Today I am the administrator of Physicians Surgical Center in Lebanon, Pa., a bustling facility with a staff of 25 that cares for 100-plus patients each week. But my ORs weren't always filled, or even built, for that matter. I was hired in April 2005 to manage a center that was still under construction and scheduled to open four months later. I didn't have a desk, a co-worker or even a clue as to where to start. Only one thing was clear: I needed help.

Home sweat home
With the center nothing but studs and stones, my house became a makeshift office. I set up shop at my computer desk and on a card table in the second floor hallway and counted on Riley, my golden doodle, to greet the stream of UPS drivers who quickly learned to include dog biscuits with their deliveries.

The first calls I made were aimed at finding an OR tech. I didn't have a surgical background and wanted an expert sidekick who could handle the facility's clinical setup. The interviews netted Cindy Kocher, ORT, who joined me in the upstairs hallway. Her first charge was to ensure the facility was stocked and ready to go on opening day. Cindy researched where instruments came from, set up in-house meetings (literally) with vendors and began to compile instrument sets.

I found that hiring an OR tech proved even more valuable than bringing a materials manager on board. Techs know instrumentation and understand how the instruments work in actual practice. They have a behind-the-scenes knowledge of the OR and use this insight to fill the facility with tools and supplies that physicians will actually use. I believe a materials manager can follow a supply recipe, while a tech can write the steps with the right instrumentation mix.

Conventional wisdom says your business manager should have a financial background or experience running a physician's office. That may be true, but I believe a high energy level is just as important.

I fell into some good fortune when I received the resume of Chris O'Donnell, a woman who owned her own answering service. Her high-octane personality was evident over the phone and she was at my house 45 minutes after our initial conversation, the sign of a real go-getter. Chris knew a great deal about insurance contracts and had once served in each of the positions she would manage in our business office. Practical backgrounds can be more valuable than highly credentialed bean counters. I hired her on the spot.

Chris soon joined Cindy and me at a crowded card table. We had three cell phones, two computers and a land line between us as we began the search for even more employees.

Interview skills
It's true that surgery centers are an appealing workplace for RNs who yearn for predictable hours and free weekends. But don't fall into a false sense of confidence when trying to fill a facility that isn't yet built, especially in a town with a successful community hospital. I began interviewing candidates in May, three months before our scheduled opening. Instead of having my pick of qualified applicants, I had to convince nurses that they would soon care for patients in a successful new surgery center, even though I was interviewing them at my kitchen table. It was a tough sell.

When interviewing, ask the candidates to rate themselves on communication skills, job knowledge, initiative, dependability, flexibility, organizational skills and adaptability. In the course of these self-assessments, potential hires will inevitably provide valuable insights. So listen closely and trust your instincts because the discussions are an opportunity to gauge their interest and qualifications for work in an outpatient facility.

Are they motivated self-starters? Are they driven to succeed? Outpatient surgery is a unique setting. The environment is fast-paced and smaller staffs are often trusted with greater responsibilities than their acute care colleagues. Simply stated, if a nurse doesn't have a little get up and go, she doesn't belong in a surgery center. There's no place to hide and no nurse educator to go to for answers.

Lean and mean
Even if you secure new hires months before the scheduled opening of your center, wait to add them to payroll. As with any construction process, timelines are estimates and important target dates are often missed. The last thing you need is salary expenses hanging over your head when ORs remain dark and revenue streams dry. But don't underestimate the amount of work that needs to be done just before opening and how valuable your new hires are in completing the tasks.

Despite the common belief that part-time employees keep salary expenses down, I discovered that having a full-time staff proved invaluable. When ORs emptied, nurses organized orientation programs for the positions we would soon fill. Boxes also needed unpacking, supplies needed stocking and forms had to be made. When the PACU emptied, I had RNs drafting the facility's policy and procedures. Having a limited staff ensures you'll stay lean and mean during the opening of your center. It also means everyone will stay busy with supplemental projects when ORs are dark.

Forever friends
Staffing and opening a center from scratch will be one of the hardest things you'll ever attempt. But after the sweat and stress fade, an incredible bond with co-workers based on shared experiences and laughter will remain forever.