What are the gaps in the patient experience in operating room?

Estimated reading time: 8 minutes

Patient experience is often treated as a design problem. Resolved through adding spa-like waiting rooms, warm finishes, and thoughtful amenities, but those details aren’t what shapes how a patient feels on the day that matters most: surgery day.

According to Amy Anderson, MBA, a plastic surgery practice management consultant and founder of ACG Practice Partners, the OR suite is one of the most overlooked parts of the patient experience precisely because practices get so focused on clinical quality and safety that they push aside the emotional experience of the day. The details that create and shape patient trust and satisfaction are operational from how a patient is prepared before surgery, how discharge is verified, how sterilization and training are handled, and how a team communicates with each other in the room.

Why the OR suite and surgery day are often overlooked

Most practices put strategic thought into the steps of the patient journey that bring them to their appointment. The first phone call, the consultation, the steps of working with the office before surgery is ever scheduled. Yet, the day itself often gets less attention. Anderson points out that this isn’t inherent negligence but a byproduct of how much weight the clinical process rightly carries.

Safety and quality dominate the conversation on surgery day, and the emotional reality of the day—that this can be a destabilizing and fear-filled day in a patient’s life—gets treated as secondary. The opportunity, as Anderson frames it, is that smoothing out the stress of that day for patients and their families is a natural extension of clinical excellence.

Common discharge and intake protocol gaps

Some of the most consequential gaps live in intake and discharge, not in the surgery itself. Anderson shared a story that illustrates exactly how much can hinge on a single verification step. A patient scheduled for facial plastic surgery arrived with her daughter as her chaperone and ride home. The daughter was engaged, responsible, and present for every discharge instruction. It was only after the two had left, when a staff member complimented the car in the parking lot, that the practice realized the daughter had turned 17 only a few months earlier. The patient, post-anesthesia, had just been discharged into the care of a minor.

Nothing went wrong. But the near miss points to a gap that exists in nearly every OR: the protocol says patients must be discharged to a responsible adult, but few practices have a concrete process for confirming age or identity. A rule without a verification step is not a safeguard for your patients.

Pre-op communication: what patients actually need to hear

Anderson’s approach to pre-op communication starts well before the day of surgery. The pre-operative call shouldn’t just walk through a clinical checklist. It should also help the patient visualize the day itself: what time they’ll arrive, who will greet them, what the sequence of the morning will look like.

Most patients have never walked into an OR before, and that unfamiliarity is a large part of what makes the day nerve-wracking. Verbally repeating that walkthrough again on the day of surgery, not just once during the initial call, reinforces the patient’s sense of what’s coming next and reduces the number of moments where they’re left wondering what happens now.

Sterilization, setup, and staff training

Detailed protocols matter, and Anderson is direct in her assertion that credentials alone don’t guarantee readiness. An RN or certified surgical technician may have years of hospital experience and still have never personally sterilized instruments, because in a hospital setting, an entirely separate department handles that function. In an office-based surgery suite, the same staff member may be expected to do it all. Assuming prior experience translates directly is a common and avoidable mistake.

Anderson recommends simple, step-by-step written protocols supported by photos: a documented setup for each type of case, with a picture of what the completed sterile field should look like, so a new team member has both instructions and a visual reference to check their work against so that the standard is explicit enough that no one has to second guess.

“Sterilization isn’t just an operational issue, it’s a planning issue. When we lay out a surgical suite, we’re tracing the full instrument cycle: receiving and decontamination, the sterile core’s relationship to the ORs, pass-through windows, and the path back into sterile storage. During Adjacency Planning, we map the shortest possible staff paths with no unnecessary crossover. If those relationships aren’t resolved in the space, you’re asking clinical staff to solve a workflow problem after the building is already built.”

— Monika Smith
Principal of Strategy and Design, Apex Design Build

She describes a conversation with a plastic surgeon whose patient developed an unusual infection weeks after a facial fat grafting procedure. The practice retested every piece of equipment, reran sterilization controls, and paused further procedures until they had answers, even though it wasn’t yet clear whether the infection was connected to the surgery at all.

Having documented protocols to point to is what allows a practice to know where to look first, and to demonstrate that the process was followed if something did go wrong. Prevention and liability protection are really the same discipline.

Onboarding per diem staff without losing consistency

Per diem and float staff are a normal part of running an OR, and Anderson is clear that they still require a real onboarding process, not just credential verification. Beyond confirming certifications required by accrediting bodies, per diem staff should be oriented to the specific facility and given clear guidance on what they’re expected to do. Anderson recommends against having multiple per diem staff in the room on the same day, since someone experienced needs to be present to oversee the process and serve as quality control.

Just as important is the culture around asking questions which Anderson says has to be a safe environment for a new or temporary team member to ask questions. Any team member who doesn’t ask carries far more risk than one who does.

Signs your practice isn’t OR-ready

When Anderson evaluates whether a team is truly ready, communication is the first thing she looks at, across the full chain from surgeon to nurse to anesthesia provider. A surgeon who has delegated every operational detail to someone else, without understanding how their own facility runs, is a warning sign in itself. Some nervousness on a first day in a new space is normal and even healthy. What should be present alongside it is confidence that everyone knows their role and knows to pause and ask when something is unclear.

Anderson strongly recommends walking through a full mock encounter before a new facility opens for real patients: someone playing the role of the patient from arrival through discharge, with the team working through every handoff and every piece of paperwork along the way. Running that exercise more than once is what surfaces the gaps in the patient experience that would otherwise only show up in real time when the stakes are too high.

What patients notice

Patients pick up on team tension, even when a practice believes it’s hidden. Anderson describes this as one of the clearest and most consistent things she sees: unresolved friction among staff creates an underlying feeling of unrest that patients sense, sometimes subconsciously, and it makes them question whether their surgeon will be distracted or whether the team around them is fully aligned.

Most of these types of issues can be resolved quickly with a direct conversation. The risk isn’t the disagreement between personnel itself, but letting it go unaddressed in a room where a patient is depending on total trust in the people around them.

What to fix first

Anderson’s advice for a practice looking to audit its own OR flow starts with a simple exercise: walk through the entire process step by step, with fresh eyes.

Routine is valuable, but routine is also how small details quietly erode over time, to the point where a surgeon might not even remember when a particular step stopped happening. Bringing in an outside perspective, even a trusted friend or family member willing to give honest feedback, can surface things a team has stopped noticing simply because they see it, or do it, every day.

Anderson also pointed to a project she completed consolidating a practice’s pre- and post-operative materials. Over time, documents had been added piecemeal until patients were receiving a mismatched, overwhelming stack of instructions. The fix was to rebuild it as a single, clear surgical packet: the non-negotiable clinical instructions first, followed by helpful additions like a suggested comfort-items list for recovery. The result is simpler for the practice to maintain and far less overwhelming for the patient to absorb.

The Takeaway

Great outcomes start with great processes. The OR suite is not a place where aesthetics can compensate for operational gaps, and the practices that get patient experience right are the ones treating pre-op communication, discharge verification, sterilization documentation, staff onboarding, and internal communication as seriously as they treat clinical protocol itself.

It’s a lesson that applies just as directly to the space itself. A well-designed OR suite can’t fix a broken process, but a poorly planned one can make even a strong process harder to run. Getting workflow, sightlines, and equipment placement right during design is what gives a team like Amy’s the room to build the kind of process rigor she describes.

“A successful OR isn’t designed around code compliance alone. We look at how the team actually moves through the space, where they need visibility, and how equipment and supplies are accessed and discarded during a procedure. Details matter too: how a floor feels underfoot on a long case, how much glare a surface creates, whether a contrasting wall gives the surgical team a visual break. All of it supports the process the clinical team is executing every day.”

— Monika Smith
Principal of Strategy and Design, Apex Design Build

FAQs

About Amy Anderson, MBA

Amy Anderson is a plastic surgery practice management consultant and the founder of ACG Practice Partners, where she works with aesthetic practices to strengthen the operational systems behind the patient experience, from OR readiness to pre- and post-operative process design.

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