Hi, everyone. This is Lucas Voss with Becker's
Healthcare. Thanks so much for tuning in to
the Becker's Healthcare podcast series. Very excited to
have you. Today, we're talking about reducing burnout
and boosting revenue in ASC's
workflow and tech priorities
for this year and, of course, 2026.
And joining me for today's discussion, very excited
to have them both, Audra Wallace, director of
clinical success at Subflo Health, and Linda Betwell,
CEO at Ascend Specialist. Audra and Linda, so
great to have you. Thanks for being here
today. Thank you for having us. Yes. Thank
you. It's a pleasure. Great to have you
both. I do want to start off with
introductions for our audience here. If you want
to just share a little bit about yourself
and your work in health care, Audra we'll
start off with you.
Hi. Absolutely.
I am first and foremost a clinician by
trade and training over ten years
in mostly the acute setting.
I'm a physical therapist, but
in
coordinating what's we're talking about today, I saw
firsthand how administrative friction really impacts me as
a clinician.
And that's the perspective I'm bringing and I've
brought on to, serve as the director of
clinical success at Subflo Health where my role
essentially is to bridge,
the large gap between much of our clinical
reality and operational technology
that exists today. So my, background gives me
a really unique vantage point to help evaluate
workflows, not just as processes, but really as
a lived experience and and burden that I
have felt for clinicians and our patients.
Excited to bring that perspective to the conversation
here today. Very important as well. Linda, over
to you.
Yeah. Well, I'm also on the clinical field.
I've nursed by trade. I've been a nurse
over forty years. So I've,
number one, it makes me old. But number
two, I I've had the honor or,
the frustration
of watching
us proceed through the clinical times decade after
decade.
I really never thought I'd be sitting here
today talking about being efficient in health care
because we're like the most inefficient,
industry out there. There's no doubt about it.
And
and especially as I've gotten older and
in more in the leadership and administrative role
and watching how people are people as in
insurance companies, you know, the people that that
are helping us
supposedly grow in our field are the ones
that are actually killing us in our field,
and how can we get where we need
to be. So I have, you know, worked
in the hospital. I've been running surgery centers
for over twenty five years. I've worked for
just about every management company out there in
one shape or form from and all the
way down to, independent physician owned facilities. I've
used almost every software out there at one
point or or time. So I've gathered a
lot of information, and it's really an honor
to, at this point in my life, be
able to share that everything that I've learned,
with hopefully prospective clients and just the health
care community out there in the surgery center
world.
And the how to get there is an
important part of today's conversation, I think. We'll
talk about more in you Yes. Yeah. In
a little bit. That's really, really key. And
and it was certainly part of a of
a recent webinar that you we hosted together
with Subflow.
And there was a lot of talk about
these legacy processes like
paper workflows. Yes. That is real, dear audience.
Paper workflows in 2025 and 2026.
But also phone trees, manual documentation. There's all
kinds of things that are still sort of
fueling that burnout crisis that we're seeing within
the industry.
What's one workflow
that you believe leaders
most underestimate
in terms of its true emotional
or financial cost
to staff?
Audra, I would love to start off with
you here on this one.
Yeah. I think the biggest thing is the
pre op clarification
cycle,
the ambiguous
nature that patients don't
understand what they're supposed to do and when
they're supposed to do it, that workflow of
all of the communications
that need to occur and not just communication,
but actual understanding,
the health literacy piece
that exists. How do
staff members have the time
to engage with patients
as patients need to be? How do they
have the time to figure out how the
patient needs to be engaged?
And then actually take the steps to engage
that patient in that way so that the
patient has
the best understanding and the most learning occurs
so that, you know, that only,
improves outcomes if the patient is actually prepared
and shows up for whatever
needs to occur. So,
any any type of ambiguous instruction
is creating anxiety for our patients, is creating,
lack of efficiency for our staff, and it's
a really a real drain on the humans
involved,
not to mention the cost of, you know,
wasted time.
So,
emotionally too, that
affects the humans involved because
the the staff members got into this field
to actually help people, most likely. You know?
That's most of us what we would say.
And so,
when it comes to actually doing all the
checklists and the tasks, if they're not helping
the human on the other side, then it's
exhausting to the to the clinicians as well.
Linda, I saw you chuckle there a little
bit when I mentioned the the paper piece,
which again still baffles me in in 2025.
Yeah. Yes. What's one workflow that that you
think leaders most underestimate in in terms of
this this pressure and this this true emotional
strain and and financial strain,
to staff?
Oh, you know, it's all boiling down to
the software that you have in your center
and what's helping you be more efficient.
You know, because I've seen you know, I
walk into a lot of surgery centers that
have been around for twenty plus years. They're
the ones that are probably still doing paper
charting. They think it's gonna be too expensive
and too,
emotionally,
frustrating
to flip over. Well, it is all of
those things, but once you get there now
and get that flipped, the efficiencies
so, you know, I think, you know, having
been a nurse as many years as I
have and, you know, I'm gonna say 80%
of my time in the nursing field, I
probably left work feeling like I didn't give
it my best.
I could only do so much. We were
paper charting.
Lord have mercy if we were gonna have
to stay over and chart and get overtime.
You know, somebody was gonna breathing be breathing
down your neck. So there's all these buckets
that you have to hit and you have
to do it in an eight hour day
or, you know, a twelve hour day. So,
you know, and not having the efficiencies
of automating
simple things like automating how you get,
patients scheduled in your facility, communicating of course
to those patients. And then, the nurse too,
you gotta remember that we're most codependent by
nature and if we don't do our jobs
well, we just
beat ourselves up,
over the whole thing. So
it is very crystal clear in nursing right
now how,
you know, just burnout,
everybody is. But I think if we embrace
the technology
to get there, we can be so much
more efficient. I mean, it equates to everything
from patient safety,
to revenue cycle management, which is huge. You
know, the insurance companies are beating us hands
down, and there's so many efficiencies that we're
missing,
and they seem to stay 10 steps ahead
of us. Of course, they're, you know, billion
dollar companies, us little surgery centers, you know,
we're not,
that. So getting that software, getting those efficiencies,
you know, I don't walk into a center
cold,
when I first start out. The first thing
I, you know, after I do my assessment
is I tell the leaders, the physician owners,
I said, the first thing we have to
do here, guys and girls, is get our
house in order.
We need to have the right softwares. We
need to have the right people doing the
right job,
and our lives will become so much more,
improved,
at the end of the month and at
the end of the quarter and end of
the year.
Well, I think it comes back to to
what Otter was saying earlier. Right? Clinicians get
into the field to help people, not to
do paperwork instead of in front of a
computer all day, but they they want to
care for folks. They want to be doing
the important things that matter. One thing I
did wanna touch on really quickly because it
came up, quite frequently in in the earlier
webinar that we hosted, with Subflow,
cancellations. Right? We've all done it. We've all
called in the on the day of because
something came up and we couldn't get there.
But from a business perspective, this is a
threat. This is a threat to revenue. This
is a a threat to staffing morale certainly.
And and, Audra, from from your perspective, right,
what are some of those signals
that can predict those same day cancellations?
Right? How can organizations intervene earlier to then
say, okay. We're optimizing this so it doesn't
happen?
Yeah. I think exactly what you said. If
the patient preparedness,
if a patient is better prepared,
if the staff has actually been able to
engage them appropriately,
then they're more likely to show up. Because
if they if the patient hasn't opened their
instructions
or if they haven't confirmed their appointment or
if they miss those calls to confirm information
or,
do the pre op checklist.
Those are those are clear signals. And if
we could automate those processes
so that instead of passive communication
of nudges and, you know, one way text
communication, if we could have an interactive workflow
that takes some of the burden off of
the nursing staff to do those sort of
paper tasks,
then it allows the nursing staff to have
that,
you know, have the information surfaced early on
so that they can abate whatever confusion.
Or they can alert to, hey. This person
hasn't done all the tasks that they need
to do. Let's address it, or let's go
ahead and get that appointment rescheduled so we
can fill this spot with someone else. So
if we can intervene earlier on by using
those interactive workflows with with actionable data from
them, then it's gonna help reduce cancellations because
you're catching the things earlier and able to
either adjust
and change what needs to be changed or
fill in someone else so that that the
process can continue.
Linda, I feel like that's where we're we're
coming back to the software. Right?
Those workflows. What are some of those pieces,
in place for you personally that you think
will will make it a little bit easier
to to predict, right, to optimize this when
it comes to cancellations?
Well, it it is all about communication and
it's about being,
easily
accessed with communication. You know, the younger the
staff the patients
are, most likely they're working, they're like the
rest of us. We're work you know, workaholics
working twelve hours a day. We don't don't
necessarily answer our phones, when we're at work.
So text messages the evolution of text messages
in health care,
has been super, super helpful.
Some of the softwares have limitations where it's
one way text. We but to be able
for the patient to communicate the minute that
they know something is going on back and
forth, which is where Subflo
really does bring a lot to the table
here. So we can address those things right
right up front.
And then the patient, you know, patients need
to get ahold of you easily. They wanna
make one phone call. They wanna talk to
one person.
They don't want, you know, to be run
through a phone tree somewhere
to whoever you're gonna talk to. So and
and amazingly, the I equate that to the
younger patient, but you know what? Some of
those older patients, they're pretty busy too. A
lot of them you know, I come from
Florida, so they're out there and playing golf
all day. We're not gonna interfere their golf
days,
but they will look at their text messages.
So,
yes, that communication tool is brilliant, and it's
not about, you know, just
for patient satisfaction and patient experience.
If they need to reschedule, make let's do
that, you know, sooner than later,
and just keep you on the schedule. That's
the another important part of it. It's not
just cancellations. Is are we gonna be able
to keep that patient,
moving forward?
It's really shifting from a reactive state to
a proactive state for organizations.
Right? Being able to be proactive in communication
with folks, and, you're right. There is an
older generation that's very digitally savvy.
Right. They are they are willing to take
that step which is really, really key. Linda,
I'd love to stay with you on this
next question because, again, you've mentioned you've you've
worked with so many different softwares, you've worked
with so many different pieces in this,
space.
There is a conversation around technology fatigue. Right?
There's so many options. You can go here.
You can go there. Vendors,
solutions. Right? It warrants the question, how do
I decide? How do I make the right
decision for our organization?
When leaders are evaluating these new tools, what
helps them make
clear and confident choices
instead of being pulled into this space of,
like, I don't know what to do?
You know, this is something I think about
and deal with every single day because I
do want to stay cutting edge. I want
to have the best technology at my fingertips,
and I want technologies that I can roll
in that are not, you know, high maintenance
or, you know, just gonna take all my
workforce to get something moved from one one
thing to another.
So, you know, for years, it didn't have
to worry about it because surgery centers weren't
on anybody's radar. They weren't going to make
anything special for surgery centers. We went out
looking. I mean, for I've been going to
Aska, you know, for twenty five years
looking at the technology that's there,
every year. Now, you know, there's a 100
different technologies,
there. So I do, you know, word-of-mouth,
you you get people's opinions. You know, there's
a small network of and even on AskIt
themselves, they have ways that you can, ask
questions, who's using this, who's using that. Because,
you know, you talk to vendors that'll have
the the best idea in the world, but
they've never been in the clinical space before.
And now they're trying to figure out how
to make their technology fit in the clinical
space. And, you know, and, you know, the
I try to give,
those vendors,
you know, some suggestions, like, have you talked
to the bigger people out there? Maybe there's
something you can bring to the table because
you know someone are gonna wanna buy you,
you know, when you get there.
But we, as leaders,
the more
companies that we deal with, the more vendors,
the more difficult it gets. I mean, when
you enroll an employee when you, you know,
day one orientation,
and here's our IT list of all the
things that you have to be a part
of, and there's 30 things on there that
you're gonna have 30 different logins.
That's
getting a little over the top, on here.
So trying to get our everybody
has great ideas. I mean, in the perfect
world, the best of the best will get
together and make the best product
possible.
When I had more time, I would sit
and listen to all of them. I would
I would click in,
a meeting with every single one of them.
Tell me what you've got. Now
I just do not have the time,
and it is just extremely frustrating. But every
time I say no, then there's a little
voice in the back of my head saying,
you just let the best technology in the
world walk right by you, Linda. So we're
so there needs to be
a vetting process.
You know, I I make the decisions very
carefully, and I get my whole team involved
if I'm gonna use a different technology,
out there and get everybody's perspective,
on it. So I do think it is
a team effort. Everybody has to have buy
in when you're gonna whatever
it is that you're doing.
But, yes, every time I get one of
those calls, it's like,
here we go again.
It it is tough. It is tough. But
I think, again, what you've mentioned, we hear
that at Becker's, quite frequently as well as
that clinical experience is so critical for companies
to be able to to work with folks
in the health care space. Audra, I imagine
you have similar thoughts on this too. You
you're probably inundated with similar
requests.
Yeah.
What's your take on on how leaders can
really evaluate and make the right decisions when
it comes to all of these technologies?
Yeah. I think it's that you're exactly right
that the clinician's
experience and the clinician understanding and buy in
is such a big piece of this.
I think,
like Linda said, word-of-mouth and understanding
who do you respect and what do they
use. So you can see really what is
working.
But I think overall,
clinicians don't need just another tool. The ASCs
don't need another another piece of technology. What
they need is the right one that actually
looks at what is the workflow from start
to finish. How is this gonna impact the
humans that are on the other side? How
is this gonna impact the bottom line?
Is it
easy to implement? Do they have an implement
implementation team that actually understands
the workflows
and is trying to get to understand how
do you currently do it? Could it be
done better? How can our technology help you
do it better? You know, that literally is
my whole job now. And, part of what
I love it, I've I've been a part
of, you know, quality improvement committees and efficiency
committees at these large organizations.
And,
if you don't actually try to understand
what is our current workflow and what is
our ideal workflow and what does it take
to get, you know, to bridge that gap,
then the piece of technology isn't any good
if the workflow underneath it is completely broken.
So
as long as the the
people are understanding
the workflow, how to make it better, and
can help your team implement it. I I
laugh frequently that I work at a technology
company because I am the least tech savvy
person, but that's possibly the most helpful thing
for our clients is if I can do
it, anyone can do it. And so trying
to understand,
how is it gonna affect the humans on
the other side,
and actually improve
their lives, I think,
you test it with them and they say
yes, then you're a year ago. Because there's
also so many technologies that as a clinician,
our our higher ups bought and spent all
this money on, and then
it was either too complicated or didn't do
what it was supposed to do. And so
we never used it. And then it's just
a whole bunch of wasted time and energy
and effort and and meetings after meetings. So
those are kind of the big points for
me.
Well, and it comes back to what Linda
was saying earlier too. When when we are
evaluating, that's really the critical word is evaluating.
Right? Work what do the workflows actually look
like? Where does technology fit in? But actually
doing the job of evaluating these tools, evaluating
what helps organizations is so critical in determining
what are the differentiators and the difference makers
that can actually make a difference for organizations,
which is so key. I I wanna spend
a little bit of time looking ahead to
next year and and possibly beyond
looking ahead to the future a little bit.
What's one thing AC leaders should prioritize in
the next year to support both efficiency and
also financial sustainability?
And what sort of the first step they
can take right now to be able to
be prepared for 2026
and beyond? Linda, we'll we'll start with you.
I I think you need you need to
do a quick assessment of what all technology
you have currently. Reevaluate
at this point. If it's not
a a technology that is positions itself to
move forward, then you might need to, you
know, look somewhere else.
And and that's really hard,
to do.
Really, really hard. So and, you know, surgery
centers
are the heartbeat of my life. You know?
I've watched so much good and so much
bad. I probably seen more bad than I
have good in some of the situations,
that I've been in, and I don't want
anybody to go down that road, number one.
Number two, I'm, you know, I'm very, involved
in rural health care now that I live
in Wyoming, and I'm watching these centers struggle.
They're
sparsely populated. The states are. The surgery centers
are small. They're they have completely different needs
than surgery centers that are in urban areas.
We're not gonna have as many it's we're
just it's just smaller. And your case mix
you know, the higher your in your, Medicare
or government payer is
and the lower your volume, you put that
together,
high government mix, low volume altogether,
it can be a recipe for disaster.
So there are ways to manage all of
that. So I think I would encourage
smaller surgery centers to look for companies like
mine or somebody out there that has that
has the expertise
to help guide you through the decisions,
for business development. Because there you have to
be very specific,
for it. So your technology better be there.
Do you have the resources that you need?
Do you need to partner? I don't think
everybody needs to, you know, be bought up
by all these big management companies out there.
That's why, you know, our company is a
little bit different. We don't buy you. We
just tell you how to be successful and
walk with you through that success on it.
And I think that's a much better of
all since I've evaluated
every management company out there.
For me sitting in my chair as a
leader, if I had somebody that just helped
me with the resources,
it would have just been monumental for there.
So make sure you got the support. Make
sure you have the technologies,
moving forward.
That starts with evaluating and then, again, finding
the right partner like you've said. Audra, same
question for you. What's one thing,
leaders should prioritize, and and what are some
of the steps that that they should take
right now?
Yeah. I think
just simplify.
I think so often we keep adding on
these add ons
and then you have all these operational, you
know, inefficiencies
where it it the patient bounces back and
forth between people 18 different times just to
get to pre op.
So if we could
pause
and map the end to end workflow
and let's address one piece or let's address
one workflow through the whole journey
to to simplify that it keeps the patient
on track has fewer, you know,
extra
things.
It lets the staff get back to being
the clinician in front of the patient and
use their brains like they want to operate
at the top of their license
because you've taken off the burden of some
of those,
paper processes or repetitive tasks. You know? See
what are the manual tasks? What are the
repetitive tasks? What actually requires clinical brain? And
let technology do the repetitive
tasks so that
the clinicians can use their expertise again.
I think that would be the biggest thing
for me. Yeah. Topical license work is such
an important piece to mention for for a
lot of people. It's it's key to be
able to prioritize care, make sure the patient
is at the center of everything that clinicians
are doing, which is so, so, so important.
Well, Audra and Linda, it's it's so fantastic
to have you both on such a great
conversation, great insights. I wanted give the floor
over to you here.
Anything else we didn't touch on? Any final
thoughts you'd like to share from our conversation
today, Audra? We'll we'll start with you.
Yeah. I think the the biggest thing that
I've seen since working with Subflo Health in
this sort of clinical success position is
we need to get back to letting the
staff
interact with the right patient with the right
information
at the right time. And that is done
by automating these, you know, inefficiencies,
automating the task that can be while extracting
actionable data. So it cannot just be technology
go do your thing. It is technology with
human in the loop so that the human
in the loop can use their clinical brain.
And that that really is my job here
at at Sunflow Health. And what we're trying
to do is to take off those manual
tasks to automate those workflows
while still extracting the actionable data of which
patient needs to be contacted, which patient needs
a little more hand holding, or which patient
just let them be. Stop bothering them so
that patients have the best experience and have
the best outcomes
while your clinicians and your staff are
using, you know, top of their license, which
only impacts, you know,
beneficially the bottom line,
if you're using your staff appropriately
and having those good outcomes that help reimbursement.
So thank you so much for having me
on today. It's been a blast to be
able to speak about all of these things.
That's great to have you. Linda, anything else,
to share here? Any final thoughts from you?
Yeah. I think so. I completely agree with
with Audra. We're on the same page on
a on a lot of different things, but,
you know, we keep talking about the patient
experience, which, of course, is very important,
But the patients are not gonna have the
best experience unless your employees are having the
best experience.
And pulling those employees in to help be
part, you know, when we brought Subflo in,
you know, we started using it for our
total joint program. We had the right people
there. We were working
close, and and I have to give Subflo
some major kudos here because
they were such a pleasure. You can tell
that their people are first that work there
because they were such a pleasure,
reactive, engaged. How can we fix that? Let's
fix it. It wasn't a six month decision,
you know, to get something working. So we
got it rolled in pretty smoothly. And because
our and our employees were excited about it.
They were looking for this tool. So once
they became excited about it and then it
gets passed on to the patients, so when
we rolled it out for our total joint
program, it was hugely successful because we put
the the time in,
for both of them. So, yes,
a matter of you know, I I have
actually changed in my,
mission statements.
Now wherever I go, if I'm having write
a mission statement, I actually took patient first
out
because I believe that it's people first,
and that means your employees, that means your
vendors, that means
everybody. If everybody can get along
well,
then the patients and the physicians, they just
win the whole way, the whole way around
for sure. So, yes, technology
is gonna make us more efficient. I believe
it's gonna make my our employees happier,
and happy employees make happy administrators.
So that's a very good thing.
It's a holistic approach that then leads to
again, we talk about human in the loop.
The human is still at the center of
everything. The people are at the center of
everything, which is so, so key.
Audra and Linda, thanks again for being here
and for your time and insights today. It's
great to have you both. Thank you. It
was a pleasure.
And we also want to thank our podcast
sponsor, Subflo Health. You can tune into more
podcasts from Becker's Healthcare by visiting our podcast
page at beckershospitalreview.com.