Same-Day Surgery Manager: Staffing is tough: Can you make everyone happy?

By Stephen W. Earnhart
President and CEO
Earnhart & Associates
Austin, TX

Wouldn’t it be nice not to have to deal with staffing issues? Really, what do people expect of us? We try hard to accommodate everyone, but it seems like often we come up short.

If there is one question that comes up more than any other in this industry, it always is somehow related to staffing. Always. Don’t assume you know the answer to just about anything that deals with people and resultant payroll.

Personnel (labor) cost and supply expense account for about 50% of a facility’s budget. A benchmark that I often see is that somehow — I have no idea why there is a correlation — supply cost and personnel cost tend to be about the same percentage of net revenue. That is a large chunk of change that needs to be accounted for each month.

Also, because of the high degree of cost, staffing always is on the mind of investors. "Why do we need so much staff?" they ask. "Why is everyone sitting around doing nothing?" It goes on and on.

Is there an answer? I think partially there is.

For the most part, surgery centers and hospital surgical departments are fairly predictable in their needs. Granted, new centers just beginning operations still are experiencing scheduling gaps, but they eventually will stabilize the peaks and valleys in the surgical posting. So, as many investors often ask, "Why do we have staff sitting around doing nothing? Why aren’t staff sent home when surgery is complete?"

We all know that staff retention is critical to efficient operations. Training new staff members is expensive (assuming you can find them). If that reason is not enough, your surgeons — yes, the very ones who complain about too much staff — are all over you for giving them "the new one." Every one of us has to keep staff employed, even if we don’t need them for 40 hours per week, just so we don’t lose them. I’ve done it myself — many times.

It is easier than cutting staff hours and getting them upset with you or losing them to another location. If we all wimp out like me, then we are going to deal with investor ire and get that dreaded look of "does he know what he is doing" at each board meeting.

There must be a way to satisfy all parties. There is, and it is relatively painless.

You need to plan out your staffing needs. You realistically cannot alter your entire staff overnight. The majority of investors I am used to dealing with basically want a plan and a timeline of when they can expect to see a change. Give it to them. Now, if you are blessed and no one is looking at your staffing costs, then you have achieved nirvana and may float onto your next life experience and ignore the rest of this column.

For the rest of you, you need a mixture of full-time and per-diem staff. I’m referring to staff who work the full hours each week and per-diem staff who go home when surgery is complete.

What is the mix of full to per diem? Everyone is different, but I think a healthy mix is 50/50. That ratio gives you the opportunity to get creative with your staffing budget and benefit costs. How do you get there? Well, it takes time, and it isn’t the easiest undertaking you will face.

Start by replacing new staff with per diem. If you have a full-time staff opening, try filling it with two per-diem members. As current staff members leave, replace them with part-timers as well.

It is risky; I agree. You get a breathing body in front of you who wants a full-time job with benefits or forget it, and it is hard to turn him or her away.

That is exactly why you need a game plan and support from your investors. They need to understand the downside risk of not being able to attract new staff. If they cannot support you, then you need to have a very serious discussion of how they expect you to reduce staffing hours.

The process literally can take years to get to the point that you are not dependent upon fully benefited, full-time staff members. But every plan needs to begin somewhere. Sitting down with your investor group and getting realistic expectations and a time frame is the first step.

By the way, the surgeon investors who scream the loudest to reduce staffing expense always will be the ones who complain that they don’t have enough staff in their rooms. Notice that?

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.

Contact Earnhart at 8303 MoPac, Suite C–146. Austin, TX 78759. E-mail: Web: