How to hire a surgical services director: 6 questions to ask right away

Has your hospital recently lost its director of surgical services due to retirement, resignation or termination? You may not know it, but finding a replacement will be a major challenge.

Nationwide, the supply of experienced OR leaders is shrinking. According to a recent study, more than one-third of OR managers plan to retire by 2018. Healthcare recruiters report that OR leadership positions are the hardest vacancies to fill. At the same time, choosing the right person to serve as OR director is critically important. Surgical services can account for up to 65 percent of total hospital revenue. Your hiring decision will have a huge impact on your hospital's financial performance.

To hire a strong OR director, you need to understand your situation, identify your needs and know your options. Start by asking the following six questions:

1. How quickly do we need someone in this role? Most hospital leaders assume they can find and recruit a new OR director within a few months. The truth is you need to plan for a long search. The absolute minimum for filling this position is six months. I know of hospitals in attractive locations that are still searching for an OR director after a year and a half.

Can your OR afford a leadership gap of 12 months or more? One year is more than enough time for revenue to soften and costs to jump. Many COOs and CNOs conclude that the only way to avoid a dip in profitability is to contract with a temporary OR director. There are many benefits to hiring an interim director for surgical services, but one of the biggest is stability. An experienced interim leader can keep OR performance on track while you search for a permanent hire.

2. Do we understand what we need in the OR? Filling an OR leadership role is harder — and less successful — when you are not clear about what you want a new director to accomplish. The problem is that most hospital executives do not understand how far their OR falls short of peak performance.

Energize your candidate search by clarifying your OR's opportunity to improve. Three areas stand out:

  • Most ORs suffer from high cancellation rates and low utilization. Any new OR director should have a demonstrated ability to increase department efficiency and productivity.
  • Does your OR focus on surgeons as its most important customers? Your new OR director should understand how to partner with surgeons and collaborate on strategies to grow profitable case volume and revenue.
  • Payers are increasingly tying reimbursement to quality, safety and patient outcomes. Look for an OR director who understands how to optimize OR quality to maximize payment.

3. Did this candidate "grow up" in the OR? Hospitals sometimes try to fill OR leadership roles by hiring laterally from other units, such as the cath lab or even the finance department. In my experience, this never works. While the candidate may have a management background, his or her lack of OR-specific experience is an insurmountable handicap.

Only an "OR native" can understand the unique workflows, practice standards and performance challenges of a hospital surgery department. For the same reason, an OR director should be a nurse, not an anesthesiologist. Even the most engaged anesthesia provider cannot match a seasoned OR nurse for practical knowledge of frontline surgery department operations.

4. Is this candidate a good cultural fit? A director accustomed to managing a large OR can experience culture shock when moving to a smaller organization. She may be used to having support staff in quality improvement, risk management, infection control, supply chain management, data analysis and other disciplines. In smaller ORs, these resources are either nonexistent or bundled together in a single job title. The newly hired OR director may become very frustrated with her new "side" responsibilities.

Conversely, a candidate from a small hospital may have trouble transitioning to a larger OR. He may miss being directly involved in all aspects of OR operations. He may also be surprised by the politics of a large surgery department. In addition, the move from a non-union to a union environment can be a dramatic change.

All this raises the question, should you hire your next OR director from within your own ranks? Many ORs find grooming and promoting a clinically experienced OR nurse is a good solution to the recruitment conundrum. Look for someone who is willing to pursue further education, learn the business side of the OR and be mentored into a leadership role.

5. Can the candidate relate to neurosurgeons, housekeepers and everyone in between? "Excellent communication skills" is part of every leadership job description. To be an OR director, however, you need something more. You must be adept at relating to people from a wide range of personal, professional and educational backgrounds.

Effective OR directors can go toe-to-toe with surgeons on important issues — then turn around and work with the staff who mop the OR floors. They can respond to the needs of nurses, techs and central sterile staff. And at the end of the day, they can be compassionate with patients and family members.  Visibility and competency in the OR are valued traits for today's OR leaders.

6. Is this candidate a one man show? No matter how talented an OR director is, he or she cannot run the department alone. To manage operations effectively, improve processes and boost results, an OR director must secure the cooperation of others.

Collaborating with physicians is foremost, but an effective OR director also needs to work with executive administration. In better performing hospitals, the OR director is an integral part of a surgical services executive committee — a multidisciplinary governance body that directs the operations of the OR. Strong OR director candidates should know how to function within an SSEC to initiate change and achieve ambitious performance goals.

Emergency checklist
When a vacancy develops in OR leadership, it is important to act promptly. First, consider engaging an interim OR director. Again, the supply of qualified OR director candidates is small and shrinking. Even top hospitals are spending up to two years to find a full-time replacement. An interim OR director can usually be on the ground within two weeks.

Second, perform a needs assessment for your OR. Before you can conduct an effective candidate search, you need to understand your OR's situation and opportunities. An experienced interim director can help you evaluate your current processes, staffing structure, budget and strategy. Outlining an OR improvement plan will focus your search efforts and help you attract the most motivated candidates.

Third, consider all your options. Challenging times call for creative measures. There are many ways to secure the expertise you need — not only to fill a leadership gap, but to improve OR performance. A creative approach to OR leadership can help you strengthen your surgery department for the long term.

Alecia Torrance, RN, BS, MBA, CNOR, is senior vice president of clinical operations at Surgical Directions, a perioperative consulting firm that helps hospital ORs improve efficiency, financial performance, clinical outcomes, and patient and staff satisfaction. Alecia heads the firm's Interim Leadership division, which provides experienced perioperative leaders to serve in interim and permanent OR management roles supported by the experts at Surgical Directions. Leaders are available to serve as OR directors and managers; sterile supply directors, managers and supervisors; materials/supply chain management directors and managers; and OR business managers. Alecia can be reached at (312) 870-5600 or

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