orm_october-2023 - 23

Finances
ing about what you need next week, next
month, next quarter, and next year, " she
says. " When you have the opportunity,
drop hints and keep building on that so
you tell the story of what you need and
keep them informed. "
Jessica Gruendler,
DNP, RN-BC, CPHQ,
CNOR, senior director of
nursing operations and
perioperative services
at Dignity Health in San
Francisco, says perioperative
leaders need to be
able to communicate the
units of service for each
of their departments. As
Jessica
Gruendler,
DNP, RN-BC,
CPHQ, CNOR
noted in Part 1, these units differ by
location. " You not only have to understand
the complexity behind those units
of service, you also have to be able
to verbalize all of the other resources
(such as nonclinical staff) and all of the
other tasks that go into maintaining an
OR, " she says. For example, schedulers
are needed no matter how many cases
or minutes of service there are during
a day.
Gruendler also spends time helping
the C-suite understand how acuity in the
OR differs from patient acuity on a hospital
unit. Acuity for postsurgery patients
can be measured based on data from
the EHR, but in the OR, acuity is based
on the type of surgery. For example,
a simple mastectomy might require a
surgical technologist, a circulator, and
two instrument trays, while a total joint
might require an additional surgical
technologist and 25 instrument trays. In
addition, a third person in a robotics or
total joint OR to help with setting up the
first case and turning over the room can
improve efficiency.
As with Wellstar Paulding, rounding is
a key component to helping senior leadership
at Dignity Health to understand
perioperative departments. As part of
the " Stronger Together " program, senior
leadership (including the C-suite) round
every day; rounds include discussing
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Culture and productivity
Being able to operationalize
results effectively
depends on having staff
who buy into the need
to consider the business
side of healthcare. During
the interview process,
" You want to make sure
that the person you're
planning to make the
offer to understands that
we are here both to serve our patients and
to be efficient because we want to be taking
care of our community for a long time, "
says Lydia Casteel, MSN, RN, CCRN, director
of nursing for surgical services at
Wellstar Paulding Medical Center. Leaders
should look for staff who see cross-training
in different areas not as a burden, but to
ensure there is appropriate staff to care for
patients.
Education about the financial aspects
of care is helpful, notes Jodie Lockwood,
MSN, RN, CNOR, perioperative nurse manager
at Nemours Children's Hospital. " We
Jodie
Lockwood,
MSN, RN,
CNOR
metrics being measured. Rounding assignments
change weekly. " The C-suite
becomes familiar not only with the complexity
of the OR but the terminology, "
Gruendler says.
Even with strong partnerships, it can
be difficult for perioperative leaders with
underperforming metrics to face questions
from senior leadership. Gruendler
recommends sharing efforts to address
the problem. " If I can get them to understand
how I am working to keep down
my costs, avoid waste, and be efficient,
it helps a lot, " she says.
Perioperative leaders also need to
ensure they understand productivity so
they can communicate effectively with
upper management. " Many OR directors
don't have a good understanding of
the financial and operational part of the
OR because they're so focused on the
clinical, " Gruendler says. " That's a huge
help staff understand that our revenue
depends on getting cases booked, " she
says. " We also talk about how we can keep
patient safety top of mind and still accomplish
efficiencies. " The organization
combines education with collaboration between
staff and management (for example,
providing staff input as to how cases are
scheduled) and ongoing communication.
These efforts have paid off: There has been
no postanesthesia care unit turnover in over
18 months.
" Listening to our frontline team members
is extremely important, " says Edna Gilliam,
DNP, MBA, RN, CNOR, assistant vice
president for perioperative services and
sterile processing department for Nemours
Children's Hospital. Staff are encouraged
to be transparent by sharing their views
and feelings even when disagreeing with
leadership decisions. " It doesn't necessarily
mean we'll change the direction, but we
will consider what was said and potentially
modify how we get to the end result, " she
says.
knowledge gap that OR directors need
to fill with education. "
The effort to build understanding
can provide significant benefits (sidebar,
Success story: Productivity and positive
change). A year ago, Gilliam says
Nemours retooled the OR education
program and built pipelines with area
colleges, which resulted in nearly erasing
a deficit of 15 open positions. Now,
however, those new nurses are completing
orientation and require mentoring as
they continue to learn their craft.
" I need to give them the ability to
learn while also maintaining an appropriate
staff mix to keep patients safe, "
Gilliam says. She feels the work she
has done with leadership has positioned
her well to advocate to the C-suite to
" overhire " slightly so veteran nurses are
available to help new nurses, who will
not be fully comfortable in their role for
OR Manager | October 2023 23
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