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’re super busy 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 could help.

1Late 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 might 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 long as they notified the appropriate manager. Assigning lates in advance is way easier than begging people to stay over.

2Late differential. Because our days would often routinely run over in the busy winter months, we asked the governing body to approve differential pay. We applied the $2-per-hour differential after 4 p.m. for any OR staff still working, and after 5 p.m. for the PACU team. The differential, as much a financial incentive as it was an acknowledgment for the extra time, went a long way with the team. It definitely had a positive impact on morale and made late days more bearable and financially rewarding.

3Staggered 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 might 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. Keep in in mind that staggering only works if you live in an area without significant rush-hour traffic problems.

4PRN float pool incentives. Some facilities pay more for better availability. Consider offering more pay to PRN staff who agree to work more and for holiday time coverage when staffing can get really challenging.

5Be proactive. Staying ahead of the game whenever possible is key. Have a game plan for the next month or even 3 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 staffing needs.

6Involve your staff as appropriate. Like the app that’s featured to the right, your team could have out-of-the-box solutions to scheduling challenges that you might not have considered. 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.

7Buy lunch. Although it might seem like a simple solution, covering lunches is more efficient if you order lunch on busy days. The key is to have lunch 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 the food 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 p.m. Usually the pre-op and OR staff are ready to eat by 11 a.m. if they started their day at 6:30 a.m., and getting a break for lunch without food available doesn’t fly.

8Groom up-and-coming leaders. I don’t have to tell you that it’s 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. You can train the right person who has the insight, energy and drive to be your next team lead or manager. Look for staff who 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 that support leadership growth like QAPI studies, infection control monitoring or peer review projects. Then, when a new role or opportunity becomes available, the right person is ready for the challenge. OSM