This Week in Surgery Centers: Janet Carlson – Optimizing the Physician Experience: Communication and Collaboration

Janet Carlson – Optimizing the Physician Experience: Communication and Collaboration

Here’s what to expect on this week’s episode. 🎙️

Knowing how to communicate with your doctors and collaborate with them can be tough, especially if you have dozens or more who perform surgeries at your facility.

In our latest episode on “Optimizing the Physician Experience,” Janet Carlson, Executive Director of ASCs at Commonwealth Pain and Spine, shared valuable insights on overcoming communication barriers and fostering collaboration between staff and physicians.

Here are the key points:

🗣️ Streamlining Communication: Inconsistent communication, often due to fractured lines and too many intermediaries, can lead to critical details being lost. Establishing a clear chain of command and communication procedures is essential.

🤝 Building Relationships: Physicians tend to communicate with those they are most comfortable with, which can bypass essential team members. Admins should ensure that all stakeholders are aligned and that communication channels are consistent and transparent.

🧑‍💻 Technology Integration: Janet emphasizes the role of technology in enhancing communication, from using apps for real-time scheduling to mass texting systems for urgent updates.

🔄 Feedback Mechanisms: Regular feedback is crucial. Janet conducts and recommends annual one-on-one meetings with surgeons to discuss what’s working and identify areas for improvement.

📅 Consistent Meetings and Transparency: Commonwealth Pain and Spine maintains regular meetings and communication across all levels, ensuring that everyone is informed and aligned. Attendance and participation in meetings are expected and communicated clearly.

These practices highlight the importance of structured communication, technology integration, and regular feedback in creating a cohesive and efficient environment in surgery centers.

Listen to the full episode for more detailed insights!

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. Today is the third and final part of our three part series on how you can optimize the physician experience. Dr. Justo covered the importance of encouraging your doctors to learn new procedures. Lindsay Schulte covered how you can make sure you’re fully aligned with your doctor’s preferences and Janet Carlson joins us on this episode to talk about improving communication and collaboration.

Erica: So Janet is the executive director of ASCs [00:01:00] at Commonwealth Pain and Spine. They have roughly 22 docs, so she shared tips for removing some common barriers, the role technology can play, and the things that they do successfully at Commonwealth. After my conversation with Janet, we’ll wrap up the episode with the third installment of our AI segment.

Erica: So we’ve covered ways you can use generative AI to create staff schedules, write patient education materials, handle the heavy lifting when writing post op instructions, improve your website, and manage your social content. Today, we’ll take it one step further and look at five ways you can use AI to help you analyze data, spot trends, and present your findings to your board or any stakeholders.

Erica: Hope everyone enjoys the episode, and here’s what’s going on This Week in Surgery Centers.

Erica: Hi, Janet. Welcome back to the podcast. Hi. How are you? Thank you. Case any of our [00:02:00] listeners missed your first episode with us, can you please share a little bit about yourself and Commonwealth?

Absolutely. So my name is Janet Carlson. I’m a registered nurse. I am very passionate about the ambulatory surgical space and how it is the site of service in perpetuity.

As we look forward. in health care trends today. So my job is with Commonwealth Pain and Spine. I’m the executive director of A. S. C. S. And I’m executing on our clinical footprint and multiple locations building brand new build to suit de novo A. S. C. S. To support our clinics and our patient population all over our region.

Erica: Great. Thank you. And I’m excited to have you on today so I can pick your brain about how ASCs can improve communication and collaboration with their physicians. So what are some common barriers between staff [00:03:00] and physicians?

To be frank with you, I feel like there are too many cooks in the kitchen sometimes in, in surgery centers, and just, it’s fractured the lines of communication in a lot of surgery centers that I’ve been familiar with.

For example, a surgeon may want to add a case and they’ll text their vendor rep. Or they’ll text the O. R. charge nurse or their P. A. or nurse practitioner. But many times a lot of the details of this request are lost in this inconsistent manner. So the message isn’t fully delivered and isn’t fully received in a communication cycle.

That’s one of the top three. things that I would point out and say is the surgeon is obviously well intended, but it’s just knowing that when it’s fractured like that the referral for the patient or the add on of the patient means that there’s a higher risk that the [00:04:00] patient isn’t optimized before surgery, thus increasing the chance there may be a day of surgery cancellation.

Erica: Sure. And do you find that they text who they’re most comfortable with? Who they have the closest relationship with? Okay.

Yeah. And like I said, for example, a lot of them, it’s their vendor and the vendor may not communicate with the administrator of the ASC or the scheduler or the OR and PACU charge nurses, the director of nursing.

And so the vendor to their defense may think. This is already on the books and everything is done and authorized and pre authorization has been done and the preoperative anesthesia assessment has been done when in truth it hasn’t.

Erica: Gotcha. So how can admins fix that? How can they foster that, that tighter collaboration and between the physicians and the rest of the team?

I [00:05:00] think it’s key to come in and basically learn your environment if you’re new to it, or if it’s Been ineffectual is to basically take a step back and study what’s going on currently, and then begin and establish and implement a new solid chain of command or chain of custody of communication procedures.

So just getting all stakeholders at the table, explaining the why, letting them know what you assessed and then say, look, here’s the who of the problem. Or, the opportunity is probably a better way to explain it as an opportunity, the who, then the what, then the why and the how. So if you can answer all those questions, moving forward, stating to all stakeholders, future forward, this is how we’re going to add on cases.

And this is the process that we will follow. And I [00:06:00] find you’ll have success if you over communicate that. I usually. Recommend a high level meeting with your physician stakeholders and then also communicate with the, their apps. Make sure the clinic is completely on board as well, because oftentimes the clinic and the a SC aren’t necessarily totally tied to one another.

There could be multiple independent clinical practices feeding the a SC, so you have to make sure that you’re consistent in your messaging to the. The people, the physician offices. pushing your surgical volume to your ASC. And so once you have that established, you’ve shared it with all the stakeholders, over communicate it.

I’ve even printed things out on a very obnoxious neon colored. piece of paper and laminated it and put it next to every computer as a new process. Like when scheduling, [00:07:00] when adding a patient on, when needing to change details of a surgery, this is the way we’re going to move forward. Perfect.

That

Erica: makes a ton of sense. What are some of the best practices for collecting and acting on feedback from physicians themselves?

I get continual feedback from physicians every day. Most of them are not shy about sharing it, which is wonderful. Sometimes I’ve found that they’ve received half of the story, what they’ve heard particularly in the OR and then what is actual and real sometimes could help avoid a lot of drama that’s unnecessary, but I have created an informal brief 10 question Just a quick bulleted question survey that I would sit down with my surgeons in my surgery centers at least once a year and go through these 10 questions.

All of my credentialed surgeons, anesthesiologists, any proceduralists. And then I would [00:08:00] sit and ask them these 10 questions based on, what is working well for them? What is an opportunity that we could improve upon? What would they like to do moving future? Do they see additional training where they’re going to need a new capital expenditure?

Am I going to fund it? need to find new equipment for them. So as I’m forecasting and planning for the next fiscal year, I do this and have these meetings with these surgeons before I do my budgeting process. So I’m as comprehensive as possible in planning for capital expenditure outlay and whether I need to change the way I do my staffing.

And if the staffing needs to have additional training. To do some of these new procedures. The physician surgeon would like to add to our offerings at the ASC. So that’s one way I collect feedback from surgeons.

Erica: Do you, are those meetings just one on one in person or what’s the format of those?[00:09:00]

Erica: Great

question. One on one in person, private in my office. Got it. The other thing that I do that works well is to send all of my shareholders that are invested in the surgery center, a high level monthly operating report for all of our clinical metrics, our operational metrics and our financials.

And so they can see what’s driving our gross revenue and our net revenue, what they can understand what the big levers are for our. Our expenditures, meaning our overhead, our implant, medical supply, spend and labor. Those are typically my biggest levers on the P and L monthly that you need to stay on top of.

And I communicate that out to them, letting them know if we have overtime, which frankly, traditionally in my experience has been a good thing. Overtime. means that we’re busier and we’re doing higher acuity cases. So I don’t have a problem paying [00:10:00] overtime, but I just want to be smart about it as well. So I like to share all the information I have in real time with the physicians so that they understand, Hey, everybody took vacation in August.

So we’re really not going to have a distribution to reflect that you all went on vacation at the same time. Here are some recommendations of how we could do this moving forward.

That’s funny.

Erica: Yeah. We definitely see even on our end, just working with clients and stuff. It’s definitely a little quieter in the July, August timeframe.

It is, but then we make up for it in Q4 always. So we know that it’s a, we know it’s a natural sort of progression fluctuation, but if we could have better utilization of staggered vacation times, and not have unutilized block time, that would be preferred.

Erica: Sure. What role does the, Could technology play in enhancing communication? [00:11:00]

Oh my gosh. This is another topic I could talk on for a totally different session. I think there’s a huge opportunity here to improve in our communication habits using technology, but first you have to solve for. What’s the need, right?

Are you wanting to have all of your physician, surgeons, and APPs and leaders in the ASC have access to an app with your daily schedule on it so that they can make real time decisions on the fly? What does that look like? Who do you give that access to? Are you able, using the app, to change the details of the surgery?

The time, the vendor the date? And if so, you have to have a high level of trust in that individual to do that on the fly, and make sure that they’re making the right decisions for the ASC. That’s an example of, It’d be great to have [00:12:00] the software on your phone to look at your surgery schedule so you can say, yep, absolutely, please add on that extra case, especially the docs that are covering call in a hospital and they see, for example, a fracture and they need to do an ORIF of the upper extremity.

They’ll text me, call me and just say, Hey, I need to add a case on at this day. And so I, Pull up an app and look and say, sure, absolutely. We can do that. We’ll start you at this time. Go ahead and tell the patient we’ll be calling them to get them scheduled for surgery, but go ahead and give them this date and time.

So that’s one way that you can use technology to improve communication instead of the 5, 000 emails, which we’ve now migrated over to text messages. But hopefully eliminating some of that back and forth and the phone calls, things like that. So I feel like there’s always a way that we could use technology for communication.

But one of the biggest ones in [00:13:00] the surgery center is the schedule and how to manage it after hours. The other thing is it, and the other thing is if you’re deciding you’re going to have a new communication tool, for example, to send a mass text out to your team, which again, I love that you can time scheduled messages, you can send, oh my gosh, the electricity went out.

A message to everybody delayed all this time. You just need to make sure that everybody is receiving the information and that you have set a reasonable timeline for everybody to implement this, make sure they have the technology, make sure we’re able to connect with them with their correct phone numbers, that they see the communication.

And then if this is like a system wide implementation, you have to set a reasonable timelines and milestones to learn and adopt and implement new technology. [00:14:00] Perfect.

Erica: So you’ve shared a few ways that you handle things at Commonwealth, but are there, is there anything else that you do personally or that you’ve seen work?

Erica: Sure. To help foster communication and collaboration.

Definitely. There are many ways. So we use, during working hours, real time messaging on teams. And so people will message back and forth quickly. We set meetings at a regular cadence Whatever the project is bi weekly, sometimes weekly meetings.

We do monthly wide company newsletter that goes out to everybody under the Commonwealth umbrella. We also have bi monthly leadership meetings and then monthly physician provider meetings. And then also part partner meetings. So it depends on the lane, but there is a well [00:15:00] established repetitive process to keep every stakeholder informed.

And that we are definitely committed to. Communicating clearly to everybody. So there’s no surprises. It’s all transparent. So I think Commonwealth does a wonderful job of fostering that collaboration with everybody via the various modalities I just explained for communication.

Erica: Yeah, do you get pretty good attendance at those meetings?

We do. It’s an expectation that’s established clear, clearly as well as you’re expected as a partner to attend the meeting. As a physician and a PA or a nurse practitioner, you’re required to be on a clinical call. As an executive, you’re required to be on these leadership meetings. It’s your attendance is expected.

And so if you don’t attend, it’s usually a very good practice to let your one up know that you’re not [00:16:00] coming and also give them your report out so they can give the report for you.

Erica: Love it. Those are great policies to have in place. So they’re clear expectations. You’ve communicated extremely well.

Erica: All right, Janet, we do this every week with our guests. What is one thing our listeners can do this week to improve their surgery centers?

Honestly, I think just opening your worldview, being, um, willing to think outside of the box on established, often practice status quo. There’s my least favorite saying when I seek to understand a process and I’ll ask, can you tell me why you’re doing it this way? I’d like to understand, give me the history behind it.

Tell me the why. And of course, The response typically is this is the [00:17:00] way we’ve always done everything. This is the way we always do it. And I, that just. That really is not the answer that my favorite answer, frankly. So I guess what I’m saying is be willing to challenge the established status quo.

Because they’ve always done it that way doesn’t necessarily mean they should continue to do things that way. Not saying their way isn’t effective, but there may be a better way to operate more effectively. More on a lean scale where you can save some resources here and you can pick up synergy here by doing something different, it’s just.

Never too late to learn and adopt something new. And I find when I talk to other leaders in the ASC space, it’s wonderful to hear what they’re doing because you get an idea and you’re like, Oh, I’ve been trying to solve for that. And somebody has already solved for it. So you should be willing to be open to these new processes or policies or [00:18:00] procedures for a better way of improving your clinical operations in your ASC.

I’m always open to learn something new. I thrive on that and I’d like to always be in a process of a mindset of continual improvement. But the other way to, besides thinking outside the status quo is to listen to your teammates and their feedback. Their suggestions are always welcome.

And they’re much appreciated. I’ve had multiple examples over my career where people come and bring me cost saving ideas and time saving ideas. And I’m just so grateful for it. I like to recognize and reward that feedback as well, because it’s so helpful. So those are just a few of the suggestions, but just don’t accept the status quo as well.

It’s the only way we’ve done it and it’s the best way that you may learn this, there’s actually another way, or you could amend your ways and add something to the process to make it more [00:19:00] streamlined. So that’s my advice.

Erica: Perfect. That is great advice. Thank you so much for coming on today. We really appreciate it.

You’re welcome. I enjoy the time talking with you. So thank you so much, Erica.

 Yeah.

Erica: Welcome to our AI segment, where I will share safe, free and helpful ways you can start using generative AI at your surgery center today. The following examples don’t include any PHI or pose any data or security risks to you at all, so you should feel very comfortable getting started and playing around.

Erica: So as promised, we’ll look at five ways you can use AI to help you analyze data, spot trends, and present your findings to your board or any stakeholders. All right, scenario number one, it is the end of the month and it’s time to dive into your surgery center’s finances. So you just finished [00:20:00] collecting all your financial data, which could include revenue, expenses, procedure volumes staffing costs, supply costs, and any other data points that you collect and deem appropriate.

Erica: So using your PM tool or however you collect your financial data, you can convert your spreadsheet into a CSV file and upload it right into chat GPT or your AI tool of choice, and you can ask it to help summarize profitability, identify cost savings, cost saving opportunities, and highlight any areas for improvement.

Erica: You can even get specific and say, please summarize the three key highlights that the board should know about. So that’s a pretty, pretty simple example. But hopefully as we’re going through all these different scenarios you’ll start to see conceptually what your options are here and how we’re trying to help, how AI can help save you time.

Erica: So in that case, we’re just looking at kind of summarizing some of the financial data [00:21:00] from the last 30 days, let’s say. Okay, scenario number two. So in the next month or two, ASCs will start thinking about their 2025 budget. If you have not already, so let’s say you want to make some projections regarding case volume.

Erica: So as an example, you can put together a CSV file that let’s say has two years worth of case volume data per doctor. Same approach. You will upload your CSV file and ask the AI tool to predict case volumes in 2025 based off of the previous two years worth of data. Now, obviously the farther back you can go, if you have 10 years worth of data, even better.

Erica: You can also give the tool boundaries. Like perhaps you want the predictions to be extremely conservative. Or maybe you’re willing, you want it to provide a range for you so it could do that. And then you can also ask it for talking points to explain why it is predicting the numbers that it is so that [00:22:00] when you’re in your board meeting or talking to the budget.

Erica: And someone wants to know, Hey, why do you predict that Dr. Ramirez is going to do, 2000 cases, you could have all those talking points ready to go for you.

Erica: Scenario number three. Another thing that AI is really good at is comparing datasets. So in this scenario, let’s pretend you’re trying to find a new vendor for your surgical instrument.

Erica: So scalpels, forceps scissors, retractors, clamps, whatever it might be. Your current vendor who we’ll call vendor A, you feel like they’re a little too expensive and you really just want to know if you’re getting the best deal that you can get. So you have received pricing from vendor B and vendor C.

Erica: You can upload all of your supply ordering history along with the pricing from vendors A, B, and C. And ask your AI tool to compare the costs of supplies from the three different vendors and tell you what your costs would have been in the previous quarter for [00:23:00] each of them. So that will give you the insight or, again, the talking point.

Erica: So if a doctor comes up to you and says, I really don’t think we’re getting yeah, I think we can get X, Y, and Z for cheaper. You can say, Oh, I’ve actually ran that analysis. I’ll send you the whole spreadsheet. With vendor a, we’re paying X. We paid X and Q1, but if we use vendor B, we would have paid a Y.

Erica: So again, upload all those data sets, have it compare, give you those talking points so that you’re prepared. If someone does want to dive into supply costs in this example. Scenario number four. You are preparing for your quarterly board meeting, and you’ve heard grumblings lately that the doctors are not thrilled with your current O.

Erica: R. turnover times, and you want to get ahead of it. First, you gotta prep your data, right? So maybe your CSV file contains Total turnover time number of staff, who the staff were, procedure type, procedure complexity, time of day of the week, [00:24:00] who the doctor was, of course and any other variables that might be impacting that turnover time.

Erica: And you can choose, obviously the more data you have, the better historically. So you could do, let’s say six months, you can do three years, whatever it might be. Or if they said, In 2024 I really felt like this has been happening or, if there was something that happened, a turning point where you want to just evaluate the data before and the data after you can do that too.

Erica: So anyway, you’re, once you get the CSV file with all the data points you want, you can tell your AI tool, I’m looking for ways to improve my OR turnover times. Can you please look at the following data and find any patterns for the longest turnover times or any other trends that might be the root cause?

Erica: And after reviewing its findings, you can then ask the AI tool for three ideas or tests you can run to try to reduce the time. And then to take it one step further, you can also ask it how to best display the data to your doctors and also [00:25:00] to create a spreadsheet for you to help you track the success of your tests moving forward.

Erica: So let’s say one of its recommendations is, or one of the trends that it finds is, Hey, when Dr. A is with this this nurse turnover in this procedure, turnover times seem to be higher. Maybe we’re going to swap out that nurse, whatever it might be. I could create that spreadsheet for you too, so you could track it and then you can tell your doctors, Hey, I hear you.

Erica: We want to improve our turnover times here. The tests that I’m running, you could take a look at this spreadsheet at any time to see how the tests are going as we’re trying to improve. And lastly, scenario number five. So sticking with the board meeting theme here. I know most ASCs do not use PowerPoint slides during their quarterly board meetings, but I would highly recommend doing so when you’re reviewing your KPIs and metrics, specifically RCM metrics or anything you’re trying to highlight trends for or tell a story for.

Erica: It’s estimated that 65 percent of people are primarily [00:26:00] visual learners. So using visual representation of your data will be extremely beneficial. But if you’re new to presenting data, it can certainly feel a little overwhelming. So in this example, and this could apply to any data set, right? It could be financial, clinical, operational, but you can upload any CSV file you have and get recommendations on whether you should use bar charts, line graphs and then you can also use the products, pie charts, scatter charts to display those shreds.

Erica: And perhaps there’s even a specific message you’re trying to visualize. So for example, this is simple, but let’s say within your patient satisfaction survey results, you keep seeing the question regarding facility cleanliness. It’s declining, but showing the spreadsheet just isn’t getting the message across, but a line graph with a drastically sharp drop could certainly do the trick.

Erica: So if you’re not sure, and that can go for any of these examples, right? If you need that visual representation, you can ask your AI tool, what is the [00:27:00] best way to show this to get my message across. So there you have it, five ways that AI can help you today. If you like this AI series, please let me know in the comments on LinkedIn or YouTube, and I will keep it going.

Erica: 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 will see you again next week.