Same-Day Add-Ons Aren't "Good Problems". They're just problems.

Logan McKnight
2 days ago
3 min read

And worse, they're a signal of deeper leadership issues.

Every leader in the Med-Device/neuromonitoring industry knows all about same-day add-ons.

Surgeon calls with a case. Maybe it's an emergency, maybe someone forgot to call...

Regardless - You scramble.

Someone covers it.

You bill for it.

Win, right?

Until you start to lose your best people, or worse, get a mass exodus.

If same-day add-ons are constant at your company, that is not a scheduling problem.

It is a leadership problem.

What Add-Ons Actually Reveal

Teams that rarely get surprised by add-ons are not lucky. They are proactive.

They know what is coming because:

Someone owns the relationship with the OR scheduler
Someone checks in with the surgeon’s office before the week starts
Someone is paying attention

Same-day add-ons stack up when no one is really owning the front end.

When your team is reactive instead of proactive. When the only people who actually know what is happening are the ones at the top.

That is not a scheduling failure. That is an ownership failure.

Why This Is Easy at Small Companies

At a small company, the owner knows the surgeons. The team is tight. Everyone sees the schedule and talks to each other. When something is coming, people know.

There is natural ownership because there is proximity. The feedback loops are short. If something falls through the cracks, everyone feels it. But that does not scale.

Why This Breaks at Bigger Companies

As you grow, you cannot know every surgeon. You cannot check every schedule. You are not in the room when relationships are built or missed.

So you hire managers and hope they will own it the way you did.

But if you have not modeled ownership and explicitly handed it off, you just built a bottleneck. Now everything runs through one or two people who are trying to hold it all together.

They burn out. Things slip. Add-ons pile up because no one downstream feels responsible for preventing them.

How Ownership Scales

The only way to scale ownership is to distribute it.

You model it.

You hand it to your leaders.

They hand it to their teams.

Everyone understands their piece of the puzzle and takes responsibility for it.

When a tech knows, “I own the relationship with St. Mary’s OR scheduler,” they check in before the week starts. They catch the add-on before it becomes a fire drill. They protect their own schedule and everyone else’s.

That is not micromanagement. That is clarity. And clarity only happens when leaders trust their people with real responsibility.

The Generational Opportunity

Here is what many owners overlook: younger technicians actually want this.

They do not want to be told what to do and kept in the dark. They want to understand how the business works. They want to contribute beyond just showing up for cases.

When you create bottlenecks, you are not just burning out your senior people. You are boring your junior people. They see a ceiling and start looking elsewhere.

When you distribute ownership, you create opportunity. You give people something to grow into.

They stay because they are building something, not just executing tasks.

The Question

If same-day add-ons are constant at your company, stop blaming the surgeons or the schedulers.

Ask yourself:

Who owns the relationship with each facility?
Does that person have the authority and accountability to stay ahead of scheduling?
Or is everything running through one or two people who cannot possibly keep up?

Same-day add-ons are a bigger problem than leadership realizes.

The cost is not just the scramble. It is the burnout, the turnover, and a leadership culture that never learned how to scale.

The good news? 𝗬𝗼𝘂 𝗰𝗮𝗻 𝗰𝗵𝗮𝗻𝗴𝗲 𝘁𝗵𝗮𝘁 - 𝗦𝘁𝗮𝗿𝘁𝗶𝗻𝗴 𝗻𝗼𝘄.

Logan McKnight

Logan McKnight is an Executive Advisor and Consultant for med-tech leaders.

With 20 years of experience building teams and growing companies in med-tech, she helps executives lead without burning out and build leadership teams that create impact.