Do you have an OR succession plan? Don’t wait until it’s too late
By Don Sadler
The job of an operating room or perioperative services director is an extremely hectic and busy one. OR directors and directors of surgical services (DSS) face a never-ending list of urgent deadlines and priorities on a daily basis that must be dealt with immediately, if not sooner.
Important But Not Urgent
The biggest challenge for hospitals with regard to succession planning is the simple fact that most of them aren’t doing it, says Sue Smith, RN, BSN, MHSA, CNOR, a principal with the Surgery Management Improvement Group.
“OR succession planning is important, but it’s usually not urgent, so it isn’t prioritized,” says Smith. “As a result, many hospitals today are not prepared for the looming retirement of their OR and perioperative services directors and other leadership positions within the OR.”
The statistics bear this out. The average age of perioperative leaders today is 51, and 60 percent of them are over age 50, Smith notes.
“The simple fact is that senior OR leadership is nearing retirement, but there isn’t a strong pool of leadership talent ready to replace them,” she says. “And the pool of leadership talent is expected to drop by 15 percent over the next few years.”
Smith shares some other sobering stats regarding OR succession planning, including the fact that two-fifths of newly hired OR leaders do not remain past their first 18 months on the job. Also, the median length of time between leadership successors is 12 months. And as many as 25 percent of OR leadership positions currently remain open.
Acute Candidate Shortage
There are a number of different causes for the potential looming crisis in OR leadership, says John Gialanella, RN, MPH, a principal with the Surgery Management Improvement Group. These include the increasing complexity of OR management responsibilities and the fact that many OR nurses simply are not attracted to careers in healthcare management.
“The result is an acute shortage of candidates for OR leadership positions,” says Gialanella.
Gialanella summarizes the main responsibilities and required skill sets of a director of surgical services as follows: people management, physician management, materials management and financial management.
“This is the hardest perioperative position to fill,” he says, “but succession planning also needs to occur for other OR leadership positions. These include specialty coordinator roles, which can be good building blocks to help prepare staff for director positions down the road.”
Another factor is the limited financial resources that are available for OR management education and training.
“There is money for clinical training, but funding for education in financial management, human resources, operations and regulatory training often isn’t available,” says Linda Groah, RN, MSN, CNOR, NEA-BC, CNAA, FAAN, the executive director and CEO of the Association of periOperative Registered Nurses (AORN). “This ultimately confines nurses to clinical practice.” Suby concurs.
“There is an overall lack of financial and budgeting training for future OR leaders,” she says. “Many hospitals have reduced or eliminated these training programs, which has resulted in a deficit in management skill sets among OR nurses.”
This is an especially big problem when you consider that the OR is a big revenue generator for most hospitals.
“This is why perioperative leaders need to have a solid understanding of the business aspects of running the OR,” Suby says.
In addition to financial and budgeting skills, OR leaders should also be strong communicators, Suby adds.
“OR leaders have to be comfortable dialoging with the executive team,” she says. “If you don’t know your numbers and can’t express yourself strategically to executives, instead of having a seat at the table you’re going to end up on the menu.”
The End is in Sight
Darlene G. Hinkle, RN, MSN, CNOR, the director of perioperative services at Fairgrounds Surgical Center/Lehigh Valley Hospital in Allentown, Pennsylvania, is among the current generation of OR leadership that is eyeing retirement in the not-too-distant future.
“I’ve been in my job for 26 years and I know there’s an end in sight, probably about five to eight years out,” she says. “So, succession planning is top of mind for me right now. The hard part is finding staff who want to manage the OR. With their family responsibilities and the stress and long hours that are part of OR leadership, staff nurses tend to view it differently now.”
Hinkle says two of her managers have been with her for 20 years.
“But they are about my age so I don’t think they want my job,” she says. “My youngest manager recently went back to school for her MBA, so I’m excited about her potential for future leadership. I’m working with her to make sure her OR schedule accommodates her education schedule.”
Suby believes that the responsibility for OR succession planning starts in the hospital’s C-suite.
“The hospital’s executive management team needs to initiate succession planning because it is a long-term, strategic process,” she says.
“Executives need to identify what skills are needed by OR leaders and whether existing staff possesses these skills,” she adds. “If not, they’ll need to look outside the organization to recruit future leadership.”
There are pros and cons to recruiting OR leaders from outside the organization versus promoting existing staff to leadership positions.
“When leaders are brought in from the outside, they may bring fresh ideas for improvement and new perspectives in terms of how to deal with problems or issues,” says Groah.
“However, promotion from within is a great retention device because your staff feels valued,” she adds. “This can help with recruitment. Also, promoting from within helps maintain important institutional knowledge, as long as it doesn’t trap the facility into the attitude of ‘that’s the way we’ve always done it.’ ”
Of course, promoting leaders from within your organization is contingent on having staff that are motivated and prepared to move into leadership positions. Gialanella estimates that about 75 percent of surgical services directors are now brought in from the outside because organizations haven’t adequately trained and groomed new leaders internally.
A Formal Process
Smith recommends making leadership development a formal, ongoing process with each member of the surgical team who has expressed interest in increasing their leadership responsibilities.
“Conduct a leadership review with these staff members six months after you have conducted their annual performance review,” she says. “These reviews will be similar, but the leadership review will evaluate staff not for the job they have now, but for the job they might have one day in the future.”
Gialanella recommends “keeping your radar up at all times and keeping your finger on the pulse of your organization. This way, you will have a good idea not only when a leader might be leaving or retiring, but also which staff members might be ready to step up into this leadership position.”
