How to select the right staff for your program

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates, Dallas

Same-Day Surgery Manager

Depending upon which side of the "profit" curve you are on — i.e., hospital not-for-profit or ambulatory surgery center (ASC) for-profit — will determine how you react to this month’s column. When developing the operating entity for a new ASC, we typically have one or two "steering committee" meetings per month. The steering committee is made up of a representative from each specialty that will be utilized in the new venture. I have been to 11 such meetings in the past 30 days, and it hit me at a meeting last night that the most time is spent on the partnership agreement, the offering memorandum, and staffing. Staffing is a major issue with every new start-up.

Do you want to know what we talked about? Some of it is pretty interesting. First, almost every group of surgeons is concerned about the nursing shortage. They see it in the hospitals they work in, and they are fearful that they will have difficulty recruiting quality staff for their center. Well, there’s good news, and there’s bad news. We explain that the shortage is real and worsening but that we never have had difficulty recruiting ASC staff due to lack of available nurses. The only exception was nurses who did not wish to work with a certain group of surgeons.

In contrast to what many hospitals are experiencing, we have a waiting list of outstanding nurses who are waiting for an opening.

Why? One reason is the profit-sharing concept. Clearly, that concept is enticing to nurses who typically don’t have that option in our line of work. (For more on profit-sharing, see "Staff incentive plans that make sense," Same-Day Surgery, February 2001. You can find this story in the archives at The lack of being "on-call" and the personal disruptions that it causes is another attraction. And, although cross-training is (should be) mandatory for each department or center, being rotated to a less-desired department rarely occurs. Lack of trauma and OB coverage is a magnet to some, while the rapid pace with generally healthy adults is gratifying to others.

Lest we forget, the ability to work less than full time is a major attraction for mothers of young children who wish to keep their skills sharp by working, and yet not have to disrupt their families by working a set number of hours per week or month.

While this shifting paradigm attracts staff to ASCs, it does not necessarily meet the needs of invested surgeons in their new business. They are educated that there are three key factors to success in an ASC: cases, staffing, and supply cost. The proper blend of these three ingredients can mean the difference between success and failure (oh, yes, there are many ASC failures) for this new surgery facility. While the concept of "less staff is better than more staff" is often lost on the average department head, in reality, it is true. The key is the right staff and not the number of staff.

So, what do the surgeons look for in their staff? Personality: the ability to smile. You can teach someone to do most anything but smile and have a "can-do" attitude. I can feel the hate mail being written right now, but the reality is that we all want to surround ourselves with people who are fun to be around. One of the very first qualities I look for in my own staff is that smile.

Next, they want dependable people. They want staff who consistently are going to show up on time. Whether you like it or not, arriving at your job on time is a sign of respect for your employer. They want respectful staff.

They talk about skills and those who excel at what they do — and no, experience is not the No. 1 consideration. You may be the "best" orthopedic nurse in the operating room, but if you don’t have the others skills they are looking for, they will not want you. Too many times, I see technically superb nurses get passed over for less-experienced but more motivated and enthusiastic applicants. The surgeons will say that they can put up with teaching and training the staff to become technically competent rather than deal with personality issues that jeopardize the success of the center. Passive/aggressive personnel need not apply.

So, after all that, what happens next? The days pretty much are past when there was a significant variance in pay between not-for-profits and for-profits. The pay usually is the same hourly rate for either. The difference and opportunity comes in the ability to share the profits. As staff, we enjoy being chosen to work at the center, but we are not naïve. We expect to be included in the success of the center. When the surgeon receives a distribution, we want one as well. The fact that there are fewer of us on staff means that each one has to pull just a bit harder, and we want and deserve that recognition.

Keep smiling!

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: Web: