You get paid by the patient, not by the hour. So why are you bound to the traditional five-day workweek? If you compress your surgery schedule and eliminate one day of surgery, converting your facility to a four-day workweek - especially during the startup of a new center - can greatly improve in efficiency.

Not only will a four-day workweek do the obvious - decrease your clinical staffing costs by 20 percent - but you'll also ensure that your employees are busy when they're at work and your surgeons have all the help they need when they're at your facility. Now, a few of your surgeons and most of your full-time staff might protest long and loud, but over time a compressed surgical schedule will greatly improve your productivity and your profitability.

Set the stage with surgeons, schedulers
Identify your surgeons' needs well before you make the switch. What day and times do they prefer to operate? How many days of OR time will they need each week?

Have your docs fill out a survey. Their requests will then be in writing, avoiding a he-said, she-said argument. The information you collect will also let you create charts or graphs to help you visualize the schedule requests. Some surgeons may resist a change to their operating schedules. There's no easy answer to swaying physicians on a new concept, but here's a tip: Assure them that as the schedule gets busier, they will get preferred choice for the times or days they favor.

Next, get to the surgeons' schedulers. Often forgotten, they're essential players in the surgical schedule game. Schedulers control when and where surgeons' patients go for surgery, so getting in good with them is important. Take physicians' schedulers out to lunch or breakfast, invite them to tour your facility and even let them watch the types of procedures they schedule. Schedulers often have no idea how long the surgeries they book actually take in the OR. Having them observe a case will not only make them feel important, it will also give them valuable perspective on your scheduling needs.

When you're trying to compress your OR times, a scheduler who knows and feels comfortable with your staff will work to make the changes you need, serving as a valuable ally. But if she doesn't know or like your facility, you can forget about getting that surgeon on board with any changes you'd like to make.

While the surgeon's scheduler plays an important role in compressing your surgical schedule, so does the person manning the phones in your facility. You need someone who sweats the details and doesn't get frazzled with several phones ringing off the hook. The ability to say "no" in a polite manner - something that is not always easy to do when dealing with a physician - is also a valuable skill. Your scheduler needs to understand that you support her in turning down a surgeon who calls and wants to add a single procedure on a light Thursday when that request doesn't coincide with your goal of adding many cases to a compressed block schedule.

Versatile reality
Cross-training staff is nothing new, but the practice is essential for compressing your surgery schedule. Here are some alternative assignments that I've doled out in the past.

• Pre-op/PACU RNs. There are few other employees in your facility that possess the multifaceted skill sets of RNs, so take advantage of that versatility. They're able to help with room turnovers, assist with supply ordering, handle your drug and supply inventories or send infection and complication surveys out to surgeons - and ensure they come back. I give many of my RNs side projects or alternative responsibilities and more often than not the task is completed with very little need for supervision.
• Surgical techs. These OR helpers can assist in pre-op/PACU by pulling medical records or handling patient insurance claims. I've trained techs to look at the surgical schedule and verify co-pays and deductibles with the insurance companies before the RN makes the pre-op phone calls to patients.

When staff complete their clinical responsibilities, and a couple hours remain before the end of the workday, keep them working. Most techs and RNs will be receptive to taking on additional responsibilities because they realize those skills offer greater job security - both in your facility and on their resume for future opportunities. If staff aren't open to training outside their ordinary jobs, make them aware of the value of enhancing their knowledge base by learning a marketable skill. As a last resort, tell resistant workers that their employment at your facility depends on their willingness to cross-train.

Power to be flexible
In addition to cross-training, you need to take advantage of part-time and per diem employees; they'll flex with the schedule and let you run various numbers of rooms on different days - things a full-time staff won't permit. Part-time staffers are also less expensive.

Hiring part-time staff allows for flexibility, but you need to make staff well aware of the surgical schedule's unpredictability. Don't promise shifts or specific days to anyone; your staff needs to know that the hours they work are strictly dependent on the ebb and flow of the surgery schedule. Surgeons with kids often take school spring breaks off for family vacations, and I've noticed fewer physicians these days perform elective surgeries around the winter holiday season.

Hiring part-time staff, and making them aware of schedule inconsistencies, lets you stagger staff arrival times each day. Take some time each afternoon to review the next day's surgery schedule. Based on that review, you can call to add or cancel part-time staff based on need.

Consider case times, too. Review the historical data of your facility to determine which cases have a tendency to run long. This practice will cut down on staffing as well as overtime costs. Overtime expenses are generally inccured when staff are reimbursed for cases that run over allotted times. For the days on which those cases are scheduled, consider delaying the arrival of some staff. Assign them to the cases that tend to run long; because they started their day later, they won't accrue overtime hours.

A win-win
Under-utilized and over-utilized OR times are detrimental to a surgical facility's staff in more ways than one. The cost of over-utilization is more expensive due to overtime costs, but neither should be present in a facility using its employees to maximum efficiency. Compressing and keeping your staffing pattern flexible can work, and when it does, you'll accomplish the maximum amount of work in the minimum amount of time.