Perioperative Power List 2023: Developing Staff, System Level Challenges, and Cutting Costs
Perioperative leaders in every healthcare system across the country are constantly searching for solutions to the ongoing challenge of nursing shortages. System directors and VPs of perioperative services may not have boots on the ground like they used to. However, they are still responsible for making their organization as attractive as possible for prospective employees.
Tweaking the orientation process, raising wages, and cultivating relationships with area nursing schools are some of the ways our 2023 Perioperative Power List winners are problem-solving at their organizations.
How is your organization attracting, retaining, and professionally developing staff?
Dr. Edna Gilliam, DNP, MBA, RN, CNOR
Asst. VP Perioperative Services and SPD, Nemours Children’s Health
We looked at our orientation process in perioperative services and decided to create a simulated operating room. As we interviewed some of our new hires and asked them how we could make this a better experience for them, we identified that many left right after orientation. The number one reason was how they were being treated. Post-COVID, the staff was tired, working a lot of hours, and it was creating a little bit of incivility due to constantly having to orient the fundamentals. We thought if we could create a simulated space to teach perioperative nursing fundamentals, they would have a little more knowledge and be more independent when they got into real ORs.”
M. Trevor Bennett, MBA, MSN, RN, CNOR
Associate VP of Operations/Exec. Dir. of Surgical and Interventional Services, Providence-Swedish Health
“We did a lot of work last year to increase our union contract, and we were able to increase base salary and wages by about 19% over 12 months to make it attractive to come back and work with us. That stabilized our workforce. We’re also implementing Periop 101, being more in touch with our recruits to give them the experience they were after coming out of school so we can help support them in their first few days on the job.
The other thing that has changed dramatically for our organization is that our providers have come to the table lately. They’ve gone from ‘eating our young’ to being supportive and grabbing new nurses and getting to know who they were as individuals, pulling them into the rooms, showing them new and exciting things.”
April Kranz, MSN, RN, CNOR, CENP
VP of Patient Care Services/CNO, Conway Regional Health
“We’re focusing on what I call a cultural reset, which is putting the well-being of our caregivers first. We’re giving them training using a program called CANDOR. It’s a briefing session for caregivers who have gone through traumatic events to help coach each other. You wouldn’t have seen that type of training before the pandemic.
We’ve leveraged partnerships with our academic organizations and created nurse residency programs for our new grads. The AORN Periop 101 program is specifically designed for a nurse residency program for perioperative. In the past, there was this misconception that you should have some experience—either as a staff nurse or in a physician’s office—before entering the OR setting. We can take our new grads and give them that skill set so they can think critically, even though they haven’t had that experience on the floor. There has been a shift, especially at my organization, where new grades are welcome in those areas.”
Lynn Wyllie, MSN, BSN, RN, CNOR
VP of Perioperative Services, CHRISTUS Trinity Mother Frances Health System
“We eliminated all of our contract labor here in Tyler by offering competitive wages and sign-on bonuses to new associates coming into the system. We also rewarded our existing associates by offering contracts for picking up additional shifts. The money that would be going to contract staff went to our associates.
Any nurse that comes into the operating room without operating room experience, regardless if they’ve been a seasoned nurse on the floor for several years, they have to go through our Periop 101 residency, which is based on AORN’s Periop 101 module. That’s our pipeline for getting new nurses.”
At the system level, what can leaders do to cut costs and increase revenue?
EG: “The best way to do that is standardization and communication. We just recently bought a new robot at our facility in Delaware. Florida needed a robot too. So we were able to work together to have a better contract. I’m also a co-lead on our value analysis committee. When new products come into the organization, we look at those products as an enterprise; we meet monthly, and everybody asks questions. One of the requirements of attendees who bring new products to the committee is to connect with their counterparts in other states. They have to have a conversation where they say, ‘Hey, I’m bringing on this new thing. Is this something that you would be interested in?’ That way, we do an enterprise-wide trial and then make decisions jointly.”
MTB: “I had a conversation around expanding a service line. On paper, it seems logical that we would capture market share, expand the service, and grow in this region with the service line. Then you start putting the numbers together, and you don’t know if that pencils out from a business development standpoint. Healthcare margins were super slim before. Healthcare is expensive. We gave our union caregivers 19% wage and salary increases and significant raises to our non-represented caregivers. There’s the cost of biologics implants. Shipping is continuing to go up. The margin that was already practically nonexistent is now gone. You’ve got to start thinking about efficiencies and smart volume. What are you going to grow and lean into? We’re going to have to leverage our payers to reimburse more. Work with staff to accurately code, document, and appropriately drop charges. Before moving forward on new meshes, biologics, or instruments, we must ask ourselves: does this improve care? If we’re meeting the standard of care and patients are doing well, I must deny [the request]. We can no longer bring things in because people want them or they’re the newest and greatest thing.”
AK: “I look at the products that we use. Could we capitalize on contracts a little bit better? From a system level, I also start looking at what my sister hospitals are doing that are a part of my GPO. Maybe we all need to get together instead of remaining siloed and start talking about the services, products, and equipment we’re using and how we can capitalize on better contracts. For example, say I’m going to pay $100,000 for a C-Arm at my hospital. But what if other hospitals need one as well? Now I’m buying five, but at $80,000 apiece. Looking at things like that is how we’ll save money in this financial crisis without sacrificing staff.”
LW: “We focused on bringing in additional surgeons and getting them on board to comply with those contracts to use those products. Often, it’s a challenge. But I found that being engaged with the chiefs of those service lines has helped us to be able to lower our costs.
We also have a local committee at our hospital called the Non-Labor Committee, where multiple disciplines get together, and we come up with cost savings measures that don’t affect labor. So far this year, we’ve come up with 1.1 million in non-labor cost initiatives. Those things add up over the year. We had someone that came in and watered the plants, and we thought, does someone really need to do that? Couldn’t we do it ourselves? You can’t use the $12.00 pen, but you can order the $2.00 pen. Just little things that people may not think of.”
What is one win you have had as a system VP?
EG: “Back in September and October, we experienced an increase in RSV, flu, and COVID. It was creating a bed capacity issue because so many patients were coming into the ED. There was a time when we were holding like 30 or 40 patients. We were trying to keep elective surgery moving. We knew that we had to look at admissions because the elective admissions were the only ones we could control. We went back to our physicians and said, ‘Hey, does this patient need to be admitted?’ We found that a lot of it was based on patient preference and pain management. We had to look at it from a different perspective. How can we move these patients to discharge? So, we were able to reduce scheduled surgical admissions, between September and December, by 68%. That helped us keep our elective schedule moving.”
MTB: “I think the biggest win I have right now, from the feedback I’ve had, is that my team feels supported by me as a leader. I think it matters to have those emotional connections with your teams and to have some of the difficult conversations I’ve had with them in one-to-one settings. I’ve found a place in my leadership career where I can sit and listen without providing feedback. Just be a voice that they feel comfortable enough to sit and have a conversation with.”
AK: “We created a multidisciplinary SSI (surgical site infection) Committee. We talk about ortho SSIs and invite physicians, service line leaders, the quality people, pharmacy, and the nurses involved in pre-op and post-op care. Before they come to this meeting, everyone has done a deep dive into the chart to speak to their specific area of care. The greatest thing that comes out of this meeting is that sometimes we find nothing, and we figure out that our care was amazing, but this patient was maybe noncompliant at home. The accountability factor is that we are making process changes. Physicians are saying maybe they need to change the prep they’re using, or we’ve got pharmacy saying, maybe we need to put up antibiotic guidance in the OR rooms instead of just putting it on our EMR system. That is probably the biggest accomplishment because getting a group of people from 10 different disciplines to get together and agree in one direction we should be going is a huge accomplishment.”
LW: “The surgical volume at all my locations has grown 12%, which is huge with the current healthcare landscape. I’m currently building two additional ORs with seven Pre-Op and PACU bays on the third floor of our hospital. We’re on the 1st floor because we’ve hired five additional surgeons starting in August. We just purchased an additional Da Vinci XI robot. So now we have five robots in our robotic fleet. Our system office asked me to write a surgical playbook about how to do things in surgery based on certain metrics and efficiencies in the operating room. That has been sent out to all of the CHRISTUS hospitals to follow for OR efficiency. CHRISTUS is calling this ‘The year of the OR,’ so we are really focusing on our efficiency. I’ve had the opportunity to lead that charge, and I go to other CHRISTUS hospitals and help them with their OR efficiencies. That’s been fun. The playbook was something that took a lot of time. But now, everyone can see it electronically and use it to hit certain efficiencies, like FCOTs, blockage utilization, and the basic metrics we all follow.”