Same-Day Surgery Manager

Expanding your OR space, and other managers’ issues

Tips for tackling staffing, profit-sharing

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

Question: We need to expand our freestanding center by one more operating room. We have a storage room that is about 300 square feet that we are using for storage. Can we use this?

Answer: Probably not. Although exemptions can be obtained, for your needs you need a full-service operating room that is going to be required to be 420 square feet. In addition to that, you also will need three additional beds (usually one pre-op and two post-op). However, there is the possibility to convert to a special procedures room, which may require fewer than 400 square feet. Check your state regs and meet with an architect who understands surgery centers.

Question: Our hospital is expanding, and the administrators have asked me to help them plan how many operating rooms we will need. I heard you speak last year, and you said that on average, you can do about 1,000 to 1,500 cases per operating room. Can I use that figure for our planning purposes?"

Answer: The short answer is No. That figure you heard me give was for a typical surgery center, not a hospital with more complex procedures. A good rule of thumb for a hospital is closer to 800 cases (patients, not procedures) per year per operating room.

However, for planning purposes, you probably are better off counting your historic surgical minutes rather than cases. Add them up and divide by the average number of minutes per your work day, and then divide by the number of operating rooms. You should look at about a 75% utilization rate. If you get too much above that percentage, you lose the ability to "flip-flop" cases. When in doubt, add an operating room. Surgery is up everywhere.

Question: You gave a staffing pattern in one of your articles last year that I completely disagree with. I cannot staff my center with the number of people that you said could be done. My surgeons scream if they do not have the help that they want. Do you actually have any experience in an operating room? If you did, you would understand that surgeons want as much staff as they can get!

Answer: I actually do have experience in the operating room, first as a scrub tech for about seven years, then as an OR nurse for a several others, and then as a certified registered nurse anesthetist (CRNA) for nine years. After that, I had seven years as an administrator in several surgery centers.

Note for readers: I called this manager and found out that her surgeons had tried to start a surgery center last year and the hospital fought their certificate of need to the point where the surgeons had to abandon their plans for their own center. A phone call to the medical director of the hospital revealed that surgeons were upset with the hospital and were using as many resources as they could. The medical director told me that their supply cost had more than doubled since the surgeons’ plans were curtailed. I stand behind my staffing plan.

Question: I want to give my staff a profit-sharing plan. Once a quarter, the surgeon investors in our surgery center get their "check" that is their profit from the previous quarter. Some of the staff members complain that they are a big reason for the surgeons’ profits, and they want to know why they cannot share in the profits. Do you have an easy suggestion as to how that can happen?

Answer: Sure. Get your board of directors to take a percentage of their profits. I suggest 3% and put it in a staffing pool that you divide among the staff once a quarter. When the surgeons get their check, the staff gets theirs as well.

Footnote: The board agreed to 2% for the staff. That amount ended up being about $38,000 per year to be split among the 15 staff members.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 3112 Windsor Road, Suite A-242, Austin, TX 78703. E-mail: Web: