Applying Science and Strategy to Operating Room Workforce Management

Victoria Butler, MS, RN, CNOR, FACHE; Christopher Clinton, MHA; Harsha K. Sagi; Robert Kenney, MBA; Wael K. Barsoum, MD


Nurs Econ. 2012;30(5):275-281. 

In This Article


Planning for appropriate staffing in the operating room (OR) is a balancing act between the often competing priorities of providing high-quality care for patients, providing convenient access for surgeons (revenue generation), providing healthy work environments for staff (with attention to work-life balance), and functioning at or below budget. Another piece of the puzzle is understanding the regional market pressure and/or length of the recruitment process (position posting to hiring/onboarding), often referred to as "the pipeline." Lastly, a further complication may be the size and complexity of the organization. The particular challenge for OR management is that the traditional means of planning nurse staffing (hours per patient day or just "history") are either poorly translated to the setting or do not provide decision makers with a platform to defend their needs, especially in an era of health care reform.

Operating rooms normally call for case scheduling and distribution to be done using a "block scheduling" or an "open posting" approach. With block scheduling, the days of the week and hours of operation are divided using a service line approach (orthopedics, neurosurgery, etc.) or sometimes even by individual physician name or practice group. With open scheduling, cases are booked on a "first-come, first-served" basis (although some rules or time constraints may apply). Historically, if the ORs were open for booking, staff needed to be available to perform any cases placed in the room. The obvious problem with this type of resource planning is that it assumes the OR is filled with a case from open to close. Various methodologies evolved to address the turnover time between cases as well as any non-direct patient care activity (often referred to as the "white space" on the schedule). As the financial picture for hospitals changed over the past 20 years, operating room directors often found themselves at a loss to explain or defend their staffing budgets.

Approximately 2 years ago, the Cleveland Clinic Surgical Operations Department initiated a quality improvement project aimed at applying a scientific method to OR staffing. One goal was to provide a defensible plan for allocating direct caregiver positions. A second goal was to provide a quick and easy way for nurse managers and directors to track positions and graphically depict the effect of vacancies and orientation on their staffing budgets. This article includes a brief review of the literature and an overview of this project, with a focus on the registered nurse (RN) and surgical technologist positions in the OR. While we have additionally deployed staffing models in all surgical operations areas, including the ambulatory surgery, post anesthesia care, and sterile processing areas, we will only discuss these briefly in this article. Although we will not present a formal research study (implications for further research will be discussed in the conclusion), we present data related to use of overtime, lead time for posting positions, employee satisfaction, and the effects of the OR staffing models on financial performance.