ance are having cases you can count on and good payer contracts."
Who's in charge?
The ship is also a lot more likely to go down if it isn't clear who's
the captain, or if the captain is neither immersed nor well-versed
in all the details.
When the chain of command is compromised or diluted, says
Mr. Zasa, it's a recipe for trouble. If there's a management com-
pany involved, but there's also a physician that the nurses think
they're reporting to, the management company may decide to
cut ties, he says. "And you end up with a doctor who isn't expe-
rienced at running a surgery center, listening to nurses who
aren't experienced either, and they're all having to deal with fair-
ly complex issues."
Another dangerous scenario: A physician becomes a sounding
board for the staff. He hears their version of the truth, but since
they lack objectivity, the physician gets agitated over what may or
may not be the whole story. That, too, can undermine manage-
ment and cause it to lose control, says Mr. Zasa. When it happens,
the center may start drifting off into a sea of uncertainty.
Any time management is undermined, it creates an untenable
structure, says Mr. Zasa, adding that the best solution is to have a
governing board: "Five heads are better than one, and that dilutes
the influence of one person. Now you're operating like a real busi-
ness entity, with 5 to 7 board members providing input, entrusting
management, but also objectively evaluating management."
That objectivity is crucial, and benchmarking is an essential com-
ponent of it. A failure to objectively evaluate how your center com-
pares to others is another death knell, says Mr. Zasa. "You don't
run surgery centers off of spread-sheets, but if there's a problem,
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