Contrary to conventional wisdom, safety measures don't have to slow OR efficiency, and efficiency doesn't have to threaten surgical safety. In fact, they're 2 sides of the same coin, says Vinod Malhotra, MD. "Patient safety plus efficiency, together they contribute to the overall quality of care."

That's a formula Dr. Malhotra has honed in the more than 30 years he's spent as a practicing anesthesiologist at New York-Presbyterian Hospital. Boasting 23 inpatient ORs, 17 ambulatory ORs and another 18 rooms where interventional procedures are performed, the New York City teaching hospital strives for efficiency not as a luxury, but as a key to survival. Dr. Malhotra has served as its clinical director of operating rooms since 1995, and overseeing a facility that hosts 30,000 OR cases and 28,000 out-of-OR interventions annually has taught him a thing or two about what it takes to strike a balance between safety and efficiency, which he shares through lectures nationwide.

First, he explains, you must understand efficiency as more than just going faster. "Efficiency is not rushing things and making decisions in haste," he says. "Rather, it's a careful, planned response to events as they unfold during the day."

For example, consider the pre-op time out. When the concept was introduced at New York-Presbyterian, "initially it was seen as more busywork by some of our colleagues," admits Dr. Malhotra, who also serves as a professor of clinical anesthesiology at Weill Cornell Medical College in New York. But through collaboration with surgeons, anesthesia providers and nursing staff, administrators were able to draft a time out protocol that not only reduced the risk of errors, but also enhanced efficiency by ensuring that the surgical team had all the supplies, equipment and information they needed for a smooth case.

Another effort that plays a role in both efficiency and safety is standardization. A few years ago, Dr. Malhotra found that the hospital used as many as 8 different mixtures of local anesthetics in several different strengths to cover physicians' preferences. This wide range of options created both efficiency and safety concerns, as it was more difficult for staff to locate the right combination and easier for them to accidentally pick up the wrong mixture or strength.

"Standardization [of anesthesia drugs] makes it easier to stock, easier to find, safer for the patient and more efficient because you don't have to look for all different types of combinations," says Dr. Malhotra, who eventually whittled the hospital's choices down to 2 drug mixtures.

In implementing such strategies, he says, it's important to understand not only the processes that contribute to safety and efficiency in the OR, but also the people who must carry out those processes on a day-to-day basis. "Some of the changes require a cultural change or a behavioral change, and they might not be met with full enthusiasm up front," says Dr. Malhotra. The best way to overcome that hurdle? "Engage individuals in conversations and discussions about the changes you're making. Make them a part of the decision-making process — that goes a long way."