Executive Summary
This is a business plan for a 300-bed community hospital with a hundred physicians and twenty surgeons. There is a new space in the hospital that will be turned into an outpatient surgery center. This business plan explores how this outpatient surgery center can be designed and the number of patients it will take and its strengths, weaknesses, threats, and operations.
Market Analysis
The main marketing mix for this center includes people who need surgery. This can include people who have traumas such as broken bones or lacerations from emergencies (Ambulatory Surgery Centers in the US…, 2016). It can also include orthopedic and cataract surgery and other surgical procedures such as tumor removal (Ambulatory Surgery Centers in the US…, 2016). The center will be able to handle the surgical needs of many patients with its twenty surgeons and other employees in place for nursing, sterilization, and rehabilitation. Many of these patients will be referred by the hospital, allowing for the patient flow to include patients that the hospital does not have the time to care for.
Trends
The outpatient surgery center is a perspective direction of modern medicine. Plenty of operations that previously required a long hospital treatment are now done in outpatient conditions for one or several days. The popularity of ambulatory surgery centers is huge (Boodman, 2014).
They have been rising in popularity since the 1970s (Ambulatory Surgery Centers in the US…, 2016). But there are many concerns about the legitimacy and safety of such centers following the death of Joan Rivers, who was undergoing treatment at such a center in Manhattan (Boodman, 2014). These safety concerns can be assuaged by proper certification for the center as well as highly qualified staff overseen by the hospital’s large surgery staff of twenty surgeons. The supervising staff can prevent violations of accreditation that led to Joan Rivers’s death (Boodman, 2014).
The paramount mission of the center for outpatient surgery is the extension of health care opportunities for patients providing surgical treatment quickly, efficiently, and in a comfortable environment. The reduction of the time and cost of the treatment occurs due to the use of high-tech equipment and minimally invasive techniques (Al-Amin & Housman, 2012). Therefore, the center for outpatient surgery is an effective clinical and organizational direction of development for modern medicine and public health. The patient flow should be optimized by minimizing the waits and delays.
Licensing
Any medical activity is subject to compulsory licensing. To obtain a license, the potential outpatient surgery center should have an appropriate space, a list of necessary medical equipment, and staff with valid certificates (Mercier & Philip, 2009). The consideration of the application takes place within two months. The license applies only to a specific address. The difficulty lies in the fact that each health care service requires a separate license. A specially created registry can maintain the necessary documentation, registration, in particular, temporary disability materials, regulate the flow of the primary flow of patients, receive calls as well as manage the implementation of hospitalization and the solution of transportation issues.
Employees
Employees needed per operating room include one RN, one scrub tech, four pre-op RNs, four post-op RNs, two registration clerks, one custodian, two sterilization clerks, and a receptionist with knowledge of medical billing and coding. All employees must have proper training and licenses in their fields (Accreditation Organizations, 2016). The center itself must maintain standards set by the American Association of Accreditation for Ambulatory Surgery Facilities, HFAP, and Accreditation Association for Ambulatory Health Care (Accreditation Organizations, 2016).
The American Association of Accreditation for Ambulatory Surgery Facilities measures and monitors medical competence, Accreditation Association for Ambulatory Health Care uses peer-based measurements to accredit facilities, and HFAP surveys hospitals for quality of care and medical competence (Accreditation Organizations, 2016). The outpatient center must provide care and have certified and licensed employees able to provide the quality of care needed for these organizations to approve the center for accreditation so that it can be a trusted and safe source of healthcare.
Aspects of meeting physician needs on both the surgery center’s performance and that of the main operating room in the hospital should also be thoroughly considered. To avoid any misunderstanding, it is essential to provide investigations and elaborate on a uniform standard of health care provision.
Training and Certification
Advances in technology, globalization, and constant organizational transformation are forcing medical centers and their employees to learn and acquire new skills in developing new business models to work with new technologies. In order not to lose their competitive edge, medical centers have to constantly increase the pace of acquisition of necessary knowledge and skills. Such a need pushes the center’s management with a dilemma: on the one hand, employees need more training hours, but in the framework of constant change, the number of hours devoted to training is strictly limited. In this connection, the surgical learning is the best solution to the problem.
Using this approach, the maximum efficiency will be achieved through the training of specialists empowering the development and implementation of short and narrowly focused lessons that are required for surgeons and employees.
The basic idea of surgical training in this business plan is based on the fact that employees do not need comprehensive training concerning the new technology or program (Maruthappu, Duclos, Lipsitz, Orgill, & Carty, 2015). However, they need to learn more specific aspects related to the current operation. The reduced content should be transformed into short courses that are fast to develop and easy to use. Short training programs are more easily integrated into the working schedule of the staff. The attendance of training courses will be increased by the fact that the programs are short and more interesting. As a result, one will receive the progressive ambulatory surgical center with trained and certified staff.
Construction
Construction factors are another large consideration. Constructing a new space will include the cost of construction. But it will also include zoning and bringing the building up to code according to city requirements. The design of the building must make it very handicap accessible since many patients may be in wheelchairs or will be after surgery. Parking should be ample and easy to access for patients (Boodman, 2014). The design of the outpatient surgery center should follow the overall design of the hospital as a part of it. All the rooms should be equipped with special chairs and other utilities necessary for the pre- and post-operation periods.
The number of operating rooms should be approximately seven to provide timely surgeries. At the same time, the center should include physician space, in other words, changing rooms, workspace for paperwork and staff space such as changing rooms. It is also important to point out that the creation of a break room for relaxation will reduce the stress level of employees. Its design should be performed in green as such color contributes to the pacification and comfort.
The billing system should be organized appropriately to guarantee the calculating costs of medical services queries to the insurance companies and their processing. The center should be attached to the hospital to ensure timely health care services and control of the post-operational period.
Equipment
The equipment of the center for outpatient surgery will allow providing virtually the entire spectrum of surgical operations from the day surgery category. In particular, the following equipment is necessary to provide the appropriate treatment:
- endoscopic equipment for endosurgery;
- holmium laser that was previously inaccessible under the conditions of ambulatory operations to treat diseases of the bladder wall using it as a laser scalpel;
- ultrasound devices in both the operating and observation rooms;
- medical facilities including apparatus for RFA and EVLT, heart monitor and/or a pulse ox meter, blood pressure monitors, ventilation apparatus, defibrillator, operating table, medical couch;
- consumables: disposable kits for the operating field, intravenous catheters, gloves, etc.;
- sterilization equipment;
- medicines according to the profile of the medical center;
- anesthetic equipment, equipment tracking, monitors, and others will ensure the high-quality of operations using all the possible kinds of general and local anesthesia. For example, equipment installed for the anesthesiologist and expert classes will include the anesthesia-breathing apparatus of Draeger.
Daycare chambers will be equipped with functional beds, Ventilator Puritan Bennett 560, and oxygen concentrators. The installed equipment will allow monitoring the condition of the patient transmitted from the operating room and to react promptly to any deviation from the norm.
Expenses
The main costs for the implementation of the business plan will relate to equipment and facilities as well as the medicine purchase. When planning costs, the fact that the center will be inactive during the licensing period should also be taken into account. Staff costs related to wages include the monthly labor costs of personnel and tax rates. Capital expenditures include the following expenses:
- The building of premises for the outpatient surgery center, design, and repair facilities;
- Licensing;
- Equipment, furniture, air-conditioning, and ventilation system.
Fixed costs related to the work of the center will comprise:
- Production costs include the cost of materials for the surgery complex, repair costs, clothing for staff;
- Administrative and office expenses such as utilities, current expenses for office supplies and materials for office equipment, security alarm);
- The total labor costs;
- Constant marketing costs.
Also, electricity, thermal energy, and other resources should be considered while planning costs.
SWOT
Strengths
A significant strength would be its attachment to the hospital. Many patients express misgivings about going to ambulatory surgery centers because they are not “real hospitals,” like the fears expressed by Wendy Salo (Boodman, 2014). Being attached to a hospital with such a reputable staff of surgeons can help ease the concern of some patients. It can also provide more outpatient services with a hospital affiliation (Ambulatory Surgery Centers in the US, 2016).
One of the most important advantages is the unloading of hospital beds by transferring part of routine surgical interventions in terms of health centers, which operates in the hospital structure. At the same time, the organization of early discharge of patients from the hospital with subsequent follow-up care in the clinic would benefit both the center and patients (Merrill & Laur, 2010). All patients will be placed in the superior chambers equipped with modern facilities and are under round the clock supervision of qualified medical staff so that they will feel comfortable and calm. Moreover, the postoperative complications in the surgical day hospitals are on average less than 1 percent (Carey, Burgess, & Young, 2011).
The quality of operations in the outpatient surgery center is defined by experienced surgeons and nurses. Comparing volumes of the main operation room with those of the outpatient environment, one might note the increased capacity of the latter.
What is more, one might note such advantages as follows:
- reduction of wait times of patients. Outpatient surgery centers have shorter wait times and fewer budgetary constraints (Ambulatory Surgery Centers in the US, 2016);
- the release of specialized surgical hospital beds for the treatment of clinically complex patients;
- the same surgeon holds the complete continuity of the examination and treatment of patients – preoperative preparation, surgery, postoperative treatment until the patient’s hospital discharge;
- patients stay at home in a habitual environment (Grisel & Arjmand, 2009);
- active lifestyle contributes to the rapid recovery;
- reducing the probability of in-hospital infections and thromboembolic complications in patients;
- significant financial savings (ASCs: A Positive Trend in Health Care, n.d.).
Weaknesses
The primary weakness is its affiliation with a hospital. While this is a strength, it doubles as a weakness. Another weakness is the need for the center to be constructed. Construction costs, zoning, and time are all involved in the construction process, which can be a weakness for the center.
Operations
The content of operations of the ambulatory surgery center is determined by the variety of forms of its activity:
- The outpatient center is part of the overall hospital, but it will be its separate entity (Pickles, 2015). This means that the center will have its financial statements. It also requires a deep understanding of the regional health care delivery system to provide legally and ethically sound care (Pickles, 2015).
- Selection of patients with surgical diseases among the population including the workers and employees of industrial enterprises, institutions, and other organizations;
- Implementation of permanent relationships with the clinics and dispensaries;
- Clinical diagnostic study of supervised patients using modern methods and equipment;
- Consultative reception of patients of surgical clinics and dispensaries for the selection of patients requiring surgical treatment; definition of the indications for surgery, preoperative examination, the scope of the operation, and capabilities;
- Diagnostic use of invasive techniques, the performance of operations according to the approved list, the observation of patients operated on in the next few hours after surgery in the recovery room of the hospital, day surgery follow-up treatment at home;
- Comprehensive treatment of patients with surgical diseases including drug and infusion treatment, the use of extended wear bandages, physiotherapy, plasmapheresis, medication blockade, and the necessary range of rehabilitation measures (Starr, 2012);
- Organization of follow-up care for operated patients for timely implementation of the necessary therapeutic and preventive measures to prevent disability and reduce its period. Research and comprehensive assessment of the short- and long-term results of the surgical treatment and the development of evidence-based recommendations.
- Further training of surgeons and nursing, training of graduates of medical institutions.
Threats
The main threats include competition with other hospitals and other centers. This can especially be an issue with a large amount of distrust people feel for outpatient surgery centers (Boodman, 2014). Competing with other organizations can entail providing the best care possible. It can also involve providing a more comfortable and compassionate environment that will be memorable to patients in their difficult and often scary times of receiving surgery.
Initial capital requirements are one of the biggest threats facing ASCs (Ambulatory Surgery Centers in the US: Market Research Report, 2016). Being part of a hospital can help this center establish the capital needed to get started. Still, it will be a major financial endeavor.
One of the other project risks is associated with possible changes in the financial situation in the country due to the influence of internal or external factors. One more threat category may include a possible increase in costs and timing on the establishment of the center’s services or a possible reduction or increase in prices for services.
The probable management risks are related primarily to the inability of managers or a team to implement the project objectives and to achieve goals set in the business plan. The reduction of this type of risk is largely determined by the effective selection of personnel. To reduce this type of risk, it is possible to use the potential of an employment agency as well as the use of the resource business consultants, who have extensive experience in implementing projects.
Other risks include all kinds of risks of natural disasters, other force majeure related to property damage, and clients’ lawsuits in connection with human error. The above risks are easily minimized through insurance mechanisms. Based on the foregoing, all of the project risks can be regarded as moderate which is quite acceptable for the successful implementation of this business plan. Finally, taking into account all the above issues, it seems possible to implement the business plan within half a year.
References
Accreditation Organizations. (2016). Ambulatory Surgery Center Association. Web.
Al-Amin, M., & Housman, M. (2012). Ambulatory surgery center and general hospital competition. Health Care Management Review, 37(3), 223-234.
Ambulatory Surgery Centers in the US: Market Research Report. (2016). IBIS World. Web.
ASCs: A Positive Trend in Health Care. (n.d.). Advancing Surgical Care. Web.
Boodman, S. (2014). Popularity of Ambulatory Surgery Centers Leads to Questions about Safety. Kaiser Health News. Web.
Carey, K., Burgess, J. F., & Young, G. J. (2011). Hospital competition and financial performance: The effects of ambulatory surgery centers. Health Economics, 20(5), 571-581.
Grisel, J., & Arjmand, E. (2009). Comparing quality at an ambulatory surgery center and a hospital-based facility: Preliminary findings. Otolaryngology – Head and Neck Surgery, 141(6), 701-709.
Maruthappu, M., Duclos, A., Lipsitz, S. R., Orgill, D., & Carty, M. J. (2015). Surgical learning curves and operative efficiency: A cross-specialty observational study. BMJ Open, 5(1), 1-7.
Mercier, D., & Philip, M. (2009). Is Your Ambulatory Surgery Center Licensed, Accredited or Certified? ASA Monitor, 72(8), 10-14.
Merrill, D. G., & Laur, J. J. (2010). Management by Outcomes: Efficiency and Operational Success in the Ambulatory Surgery Center. Anesthesiology Clinics, 28(2), 329-351.
Pickles, V. (2015). Strategic Planning for Your Surgery Center. Ophthalmology Management.
Starr, C. (2012). Ambulatory Surgical Centers: Good for You and Your Patients. Medscape. Web.