Summary of Pizza, Croissants and High Flow Lists- NOA Conference 2025

The video from the NOA Conference 2025 focuses on improving efficiency and teamwork in orthopedic surgical lists within the NHS, particularly through the use of “high flow” or “hit lists” — operating theater schedules designed to maximize surgical output and minimize downtime.

Key Lifestyle and Work Efficiency Tips:

• Motivation Beyond Pay: Staff are motivated primarily by impact and making a difference, not financial reward.
• Creating Ownership and Team Culture:
  • Encourage bottom-up innovation by involving frontline staff in identifying inefficiencies.
  • Foster a culture of recognition and regular feedback to boost pride and performance.
  • Emphasize teamwork where challenges and successes are shared.
• Efficiency Principles:
  • Efficiency means doing what matters most smarter, not just doing more with less.
  • Cutting wasted time and unnecessary steps frees staff to focus more on patient care.
  • True efficiency depends on relationships and shared purpose, not just systems.

High Flow (Hit) Lists – Surgical Efficiency Model:

• Definition: Operating theater sessions focusing on high volume, low complexity procedures performed back-to-back with minimal downtime.
• Benefits:
  • Increased surgical output (e.g., 7 joint replacements in one list).
  • Reduced turnaround time between cases (from 90 minutes to about 10–20 minutes).
  • Better utilization of theater time and reduced operational costs.
  • Improved staff morale and patient outcomes, including earlier care and fewer readmissions.
  • Approximately 30% of cases discharged on the same day.
• Implementation Steps:
  • Start planning in the clinic by selecting suitable patients (ASA 1 or 2, non-complex cases).
  • Assemble consistent, well-trained teams (regular surgical assistants, anesthetists with trainees, scrub nurses familiar with the surgeon’s needs).
  • Use a prep room to prepare instruments and induce the next patient while the current surgery is finishing.
  • Conduct a brief team meeting at the start to align and authorize sending for the first patient.
  • Automate patient flow so the next patient is ready as the current surgery ends.
  • Rotate staff to manage fatigue, especially among anesthetic and surgical assistants.
• Training Impact:
  • Trainees may not perform entire surgeries but gain experience by performing parts of multiple cases in one day.
  • High volume exposure helps trainees anticipate surgical challenges and improves their skills.
  • Focus on quality training over merely ticking procedural boxes in logbooks.
• Challenges:
  • High coordination and planning required.
  • Staff fatigue and retention issues.
  • Not all specialties or units have facilities or staffing to implement this.
  • Need to make units attractive workplaces with good culture, competitive pay, and reasonable hours.

Additional Insights:

• Staff prefer working in High Flow Lists due to the adrenaline and sense of achievement despite the intensity.
• Efficiency gains translate into significant cost savings for the NHS (estimated £180,000 saved in extra cases performed).
• Early finishing staff are allowed to leave without penalty, improving morale.
• The approach is evolving with parallel lists (multiple theaters running simultaneously) and expanding to other procedures beyond hips, including hands and foot/ankle surgeries.
• Sustainability and carbon footprint impacts are being explored but not yet quantified.
• Surgeon specialization (e.g., focusing on hips only) enhances efficiency and outcomes.

Notable Locations, Products, and Speakers:

• Kent Medway Orthopedic Center: Example of a unit successfully implementing High Flow Lists.
• Hamburg Hospital: Referenced for comparison of turnaround times.
• Susan Ununice: Theater manager coordinating High Flow Lists.
• Speaker: Consultant orthopedic surgeon, national clinical adviser, and advocate for efficient surgical workflow and team culture.
• References: Leadership book “Seven Habits of Highly Effective People” recommended for understanding motivation.

Summary:
The presentation highlights how well-planned, team-based, high flow surgical lists can dramatically increase efficiency and output in orthopedic surgery without compromising training or patient care. Success depends on strong teamwork, clear communication, patient selection, and creating a positive work culture that motivates staff beyond financial incentives. The model shows promise for reducing NHS waiting lists and improving staff satisfaction, with ongoing efforts to expand and sustain these gains.

Category

Lifestyle

Video