You're not in business to lose money. The ASC is an entirely separate issue and should not be considered as part of the hospital stipend problem. Someone's gonna have to be the hard-ass and say "this is the deal, this is what it costs, this is when we're available and how many staff will be available to cover it". Even before we became hospital employed (and even now) we work closely with the OR scheduling office. We have a "grid" telling them what is available each day. They want to open more rooms at hospital #2 that day? Fine - close rooms at hospital #1. We limit the number of rooms after 3pm, 5pm, and 7pm. We have people in-house 24-7 but we will not keep an excess of people around after hours. Our shift people go home when their shift is done. They do not start more cases than what can be finished by a certain time. If the limit is 2 rooms after 7pm, including emergencies, they do not start a case at 6:30 that will run until 7:30. It will have to follow.
