surviving the Anesthesia Staffing Crisis
- Ambulatory Surgery Center Stakeholders Sound Alarm Over HHS Proposal to Rescind Public Participation in Rulemaking
- ASCs Provide Updates on CRC Screening
- What 23 match day statistics say about the future of medicine
- HST’s State of the Industry Report
Brought to you by HST Pathways.
Recommended
Transcript
Introduction and Episode Overview
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest.
00:00:12
Speaker
And then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have. So let's get started and see what the industry's been up to.
00:00:27
Speaker
Hi everyone, here's what you can expect on today's episode. Last week we covered how to choose the best staffing agency with Mytevrchani. Today with Mark Henderson Leary, we'll continue staffing best practices with a discussion on building a sustainable culture.
00:00:43
Speaker
Mark shares some tips on how to define what your culture is, identify those who may not be the best fit, and hire those who are. In our news recap, we'll cover the latest on the anesthesia staffing crisis, the concerns ASC leaders have over some proposed changes to longstanding HHS policies, National Colorectal Cancer Awareness Month, and of course, end the new segment with a positive story about the National Resident Matching Program that took place mid-March.
00:01:13
Speaker
Hope everyone enjoys the episode and here's what's going on this week in surgery centers.
Mark's Accidental Leadership Journey
00:01:22
Speaker
Hi, Mark. Welcome to the podcast. Thank you so much for having me. Can you please share a little bit about your ASC experience? I found myself in healthcare care leadership and management coaching accidentally, found a passion for it and stumbled into various different healthcare settings.
00:01:40
Speaker
And then learned accidentally through a client that what an ASC was, who happened to have one and backed into this and had my mind blown as to what that was. Over the last six years, I worked with several and particularly in depth with with that initial one,
00:01:56
Speaker
to as a way to test my theories about what the principles are for running a great business. And so over the last 10 years or so, I've really been tested around, okay, I think these principles hold in all situations. Let's go find out. That's perfect.
00:02:13
Speaker
And I'm excited to have you join us today to keep our three-part series on staffing strategies going.
Building a Sustainable Culture
00:02:20
Speaker
So last week, we talked about how to select the best agency for an ASC, which is not an avenue a ton of ASCs use currently.
00:02:28
Speaker
But today, we're going to talk about building a sustainable culture. So let's dive right in. What are the key elements of a strong, sustainable culture in an ASC, and how does that impact staff retention?
00:02:40
Speaker
So i just want to be blunt and that the unfortunate reality is that there's no silver bullets on this. And I think that because the typical ASC administrator is so short on bandwidth,
00:02:57
Speaker
and trying to do so miracle miracles with really nothing. It's very bad news for me to tell them that to build a sustainable culture, it is not a light switch. It is not a couple of things. It's not a poster.
00:03:11
Speaker
It is a two-year journey to transform a culture that is not where it wants to be. And I think, I'm i'm guessing, the majority of people listening to this look around their culture and don't have that ideal culture that they wish they had.
00:03:25
Speaker
They feel very far away from it. And so the bad news is that we have to get really committed to core values. And core values are those three to seven statements that we can use to describe who's one of us and who's not.
00:03:42
Speaker
These core values are who we are, not who we want to be. And where that gets tricky is because... We look around the culture, we might see a lot of different things that we don't want, and it might be hard to determine who we think we really are at our best at our core values. And so let's just say
Cultural Transformation and Hiring Practices
00:04:01
Speaker
we got to get a small enough people in the room that we can look around and say, this is the team. This is a team I trust to take me into enemy lines and survive.
00:04:11
Speaker
What makes us, what glues us together? What beliefs do we share that are true on our worst day? Are we detail-oriented people? Are we do what it takes? Are we grit people? Are we fun people?
00:04:22
Speaker
Are we always optimists? Are we always pragmatic? Or what is it? And getting three to seven statements that sort of We look around the room. If we get people who believe these three things, four things, can we take over the world? Yes, we can.
00:04:35
Speaker
And when you get those committed, then you start filtering the culture one by one. And it takes a while because what we find is that say there's 50 people in the organization and you feel like 30 of them are terrible, which is not uncommon like at all. if That's you. That's just normal.
00:04:55
Speaker
The feeling is, what am I going to do to turn over 30 people? I can't turn over 30 people. That's insane. This is just ridiculous. That's not how we solve it. We solve it one at a time.
00:05:06
Speaker
And you may be able to identify one or two sort of toxic people in the culture, but you may not. You may see one or two really bad ones and five or 10 like kind of medium ones. But essentially you got to figure out whether these people are in the culture or not. And one at a time, you start getting the right, the wrong people off the bus. You say, look, you just, you're a fine person. You don't work here.
00:05:24
Speaker
And one at a time, the dominoes start falling and you start seeing that one very influential person suddenly affects four or five people. And then, and you'll see this four or five people suddenly start working better. And you also see two or three people check out and go.
00:05:37
Speaker
But the whole point of the story is it's long game. Two years from now, what does this culture look like? These three to six, usually three to four or five max statements of who our culture is.
00:05:48
Speaker
Let's envision that. And then one person at a time, let's get somebody off the bus. And then when we go higher, let's hire one more person. And if you commit to this formula, I say, commit.
00:05:59
Speaker
because this does not happen fast and it does not happen linearly. We don't suddenly turn the culture over in a day. In fact, we get one great one and then they leave because they're like, man, this place sucks.
00:06:10
Speaker
And so damn it, I got to go back to the well and do that again. And after two quarters, three quarters, four quarters, like, you know what? got a couple of really good managers here who are really good at calling the culture out. I think we can get this thing to flip over.
00:06:23
Speaker
And it's really just this commitment over the time to turn it over. And I got to tell you, to When you get it, it is worth it. And when you get there, you protect it and you start repelling those wrong fits and you start attracting those right fits because, and this is the part I want everybody to take the hope of, you gotta know the most of the healthcare care organizations you're trying to recruit from do not have that.
00:06:48
Speaker
all the institutions out all the institutions out there, there are people going, there's got to be a place where it doesn't suck. There's got to be a place where people care about working hard, who appreciate me when I work hard and who take care of the patients.
00:07:01
Speaker
They're out there. They don't know how to find you, but as you build your culture and people start talking about it, they will start finding you and you will be on the other side of this and you won't have to work so hard. Sure.
00:07:11
Speaker
Yeah, no, that's all great insight. So let's say we've come up with our our core values. We've identified which ones we don't think align with our culture that we want to part ways with.
00:07:23
Speaker
How do you approach those kind of difficult staffing decisions, like letting go of someone who isn't aligning with the culture? Using a business operating system brings you these tools. Like in EOS, we call it the people analyzer.
00:07:36
Speaker
And it is a very simple tool that allows us to, in black and white terms, see whether these people are meeting our criteria or not. And that, don't underestimate the value of that. Just having a, oh, they're below the bar.
00:07:49
Speaker
As opposed to, i don't know, think okay, and like' irritating. but yeah So let's get binary on this. Oh, you know what? According to my own standard of excellence, they're below the bar. You want that black and whiteness for sure.
00:08:01
Speaker
But that's not the end of the conversation because i think what you're and implying or talking about the scenario is like, is this sense of feeling held hostage to somebody we wish we didn't have to be held hostage to. Now, the first thing I will add to that is,
00:08:14
Speaker
the at-bats. And I'm sure you've talked about that hiring an agency and things that go with that. The one of the first steps is making sure someone in the organization owns the role of recruiting.
Recruitment Strategies for Better Staffing
00:08:25
Speaker
I cannot overstate how critical this There's somebody in your organization, maybe you, But if there's nobody with the recruiting role, you will always feel held hostage. And that has to stop. So you have to make sure there's somebody who's at least figuring out how to get some at bats. And so you can get some flow through the organization at all times.
00:08:44
Speaker
And so make sure there's somebody who knows this that's their job. They're measured on it. And we have this ability. So we don't feel like we're stuck in prison with people we can't replace.
00:08:55
Speaker
So that's just part of the process. We have to commit to that and never let go of that. But in terms of the decision, when we have, we'll say four people on a team and one of them's toxic and we feel we wish we had five people, we feel underwater.
00:09:10
Speaker
and There's this, let's hold on to the four people. Let's not replace this person until we have somebody who's good enough, but I'm too busy, so I'm never going to have time to replace this person because I'm not posting because because we're all underwater. That so sort of sustains this suffering forever.
00:09:26
Speaker
The organizations who say, you know what, we don't tolerate being held hostage for any reason. And this person is gone and we'll figure it out with the remaining three people.
00:09:38
Speaker
In my experience, nine times out of 10, even when that remaining three people are like, you know what, we're working 60 hours a week. But man, thank goodness we don't have to deal with the problems that last person was making. And it's this breath of fresh air. like, we don't mind working hard if we're not working against ourselves.
00:09:56
Speaker
We don't mind doing this right the first time with extra effort, but undoing bad work and having to fix problems somebody else was creating, that's demotivating. That is morale crushing. So leaning towards making the change to give the people the sense that we care about the values and that this is the team we trust and it's just us here is, in my experience, way better than we can't.
00:10:20
Speaker
Beyond salary, what factors contribute to keeping staff committed long term?
Boosting Morale through Clear Roles
00:10:27
Speaker
ah go to morale on this one. And the morale of an organization is exactly equatable to one thing.
00:10:36
Speaker
Are we winning or not? And if people don't feel like they're winning, morale is declining. And if people feel like they're winning, morale is improving. And it's no it's no more complicated than that.
00:10:47
Speaker
And so if you're asking people to sacrifice, that's not inherently a problem. If we're sacrificing and losing, that's a problem. So bear that in mind. If people are like, it's tough here, we work extra hours, and we are the best in the area, the best in the region, best in our whatever, and that's why. And if you want to be a part of us, you're going to work hard too.
00:11:09
Speaker
It's a point of pride. So we have to make sure have crystal clarity on what winning looks like. And this can be a little complicated, but the simple formula is...
00:11:23
Speaker
find a way to win. And you will have to figure out like if your version of winning doesn't match other people's, then that those people are aren't, you're not gonna keep those people. So I don't recommend you go way out of your way. if you're going to try to give people what they want, these schedules and they want to be able to work from home or whatever, obviously in the ASC world, there's not a lot of that, but sometimes we have to set the bar really low on, on winning.
00:11:44
Speaker
And so,
00:11:46
Speaker
I think the biggest mistake is saying, I want to retain this team. We want to win big and we want to hit grand slams. Grand slams aren't on the table for us. Winning might it be on time arrivals, these little wins and giving people the reward. It's good job that we won today. We won the day.
00:12:06
Speaker
with this very small thing. And we keep building up from that, giving everybody a chance and a sense of winning in a little way and and making it possible to recognize, because this whole thing about keeping people beyond, beyond the money is about making people feel that they're important and that they make a difference.
00:12:31
Speaker
And when they're not there, they're missed. So there's a strong correlation between their presence and winning and these simple things. So give them rewards and acknowledge their contribution in the most basic, simple things that contribute to a great day and simplifying the jobs, simplifying the roles. And one of the sort of diseases of ASCs,
00:12:55
Speaker
is rooted in the DNA of how these administrators are trained in my experience. And it is that the administrator is expected to do everything. And you know everything from life safety to physically getting patients moved around, all the paperwork, all the data is correct, handling an audit in a survey and somehow leading, somehow hiring and firing, somehow driving culture.
00:13:20
Speaker
And somehow these AAC administrators start figuring that out. And so this mindset of maybe everybody can do that. No, we we cannot. They cannot.
00:13:31
Speaker
And this is simply looking at the structure of the organization and saying, what are the roles? What are the functions in this organization that we need to have? Do we need a nurse administrator separate from the overall overall administrator? Do we need Any kind of managers and somebody in charge of life safety and what are all the roles are crystal clear.
00:13:47
Speaker
So we have as many, we'll call them positions on the baseball diamond that are appropriate to play the game we want to play. And so we do this instead of an account, organization, organizational chart. Organizational charts are very confusing.
00:13:58
Speaker
But if we build this sort of map of the roles, one of the number one things we can start doing is making each of these jobs doable. Because the tendency is to be like, just handle it, you know, figure it out. You've been in this business 20 years. You have experience. You know where the all the sutures are. You know how to handle inventory, you how to handle entering this data. You know how to handle all these things.
00:14:19
Speaker
It's totally unreasonable that everybody have that. So really getting good at making each of these seats crystal clear with the five roles that they need to be good at.
00:14:29
Speaker
And when we start making each of these jobs more doable, Lots of things happen. The ability to win, the the clarity of what my role is and the clarity what other people's roles is. I don't have to do that anymore. I don't want you throwing the ball and catching it too.
00:14:46
Speaker
You've been doing that. It's been amazing, but we're not going to do that anymore. We got somebody else who's going to catch the ball and that's not your job anymore. And when we start doing this, the clarity, lots of things bubble up. We start having, realizing people are in the wrong seats. And now, they and so there's just a million things that can go into the fundamentals Yeah, I think that's a good comparison to the organizational chart versus the accountability chart, because sometimes i do look at an org chart and like, okay, i know your title. I know who you report to, but I don't know what you actually do.
00:15:14
Speaker
oh my gosh. So well said. You nailed it. That's exactly what happens. Yeah. Perfect. Thank you so much for all of that advice, Mark. We do this every week with our guests.
00:15:25
Speaker
What is one thing our listeners can do this week to improve their surgery centers? thought about this one a lot. This is the hardest leadership skill that people will develop and learn to tell the truth.
00:15:40
Speaker
this is This is one of the hardest things you'll do when you see somebody who you've checked out on or you think is checked out on. But to really hold yourself accountable as a leader, to be in integrity with that person is below the bar.
00:15:59
Speaker
And I am no longer telling them, I'm no longer giving them feedback. I am walking a wide berth around them and essentially endorsing their bad behavior.
00:16:11
Speaker
Everybody in the organization deserves deserves to know where they stand and give them that feedback to help them be better and give them the dignity and empower them to respond to that.
00:16:25
Speaker
It's not your job to help them get there necessarily. You can help them, but you don't need to force them to do the right thing. You can treat them as adults, give them the feedback, positive and negative.
00:16:38
Speaker
But make sure you're telling the truth, whatever that truth is, whether they're doing well, they're not doing well, they could be better. And make sure you're in integrity and and and don't endorse non-confrontation.
00:16:51
Speaker
Don't and endorse or encourage that bad behavior. That is great advice. Thank you so much for coming on today. We really appreciate it. Thank you so much. It's been a blast.
Anesthesia Staffing Crisis and Solutions
00:17:04
Speaker
As always, it has been a busy week in healthcare, so let's jump right in. Across the country, ASCs are feeling the pressure when it comes to anesthesia coverage. We've covered it a bunch. ASCA recently did one of their 60-second surveys on it.
00:17:18
Speaker
This topic is really everywhere right now. But in a recent salary survey, many ASC leaders said they're now having to think creatively, whether that's paying stipends, canceling cases, or closing rooms entirely.
00:17:31
Speaker
Some say local hospitals are scooping up anesthesia providers, leaving ASCs to compete for what's left. At one center, anesthesia providers won't commit until the day before unless they have a full lineup.
00:17:44
Speaker
Others report operating with fewer providers than usual and having to cap rooms when coverage ends early. Even ASCs using CRNA-only models are running into problems. CRNAs may be unavailable at the last minute or less comfortable performing blocks or handling more complex procedures.
00:18:02
Speaker
Some facilities are using locums to fill the gaps, but that comes with its own challenges in consistency and cost. And a handful of ASCs are attempting to get ahead of the problem by building their own anesthesia teams.
00:18:15
Speaker
Livonia Outpatient Surgery Center created a group of 15 CRNAs and does all their billing in-house. Another ASC in Wisconsin took advantage of a shift at a local hospital to launch a new anesthesia care team model.
00:18:29
Speaker
And some centers are skipping anesthesia providers altogether using RN-led sedation with good outcomes, but those setups are still rare. So where do we go from here? What do we do?
00:18:40
Speaker
There's no one size fits all solution. ASCs need to stay agile, pay attention to market dynamics, and be open to alternative models. Whether it's building in-house teams, adopting nurse-led sedation where appropriate, or creatively mixing W2 and 1099 staffing, flexibility and proactive planning are key to maintaining safe, efficient surgical care in a tight anesthesia market.
00:19:05
Speaker
And this article came from the latest edition of the Outpatient Surgery magazine. So if this is something you're struggling with, I'd highly recommend reading the full story for yourself. There's a lot more in there and a lot of great ideas as to how you get can get creative to solve these problems.
00:19:22
Speaker
All right.
Advocacy in Healthcare Rulemaking
00:19:23
Speaker
ASC leaders are raising red flags after the U.S. Department of Health and Human Services, HHS, proposed rescinding a longstanding policy that requires public participation in certain rulemaking, especially around Medicare, Medicaid, and reimbursement.
00:19:39
Speaker
If finalized, this move could make it much harder for ASCs and healthcare providers to weigh in on regulations that directly impact their operations. Danilo Duprele, president-elect of the Arizona Ambulatory Surgery Center Association, says collaboration between policymakers and care providers is key to building practical policies that benefit patients.
00:20:03
Speaker
Without input from ASCs, the risk is that future rules won't reflect what's happening in real care settings. Several organizations beyond the ASC world have also spoken out.
00:20:14
Speaker
LeadingAge's CEO called the proposal troubling, warning it could lead to inefficient or poorly designed policies. The Association for Professionals in Infection Control and Epidemiology echoed those concerns, noting that public comment is essential to shaping regulations based on real-world insights.
00:20:32
Speaker
Legal experts also warn that HHS may be trying to speed up rulemaking, but it could backfire. Rachel Carey, an attorney at Whiteford, Taylor & Preston, noted that skipping public input could trigger legal challenges.
00:20:46
Speaker
Courts have already stepped in to block rushed efforts, like a recent attempt to cut n NIH funding. Interestingly, though, this rule change comes at a time when HHS and CMS are usually releasing new rates and guidelines.
00:21:00
Speaker
Yet things have been unusually quiet. That silence could suggest big policy changes are coming fast and possibly without much warning. If public comment goes away, ASC leaders could lose a vital tool for influencing policy.
00:21:16
Speaker
That means staying engaged, building coalitions, and being ready to respond quickly through legal or advocacy channels. The more connected ASCs are to what's happening in D.C., the better they can protect their interests and their patients.
00:21:29
Speaker
So please make sure you are staying in close contact with your state associations and ASCA so you can voice your opinions and we can stay on top of this. Okay, third story.
Rising Colonoscopy Volumes
00:21:39
Speaker
March was National Colorectal Cancer Awareness Month, and ASCs around the country are seeing rising colonoscopy volumes, especially among younger patients.
00:21:49
Speaker
The Endo Center at Voorhees hit a record 16,000 screenings in 2024, which is up from 13,700 in 2023. That growth is tied to updated guidelines, lowering the screening age from 50 to 45, increased insurance coverage, and public awareness from figures like Chadwick Boseman.
00:22:11
Speaker
Across the board, ASCs are working hard to ease patient anxiety and improve access. Dallas Endoscopy Center uses automation to clarify costs and assure patients about comfort.
00:22:22
Speaker
The Endo Center at Voorhees offers fast-track scheduling, skipping pre-op visits for eligible patients, and even uses AI-assisted polyp detection, something patients are now asking about.
00:22:35
Speaker
Text reminders, driver trackers, and community outreach events, including inflatable colons, are making a difference in patient engagement. Downtown Endoscopy Center stays proactive with recalls and follow-ups, reminding patients when it's time to come back.
00:22:50
Speaker
But of course, there are challenges too. Rising costs, tight reimbursements, and growing use of at-home tests are real concerns. ASC leaders stress that at-home kits don't replace colonoscopies and may still lead to one if something abnormal is detected.
00:23:07
Speaker
Continued education is key to helping patients make informed choices. But going back to demand and reimbursement really quick, in HST's State of the Industry report, we shared a bunch of benchmarking data broken down by specialty, and GI is always a really always has a really interesting story to tell.
00:23:26
Speaker
When we look at net revenue per case, GI is at the bottom of the list, absolute bottom, only bringing in $1,362 per case.
00:23:38
Speaker
But when we look at OR utilization, GI is at the very top of the list with nearly 60% usage. And to match, GI also has the second highest case volume out of all specialties, averaging 176 cases per month, coming in only second to ophthalmology, which averages to 20 cases per month.
00:23:58
Speaker
So imagine a world where we can get reimbursement up a bit and increase revenue per case by even 5%. That's an extra $150,000 in revenue on the year, you know, going off of that average of 176 cases ah per month.
00:24:14
Speaker
So while ASCs continue to prove their value in preventative care, they really need continued advocacy around reimbursement so they can continue saving lives through early detections.
Interest in Medical Careers and Residency Trends
00:24:26
Speaker
And to end our new segment on a positive note, on March 21st, the National Resident Matching Program released statistics for the 2025 match cycle, which began on March 17th. The 2025 match cycle hit new highs with around 47,000 certified applicants,
00:24:44
Speaker
which is a 5% increase from 2024, which hopefully indicates a growing enthusiasm for medical careers. A total of 43,237 residency positions were offered,
00:24:57
Speaker
which is also up four point two percent including eight hundred and seventy seven more primary care swas Orthopedic surgery filled 100% of its residency positions, reflecting strong interest in a specialty that's vital to ASCs.
00:25:12
Speaker
Internal medicine added 679 positions and filled in total. Pediatrics saw a boost in both positions and match rate, jumping to 95% filled.
00:25:25
Speaker
Emergency medicine made a major comeback with its fill rate climbing from 82% to 98%. And then OBGYN also remained strong with just 10 unfilled spots nationwide.
00:25:38
Speaker
Even with a few anesthesia vacancies, the majority of slots were filled, highlighting continued demand across surgical specialties. The surge in applicants and rising fill rates across key specialties is great news for surgery centers.
00:25:51
Speaker
It points to a healthy pipeline of future providers in orthopedics, primary care, and beyond, helping address staffing shortages and ensure long-term growth. And that officially wraps up this week's podcast. Thank you, as always, for spending a few minutes of your week with us.
00:26:06
Speaker
Make sure to subscribe or leave a review on whichever platform you're listening from. ah hope you have a great day, and we'll see you again next week.