I have found that staffing has always been one of the biggest challenges in surgical leadership.  Even with the best plan in place, Murphy’s Law prevails.  Someone tends to call out on the one day when you are super busy, relying on yourself as plan “b”, and that one case that had to get done to use the same staff on an afternoon case runs over.

Here are some tips that I’ve learned over the years that may help.

Late days.  For those unexpected late days when cases run over their scheduled times, or that late add on case, you may want to assign routine late days.  I once ran a center when, on busy winter days, we may have several rooms running over.  The way we kept it as fair as possible was assigning all staff one first late and one second late day per week.  We even let the staff choose which days, as long as we had the schedule covered.  If they wanted to switch with a team member they could do so as well, as long as the appropriate manager was notified. Assigning lates in advance is way easier than begging people to stay over.

Late differential.  Since our days would often routinely run over in the busy winter months, we actually went to the Governing Body and got differential pay approved.  For us, we had it apply after 4:00 for any OR staff still working, and 5:00 for the PACU team.  It was as much a financial incentive as it was an acknowledgement for the extra time and went a long way with the team.  It definitely had a positive impact on morale and made late days more bearable.

Staggered Start Times:.   Some staff would prefer to come in early, and some staff would love the time to get the kids on the bus.  You may be able to flex time in and out based on volume, role, and patient arrival and discharge times.  On busy days, you can even use prn staff that want to be home for kids as a prime time float team to cover breaks and lunches.  Staggering only works, however, if you live in an area without a significant rush hour traffic problems.

PRN float pool incentives:  Some facilities pay more for better availability.  Consider offer more pay to prn staff who agree to work more and to holiday time coverage when staffing can get really challenging.

Be Proactive.  Staying ahead of the game whenever possible is  key.   Have a game plan for the next month or even three months if you can.  Things will change, but the framework will be there sooner to fend off any significant challenges caused by scheduled outs or increased needs.

Involve your staff as appropriate.   Sometimes they may have out of the box solutions to scheduling challenges that you may not have thought of alone.  I once was able to reduce RN staffing by one FTE and not fill an open position with the help of the existing nursing team and a group approach to sharing the patient load.  Schedule staff meetings to review staffing challenges and discuss coverage.

Buy lunch.  Although it may seem like a simple solution, If you order lunch on busy days, covering lunches is more efficient if lunch is available when people get time to eat.  When staffing is short and cases are heavy, have some pizzas delivered in time for everyone to enjoy.  Make sure it gets delivered early enough for the first group out, as well.  If lunch is being arranged, make sure that it doesn’t arrive at 12:30 either.  Usually the Pre-Op and OR staff are ready to eat by 11:00 if they started their day at 6:30, and getting a break for lunch sans food doesn’t fly.

Finding up and coming leaders:  It is  becoming more  and  more challenging to find the right fit for surgical leadership positions.  Start mentoring the best and  brightest who demonstrate the skills to be a good leader early.  You can train the right person who has the insight, energy and drive to be your next team lead or manager.  Look for staff that show motivation, positivity, responsibility, and trustworthiness.  Mentoring is one of the most important things we can do to support the future staffing leadership needs.  Assign key tasks support leadership growth like QAPI studies, infection control monitoring, or peer review tasks.  Then, when a new role or opportunity becomes available, the right person is ready for the challenge.

Do you have a great staffing tip?  Please share in the comments below, and thanks for reading!

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