How operating room efficiency is understood in a surgical team: a qualitative study

OBJECTIVE: Building surgical teams is one attempt to ensure the health-care system becomes more efficient, but how is 'efficiency' understood or interpreted? The aim was to study how organized surgical team members and their leaders understood operating room efficiency. DESIGN: Qualitative study. SETTING: A 1100-bed Swedish university hospital. PARTICIPANTS: Eleven participants, nine team members from the same team and their two leaders were interviewed. METHODS: The analysis was performed according to phenomenography, a research approach that aims to discover variations in peoples' understanding of a phenomenon. RESULTS: Seven ways of understanding operating room efficiency were identified: doing one's best from one's prerequisites, enjoying work and adjusting it to the situation, interacting group performing parallel tasks, working with minimal resources to produce desired results, fast work with preserved quality, long-term effects for patient care and a relative concept. When talking about the quality and benefits of delivered care, most team members invoked the patient as the central focus. Despite seven ways of understanding efficiency between the team members, they described their team as efficient. The nurses and assistant nurses were involved in the production and discussed working in a timely manner more than the leaders. CONCLUSIONS: The seven ways of understanding operating room efficiency appear to represent both organization-oriented and individual-oriented understanding of that concept in surgical teams. The patient is in focus and efficiency is understood as maintaining quality of care and measuring benefits of care for the patients.