For years, Ramin Raiszadeh, MD, watched the same thing happen between operations. The patient left. Environmental services cleaned. Nurses reset the room. Anesthesia prepared the next patient. Surgical technicians readied equipment.
Everybody was working. And the operating room still sat empty.
“Everybody’s working hard, but the right hand isn’t speaking to the left hand,” Dr. Raiszadeh, an orthopedic spine surgeon at the Spine and Brain Institute of San Diego, told Becker’s.
After more than two decades around operating rooms, he had grown accustomed to the delays. Eventually, he stopped accepting them.
Between cases, Dr. Raiszadeh began standing in the OR with a clipboard and stopwatch. He watched, timed and recorded the individual steps between one operation and the next. What he found was not one major bottleneck. It was minutes disappearing between dozens of small handoffs.
A preoperative nurse could have a patient ready without knowing where the OR team stood. One task could finish without the person responsible for the next knowing it was time to begin. Activities that could happen simultaneously instead happened sequentially.
The problem, Dr. Raiszadeh concluded, was not how hard people were working. It was whether their work moved together.
That idea has since evolved into a real-time workflow platform being implemented across the operating rooms at Sharp Grossmont Hospital in La Mesa, Calif., where the Spine and Brain Institute works with San Diego-based Sharp HealthCare to provide spine and neurological care. Dr. Raiszadeh developed the platform and is its founder.
But the technology is only part of what he is trying to change. His larger argument is that hospitals have spent years making what happens inside an operation more sophisticated while leaving much of the time surrounding it dependent on fragmented communication, ingrained habits and people trying to figure out what everyone else is doing.
The Formula One lesson
Dr. Raiszadeh borrows his model from Formula One, the international racing series whose pit crews are known for executing highly choreographed tasks in seconds.
The crews do not succeed because every mechanic simply moves faster. Each person knows the assignment, when to begin and how that task fits into the larger sequence.
Dr. Raiszadeh wondered why an OR could not function the same way. His first attempt was literal: He assembled a dedicated four-person “pit crew” to turn over a room.
It worked. Then he saw the problem.
“You can’t scale a business by just people,” he said. People call out. Experience varies. The team familiar with a surgeon’s cases one day may look different the next.
So the question changed: Instead of relying on the perfect team, could he create a process that different teams could execute the same way? That meant breaking the perioperative workflow into specific events, defining who owns each one and making progress visible across the team.
For Dr. Raiszadeh, that visibility introduces two things ORs have historically lacked: accountability and transparency.
He saw how quickly small gaps accumulated. A surgical technician waiting a few extra minutes to begin one task does not sound consequential. But repeat those delays across more than 20 steps and several cases, and portions of an hour can disappear.
That was the lesson of the stopwatch. Not every task needed to become faster. The waiting between them did.
The study showed what happened as the team learned
An initial study at Sharp Grossmont examined 51 consecutive elective adult degenerative spine cases.
Average turnover after implementation was 26.5 minutes, compared with a historical institutional average of 38 minutes, a 30.3% descriptive difference. Because that comparison used a historical baseline rather than a concurrent control group, it does not establish that the platform itself caused the reduction.
The more revealing result may have been what happened over time. Average turnover fell from 28.9 minutes during the first 26 cases to 23.9 minutes during the next 25, a statistically significant improvement.
To Dr. Raiszadeh, that reinforces the importance of familiarity.
“The teamwork, the camaraderie, the transparency, that’s the key element,” he said.
The goal is not to use transparency to identify who should be blamed when a room runs late. He sees it as a teaching tool, particularly when a team is less familiar with a surgeon or workflow. That distinction matters because the larger challenge is not installing technology. It is getting an entire OR to use it.
“Everybody’s got to buy in,” he said.
Turnover may be the wrong finish line
As the work expanded, Dr. Raiszadeh had another realization. Hospitals may be focusing too heavily on turnover time itself.
Turnover generally measures the interval from one patient leaving the OR to the next patient entering. But from a surgeon’s perspective, that does not capture all the time between operations.
Before the first patient leaves, extubation and transfer have to occur. After the next patient enters, anesthesia, positioning, lines and preparation can still stand between the surgeon and the next incision.
A fast turnover can therefore coexist with a long wait to operate.
“What is really critical, is actually not your turnover time. It’s your skin-to-skin time,” Dr. Raiszadeh said.
He uses the phrase differently from its traditional surgical meaning. In this context, he is measuring from dressing placement on one patient to incision on the next. A 20-minute turnover means little, he argues, if that larger interval stretches to 90 minutes.
“If you can do in the hospital setting less than 60 minutes, you’ve hit a grand slam for these cases,” he said. The current rollout is using a target of less than 70 minutes as teams learn the process.
That shift in measurement gets closer to what Dr. Raiszadeh actually cares about. Not how fast the room technically turned over. How long the surgeon went without operating.
The people asked to move faster need a reason to care
That is also where Dr. Raiszadeh sees one of the hardest cultural problems. Surgeons, patients and hospital administrators have obvious reasons to want greater OR efficiency.
The incentives for frontline staff are more complicated. If a surgeon can fit five operations into a block instead of four, the surgeon gains capacity. The hospital gains another case. But the nurse or technician may experience the same change as more work packed into the same shift.
Dr. Raiszadeh does not think hospitals can ignore that tension.
“If I’m pushing them, how do I make it so they’re aligned with me?” he said. Sharp Grossmont’s rollout includes a team-building fund tied to workflow goals. Instead of rewarding individuals, the program can contribute up to $800 a month for OR team activities.
The mechanics are less important than the philosophy behind them.
“This is a teamwork process,” Dr. Raiszadeh said. “Teams work better than individuals.”
He also recognizes the downside of making every step visible. Some staff, he said, are uncomfortable knowing that delays can immediately be seen.
“Now you’re accountable, so I’m watching it, and everybody’s watching it,” he said.
That tension may ultimately determine whether the model works. Transparency can expose a bottleneck. It cannot create trust around what leaders do with that information.
For surgeons, the payoff is time
When asked where greater perioperative efficiency could have the biggest impact, cost, workforce, capacity or patient access, Dr. Raiszadeh started somewhere simpler.
“My most valuable asset is my time,” he said. For surgeons, the minutes between operations can be unusually unproductive. If the office is elsewhere, there may be little meaningful work they can do while waiting for the next patient.
Recovering that time can mean another case, returning to clinic earlier or simply ending the surgical day when it was supposed to end.
Hospitals have a different equation. The expanded Sharp Grossmont rollout is tracking overtime and double time, meal penalties, flexed staffing and add-on cases. Dr. Raiszadeh said early internal data suggest improvement in several labor-related measures, though the broader rollout remains ongoing.
Better visibility could eventually help hospitals decide not only how quickly rooms should move, but how many rooms need to be open and where staff are actually needed.
That is where a few minutes between cases stop being a surgeon annoyance. They become an operating expense and a capacity problem.
The hardest part to scale is culture
Dr. Raiszadeh believes the same basic process could ultimately apply far beyond spine surgery. The harder question is whether another hospital can reproduce the behavior around it.
He is unequivocal about what that requires. “If there is not leadership that is totally embracing it, it won’t work,” he said.
Hospitals have to be willing to expose inefficiencies, standardize work that has long varied from room to room and ask teams to behave differently. They also have to prove that doing so produces something more meaningful than a better stopwatch number.
Dr. Raiszadeh believes that means objective gains in surgeon experience, staffing costs, capacity and ultimately patient access.
The published evidence is still early, and broader studies will be needed to determine whether the results hold across hospitals and specialties.
But the problem he is trying to solve is familiar to almost any surgeon. Operating rooms have become extraordinarily advanced at what happens during an operation. The time between them can still depend on a phone call, a handoff or someone realizing the next person is ready.
After years of watching those minutes disappear, Dr. Raiszadeh has come to see the problem differently. The next major gain in OR efficiency may not come from asking anyone to work faster. It may come from making sure no one has to wait for everyone else.
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