Same-Day Surgery Manager: SDS managers share their biggest headaches
SDS managers share their biggest headaches
By Stephen W. Earnhart,
MS
President and CEO
Earnhart & Associates
Dallas
As a manager, what is your greatest challenge? What cause your greatest headaches and takes the most of your time? In an informal and anonymous poll of a number of my friends in the business, I decided to stretch my friendship and ask them these questions:
Here is the setup: There were 12 participants. All were RNs. Three were administrators in multispecialty for-profit surgery centers.
Three were nurse managers in different multispecialty for-profit surgery centers. Three were directors or department heads in not-for-profit, hospital-owned surgery centers without physician investors. Three were clinical nurse managers in different not-for-profit, hospital surgery centers without physician investors.
All had 48 hours to think about the question. Responses were verbal so they could be completely open and honest. Here are the questions and responses.
1. What single problem in your facility causes the most serious problems or consequences that you deal with on an ongoing basis?
- Administrators in multispecialty for-profit surgery centers: "Sexual harassment issues." (Whoa!) Even I was surprised. They reported this is the single most important hassle they face on a continuing basis. And this answer was from all three of them. They didn’t elaborate, but they said it continues to be a problem.
- Nurse managers in
different multispecialty for-profit surgery centers: Two of the three
said "sexual harassment issues." (Hello?) The third said, "Anything and everything
that anesthesia touches causes problems for me." (See why this is anonymous?)
Since sexual harassment still seems to be an issue — I thought this went away a long time ago — it is important for each person to review the department’s policy and adhere to it. What some might consider innocent banter, others find offensive — so re-learn the rules!
- Directors or department
heads in not-for-profit hospital-owned surgery centers without physician investors:
"Unrealistic budget cuts" was cited by all three as their greatest headache.
All said they are in situations in which their budgets are decided by some hospital official who doesn’t understand the business. Is there anything you can do? Oh, yes: Plead your case. Cite comments by your surgeons that they will leave and create their own center if things get too tight around your department. Convince your uppity-ups that it is far better to spend a few more dollars on staff now than contend with a flight of experienced staff and disenchanted surgeons.
- Clinical nurse managers in different not-for-profit hospital surgery centers without physician investors: One response was "finding qualified staff." Another response was "constantly losing best staff members to the for-profit surgery centers." A third response was "finding a way to offer financial incentives to good staff."
2. What service in your facility is the most difficult to work with?
- Administrators in multispecialty for-profit surgery centers: 100% replied, "Anesthesia." (Uh, oh.)
- Nurse managers in different multispecialty for-profit surgery centers: 100% replied, "Anesthesia."
- Directors or department heads in not-for-profit hospital-owned surgery centers without physician investors: Two out of the three were — you guessed it — "anesthesia." The third director cited "hospital administration — or lack thereof."
- Clinical nurse managers in different not-for-profit hospital surgery centers without physician investor: Survey says, "Anesthesia." (Hey, come on now. What gives with all this?) What can you do? Communicate with them. Your anesthesia staff members do have ideas. Listen to them. You might be surprised how absolutely easy it is to work out a mutually agreeable situation to just about all your (and their!) problems.
3. What one thing would you change in your area if you could — right here, right now?
- Administrators in multispecialty for-profit surgery centers: One response was "Insipid [Health Insurance Portability and Accountability Act of 1996] regulations." The second response was "the cutdown in the level of testosterone in the center." (She used another phrase that was not so nice.) The third response was "eliminate uncaring nonphysician investors in the workplace."
- Nurse managers in different multispecialty for-profit surgery centers: One response was "arrogance of male surgeons." (It’s sort of tied to the second response from the administrators.) Another response was "everything related to anesthesia." A third answer was "the need for anesthesia personnel."
- Directors or department
heads in not-for-profit hospital-owned surgery centers without physician investors:
One response was "budget reviews when the decisions have been made before
I enter the room." Never, ever accept an unrealistic budget that someone has
done for you. Fight it, and make sure everyone knows that you do not agree.
I guarantee that a year from now when you don’t make your numbers, then everyone
will point a finger at you.
Memory is fleeting, so make sure the people that matter most know that you do not accept it. A second response was "for-profit surgery centers." A third response was "all managed care plans, programs, contracts, and anything else that has the word contract’ in it."
- Clinical nurse managers
in different not-for-profit hospital surgery centers without physician investors:
The first response was "OR directors that are clueless to what goes on in
the operating room." OR directors: Do you want to impress your staff? Put
on scrubs and go into the operating room once in awhile. Give coffee breaks,
sit in the lounge with the rest of the staff, and listen to the gossip. You
don’t have to be pals with your staff, but you do have to be visible.
A second response was "poor rate of pay for staff." Want a raise in this environment? Do something to earn it; showing up for work doesn’t get it anymore. Put together a list of improvements that you can effect, which will save the hospital money. Put actual dollars saved beside each item. Tell your boss that you would like to head up a task force to implement the improvements. You think that won’t work? Try it!
A third response was "lack of proper incentives for staff members to be efficient." (FYI: They are out there!) Probably the best incentive is to send your staff home when their assignments for the day are complete — with pay! Why not? You are paying them eight hours to do something. If they can do it in five hours, and make the surgeons happy with the rapid turnover, why not? You have absolutely nothing to lose by trying it.
With the small number of individuals involved, this survey was hardly scientific — but it is insightful. Face your challenges head-on before they lead to low morale, lawsuits, or worse!
(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web: www.earnhart.com.)
As a manager, what is your greatest challenge? What cause your greatest headaches and takes the most of your time? In an informal and anonymous poll of friends in the business, Stephen W. Earnhart asks these and other questions.Subscribe Now for Access
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