Ep. 108: Mark Henderson Leary – Staffing: Building a Sustainable Culture
Here’s what to expect on this week’s episode. 🎙️
Staff retention starts with culture—not quick fixes.
On this week’s episode of This Week in Surgery Centers, we sat down with Mark Henderson Leary to dig into what it really takes to build and sustain a strong culture at your ASC. Here are some of the biggest takeaways:
🔹 Building a great culture takes time—think 2 years, not 2 weeks.
🔹 Culture starts with clarity: Identify 3–5 core values that define who you are, not who you wish you were.
🔹 Don’t get overwhelmed by toxic staff—remove misaligned team members one by one and watch the ripple effect.
🔹 Beyond salary, what keeps people around is the feeling that they’re winning. Set clear, attainable goals and recognize contributions often.
🔹 Make roles doable. If one person is catching and throwing the ball, it’s time to rethink your structure.
🔹 And the hardest, most important leadership skill? Tell the truth. Give clear feedback. Don’t let avoidance become quiet endorsement.
Tune in to hear more tips from Mark on building a sustainable culture!
Episode Transcript
[00:00:00] Welcome to this week in Surgery Centers. If you are in the ASC industry, then you are in the right place every week. We’ll start the episode off by sharing an interesting conversation we had with our featured guest, 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.
Erica: Hi everyone. Here’s what you can expect on today’s episode. Last week we covered how to choose the best staffing agency with Mae Ani. Today with Mark Henderson Leary, we’ll continue staffing best practices with a discussion on building a sustainable culture. 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 a SC leaders have over some proposed changes to [00:01:00] 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. Hope everyone enjoys the episode and hears what’s going on this week in surgery centers.
Hi Mark. Welcome to the podcast.
Mark: Thank you so much for having me.
Erica: Can you please share a little bit about your a SC experience?
Mark: I found myself in healthcare leadership and management coaching, accidentally found a passion for it and stumbled into various different healthcare.
Settings and then learned accidentally through a client that what an A SC 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’ve worked with several, and particularly in depth with with that initial one to as a way to. Test my theories about [00:02:00] 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.
Erica: That’s perfect. And I’m excited to have you join us today to keep our three part series on staffing strategies going. So last week we talked about how to select the best agency for an A SC, which is not an avenue, a ton of ASCs use currently. But today we’re gonna talk about building a.
Sustainable culture, sustain. So let’s dive right in. What are the key elements of a strong sustainable culture in an A SC and how does that impact staff retention?
Mark: So I, I just wanna be blunt and that the unfortunate reality is that there’s no silver bullets on this. And I think that because the typical a SC administrator is so short on bandwidth and trying to do s [00:03:00] 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. It is a two year journey to transform a culture that is not where it wants to be. And I think I, 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. They feel very far away from it.
And so the bad news is that we have to get really committed to the core values.
And core values are those three to seven statements. That we can to describe who’s one of us and who’s not. These core values are who we are, not who we want to be. And where that gets tricky is ’cause, if 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 [00:04:00] so let’s just say we gotta get as small enough people in the room. That we can look around and say, this is the team. This is a team I trust to, to take me into enemy lines and survive.
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? 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. 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 ’em are terrible. Which is not uncommon, like at all. If that’s you, that’s just normal. The, the feeling is what am I gonna do to turn over 30 people? I can’t turn over 30 people.
That’s [00:05:00] insane that, this is just ridiculous. That’s not how we solve it. We solve it one at a time, 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 gotta 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. 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.
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 seven, usually three to four or five max statements of who our culture is. Let’s envision that, and then one person at a time, let’s get somebody off the bus. And then when we go hire, let’s hire one more person.
And if you commit to this formula and I say commit. Because this [00:06:00] 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. ’cause they’re like, man, this place sucks. And so dammit, I gotta go back to the well and do that again.
And after two quarters, three quarters, four quarters, you’re like, you know what? I 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 and it’s really just this commitment over the time to turn it over. And I gotta tell you that 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 organizations you’re trying to recruit from do not have that all the institutions out, like all the institutions out there, there are people going, there’s. Gotta be a place where it doesn’t suck. There’s gotta be a place where people care about working hard, who appreciate me when I work hard, and who take [00:07:00] care of the patients.
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.
Erica: Sure. Yeah. No, that’s all great insight. So let’s say we’ve come up with our core values.
We’ve identified which ones we don’t think align with our culture, that we wanna part ways with. How do you approach those kind of difficult staffing decisions, like letting go of someone who isn’t aligning with the culture? I.
Mark: Using a business operating system brings you these tools.
Like in EOS we call it the People Analyzer. 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, as opposed to I don’t know.
They’re okay and they’re irritating, but, 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 [00:08:00] whiteness for sure. But that’s not the end of the conversation because I think what you’re 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 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. I cannot overstate how critical this is. 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 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. And so make sure there’s somebody who knows, it’s that’s their job, they’re measured on it, and we have this ability, so we don’t feel like we’re stuck in.
People we can’t replace. So that’s just part of the process. We have to commit to that and never let go of that. [00:09:00] 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. There’s this let’s hold onto 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 gonna have time to replace this person because I’m not posting. ’cause I, because we’re all underwater. That sort of sustains this suffering forever.
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, in my experience, nine times outta 10, even when that remaining three people are like, you know what? We’re working 60 hours a week, I.
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. It’s like we don’t mind working hard if we’re not working against ourselves. We don’t mind doing this right the first time with extra effort, but [00:10:00] undoing bad work and having to fix problems somebody else’s.
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.
Erica: Beyond salary, what factors contribute to keeping staff committed long term?
Mark: I go to morale on this one, and there morale of an organization is exactly equatable to one thing. 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. 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 [00:11:00] 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 wanna be a part of us you’re gonna work hard too. It’s a point of pride. So we have to make sure we have crystal clarity on what winning looks like. And this can be a little complicated, but the simple formula is.
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 aren’t, you’re not gonna be able to keep those people. So I don’t recommend you go way outta your way if you’re gonna try to give people what they want these schedules and they want, to be able to work from home or whatever.
Obviously in the a c world, there’s not a lot of that, but sometimes we have to set the bar really low on, on winning. And so I think the biggest mistake. Is saying, I wanna retain this team. We wanna win big and we want to hit grand slams. Grand slams aren’t on the table for us. Winning might, be on time arrivals these little [00:12:00] wins and giving people the reward. It’s good job, that we won today, we won the day. We, 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 making it possible to recognize, ’cause 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. 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 is rooted in the DNA of how these administrators are trained in my [00:13:00] experience. And it is that the administrators expected to do everything and you know everything from life safety to. Physically getting patients moved around, all the paperwork, all the data’s correct, handling an audit and a survey, and somehow leading, somehow hiring and firing, somehow driving culture.
And somehow these a c administrators start figuring that out. And so this mindset of maybe everybody can do that. No, we, they cannot. They cannot. 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 over 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. So we have as many. We’ll call ’em positions on the baseball diamond that are appropriate to play the game we wanna play.
And so we do this instead of an account an organization. Organizational chart, organizational charts are very confusing. But if we build this sort of [00:14:00] map of the roles, one of the number one things we can start doing is making each of these jobs doable. ’cause the tendency is to be like, just handle it.
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, to how to handle entering this data, you know how to handle all these things. 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.
And when we start take, making each of these jobs more doable. Lots of things happen. The ability to win the cl, the clarity of what my role is and the clarity of 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. You’ve been doing that. It’s been amazing. But we’re not gonna do that anymore. We got somebody else who’s gonna 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 that, and so there’s just a [00:15:00] million things that can go into the fundamentals.
Erica: Yeah I think that’s a good comparison to the organizational chart versus accountability chart because sometimes I do look at an org chart and I’m like, okay, I know your title. I know who you report to, but I don’t know what you actually do. Oh my gosh. So awesome. So I think that’s,
Mark: you nailed it.
That’s exactly what happens.
Erica: Yeah. Perfect. Thank you so much for all of that advice, mark. We do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers?
Mark: I thought about this one a lot. This is the hardest leadership skill that people will develop and learn to tell the truth.
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 and I [00:16:00] am no longer telling them. I’m no longer giving them feedback.
I am walking a wide birth around them and essentially endorsing their bad behavior. Everybody in the organization de 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. It’s not your job to help them get there necessarily.
You can help them, but it’s, you don’t need to force them to do the right thing. Treat them as adults. Give them the feedback, positive and negative, 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 don’t endorse through non confrontation.
Don’t endorse or encourage that bad behavior.
Erica: That is great advice. Thank you so much for coming on today. We really appreciate it.
Mark: Thank you so much. It’s been a [00:17:00] blast.
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 62nd surveys on it. This topic is really everywhere right now, but in a recent salary survey, many a SC leaders said they’re now having to think creatively, whether that’s paying stipends, canceling cases, or closing rooms entirely.
Erica: 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. Others report operating with fewer providers than usual and having decap 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 [00:18:00] blocks or handling more complex procedures. Some facilities are using locums to fill the gaps, but that comes with its own challenges and consistency and cost. And a handful of ASCs are attempting to get ahead of the problem by building their own anesthesia teams. Lavonia Outpatient Surgery Center created a group of 15 CRNAs and does all their billing in-house. Another A SC in Wisconsin took advantage of a shift at a local hospital to launch a new anesthesia care team model.
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? 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 and 10 99. Staffing flexibility and [00:19:00] proactive planning are key to maintaining safe, efficient surgical care in a tight anesthesia market. 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. All right. A SC leaders are raising red flags after the US 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 if finalized. This move can make it much harder for ASCs and healthcare providers to weigh in on regulations that directly impact their operations.
Danilo dle, President-Elect of the Arizona Ambulatory Surgery Center Association says collaboration between policymakers and care providers is key to [00:20:00] building practical policies that benefit patients without input from ASCs. The risk is that future rules won’t reflect what’s happening in real care setting.
Several organizations beyond the A SC world have also spoken out leading ages. 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. Legal experts also warned that HHS may be trying to speed up rulemaking, but it could backfire. Rachel Carey, an attorney at Whiteford Taylor and Preston noted that skipping public input could trigger legal challenges.
Courts have already stepped into block rushed efforts, like a recent attempt to cut NIH funding. Interestingly, though, this rule change comes at a time when HHS and CMS are usually releasing new rates and [00:21:00] guidelines. 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, a SC leaders could lose a vital tool for influencing policy. 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 dc, the better they can protect their interests and their patients.
So please make sure you are staying in close contact with your state associations in asca so you can voice your opinions and we can stay on top of this.
Okay. Third story March was National Colorectal Cancer Awareness Month and ASCs around the country are seeing rising colonoscopy volumes, especially among younger patients. The Endo Center at Vorhees hit a record 16,000 screenings in 2024, which is up from 13,700 in 2023. [00:22:00] 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 Bozeman. 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.
The Endo Center at Vorhees offers fast track scheduling, skipping pre-op visits for eligible patients, and even uses AI assisted polyp detection. Something patients are now asking about. 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. But of course there are challenges too. Rising costs type reimbursements and growing use of at-home tests are real concerns. A SC leaders [00:23:00] stress that at-home, kids don’t replace colonoscopies and may still lead to one if something abnormal is detected.
Continued education is key to helping patients make informed choices. But going back to demand and reimbursement really quick. In HSC 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.
When we look at net revenue per case, GI is at the bottom of the list, absolute bottom only bringing in $1,362 on average per case. 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 two 20 cases per month.
So imagine a world where we [00:24:00] 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, uh, per month. 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 detection.
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, 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, which is also up 4.2%, including [00:25:00] 877 more primary care slots. Orthopedic surgery filled 100% of its residency positions, reflecting strong interest in a specialty that’s vital to ASCs.
Internal medicine added 679 positions and filled 11,750. In total pediatrics, saw a boost in both positions and match rate. Jumping to 95% filled emergency medicine made a major comeback with its fill rate climbing from 82% to 98%, and then O-B-G-Y-N also remains strong with just 10 unfilled spots nationwide.
Even with a few anesthesia vacancies, the majority of slots were filled. Highlighting continued demand across surgical specialties. The surgeon applicants in rising fill rates across key specialties is great news for surgery centers. It points to a healthy pipeline of future providers in orthopedics, primary care and beyond, helping address staffing shortages and ensure long-term growth.
[00:26:00] And that officially wraps up this week’s podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you’re listening from. I hope you have a great day, and we’ll see you again next week.