The Healthcare Manager's Playbook

One of the biggest challenges for managers in healthcare is dealing with variation. For most hospital-based clinical departments (nursing, therapy, pharmacy, etc.), no two days are the same. One day may bring a surge of new admissions, while the next brings multiple call-ins or an unusually high number of medically complex patients. Staffing, patient demand, and scheduling can all change from one day to the next.

If not managed well, variation leads to friction, inefficiency, and frustration. Rather than hoping variation will go away, a better approach is to become better at managing it. Variation is part of hospital-based healthcare. Census will ebb and flow. Staffing will fluctuate. Don’t become frustrated by these realities—become skilled at responding to them.

Whenever you find a response that works well, write it down. Over time, these successful responses become your playbook. Instead of solving the same problems from scratch every time they occur, you simply refer back to what has worked before. Like a football coach calling a familiar play during a game, you can confidently call that play again when the same situation presents itself. A good playbook saves time, reduces decision fatigue, and helps create more consistent outcomes.

Recognizing Variation

The first step in managing variation is recognizing how it impacts your department. Before making adjustments, ask one simple question: Will this increase demand on the department or decrease it?

The answer immediately narrows the list of potential responses (examples in table below):

Examples of ↑ Increased Demand	Examples of ↓ Reduced Demand
Staff vacation days	Too many staff scheduled for the day
Late call-ins	Fewer admissions than expected
Open positions	Patient medically unable to participate
Unexpected admissions	Patient did not show as expected
Delayed discharges	Patient called to cancel appointment
Work injury restrictions or absences	Discharge moved forward
Patient appointments (dialysis, consults, etc.)	Patient refused treatment
Modified patient schedules or care demands
High number of medically complex patients
Computer or technical issues

Once you’ve identified the type of variation, the next step is making adjustments. The sooner those adjustments are made, the less disruptive the variation will be.

Responding to Increased Demand (↑)

When demand suddenly increases, the goal is not simply to ask everyone to work harder. Instead, look for ways to create additional capacity while avoiding unnecessary stress. Most of the time, one solution is not enough. Several small adjustments often restore balance much more effectively than one major change.

Below are examples from an inpatient therapy department.

Potential Response	Why It Helps
Manager treats patients or leads a group.	Immediately increases clinical capacity. One group of four patients can provide four treatment hours in a single hour.
Therapists add group treatments.	Groups increase clinical capacity. Be careful not to overuse them.
Utilize available time earned from previous weekends (if patients completed two long treatment days).	Taking an earned short day creates additional treatment minutes without adding staff.
Push treatment time to an upcoming weekend (when weekend staffing allows).	Taking an early short day or day off creates additional treatment minutes during the workweek., however, they will need to made up on the weekend.
Add or extend PRN hours. Ask individually rather than through group texts.	Individual requests are often more successful than group texts and may result in a few extra hours rather than requiring a full shift.
Move therapist days off when possible.	Levels staffing across the week. A common example is moving a Friday off to Monday while still giving staff a three-day weekend.
Extend technician hours.	Provides additional therapist support and creates more opportunities for concurrent treatment.
Utilize similarly skilled staff from other departments.	Shifting resources between departments helps meet the overall needs of the organization. The mindset is that everyone is working toward the same goal.
Offer overtime or extra-shift bonuses.	Increases staffing capacity and rewards employees for helping. Monitor for staff fatigue if used frequently.
Split evaluations across two days.	Prevents evaluations from overwhelming an already stressed schedule.
Prioritize minimum regulatory requirements during high-demand periods.	Internal standards are often higher than regulatory minimums. Temporarily focusing on minimum requirements can help restore capacity during unusually busy periods.
Limit check-backs and schedule changes.	When treatment is refused, temporarily reducing repeated check-backs or frequent schedule changes frees up valuable therapist time.
Add small increases to everyone’s workload.	Small increases add up quickly. For example, if each therapist provides one additional 30-minute treatment and you have 12 therapists, you’ve created six additional treatment hours for the day.

While it is impossible to eliminate the stress associated with variation, knowing your options makes responding much easier. A well-maintained playbook helps leaders respond thoughtfully instead of emotionally.

Responding to Reduced Demand (↓)

Reduced demand presents a different leadership challenge. Instead of asking, “How do we get everything done?” the question becomes, “How do we best use the capacity we now have?”

These situations create opportunities to improve efficiency, reduce unnecessary labor costs, invest in staff development, and provide additional value to patients.

Potential Response	Benefit
Reduce or cancel PRN hours.	Lowers labor costs by matching staffing to demand.
Offer staff the opportunity to take vacation time or move a workday to an upcoming weekend.	Balances staffing across the week. For example, a therapist may take Monday off and work the upcoming Saturday instead.
Reduce PRN technician or non-clinical staff hours.	Better aligns support staffing with patient volume.
Offer staff to assist other departments.	Sharing resources across departments helps meet the overall needs of the organization.
Complete same-day evaluations.	Patients begin treatment sooner, allowing earlier intervention and quicker identification of safety concerns. Whenever possible, additional capacity should benefit patients first.
Increase treatment time when clinically appropriate.	Provides additional opportunities for patient progress.
Add co-treatments.	Gives patients access to the expertise of multiple clinicians while making productive use of available staff.
Complete documentation, audits, chart reviews, or mentoring.	Improves compliance while investing in staff development.
Work on skill acquisition or performance improvement initiatives.	Strengthens the department for future success.
Hold one-on-one meetings or staff meetings.	Uses otherwise idle time to develop staff, improve communication, and strengthen team performance.

One of the most common leadership mistakes is failing to respond when demand decreases. Extra capacity is valuable. If it isn’t managed intentionally, it is often wasted. Instead of patients benefiting, staff growing, or the department becoming stronger, opportunities are lost. A well-maintained playbook helps leaders respond appropriately during slower periods and continually improve the performance of the department.

Key Takeaways

The goal is not to eliminate variation—it is to become exceptionally good at responding to it.

The best managers are not those who experience fewer challenges; they are the ones who recognize changing conditions early and make thoughtful adjustments. Over time, a well-developed playbook reduces decision fatigue, improves operational consistency, and gives leaders confidence that they can handle whatever the day brings.

Variation is inevitable. Being prepared for it is a choice.

About the Author

Shane Haas serves as the Director of Clinical Informatics at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers’ Playbook.