By Lina Tan, RN, MSN
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What does the term “dream team” really mean and why is it critical to have one in the OR?

An OR dream team is the perfect ensemble of nurses, surgeons, anesthesiologists and housekeepers who are not only the best at what they do, but also have great chemistry together. I was a nurse manager for a procedure area for more than four years and an associate director of perioperative services for almost two years. I learned that building a dream team for the OR is essential because this group can provide safe (no surgical site infections), efficient (quick turnover) and timely patient care, and a healthy work environment for the staff in the OR.

How to Create an OR Dream Team

The key to establishing a dream team is transparency from the beginning. After determining the appropriate structure of the team (criteria, size and skill mix), the following components are essential:

  1. Clarify the purpose of the team: what the team wants to accomplish, the time line, history of the problem, resources and potential limitations. It is necessary that the differences in team member perceptions be expressed and understood to prevent uncomfortable interactions or even serious conflicts. Without a unified goal, team members often focus on their own agendas, and the team consequently will find itself off course.
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  1. Establish the ground rules, which include collective agreements on attendance and penalties for violating a team rule. It is necessary to create a baseline regarding how to handle team member absences and communication breakdowns.
  2. Clearly define each staff member’s role and responsibility, which includes who serves in what role and how roles are allocated.
  3. Clarify the leadership. It is necessary to have someone acting as a team leader; it is also important that the team leader be assigned for each undertaking so there is no ambiguity.
  4. Create a well-defined process for making decisions. Conflicts and differences of opinions should be considered as opportunities to explore new ideas. Decisions should be made by consensus and have the acceptance and support of all team members.
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From My Own Experiences

I decided to take a perioperative leadership role in a large health system. When I initially took over the OR, there was a plethora of problems. All of the employees, including nurses, surgeons and anesthesiologists, stopped operating on patients when the clock struck 2:00 p.m. I was told it was too late to do cases because everyone needed to go home soon. Sometimes nurses even disappeared from the OR during procedures. I actually had to look for nurses. Turnover time between cases was more than 40 minutes, and as a result surgeons did not want to operate in our OR. Almost 90% of our nurses had been working at the institution for more than 10 years, which meant they were extremely knowledgeable and I did not need to worry about their core competencies. My main focus needed to be to create a safe and healthy culture in the OR.

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I decided to observe the entire staff for several weeks. I arrived in my office around 6:30 a.m. and stayed until about 8:00 p.m., walking around the OR. I talked to each surgeon and nurse in the OR area or in my office. I asked them to share their problems and if there were suggestions they thought would solve them. After I listened to their complaints and suggestions, I gave each staff member my honest feedback and expectations, and told everyone they could communicate with me by texting, talking and phone 24 hours a day, seven days a week.

When someone did a good job, I would call them to my office and congratulate them. If someone did something wrong, I would also call the staff to my office to talk through the mistakes in a nonpunitive manner. However, there were a few counseling sessions and disciplinary actions for staff who failed to improve their performance. I hired two new nurses with only several months of OR experience, but I felt their personalities would be a good fit with the already established team. The results proved I was right as volume increased. The OR turnover time decreased to 27 minutes and stayed between 25 and 27 minutes for the rest of the year. There were no surgical site infections for more than 172 days. Unscheduled sick calls almost fell to zero, and staff now stayed as long as it took to complete cases. My OR became one of the most efficient and safest ORs in the entire health system.

Challenges in Establishing a Dream Team

The main challenges in creating an effective and efficient OR dream team are selecting the right members, engaging them and managing conflicts.

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The first challenge is to choose the right people for the team. The right people are your most important asset. Not every candidate is a good fit for your leadership style. In addition, not every candidate fits within the OR culture already in place. It is essential to find team members who share the same goals, bring new skills to the table, have different ways of thinking and approaching situations, and want to help the team achieve its collective goals. It’s not always the one who has the best reputation or the most outstanding set of talents; it is usually the one who understands what it will take to succeed and is committed to making the efforts.

The second challenge is to engage team members to accomplish the goals. Team members come on board with different levels of interest, motivation, sense of commitment, experiences, knowledge and skills. Some members view teamwork as consistent and important, whereas others have less initial interest in the team because they join at the request of someone else. Therefore, engaging all members toward a common purpose is one of the important elements for building the dream team. To engage all members, a leader must articulate expectations in a way that members feel part of the department and understand the role they play in its success. In addition, it is important for leaders to foster a culture of family and community so they feel they are working for a cause, and not just for the department and organization.

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The third challenge is to manage all conflicts. Encouraging team members to argue without destroying their ability to work together is a challenge. Because team members are aligned with different departments and have different values and expectations, there certainly will be conflicts. Conflicts can affect teamwork if you do not manage them in a positive way. First, you should consider conflicts as opportunities to explore new ideas. Team members who challenge one another’s thinking develop a more complete understanding of choices, create a richer range of options, and ultimately make effective decisions. To deal with the conflicts, some goals may need to be revisited and the process of teamwork may need an alternative solution. Simultaneously, you should encourage members to create alternative solutions and learn from one another. Ultimately, the positive result of conflict is growth, which builds a healthy relationship between team members.


Lina Tan, RN, MSN, is the associate director of perioperative services at NYC Health + Hospitals Corporation. Ms. Tan is also a member of the advisory board of OR Management News.

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