Making Efficiency a Team Priority in Cardiothoracic Surgery

Now available in audio.

Efficiency can be misunderstood as simply working faster. In reality, true efficiency in the operating room is about making every movement count, communicating clearly so that needs are understood, understanding the needs of the team, and simplifying the system. Efficiency is a collective achievement—one that the surgeon is uniquely positioned to lead, and it requires a coordinated, high-performing team. In the end, this leads to the greatest benefit of prioritizing team efficiency: delivering the highest quality patient care.

Efficiency starts with high performance. Deliberate, careful actions that are done once are faster than hurried ones that need to be redone. The adage, “slow is smooth, and smooth is fast,” is nowhere truer than in the operating room. Efficiency is making every movement count to prevent wasted activity. Prioritize making sure a task is done correctly, and the skill and efficiency will follow.

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The surgeon is one part of the operating room system, which includes nursing, anesthesia, technicians, and ultimately, hospital leadership. Efficiency cannot be achieved in a silo, since nothing that we do is in a silo. The surgeon has the unique stance to lead this complex team, to encourage participation by all team members, model preparedness, and set the agenda.

Recruiting participation from others is essential to this process. In the operating room, these include all involved parties, from the circulator or scrub nurses to the staff that helps with room turnover—all of whom are essential to team efficiency. Clearly communicating the surgeon’s needs and expectations is often the surgeon’s first priority, but equally important is listening clearly to be attuned to the needs of the team. 

I have found that when I have helped with room turnover and set it up, it has helped more than the time spent on labor alone. The true benefit was from learning where time was wasted, and as a surgeon, helping communicate what is needed versus what is not. Helping staff understand that their work is essential to the mission is critical, and listening clearly involves fostering a culture where every team member feels empowered to contribute ideas, identify inefficiencies, and take ownership of their role in patient care. Show appreciation for the work that is done and make sure the entire team knows the importance of their work.

Lastly, clear, concise communication helps set expectations, guide future practices, and direct efforts. Rather than leaving the team guessing, communicate early and clearly. Standardization helps with this process. Some surgeons often forget to update their case cart and re-invent the wheel each week. Putting in extra effort helps ensure that time spent getting the case ready is not wasted. Complexity is the enemy of efficiency. Standardized protocols and routines reduce confusion, minimize miscommunication, and set clear expectations for every team member.

Standardization is not about rigidity, but about creating a reliable framework.  Nowhere is this better demonstrated than in simulation training, where key parts of a complex operation are brought down to several simplified and reproducible steps. Efficiency is gained through repetition and anticipated moves, allowing for attention to be focused on the unique challenges and maneuvers needed.  

Making efficiency a team priority is not about working faster, but about working smarter—together. By focusing on deliberate action, clear communication, standardization, and team engagement, we create an environment where every member is empowered to contribute to high-quality, efficient care. 

Ultimately, when it comes to patient care, the pursuit of efficiency is inseparable from the pursuit of excellence.