News / Periop Café


July 8, 2021



Karen Buck, MS, FACHE, NE-BC, CNOR   

Love of travel and meeting new people drew Karen Buck to the interim lifestyle. During an organizational restructure at a facility she was working for, she was offered the opportunity to try an interim position.


When you begin an assignment, what is your priority? 

Before I arrive, I learn about the objectives and priorities from executive leadershipWhen I get there, I assimilate into the environment and learn about the culture. Within that first 30 days, I determine if any patient or employee concerns need to be addressed immediately.

What metrics illustrate a well-run OR? 

A combination of throughput and quality metrics. Efficiency and quality outcomes through the entire continuum of care from pre-op location with PAT optimization, to FCOTS, followed by PACU length of stay. 

Build relationships to assess the processes that drive FOCTS. While the late-arriving surgeon will always be a factor at times, there are opportunities to improve processes that drive throughput. A robust pre-admission center with staff that owns the process will help lower cancellation rates.  

To improve turnover, develop short-term task forces that are driven by staff and facilitated by a leader. Through these types of performance improvement teams, the staff determines the future state, which then hardwires the process and promotes ownership for sustainability.  

Do you have any predictions for the future of interim leadership?  

There will always be a need for interim leadership. Succession planning is challenging because many front-line nurses are choosing to stay at the bedside vs. entering leadership. With so many leaders set to retire within the next 5-10 years, this is an area of great need. 

What advice do you have for an OR manager promoted to Director?

Step back to see the larger picture. Visibility is crucial; wear scrubs every day. CEOs pay attention to this, and it demonstrates that the director is in the OR daily, keeping a finger on the pulse of operations. 

Tips for mentoring a successor? 

Remember that you are always “on.” In addition to your words and actions, people watch your non-verbal communication. Lead with conviction, but never forget humility and compassion. 

What are some ways to improve volume growth? 

Conduct an annual “right-sizing” activity with the block schedule. This will help control capacity and create the ability to accommodate new surgeons and more volume. Develop strong rules of engagement around block utilization, including no release time for no volume. Learn to anticipate the needs of surgeons in the areas of access and equipment/instruments. 

What are some lessons from the COVID pandemic? 

The ability to pivot and lean into a new situation. Consistent communication and checking in with staff to make sure they are doing okay and that you’re tackling issues in real-time. 



For Fun

Where can we find you in between interim jobs?

Spending time with my family and friends, either on or off the golf course.

What do you do for stress relief while on assignment? 

Find a local gym or pick up a couple of free weights and a yoga mat. I map out a walking route in a nearby neighborhood, too.