Remaining Competitive: How a 48-bed Hospital Transformed its CRNA Culture

Optimizing Anesthesia Services for Better Compensation, Team Culture, and Hospital Alignment

Challenge

A 48-bed hospital in the Pacific Northwest, with four operating rooms, one procedure room, and a Level III Trauma Center, sought Coker's help to improve its anesthesia service. The hospital's certified registered nurse anesthetists (CRNAs), employed through an internal anesthesia practice, were concerned about compensation compared to industry standards, making recruitment and retention difficult.

The hospital aimed to address CRNA compensation, simplify the pay model, improve operational efficiency, and align the anesthesia team with overall hospital goals. Coker was engaged to explore structural options, establish fair compensation for full-time CRNAs, and implement changes to enhance the anesthesia service's culture and performance.

Solution

Coker evaluated the hospital's challenges and developed recommendations for economic and strategic improvements. After refining these suggestions based on client feedback, Coker finalized the plan and provided comprehensive education for the employed providers, along with guidance for legal counsel.

The new model redefined expectations for full-time CRNAs and revised the shift-based compensation structure, ensuring pay aligned with workload. This approach fostered a more team-oriented culture, shifting the focus from hourly work to an engaged, collaborative provider role that supported the hospital's strategic goals.

Approach

Step 1Landscape Review
Conducted a detailed review of the existing staffing structure and expectations, including a fair market value (FMV) analysis of current compensation plan.
Step 2Industry Analysis
Researched and considered industry standards and national survey data for benchmarking, as well as leveraging Coker experience in other organizations.
Step 3Stakeholder Interviews
Interviewed key stakeholders, including CRNAs and hospital leadership regarding areas of opportunity and key qualitative factors for improvement.
Step 4Development of Preliminary Recommendations
Evaluated structural alternatives for employing CRNAs and recommended a suitable model, inclusive of standardization of full-time equivalent (1.0 FTE) requirements in line with industry norms and associated compensation adjustments.
Step 5Refinement of Recommendations
Review of proposal with key leadership and refinement based on feedback, including development of proposed performance and quality metrics to support changes from a business perspective.
Step 6Documentation of Recommendations
Documented the approach in a memorandum of understanding and educated CRNAs and leadership to ensure alignment with strategic goals.
Step 7Ongoing Assistance
As the organization has implemented recommendations, Coker has remained available to support and refine the recommended compensation structure to ensure alignment of goals and outcomes.

Conclusion

Coker's strategic guidance helped the hospital transform its anesthesia service by aligning compensation with industry standards, fostering a collaborative team culture, and optimizing operational efficiency. The new model improved CRNA satisfaction and retention and strengthened the alignment between the anesthesia team and the hospital's strategic goals, setting a foundation for sustainable success.

Boost CRNA retention and cut costs with strategic alignment.

Results At a Glance

18%Reduction of open CRNA positions from 50% in 6 months.
50%Mitigation of CRNA locum expense

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