NIFA Surgical e-News, April 25, 2014

Name: Paul Giles

Credentials: RN, CNOR, RNFA

Student Status: Graduated NIFA’s RNFA program 1999

City and State: Weslaco, TX

Current Position: Administrator, Knapp Surgery Center

Why did you originally become a nurse?
The summer I graduated high school, I turned 18 in July and by Aug. 5 was in the military, where I started out as a scrub tech. I have no idea why I chose a medical path. Maybe I watched M*A*S*H once too often.

What kind of work were you doing in 1999 when you got your RNFA training?
I was a circulating nurse working for a group of neurosurgeons in Ft. Smith, AR. They wanted somebody to assist them. All day long I’d be the circulator, going wherever they needed me the most. I had been a scrub tech and was also a nurse, so at shift change I would stay and work with them as an assistant.

They found NIFA’s First Assistant course and the neurosurgeons paid for me to take it. The program was designed to take 18 months to complete. I would take tests and send them in, then they would send me another one and so on. Since I was already working at a medical center and working with neurosurgeons and plastic surgeons, which was a great resource for me, I just had to stay diligent and continue taking the tests until I completed the whole course. It only took me three months, which was a record at the time.

When I graduated, the doctors flew me to Denver, where I did the suture tying workshop. I learned how to sew without putting a single finger in a hole. When I came back, one of the surgeons said, “You close better than I do.”

Where did you go next?
When the neurosurgeons started to retire, I thought I’d try travel nursing. My first travel assignment was in Thermopolis, WY, 120 miles west of Casper. We flew in a little puddle jumper. I thought to myself, “If I get to Thermopolis and there’s a horse waiting for me, I might just go back home.” It turned out the facility wasn’t doing too well; they were in the red. I asked the director about the situation and she thought I might be able to help. She sat me down with the Chief Financial Officer and I looked at their books. It was clear to me that they were charging too little for their services so the harder they worked, the deeper in the hole they got. I helped them fix that situation and then started to get referrals to provide the same service at other facilities.

The CEOs of various institutions all tend to know each other, so they would refer me to fix their surgery departments. I would go in as an Interim Director of Surgery and could usually fix the place within a month; one place I stayed for 9 months to fix it. In Rawlins, WY, I helped them start a hospital-based scrub school. We challenged the boards and all became CSTs.

In Eagle Pass, TX, I became the Director of Surgery and later also the Chief Nursing Officer at the Ft. Duncan Regional Medical Center. When I left there, the Regional Director of UHS (Universal Health Services) sent me to Enid, OK, where they were trying to start a heart program. I asked them, “How many hearts did you do last year?” They said, “Eleven.” I said, “That’s not a program.” I then hired a cardiothoracic surgeon to do endoscopic vein harvest, which he taught me. In the six months I was there, we did roughly 40 hearts and they did probably 200 the next year.

I helped Harlingen Medical Center (Harlingen, TX), which was a MedCap Hospital at the time, go from being the second-to-bottom ranked hospital in the group to number one in less than a year, and beat their flagship hospital by half a million dollars. I then went to Loredo Medical Center and did the first endoscopic vein harvest in Loredo.

How did you end up at your current job?
One day I was sent to a small surgery center in Weslaco, TX–Knapp Surgery Center. They had done nothing but eyes for 30 years. They had no beds, no bovies. I ended up calling all the reps in the Rio Grande Valley of Texas, brought them into the surgery center and said: “I need your stuff. Leave it here for a few months to help this center increase its revenue.” They all left it here for six months, and during that time I started purchasing the different pieces that were needed. We decided, “Let’s get the cases we know that we can do, and get the equipment to do those surgeries.”

Knapp Surgery Center went from four eye surgeons to 28 physicians. There is a hospital right in front of the surgery center, so the doctors helped us promote the center. Doctors at other hospitals chose to do surgeries with us because we ensured fast in and out.

I’m the administrator and I also circulate the cases. But I have also other circulators. I am very clear that nurses shouldn’t develop “nursitis”: “This is all I do.” In the beginning, the people here were in the mode, “All we do is eyes” and they didn’t want to do more. I hired my own team.

How does Knapp differ from other surgical centers?
We are 100% on protocol like time-outs, antibiotics 16 minutes before the surgery, etc., but standard turnover time nationally is 19 minutes; ours is 6.5 minutes, complete with cleaning the room.

One thing I do that is different, is that we don’t talk with “offices,” we talk with people. For every physician that is credentialed with the surgery center, we come up with an agreement. He takes care of his staff, I take care of my staff. The card that sits out at the front desk has my phone on 7 days a week for patients, physicians and staff. I meet every single physician every single day, every single time. I talk with every single patient. Our patient satisfaction scores are high; maybe one patient every three months doesn’t like something. If they don’t give us an “excellent” I will contact them personally to discuss it. But 99% of time we get “excellent.” And the doctors love working here.

I’ve learned every single position, including medical billing. I know how much it costs us to do each procedure. We run the numbers on every single case before we do it.

I listen to my staff. I don’t have to have all the answers. I listen to my scrub techs, nurses, billing. I listen to the physicians. If any of the processes we do are not correct or not efficient, I hear about it. It’s easy to adjust a process when the administrator is in the room doing cases with you. Tell me how to make it better, and let’s make sure it’s logical, too.

How do you explain your high energy level?
I’m in the gym every day for an hour. I’m a power lifter. By the time the physician gets there, and he might be drinking Red Bull, I’m already in high gear. One doctor said, “Whatever Paul is drinking, give me two of them!” I’m 6’ 2” and don’t get many arguments from people.