Office-Based Surgery Practices Impact of Human Resources on Office-Based Surgery Practices

Office-based surgery is defined within the legislation as that in which any surgical or invasive procedure is performed outside of a hospital or diagnostic and treatment centre, in which moderate to deep sedation or general anaesthesia is used (Patel et al., 2008). The use of office-based surgery is currently increasing, due to the recognized benefits with which it is associated, for example shorter waiting times, greater convenience and lower costs (Dalton et al., 2006). The role of human resources in office-based surgery is an important concern as it may have a significant impact in many areas of the practice, including critical aspects such as patient and staff safety. This essay examines the impact of human resources on office-based surgery, including accreditation issues, the impact on patient and staff safety, and employee and labor relations.

Accreditation Issues

Amid concerns for patient safety which arose, related to the use of office-based surgical procedures, legislators have sought to introduce various measures to better regulate this practice and improve safety. Under recently passed legislation, all office-based surgery practices must now maintain a full accredited status with one of the nationally recognized accrediting agencies. This legislation applies regardless of the size or specialty of the practice. If any physician practices in an office-based practice not accredited, this is considered to constitute professional misconduct (Patel et al., 2008). The introduction of this Joint Commission accreditation scheme is aimed at promoting a recognized standard in the delivery of care, thereby promoting a high level of patient safety (Palmer & McIver, 2008).

Human resources has a significant role to play in the accreditation process, especially in ensuring that the eligibility requirements for accreditation are met. For example there are standards set by the Joint Commission which state that four or fewer licensed practitioners must be operating from within the surgery to be eligible, therefore this must be accounted for in recruitment.

Safety and Health of Employees and Patients

Patient Safety

Horton et al. (2006) divide the issue of patient safety into three separate areas: administrative safety, clinical safety and procedural safety.

They suggest that patient safety begins at the administrative level, which involves putting procedures in place to minimize preventable errors associated with record keeping. This also incorporates appropriate processes for monitoring and reporting errors which do occur. The clinical aspects of patient safety then include appropriate evaluation of the patient to ensure that both the patient and the chosen procedure are appropriate for the office-based surgical setting. The final area of patient safety is then the surgical procedure itself.

Human resources clearly play a crucial role in the administrative elements of patient safety. Staff members dealing with the administration of patient notes clearly need to be appropriately trained and experienced to minimize the risk of errors being introduced during administrative procedures. This may be achieved through the recruitment and selection procedures, employing staff members who are suitably qualified and experienced. It may also however require a significant training input with existing staff members, across all levels from administrative staff members to clinicians. For example training with clinicians in quality assurance has been shown to have a significant positive impact on patient safety (Boonyasai et al., 2007).

This training may also play a crucial role in improving the clinical elements of patient safety, as improving clinician awareness of quality improvements and safety may further improve attitudes towards this in patient assessment. This then would leave the procedural element of patient safety. There is a possibility of adverse patient events occurring in an office-based surgery, just as there would be in the case of hospital-based surgery. Legislation states that these should be reported to the Department of Health's Patient Safety Center within one business day of occurrence (Patel et al., 2008).

One concern in the office-based surgery may be that there are less staff...

Although this may be beneficial in many ways, for example by reducing costs to both provider and patient (Spring et al., 2007), it could have the potential to lead to safety issues. A systematic literature review which was conducted by Hancox et al. (2004) did however indicate that there was no increased risk associated with office-based surgery when compared to the risks associated with the same surgical procedures carried out in the hospital environment. This included an analysis across several different disciplines including both general and plastic surgery and dermatology. They therefore advised that office-based surgery should be considered safe and should therefore not be severely restricted.
Staff Safety

It is however not only patient safety which may be of concern in the office-based surgery. Staff safety is also an important issue in office-based surgery. The fact that there are less staff members available in the office-based surgery setting may in itself place staff members at a greater risk of danger than there would be in the hospital setting. For example having less staff available for some procedures may place a greater risk on team members of injury (Thomas et al., 2006). The management of human resources would need to take account of this at two levels. The first of these would be to ensure that adequate human resources were employed by the office-based surgery and also that adequate staff were on the schedule during procedures. The second level would be to ensure that appropriate training and other resources such as equipment was provided to minimize the risk to those staff members during potentially hazardous procedures.

It is not only physical safety which must be accounted for however, but also employment security. For example if there were a greater risk of patients suing office-based practices this may not only endanger the financial security of the business but also jeopardize the job security of all staff members. Patients generally report higher levels of satisfaction for many procedures performed in the office-based surgery than for those same procedures performed in the hospital-based setting (Dalton et al., 2006; Harley & Collins, 2008). This would indicate that patients may be less inclined to pursue clinicians with legal action, thereby protecting the clinicians themselves as well as other employees.

Employee and Labor Relations

The human resources function is also crucial to ensuring that good employee and labor relations are maintained, as this is crucial to the continued functioning of the business. This involves ensuring that adequate resources are available for the planned services provided. Engaging in services which stretch employees beyond their expected role and commitment is likely to lead to tensions between employer and employee, which is not good for morale and practice functioning.

Additionally, it is important to consider that the office-based surgery practice may be significantly different to the hospital-based setting which many practitioners and other staff members may be used to. This means that training in appropriate administrative procedures may be required, along with training in teamwork, communication and public relations. By improving the capability of staff members to adapt to the new environment, employee relations is likely to be much improved through increasing staff satisfaction and general morale. It is also crucial that the appropriate support resources are in place, as the limited number of staff available may mean that there is a limited level of expertise in some elements such as IT. Human resources would need to account for this in the recruitment process, or through putting in place access to external support providers (Galati, 2006).

Conclusions

The human resources function is a crucial component of the operation of office-based surgery practices. Not only does it have an important role in the continued staffing of the practice, but also in ensuring that legal obligations are met, that high levels of patient and staff safety are maintained, and that employee relations are maintained. Crucial activities include well-planned recruitment strategies, resource planning, appropriate training and development processes and putting in place appropriate support structures for…