Who's Managing the OR?

Who’s Managing Your Operating Room Today?

There are two vital leadership roles supporting surgical services in hospitals today. These two leaders must have skills reflecting an understanding of patient care, business, and process operations; the Operating Room and Central Services directors.

These two leaders must demonstrate consistent management practices moreover be credible to administration, surgeons, and their staff.  If you read the “Who’s Managing CS” page you already know how poor leadership is determined for Central Services.

With the OR however it’s an entirely different story.  At annual conferences both nursing and CS the standing joke is “how long did your previous OR director last”. The answer is generally around three years at best, two seems to be the norm.

The question not asked is how much damage did they do and can it be fixed without further financial lose.

When reviewing your next OR directors resume you will see employment changes every two to five years jumping from hospital-to-hospital and state-to-state. Somehow they all make the same statement that they were involved in construction projects and have saved the hospital “one-million dollars”.

If your hospital is starting up a heart program, they have specialized in that, a spine program, they mastered it. Some even boast how they fixed CS. They seem to have served on boards for AORN and even published papers.

They have installed OR scheduling systems and got them up and running just too top things off.  For reason unknown to the world nursing leadership looks at movement from hospital-to-hospital as learning experiences, not failures. OR nursing leadership can simply vanish and resurface at the next hospital generally without missing a paycheck. Turnover is the norm not an indicator of a problem.     

I have worked with ten operating room leadership changes along with three interim positions in the past twenty-five years at this one hospital.  Two of the three interim directors stepped up to the plate and kept the place moving forward, they were charge nurses.

The others all had stories of how they did it better at their last hospital. Their reasons for moving around so much are as uninteresting and inconsistent as anyone could possibly imagine.  Most do not merit a review of their resume let along an interview. However they are hired over-and-over again into six-figure salary jobs with bonuses and retirements occasionally dragging an unemployed spouse along for the ride. 

If healthcare is going to make a change it has to start with leadership. Promoting individuals who almost certainly cannot complete direct patient care into positions that require the ability to manage millions of dollars of assets and people must stop.

Nursing produces some amazing people that do incredible jobs with patient care, business management is not always one of them. The fact is they should not be manageing the business side of healthcare, they should be allowed to manage patient care.

A skilled charge nurse (aka resource coordinator/RC) runs the show better then any one OR director that I have ever worked with. For the most part the charge nurses manage the daily operations of the OR with skill and accuracy. They know their surgeons needs and make the daily operations work regardless of the many obstacles before them.

The three year director simply flounders around attending meetings and pretending to know the operating budget making cuts to save their bonus when they should be spending to keep up with demand. Out to lunch or on a trip with a vendor generally gets them in trouble when making promises that cannot be kept.

If you have no standardization in your OR, look at the number of directors first. Turnover yields miss-management and confusion. These traveling nomads are usually in bed with a vendor going on trips to see the best practice and enjoying dinners while the charge nurse is running the show.

Whatever you do, do not go to a conference with one of them and except a dinner date with a vendor. They will put you into an unethical position without care or worry to your career.

One line that every one of them will say to a vendor, “we need to see it first, can you send us to one of your best hospitals”.  Vendor paid trips to Germany to see one of the leading instrument manufacturers was at one time the deal breaker for them.

If your operating rooms support five to six vendors for OR lights, tables, and instrument manufacturers look at your track record with OR directors. When looking into why the industry has adopted OR business managers and OR materials managers you find two compelling justification; traveling OR directors and the lack of business knowledge required to manage the single largest revenue and expense department in today’s hospitals.

Our industry needs “Operations Directors” with production and materials management experience not runaway Houdini’s or jumping Johosephat’s with extended acronyms on their business cards and e-mails.

These want-a-be traveling OR directors cause damage wherever they go leaving just before the shit hits the fan. They tend to go out on sick leave using up every hour of paid time off while looking for their next victim.  The operating room and related support services make up the single largest expense and revenue generating divisions of any hospital.

Poor management by these individuals affects all aspects of perioperative services, including patient care.