The ‘Science’ of OR Staffing

Nurses apply science to patient care every day. But how often is a scientific approach applied to staffing? In the operating rooms at Cleveland Clinic’s main campus, the answer is the same—every day.

When Victoria Butler, MSN, RN, CNOR, FACHE, became Senior Director of Nursing at Cleveland Clinic three years ago, she implemented a quality improvement project aimed at using a scientific method to staff operating rooms. The goal was twofold:

• To provide a defensible plan for allocating direct caregiver positions
• 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

Nursing is traditionally budgeted using hours per day by patient. But this formula isn’t well suited to the OR, which normally calls for case scheduling and distribution utilizing a “block scheduling” or “open posting” approach. (With block scheduling, the days of the week and hours of operation are divided by service line. With open posting, cases are booked on a first-come, first-serve basis.) Historically, if operating rooms were open for booking, staff was required to perform any case in the room. The issue with this method is that it assumes the OR is occupied from open to close.

“The OR is actually one of the easier areas to budget,” says Butler, who has spent 30 years administering operating rooms. “You essentially need some factor of two nurses in the room—someone in the circulating role and somebody in the scrub role. So that becomes a simple mathematical calculation of how many rooms do you want to run and what hours of the day?”

During her first few months on the job, Butler defined how many people were needed in the 82 operating rooms on main campus, plus the four ambulatory surgery centers she oversees. Then she worked in conjunction with Christopher Clinton, MHA, former Administrative Director of Surgical Operations at Cleveland Clinic, to develop staffing models for the OR based on each surgical service line. Models for each vary slightly. The model used for general surgery service is shown here:

Employing a scientific approach to staffing has made a huge difference at Cleveland Clinic. When Butler arrived in October 2010, the OR had positions in the approval queue from June. Today, requests are approved in less than a week. Because of that, managers are more at ease working in a “lean” mode. “People feel more comfortable riding a risk because they know they are going to get the necessary help and get it quickly,” says Butler.

She also notes a side benefit: Retention rates have risen dramatically, and Gallup® Employee Engagement scores have steadily increased. While this is not totally attributed to the scientific method for planning staff, it has certainly helped. Says Butler, “We are on the journey to a healthy, happy staff.”