Interview a nurse who's over 50 and she'll proudly tell you about her experiences, her amazing love for nursing and her pets. On the job, her pace is slow but steady. She brings in potluck desserts and shows off pictures of her grandkids and her new kitten. But she shows up on time, rarely calls in sick and loves her patients. Interview a 20-something nurse and she gets right down to business: What are the hours, pay rate, expectation of overtime and vacation? On the job, she's on a seemingly flexible schedule, but she's super efficient. She carries a cell phone and checks her e-mail during breaks or lunch.

How do you manage intergenerational groups with conflicting work ethics, dissimilar values and disparate work styles? How do you get them to stop being impatient with each other? It's not easy at all. One strategy that's worked for me is to insist that all staff abide by this code of conduct:

• We are here to serve our customers. Our customers are our patients, our physicians and each other.
• Arrive at work a few minutes early to log in, get dressed, greet each other and be ready to start the day on time.
• Expect to remain at work for your entire shift.
• Check with your supervisor before leaving for the day to see if she needs you to do anything else.
• You must request time off well in advance. We must respect each other by recognizing the effect on staffing when people call out at the last minute.
• Project a positive and professional attitude while at the center. We all have problems, but while at work it's not about us; it's solely about those we serve.
• Be polite and courteous to everyone. Your temperament influences the entire atmosphere and directly impacts customer satisfaction. Avoid gossip; nothing productive is achieved by gossiping.
• Keep your cell phone in your locker and limit personal calls to those permitted by the handbook.
• Respect differences and strive to collaborate daily to meet the center's goals.
• To err is human. So admit your mistake and work together to continuously improve your performance by learning from them.
• Together let's create a positive work environment where we have fun and seek ways to help and encourage each other throughout the day.

Regardless of age, each person comes to work with different experiences and value sets. A code of conduct gets everybody on the same page and each employee understanding what's expected of her while at your facility.

Annamarie Carey-York, MBA
Project Manager Tri-Cities Surgery Center
Geneva, Ill.
writeMail("[email protected]")

What Causes Surgical Delays? Let Us Count the Ways
Our staff documents cases that don't start on time, including causes for the delays. We affix a sticker to each patient's chart, on which we write the date, surgeon's name and a number that corresponds to a list of potential delays. Here's the list: 1. No delay. 2. Physician was late. 3. First case of the day delayed (staff writes in reason). 4. Previous case ran over. 5. Anesthesia delay. 6. Equipment problem. 7. Supply missing. 8. Patient was late. 9. Delay in pre-op. 10. Extended room turnover from previous case. 11. Sterile processing delay.

In addition to providing a quick reference for the number of surgical delays, the stickers help me grasp why delays occurred. Am I noticing a lot of 11's? Perhaps I need to invest in additional sets of instruments. Do I see a run of 10's? We may need to improve our cleaning regimen.

Our physician-owners take the report seriously and place particular emphasis on first-case-of-the-day delays. They decided that three unexcused first-case delays in a single quarter results in the loss of morning block time for the offending surgeon.

Monica Ziegler, MSN
Administrator
Physicians Surgical Center
Lebanon, Pa.
writeMail("[email protected]")

When Spending More Saves You Money
One of the surprising things I've learned while revamping our materials management is that it's sometimes cheaper to pay more per item for a lower volume of a supply. You don't necessarily have to have a database tracking usage of each item in your supply room (though it helps). All you need to know are your case volumes, which you can then match supply use to.

When purchasing suture (or any product that might have an expiration date, really), look at just how often the surgeon you bought it for will use that high-priced suture based on past surgical volumes. If that particular type of suture comes in a box of 36, priced at $20 per pack, you'll pay $720/box. Now if that surgeon performs few of the procedure the suture is meant for - say he only averages six per year - and the suture expires in three years, the grand total of suture packs used is 18.

This actually puts the cost of the suture at $40 per pack be-cause you have to dispose of the expired suture. If you go through all the suture before it expires, that's fine, go ahead and buy it in bulk. If you don't, however, you can save by buying a box of 18 at $30 a box instead, or by negotiating to buy the suture (or whatever the dated supply might be) on an each basis from a local hospital or your hospital affiliate.

Christi Rousseau, RN
Clinical Director
Corinth Surgery Center
Corinth, Miss.
writeMail("[email protected]")

Does Your Staff Have Any Idea What Things Cost?
Between wasted medical supplies and damaged medical equipment, our staff was costing us more than $50,000 a year, much of it needless and careless, and all of it diluting our physician-owners' distributions.

Our solution: Let all of our employees understand how much some of our medical supplies cost. We set up a game modeled after the show, "The Price is Right." We identified about 25 costly items. The employees were the contestants and the OR supervisor and materials manager played the parts of Bob Barker. They'd call two or three employees to the front of the conference room and ask them to guess how much this or that supply costs. They were shocked at how much certain items cost us - $350 for an Accutrak screw, $440 for Kugel mesh and $450 for a port-a-cath, for example.

The game was a blast and it showed just how much money we spend unnecessarily when we're not good stewards of our medical equipment and surgical supplies.

Wes Becton, MBA, CASC
Administrator
Surgical Center of DuPage Medical Group
Lombard, Ill.
writeMail("[email protected]")

Your Great Idea for This Great Tee
Share your best money- or time-saving ideas. Your idea could, for example, be a way to

• reduce PONV,
• schedule cases,
• improve staff satisfaction,
• cut costs or
• safely re-use supplies.

Your facility probably does many things - big and small - to keep costs down, save time or please staff and surgeons. We want you to share them with our readers. E-mail your tip to [email protected]. To thank you, we'll rush you a free Outpatient Surgery T-shirt.