OR Succession Planning, Change Management, and Leadership Development

Jerry Ippolito
President OR Efficiencies, LLC, Naples, FL

Last night’s party was great! I can’t think of when we all had such a wonderful time together. The OR staff, surgeons, anesthesiologists, residents and even administration were in full attendance. All of the day’s issues were put aside as we celebrated Mary’s retirement. Where have all of these years gone? Mary had been our medical center’s Director of Surgical Services for nearly three decades—she was here when I was a med student and bailed me out so many times during my anesthesia residency. She was tough but well respected for her ability to keep our fifteen rooms running like a well tuned race-car. However this morning the dreaded hangover set in—no, not the one from the extra martini; the one of the reality that the Director’s office is dark. We’ve heard nothing regarding Mary’s replacement and the Chief Nursing Officer told me that there are no qualified candidates with interest in our community. The most qualified candidate turned down the opportunity because the spouse wouldn’t be able to find appropriate employment. Several staffing agencies have been approached but qualified interim managers are not available for at least three months. One of the CNO’s thoughts is to use this void of leadership as an opportunity to bring in a consultant to assess whether we are doing things as best possible—that’s not a bad idea, but who is going to run the OR on a daily basis? I told the CEO that as Chief of Anesthesiology I’d step up to the plate and do whatever I can—he recognizes that it won’t be easy for me as the Chief of Surgery is a talented surgeon but an ineffective leader of his peers. I really don’t want to run the OR; I prefer teaching the anesthesia residents. What has happened here? Mary’s been planning this retirement for eighteen months and here we are—an ocean liner at full steam ahead and there’s no captain on board. Man the life-boats !!

The above scenario is not as melodramatic as it seems and does not represent any one hospital. Although what I’ve presented in this scenario is fiction, it is happening in real time, every day, at many hospitals across the nation. A severe shortage of perioperative services leadership is increasingly evident in the nation’s surgical programs. According to the American Association of Operating Room Nurses (AORN), the average age of the OR nurse is in excess of 42 years and increasing. Typically even the most accomplished of individuals require at least ten to fifteen years experience as a Director of Surgical Services to be optimally effective in programs with high case volumes; even more experience is required in highly political environments. Accomplished surgery leaders have been vacating the field for retirement or career opportunities in other realms of health care or industry in general. The critical shortage of incoming nurses, coupled with the lack of focused identification of leadership potential, skill development, and mentoring, has created a serious shortage of surgery program leaders. While this void of leadership is most felt among directors of surgical services, it is not exclusively limited to that population. A void of effective leadership is frequently experienced among a hospital’s medical staff (e.g. Chief of Surgery; Chief of Anesthesiology, etc.)

Directors of Surgical Services typically rise through the staff ranks as talented OR nurses. Medical staff chiefs of service are typically individuals who are recognized as excellent physicians; or well liked among peers; or recognized by peers as not wanting to “rock-their-boat”. Individuals with superior clinical skills, whether nurse or physician, are too frequently presumed to possess a similar ability to perform as managers despite lack of any planning and preparation for these new responsibilities.

The challenges of today’s complex surgical services programs dictate the need for uninterrupted and proactive management to:

• Provide dynamic, stable leadership across all components of perioperative services;
• Facilitate day-to-day communication among key stakeholders;
• Identify opportunities to implement new programs and improved processes enhancing patient care, optimizing physician productivity, and promoting staff retention;
• Assure programs’ marketability to staff, surgeons, anesthesiologists and anesthetists;
• Maintain programs’ financial viability.

Author John Maxwell writes that an organization can only grow as far as the leadership potential of its top leaders. To keep ahead of the competition, companies / hospitals / medical groups must continually make changes. Healthcare executives want their hospitals and surgical programs to rise to the next level, and to do so the administrative team, program directors, and physician leadership (surgical and anesthesiology department chairs) must be capable of supporting and sustaining necessary change. A hospital CEO (or even anesthesiology group practice president) may have the vision of where they want their organization to go, but that does not necessarily mean the leadership team possesses the skills to lead the organization along the path to success. Consultants can be engaged to identify opportunities for making program change and assist in implementing successful change. However, if a hospital’s leadership team is not capable of sustaining change, then programs will regress after the consultant leaves, regardless of the capabilities and successes of the consultant. While the consultant is guiding change, implementation projects are generally filled with staff and physician energy and excitement.

Unfortunately, without an effective leadership team to maintain program focus and determine priorities, it does not take long for effectively implemented change to become derailed by higher priorities or a lack of acceptance from others after the consultant departs. The cost of changes that fail (or then the regression of success) goes far beyond financial cost or foregone revenue. When changes fail and programs regress in organizations, employees and physicians begin to lose trust in the leadership of the organization. They become frustrated, cynical, and begin to give up. Employees and physicians often turn into chronic complainers, making future change efforts even less likely to succeed.

Most hospitals have medical staff development plans that are built on practice succession planning to assure continuity of medical staff services based at the hospital. Too frequently the need for managerial succession planning (particularly within perioperative services) goes unrecognized. There is a need for proactive identification of individuals from within the ranks (nursing; medical staff; management; etc) who can be mentored to develop their skills in inspiring excellence in themselves, their peers, staff, and their organizations (in addition to the traditional organizational and financial skills). Leaders need to be developed to support healthier organizations that produce higher levels of results. Leaders must be developed to act more like coaches within organizations. Performance and morale improves remarkably when leaders possess the ability to motivate and inspire employees and peers just like some of the great sports coaches. When an organizational culture is established and an atmosphere is developed where individuals are encouraged and nurtured to thrive the following typically results:

• Improved recruitment and retention of highly skilled staff;
• Continuity of effective management;
• Improved work processes and reduced problems;
• Improved relationships with employees, bosses,and peers;
• Development of concrete strategies to achieve their goals;
• Ability to delegate tasks and spend more time managing people;
• A sense of energy and passion for what people do;
• Improved OR productivity;
• Improved case start times;
• Decreased turnaround times;
• Decreased total case times;
• •And last but not least – IMPROVED OR EFFICIENCIES!!