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How to improve staff retention at ASC

March 02, 2023

Recently, every industry has been struggling with retaining staff. The healthcare sector is no different.  A shortage of skilled healthcare workers and the demand for qualified staff in healthcare is at an all-time high. 

Staff retention has become a critical issue for healthcare organizations, as the cost of replacing employees can be significant, and a high turnover rate can negatively impact patient care and overall morale in the workplace.

The founder of PreferredMD, dr. Biraj Patel, and the Midtown Surgery Center administrator, Ashley Poulos, sat down to discuss the current employment market, generational behavior differences, and what strategies have worked for them to improve staff retention.

Check out this accompanying presentation to the webinar to enhance visibility and comprehension of the subject matter. This additional resource provides a more detailed overview and reinforces the key points covered in the discussion.

What have you experienced in the employment market over these last few years?

Dr. Biraj Patel: There's no doubt that the biggest impact on the healthcare market has been because of COVID-19. Before 2019, the market was pretty stable, and then all of a sudden, because of the pandemic, we were all forced into a situation we weren't in before. Everyone had a chance to reevaluate their life and work environment and to demand different conditions.

2021 was the year of Great Resignation. 47 million workers quit, which was much higher than has ever happened before. In 2022, we had an average of 30% of people who either switched jobs or quit jobs, and 10% of that was in the healthcare field. 

Of that 10%, 50% were the non-clinical staff — administrators, anyone who participated around healthcare rather than through clinical medicine. 

Ashley Poulos: With all of the factors that you’ve mentioned, how much healthcare was impacted? Do you find that certain individuals have made a stronger impact than others?

Dr. Biraj Patel: The impact on healthcare was significant. I think every sector in our economy has been impacted by this shift.

I think it's important that we examine the different generations and how it pertains to an ASC because there are differences. If we look at the breakdown of the employees that we have in an ambulatory setting, you have predominantly Gen-Y'ers and Gen Z'ers. 

Gen-Y's are the ones we recognize as millennials. They are in their twenties and thirties and they are more like middle management. They are looking forward to having a well-established career and they want to provide some kind of reinforcement for their nest egg. They're looking forward to their futures. They really care about being in a career that has a positive impact. Communication is very important for this group. They connect more on social channels, they're very connected with platforms, like TikTok and Instagram.

But I think, more so, is the next generation, Gen-Z'ers. They’re in their twenties, they work as front desk staff, and schedulers. They are very connected to technology. They interact socially through technology and are very well-informed. So it's this group of individuals, I think, we need to really focus on when we're talking about retention because this is the fastest-growing sector of our society. This will be, by far, the largest group of employees in the next 5 to 10 years. So we need to focus on their needs and what they seek in their working environment.

Ashley Poulos: It seems like there are a bunch of different groups that affected what has happened over the last few years. Do you think that one group played a more significant role than others?

Dr. Biraj Patel: No, we need to look at issues that happen across generations and then focus more on younger folk. Gen Y'ers and Gen Z'ers make up the huge majority of our employees in our centers.

Ashley Poulos: So you think that they played a significant role in the shift that we've had or the Great Resignation that we've had?

Dr. Biraj Patel: Absolutely. I think we need to focus our retention methods across all generations, as well as more specific ones with the younger folk.

What are the ways to retain staff from different generations?

Dr. Biraj Patel: I think the ambulatory surgery center industry has done pretty well with compensation packages and benefits. We appreciate that everyone's well-informed and more invested in their positions. It is beneficial to motivate staff with stock options, or another kind of incentive that is driven around the success of the business. We can also look at other benefits that are presented to our employees like 401K's and retirement packages. Gen X and Gen Y are very focused on what they're going to retire with, so 401k packages are important. 

It's also very important that employees feel connected to where they work. They should feel appreciated and recognized, and you can do a lot for that. A lot of facilities I work with make an employee of the month award, sponsor lunches, or a happy hour to allow everyone to connect and improve the whole experience. 

Ashley Poulos: Are there any other ideas that could be utilized in addition to that? Or, what are other areas that, with the different generations, they would be looking for?

Dr. Biraj Patel: Between generations, I think fostering connection, having mentorship programs where different members of the team can connect with one another. It’s important to know that you always have someone to go to.

Interaction is crucial. Teamwork and collaboration are something that employees look forward to. No one wants to feel like they're by themselves and everything's on their shoulders. 

A big part of it is actually also the quality of the work. I think it’s very important if we look at what type of work everyone is doing and how we can set them up for success.

Ashley Poulos: What do you mean by the quality of work?

Dr. Biraj Patel: I mean to set employees up for success. We need to place them in a situation where failure doesn’t happen easily. We have to give staff all the opportunities to do well by making their tasks easier, more streamlined, and approachable so that people are doing the work they actually like to do and are committed to doing.

Ashley Poulos: Does it tie back to what different generations are looking for in their job and career?

Dr. Biraj Patel: Yes, I think people want to feel invested and they want to make a difference.

Ashley Poulos: You mentioned teamwork, communication, and collaboration, those are kind of the key words for producing an inclusive environment. A lot of times, we go to work and we have our tasks A, B, and C that we have to do and it takes away from everything else that is more important. Are there ways to resolve that?

Dr. Biraj Patel: Yes. We need to strip back what the most mundane, repetitive tasks are and find ways that we can improve that process. Automation is the key to this.

How can automation help with staff retention?

Dr. Biraj Patel: Automation is any process or technology by which we're decreasing human intervention, thereby reducing costs and mistakes. It's important to stress that automation is a way we can recenter people's attention to the jobs they were actually hired to do. Automation plays a large part in helping retain employees because it really does set them up for success.

Ashley Poulos: Do you think employees would have any sort of fear that it takes away from their role or any sort of job security?

Dr. Biraj Patel: Absolutely not. Automation just allows people to focus on what it is that they were hired to do. For example, we have a surgical scheduler in an ambulatory surgery center. Their job is to coordinate the process and make things fit together so that before the day of surgery all of those pieces come together. A lot of time and effort is wasted from having to search for information, resulting in burnout, because that is not what a scheduler is imagining their job to be. Automation takes away this frustrating repetitive mechanism allowing the scheduler to focus on more important tasks.

Ashley Poulos: Can automation improve job satisfaction and performance?

Dr. Biraj Patel: It absolutely leads to improved job satisfaction because now staff is focused on exactly what it is they were hired to do. They work in a process where information is delivered to them without inefficiencies, like searching for data in their emails.

Are there any examples of automation in healthcare?

Dr. Biraj Patel: A great example at an ASC would be to use automation to obtain medical histories from patients. When a case is booked, a questionnaire is sent out to a patient which is populated by them and presented to a clinical member of staff. No time is wasted leaving voicemails or trying to obtain information from patients manually. It's all done on a user-friendly platform.

The Mayo Clinic uses a very similar system, called Symptom Checker. They send out a questionnaire to a patient prior to a visit. So the day-to-day questions about their health, their history, their medications, and allergies are discovered before any clinical interaction with a nurse or a physician. Thereby, the patients can have their questions answered straight away by the nurse or the doctor.

Ashley Poulos: Is it mainly large institutes that are able to access these platforms with automation or is it becoming more of an option for the rest of us?

Dr. Biraj Patel: There are options out there that are similar to the hospital systems. Private practices now have access to those, but they're more standalone pieces of software that automate one singular part of the patient care experience. 

Ashley Poulos: Can we bring these different platforms together so we have all of our daily operations go smoothly?

Dr. Biraj Patel: The main issue with many of these platforms is that they really only cater to one or two aspects of that entire patient care journey. But more full-suite options also do exist.

Have you heard of Chat GPT? Is it being utilized in healthcare?

Dr. Biraj Patel: Yes. Chat GPT has become all the rage, especially recently, from the whole Google debacle. It is an AI platform that takes billions of pieces of information and tries to create a response to a question in the form of a human response. And it's been pretty accurate, especially the Open Source version.

Ashley Poulos: Have you used it?

Dr. Biraj Patel: I tried it last week while researching for our webinar. We looked into what Chat GPT would think of streamlining or making certain roles in an ambulatory surgery center more efficient, such as a front desk, a surgical coordinator, or a benefits clerk. 

And the results were telling. The first suggestion was to have a self-check-in for a patient. The second was the vertical integration of data to streamline the processes and make them more efficient.

What is that vertical integration?

Dr. Biraj Patel: That’s when you take information along the healthcare journey, something that a patient responds to, and that information is transmitted from patient to physician and to facility without having any redundancy. There are up to 10 different user types or roles that are involved in the surgical booking process. All of these 10 different users are inputting data in different ways.


There are 70 pieces of information that go into scheduling surgery, and that is what is connected vertically so that every user is aware of all the pieces of information that are presented or connected to this booking.


Ashley Poulos: You explained the vertical integration and it kind of goes back to the automation. What would be some of the main benefits of having automation in our system? 

Personally, I know that at our surgery center, everyone wears 12 different hats. It's a struggle when our scheduler, for instance, goes on vacation. The rest of us have to scramble to pick up the pieces, plus do our own workload. It's problematic and it sounds like this system would kind of resolve some of those issues.

Dr. Biraj Patel: Yes, you can imagine. Vertical integration is like a Christmas tree. Everyone “hangs” pieces of information in that surgery scheduling process, but there's a way that you can look at all of this information and integrate it to see what other users have entered or what is missing.

There's complete transparency, there's accountability, there is connection. You want to be able to connect with your colleagues so that you can see what they did or what they need to do and work collaboratively. 

This is all about collaboration. This is all about doing what you can to ensure that the whole patient care journey is seamless.

Ashley Poulos: It sounds like it's going to reduce a lot of potential errors, we call them near misses

Dr. Biraj Patel: Absolutely, because you've automated so many things. You've collected information from the patient, and you've created different algorithms. 

If the BMI is calculated at greater than 35 or 40, whatever your threshold may be, that's communicated to someone else in the form of an alert without a person being involved in that process, or a person having to check a chart. 

So you're reducing the number of errors that can be made and leaving all human interaction to be much more clinical and basing decisions on people's actual job titles.

Will older patients be able to effectively utilize the new technologies to present their information?

Dr. Biraj Patel: It's a valid concern. You always have flashbacks to your grandma trying to use a computer and it's fraught with disaster, but that is really not the case in 2023. Now we have UI and UX that are particularly designed for people who've never had any experience with these new platforms, to be walked through the whole process. 

That's why you have so much engagement from the older generations on platforms such as Facebook. They're well connected, they are on these platforms because the platforms are really well designed. They make it super easy. We've seen all the implementation, and the facilities with the newer platforms, and there is great uptake.

Ashley Poulos: What about my generation X? Are we going to be able to use all these different platforms easily and be able to pick up on them?

Dr. Biraj Patel: Certainly. I think they're very easy. Once you can see the information presented in a way that's simple to use and interpret, there's no doubt. 

And this is going to be the norm soon. We’re seeing it in finance, banking, and across every sector. Our homes are completely automated. We have Alexas, electronic timers (so we don’t have to follow the time), and thermostats that suggest turning down the temperature when we're not in the room. These are all mechanisms of automation.

What should we expect in the future of healthcare?

Dr. Biraj Patel: We can expect more of the same. The projected budgets for technology for in-hospital systems are seeing an 80% increase over the next 5 years. It's tremendous. There's much more engagement now. Newer platforms are coming to the market, and they are much simpler to use than in the past. And I see that the future is definitely moving in the direction of expanding the penetration of digital healthcare.

Ashley Poulos: I think that will eventually intrigue younger generations to come back into healthcare since we've had a shift with so many people leaving.

Dr. Biraj Patel: I think so too. Now Gen Z is the smallest generation in our workforce and in the next 5 to 10 years it will become the biggest. So when you have that many people who are comfortable using platforms, who see the value in them and in the connectivity, there will be a market drive to move healthcare in that direction. 

Furthermore, I think we need to look at the cost. Right now, it may seem very cost prohibitive to have engagement on a lot of these platforms. But when you look at the overall strength and the overall net positive with the decrease in cancellations, with the decrease in staff turnover, there is a financial positive, effective immediately, when you subscribe to one of these things, so I do see a massive gain here.

Ashley Poulos: So there will probably be savings. Once we have these technologies in place that save in supply error, as far as purchasing or overtime, streamline processes, can we take that and then bring it back to re-engaging the staff? And that will be a way that we can offset some of the costs that would be required to retain our staff.

Dr. Biraj Patel: Absolutely. Any savings can be moved back to growing the culture of the business. Just in terms of costs, in terms of turnover. It costs on average $5,000 to recruit a new staff member at a surgery center and it takes about 45 days. And the added stress, when you have to redistribute a leaving employee’s work across the other staff, it's a snowball effect. Our goal is to increase work satisfaction and to bring connectivity between everybody. It is to engage our employees and that would lead to a long-term positive retention flow.

Ashley Poulos: Do you think there's going to be a continued trend that the nonclinical staff has this option to work remotely? Can we accommodate all these different schedules in that way?

Dr. Biraj Patel: Yes. Obviously, cybersecurity is always a real threat, a real issue but now that we have secure platforms, you have transparency on these platforms. I see administrators, like yourself, are more and more comfortable with allowing their staff to work from home because they know exactly what is being done. It's very clear. It is not obscure or hidden in someone's inbox or on phone calls, this is all out in the open. So as these technologies develop further, you'll find that there are going to be more work-from-home situations, which feeds back into what people want out of their work life. Especially Gen Z, they are more focused on a work-life balance than any previous generation was.

Ashley Poulos: Do you find that it's because they have other avenues to supplement what their primary job would be and that's why it's not as much of a concern?

Dr. Biraj Patel: Yes. I think that they are not as materially driven as previous generations for whom it was important to earn as much money as possible. The younger generations are really about engagement, quality of life, making a difference, feeling recognized, and that is important for us to realize as employers.

Ashley Poulos: Essentially, healthcare is going to catch up to the rest of the industries.

Dr. Biraj Patel: You're exactly right. Catch-up is the operative word because there is so much opportunity there to decrease the repetitive nature of what healthcare involves. I think once that's done, we can all focus back on looking after patients.

Ashley Poulos: And the patient care, which is the primary goal.

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