DOING BUSINESS
Is Staff Hours Per Case a Reliable Labor Metric? How to best measure employee productivity in the perioperative environment BY ARNE BROCK-UTNE, MD
I was driven to write this because managers/admin- istrators get blamed for high and inconsistent staff hours per case (SH/C),
when the reason for this outcome might be completely out of their control. When managers are pushed to lower SH/C they might inadvertently lower their staffing assignments to a point below what is acceptable for safe clini- cal care. When that happens, you will have problems ranging from sub-par patient and physician experiences— resulting in poor online reviews and lost cases—to bad clinical outcomes. SH/C fits well into financial mod-
eling, however, medicine does not really work like financial modeling. A case is not a case is not a case. Every case is an individual, a patient, a per- son, and each individual and their spe- cific procedure have different nursing care requirements.
SH/C can change due to many fac- tors that are out of a manager’s con- trol. Here is why SH/C will always be inconsistent and SH/C as a labor benchmark is unreliable and poten- tially dangerous.
Nurse-to-patient ratios in PACU: Per the recommendations of the Amer- ican Society of PeriAnesthesia Nurses (ASPAN), nurse-to-patient ratios change with the type of patient and type of anesthetic. If you have a lot of pediatric patients in one month and do more general anesthesia (GA) cases, you will need more staff hours to cover these patients safely and your SH/C will go up. Conversely, with more monitored anesthetic cases (MAC), locals and adults, your staff hours will go down. There is nothing the manag-
ers or administrators can do to change that situation in either case. Higher acuity patients in preop:
A facility that does nerve blocks in the preop area and has sicker patients will require a higher number of preop RNs. If a facility is a gastrointestinal (GI) center and anesthesiologists put in their own IVs, they will require fewer RNs. Gaps in the schedule: We all want a perfectly scheduled surgical day. Why can’t the surgeons fill in the gaps? Why can’t we fill the blocks? Let’s face it—it is not going to happen. There are gaps in the schedule and there will always be gaps in the schedule. You cannot send staff home during the gaps and surgeons have clinics they have to go to and, sub- sequently, cannot operate during the
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gaps. If you have more gaps one month than another, your staff hours per case are going to go up. No manager can do anything about this. Different surgeons: Different sur-
geons take different lengths of time to do the same procedure. One surgeon might require more staff for a difficult procedure. A surgeon who just came out of training will take longer than an experienced surgeon to perform the same procedure. All these uncon- trollable factors will increase your SH/C ratio. Training staff: It can take three months to a year to train a new cir- culator or scrub tech. These trainees need extra coverage from a trainer and extra time to learn the skills needed
The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.
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