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Background: Responsible and efficient resource utilization are important factors in healthcare. The aim of this study was to investigate how total case time differs between two differently organized surgical departments. Methods: This is a retrospective observational study of a cohort of patients undergoing elective surgery for breast cancer or malignant melanoma in a university hospital setting in Sweden. All patients were operated on by the same set of surgeons but in two different surgical departments: a general surgery (GS) and a cardiothoracic (CT) surgery department. Patients were selected to the two departments from a waiting list in the order of referral for surgery. The effect of being operated on at the CT department compared to the GS department was estimated by linear regression. Results: The final study cohort comprised 349 patients in the GS department and 177 patients in the CT department. Both groups were similar regarding surgical procedures, American Society of Anesthesiologists' score, body mass index, age, sex, and the skill level of the operating surgeon. These covariates were included in the linear regression model. The total case time, defined by the Procedural Time Glossary as room set-up start to room clean-up finish, was significantly shorter for the patients who underwent a surgical procedure at the CT department compared to the GS department, even after adjusting for the background characteristics of the patients and surgeon. After adjusting for the selected covariates, the average difference in total case time between the two departments was − 30.67 min (p = 0.001). Conclusions: A significantly shorter total case time was measured for operations in the CT department. Plausible explanations may be more beneficial organizational factors, such as staffing ratio, skill mix in the operating room team, and working behavioral aspects regarding resource utilization.

Background: Healthcare systems face challenges in optimizing resources while maintaining high-quality care. Breast cancer surgery represents a substantial share of elective surgery and provides an opportunity to evaluate different organizational models. This study presents a health economic analysis comparing two models for breast cancer surgery at the same hospital.

Methods: A bottom-up micro-costing approach was employed to evaluate potential cost-savings of breast cancer surgeries performed at a general surgical department (GS) versus a cardiothoracic surgery department (CT). We analyzed 543 consecutive patients undergoing elective breast cancer surgery between January 2014 and September 2016. Resource use was identified through direct observation, hospital administrative systems, and operating room logs. Personnel, disposables, medications, and facility costs were quantified based on observed resource use within the study dataset; no external benchmarking was performed.

Results: CT was less expensive, with an average saving of 3,547 Swedish krona (SEK) per operation (95% CI: -674 to 7,510 SEK). Bootstrap analysis with 1,000 iterations showed CT was less costly in 96.2% of samples. Procedures were shorter at CT (170.8 vs. 221.3 min), enabling more operations per day (3.2 vs. 2.4). In our deterministic simulation, removing CT capacity increased waiting times by 15%, from 39 to 45.1 days, conditional on steady inflow and constant OR availability. Annual savings at the observed annual volume (~ 192 patients) were 681,104 SEK and could reach ~ 1.77 million SEK if volumes increased to 500 patients/year.

Conclusions: The CT organizational model was more likely to be less costly while maintaining shorter waiting times. These findings suggest that CT capacity may be prioritized, particularly at higher patient volumes, to support both economic efficiency and patient access.

Backgrounds: Operating-room productivity is commonly pursued through throughput metrics, yet frontline staff point to organisational and interpersonal conditions that make a working pace sustainable. How everyday practices relate to staff motivation, and thereby to dependable workflow, remains underexplored.

Research question: (1) What organisational and interpersonal conditions support or thwart a sustainable work pace among perioperative nursing staff? (2) How can these conditions be understood through Self-Determination Theory?

Methods: We used a sequential explanatory mixed-methods design at two operating room units in a Swedish university hospital. In Phase 1 the Safety Attitudes Questionnaire-Operating Room version was administered (October 2022; n = 47) to profile contextual contrasts between units. In Phase 2, semi-structured interviews (December 2022 to March 2025; n = 24) were analysed with inductive qualitative content analysis, after which Self-Determination Theory was used to interpret the resulting categories. Qualitative reporting followed the Consolidated Criteria for Reporting Qualitative Research.

Results: Survey responses differed between units in safety climate (32% vs 68%; P = 0.02), stress recognition (57% vs 21%; P = 0.02) and perceptions of management (18% vs 63%; P = 0.002). Interviews yielded four cross-cutting conditions: predictable workflow and usable tools; psychologically safe teamwork; participatory planning with visible follow-through; and learning structures for mastery, with workload as a boundary condition. The same families of practice appeared at both units but were described with differing emphasis. Interpreted through Self-Determination Theory, these conditions supported autonomy, competence and relatedness when present and thwarted them when absent; need-thwarting patterns (late list changes, parallel documentation, sharp communication, tokenistic consultation) co-occurred with workarounds and conditional intentions to stay.

Conclusion: Among perioperative nursing staff, a sustainable pace was described less as working slowly than as predictable routines, professional judgement over timing, stable teamwork, and protected standards of care under pressure. Modest, auditable routines that jointly support autonomy, competence and relatedness offer transferable, hypothesis-generating design principles for dependable operating-room productivity, rather than a ranking of units.