News / Behind the red line

Volume Growth at a Glance

June 15, 2021


Volume Growth at a Glance

Volume growth in Surgical Services is particularly challenging because it must be balanced against the quality of patient care. An interim director has a small window—typically 3-6 months—to make a significant difference. They must have a few aces up their sleeve ready to go the moment they step into the OR.  

Below, our Road Warriors for 2021 offer their first-line tactics to increase volume and make an impact within their brief tenures.


Karen Sulzman, BSN, MSN, RN   

The important thing with volume growth is making sure that surgeons know you’re going to get their patients in and out of the OR on time. In my current facility, we had to figure out how to move patients along the continuum when you’re stuck in the PACU because there aren’t beds in the hospital. We decided to expand by creating a new space so that patients can go to a “holding” area, utilizing unused space. Once that’s set up, we cross-train pre-op nurses for additional responsibilities. I’ve been at this institution for less than 6 weeks and I’ve trained about 15 nurses in how to do phase 1 nursing based on ASPAN guidelines.”


David Binkley, BSN, MS, RN 


“First, ask this question: what do you have to offer in terms of the ability to grow volume? Do you have optimal utilization of your rooms? Does your hospital have an outpatient surgery center to offload some of the cases to? So, the first thing is to know what you have available. When you have that, you can see what service lines you’d like to expand. This requires meeting with all the department heads, including the C-suite member in charge of business development. 

I always tell hospitals that they can’t be all things to all people. They must ask themselves what kind of business they want to be in and what kind of business can they execute. Once you know that, you can decide what service lines are important to your facility that you think you will be successful at. You can’t spend money trying to do adult heart transplants if you’re not equipped to do it or not in a setting to succeed. Don’t throw money at the problem, don’t dictate what you think the right service lines are. Ask the questions and the answers will make that decision for you. You also need data (margins on procedures, etc.) and close collaboration with all relevant teams.


Rene Holden, DNP, MSN, RN  

“You have to find out where your money makers are and if there is any potential for them to have more block time. You can have one doctor that does most of the cases but are they making you any money? Look and see what cases you’re getting reimbursed for the most and is it feasible to go with that route. Evaluate your service lines and see which one is going to be the best income potential. 


Ernie Nichols, BA, CRCST, CSPDT, CSPM (SPD)


“From an SPD perspective, if we can get those FCOTs started on time without any hiccups, we tend to run smoother throughout the day and into the afternoon. My first shift comes in at 5:00 a.m. Why so early? My strong team has two hours to take a hard look at everything to make sure that we have what we need to start the cases on time. I bring them in early enough to have the time they need to make a difference. At 5:20, they’ve researched the case carts, reviewed everything, and oops, we missed this thing. Now we have 90 minutes to two hours to get that taken care of and we’re still on track to start on time. I can say that where I am currently, less than 1% of the delays are because of SPD. Since I have been here, we’ve had no cancellations, which also a big challenge too.  

I also talk to leadership in ENT, plastics, orthopedics, etc., sit down with them and talk about what they need. I stay in my SPD lane and ask them what can I do to help them do their job? I go to the professional services committee meeting monthly. They have my phone number, and they often call me saying, “Look, I got this big case happening, it needs to go good, I got people coming to look at it.” I say, “I got you, we’ll do our part.” We open early and make sure everything is perfect. It’s like a football team. I’m a tackle. I block. As long as I block my assignment, I’ve done my part.” 



Interested in seeing what else our Road Warriors had to say? Check out their full interviews here.