what have you done?

I work Day Surgery, so I think I can answer some of your questions:

1. No shows: There's really nothing we do. We'll try to get hold of people scheduled later in the day and move them up the schedule, but as far as any consequences for the no shows, nothing. Sometimes it can't be helped: death in the family; pt gets a bad cold or gi bug right before surgery; transportation falls through. Sometimes they're just really dumb excuses, and we have a few who are chronic no shows. I feel like there should be a "three strikes" policy for no shows: If you fail to show and don't call to let us know that you're not coming three times, then you need to schedule your surgery somewhere else or be charged a fee.

2. Staff illness: We usually work short. Our manager sometimes helps out, but there really isn't anyone to pull to help our dept. Our system is so different from what the floors do, and they aren't exactly staffed the greatest either.

3. Politics is one of the hugest stressors. Each doc has his/her own special requests, and God forbid you forget what it is they want. If they happen to do surgery at other facilities and complain that "at 'X Hospital' they could get my pts ready in 15 minutes, you can bet we are told to step it up for them (of course, then that sets us back for other docs pts, so then they get pissed). Some don't like our protocols, other kvetch at paperwork. It drives me nuts because I think "In the time it took you to stand there and have that temper tantrum, you could have just filled out the form and your pt would be ready." Then there's the politics between departments-- a whole other ball of wax. Sometimes we have a post-op pt that needs an unexpected admit d/t post-op pain/nausea/other complications. Getting the floor to take the pt is a huge fight, not unlike when I work in the ED and have an admit.

Good luck. If you find a way to successfully deal with no shows, let me know.