OR Excellence - Where Leaders Meet, Learn and Grow Together

Red Rock Casino Resort & Spa
Las Vegas, Nevada
October 11-13, 2017

ORX Thanks Our 2017 Sponsors

Check Out These Exciting Sessions

Resuscitating a Dying Surgical Facility

Fear: The Hidden Killer

Building a World-Class Outpatient Total Joints Program

Get Ready for Surgical Price Transparency

What Can Surgical Facilities Learn From the Ritz Carlton and Other World-Class Corporations?

Every 1/2 Second Counts: A Victim's Perspective on Patient Safety

How to Transform Your Facility into a "High Reliability" Organization

Patient Safety: 54 Years of Progress ... or Stasis?

Addiction & Abuse: Medicine’s Dirty Little Secret

What If a Killer Walked Into Your Facility?

www.orexcellence.com  •  (888) YOUR-ORX

Carol Cappella, RN, MSN, CNOR

Carol Cappella, RN, MSN, CNOR

Resuscitating a Dying Surgical Facility

A conversation with OR Excellence Speaker Carol Cappella, RN, MSN, CNOR

In 2009, the Delray Beach (Fla.) Surgery Center was on its deathbed. It had been sold several times and was on the verge of foreclosure. But the prospective new owners recognized that there was still potential — in the right hands. They recruited Carol Cappella, RN, MSN, CNOR, to bring it back to life. In her presentation, "Resuscitating a Dying Surgical Center," at the Hyatt Regency Coconut Point in Bonita Springs, Fla., Ms. Cappella will explain how she embraced the challenge and helped turn the previously moribund facility into the thriving center it is now. We recently chatted with Ms. Cappella.

Q: How did you get involved with the Delray Beach Surgical Center?

MS. Cappella — I was working as a consultant, and in 2009 I got a phone call from the potential new owners, asking whether I wanted to come to Florida and help revive a surgery center. Coincidentally, I'd bought a condo in Delray Beach a couple of years earlier but hadn't moved there yet. I thought, Wow, it seems like this is meant to be.


Q: What was the situation with the center when you got the call?

MS. Cappella — It had been sold several times, and was on the verge of going into foreclosure. The people who called me were contemplating trying to revive it, but knew they needed a clinical director to help them.


Q: Why was it doing so poorly?

It really wasn't being managed by anybody. They had a management company that came down once every quarter to review things, but nobody was really watching it. The inmates were running the asylum. Plus they had very poor contracts providing terrible reimbursement. Everything was being billed and collected like a Medicare case — the contracts were that bad.


Q: What made you think you could turn it around?

They had a great market and great volume — in 2009, they had about 3,000 cases — but they didn't have the supplies they needed, because they couldn't afford them. There were a lot of issues with supply management, inventory, getting bills paid and getting money in because there was no real oversight. Eventually, we made the decision to try to renegotiate the contracts, and when companies opted not to, we dropped the contracts. We had to start bringing money in.


Q: What did you find when you first arrived?

It was a hoarders' paradise. You couldn't walk down the hallways, because there was so much clutter. The business office was just boxes and boxes of files. Every drawer had piles of paper you had no idea what it was. You opened any nook and cranny and it was stacked to the ceiling with boxes. There was opportunity beyond belief, but I knew I had to get through all the muck to find it. I had to find my path.


Q: With such a monumental task facing you, where did you start?

My first priority was to keep the schedule going, to maintain the status quo while I figured out how to de-clutter the place and get the supplies I needed. The second thing was assessing staff to make sure everyone we had was the right person for the right role. There were only 12 employees on site at the time, not really enough to cover every area. Plus, a lot of the people weren't qualified to do the jobs they were doing, and nobody was holding them accountable.


Q: How did you turn the staff around?

I knew we would lose a majority of them within a year. That was a no-brainer. Most either weren't right for the job, or were here for the wrong reasons. But it was a slow, methodical sweep. At any given time, I picked 3 things to focus on and then worked my way around the building until I got to the next 3 things on my list.


Q: Did you ever doubt your decision?

There were moments when I wondered, should I stay or should I go? I don't think I breathed for about 6 months. It was tough getting the building up to standards. Every room had a sink and we had no money, so I would come in every weekend and take the cabinets and the sinks out, and re-patch and repaint the walls. I remember thinking, I could go back to being a hospital administrator and make a lot more money, but I knew I could have a better quality of life here. I knew I just had to get through this dark hole to see some light.


Q: When did you realize that all the effort was going to pay off?

We started in May, and the following December we finally signed all the papers for the new ownership. At that meeting, the owners said they'd like to give me a Christmas bonus, but would I mind if we gave the physician-partners dividend checks instead. It was a way to show that we were really turning things around. Even though the checks were meager, their faces when I handed them the checks were a revelation. It was the first time they'd gotten them in years. As time went on and we were able to add new physicians and some new procedures — they all started smiling at me. They knew we weren't in the dog days anymore.


Q: How healthy is the center now?

We now have 30 employees and we did 4,188 cases last year. We've added spine and sports medicine and brought in more partners, we've started doing total joints and we're looking to see whether we can expand further. We're always looking for more surgeons.


Q: How does the overall morale compare?

Our staff and physicians think this is the folksiest place they've been. They know they'll be taken care of because I spoil them all. I feel like this is my family and these are my children. One key is that when people ask for things, don't ever say no. That's a cardinal sin. Even if it's a bad idea, don't beat them up. Spend the time to coach and mentor. Let them understand the reasons and the whys and the theories behind the practice.


Q: What advice would you give surgery centers that are struggling to stay afloat?

Take a step down and see what you can do to make a difference. How can you make yourself stand out so people want to come work for you? Integrity means a lot. You've got to be honest and consistent, and you have to be able to say, I made a mistake, or, it's not working, or, I need help. We're all human. It's going to work out if we stick together as a team and make it happen. My motto is, Show up and do your job. We don't have to love each other, we just have to get along with each other. And for the most part it works.

You are going to LOVE this meeting!
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