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Understanding Enterprise compliance without piles of binders or excessive travel. See how Amiee Mingus has mastered this with Surglogs

by Barbora Ilic
Amiee Mingus

For many clinical directors, overseeing multiple centers means a lot of traveling and hours spent in a pile of binders. Amiee Mingus, VP of Clinical Operations at PE GI Solutions, told us about the processes in her centers and how Surglogs has helped her and her teams to save time, storage space and reduce stress from surveys.

How many centers do you oversee? 

We have over 60 centers. I say over 60, because we always have a few that are on their way to PE GI.

How often do you travel to your centers? 

Before COVID, my team and I were travelling to our centers very often. The frequency of visits depends on each center. If it’s a new center that needs a lot of intensive care, we might go there weekly. Other centers might be quarterly. Some of us used to travel even on a semi annual basis. Since COVID, things have been a little different though. We spend a lot of time conducting virtual meetings instead of on-sites.

Can you walk me through a high level overview of a typical visit to each center?

Our primary goal, as the clinical director for a center, is to keep them survey-ready at all times. We typically check to make sure that they are in compliance with regulatory guidelines and requirements. We check their credentialing files, personnel files, their life safety and environmental logs. If they have Surglogs, that certainly makes that task much easier. 

We observe patient care, we go into the room and watch procedures to make sure that they are not only hitting all of the infection control items, but that they’re also handling the equipment correctly. We go through the training with the DON’s and administrators on any new regulatory guidelines. This has been especially true since COVID started.

How much time do you spend at one center?

It depends on the center’s needs. We might go there for the sole purpose of looking at credentialing and another time we have 10 things on our list. In general, we spend several hours on every visit.

How do you oversee compliance in your facilities now compared to before using Surglogs?

Surglogs has made it easier for us to check if they are doing all required logs, especially the EOC logs. Before, they had binders full of paper. It was always a task to pull the binders off the shelves and go through them to find out how many have been missed in the last three months or in the last three years. It was nearly impossible. In Surglogs, we can see everything at a glance. It has cut many hours of preparation off of our survey prep visits.

What are you required to report back to Corporate as it pertains to multi-center regulatory compliance?

We report back anything that is a risk for the center. For example, if a center wasn’t maintaining their credentialing files, or they weren’t maintaining any logs even after the clinical director had been working with them. We also have checklists that we go through to make sure that they’re following guidelines and regulations. If we find that certain items aren’t consistently being done, we’ll report that back to corporate.

When are you starting with survey preparation?

We do survey preparation on an ongoing basis. As soon as one survey is done, we start preparing for the next one. We like to make sure that we are survey ready all the time. Even though some of our surveys are planned, and we know they’re only going to happen every three years, the state could come at any time. We always have to be ready. 

What does the process of survey preparation look like? 

We follow the handbooks from the various organizations. We will work through each chapter with the center and we also have checklists that we work with, to make sure that they’re hitting all of the items that we know are going to be looked at on a survey. Environment of care is a huge part. Surglogs is a great help here.

Has the amount of prep time changed since you started using Surglogs in your centers?

Definitely. The ability to use Surglogs and go through their logs without searching for the information in binders makes it so much easier. Surveyors like it, too. I have had plenty of surveyors tell me that they are glad to see that we’re using a digital format for the logs because they can see it at a glance.

Have the amount of deficiencies changed since moving to Surglogs?

Yes it has. Our centers are keeping better track and are not having the deficiencies that they were getting cited for. For example, temperature and humidity logs in the refrigerator. The citations have definitely gone down in the centers that are using Surglogs.

Do you perform mock surveys? 

Yes we do. We still do mock surveys, because in addition to the environment of care area, there are a lot of other things that we’re also looking at when we are in a center. We want to watch them perform cases and make sure that they’re doing things right as far as infection control.

Do all your centers use Surglogs?

Surglogs is not used in all our centers, but we’re making a push to get it to all of them. We put Surglogs into all of our new centers coming on board. That’s one thing that we automatically install because it makes sense. 

How do they report their compliance to you now?

Either by observation when we’re on site or sometimes we’ll ask them to send us a confirmation that they have complied in certain areas or fill out a checklist. When we’re on site, one of the things that we do is to look at Surglogs to make sure that they’re up to date. 

Do your centers have different processes at each location? 

They do, they’re all independent and each one of them has their own board of managers who approves their processes. They all have their own sets of policies and procedures. Some of them look similar, but they’re not always exactly the same. So we have to flex to meet the needs of each one of the centers that we are on site with.

Did Surglogs help to standardize these processes?

Yes. When one center uses Surglogs to its fullest capacity and gets the most out of it, we can use that as an example for a new center coming on. That helps tremendously. It’s also easier for us to get them to use the same logs and when we go for a visit we know exactly what we’re looking for. 

What do you consider to be the biggest benefits of using Surglogs in your centers?

Saving cost on paper because we don’t need those huge binders anymore. It makes space in the administrator’s office and also it makes it easy to see whether the clinic is in compliance and is meeting the regulatory guidelines. A surveyor has commented to me that they feel the same way. Before, the surveyors would spend a couple of hours going through the binders. Now it’s just a couple clicks and they can see whether or not things are in compliance. It’s a big time saver for sure.

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