Defining operating room efficiency from the perspective of the staff member and the supervisor

To the Editor, We would like to thank Dr. Dexter and Dr. Masursky for their valuable comments. We have with interest read their psychological studies on OR efficiency and agree that biases can be sustained through interactions among team members. However, we suggest that the negative influence of bias and lack of knowledge among OR staff can be reduced by a team-based organization and by insuring that staff and leadership have a more congruent conception of efficiency. The main focus of our article is how the concepts of ‘efficiency’ and ‘productivity’ are understood [1]. In several studies, efficiency is defined as high throughput, reducing costs and utilizing time properly [2–6], which sometimes also define productivity [5]. The question is which definition should be used in ORs, since these are complex systems and other aspects namely patient's safety and quality of care should be taken into consideration as well [7]. Some studies maintain that the way staff members understand their work affects the way they practice their profession [8, 9]. This is the second ground in our study. Knowing how staff members understand efficiency at work helps supervisors create common goals [1]. It is not surprising that psychological biases occur among staff members as they may have a different view of planning operating cases [6]. Earlier, we demonstrated that staff members understood efficiency as ‘knowing what to do’ and ‘enjoying work’, which is distant from ‘completing a work assignment’ and ‘producing as much as possible’, as expressed by the leadership [1]. We suggested that there should be a common way of describing ‘efficiency’, in order to reach the same goal [1]. In a non-team organization, staff members did not mention ‘quality of care’ when defining efficiency, in contrast to a team-based organization. Furthermore, working according to lean principles, staff members may adapt a more organization-oriented understanding of efficiency, closer to the supervisors’ understanding of the concept [10].