What We Heard in 100+ Perioperative Interviews

June 15, 2022 – During NSF I-Corps, our team at Mente completed 100+ interviews with perioperative leaders, surgeons, OR nurses, sterile processing, and supply chain teams. We went in expecting to validate a product. We came out with something more useful: a clearer picture of how perioperative improvement actually gets done, what consistently slows it down, and what separates “pilot success” from sustained change.

Metrics Perioperative Leaders are Looking At

Across hospital types, we kept hearing the same operating metrics described as the “daily dashboard” for perioperative leadership:

• First case on-time start
• Turnover time
• Case posting accuracy and schedule integrity
• Cancellation rate

Hospitals may describe their strategy differently, but these metrics can succinctly sum up how well an OR floor might be operating. If an improvement effort doesn’t move one of these, it tends to get categorized as “nice but not urgent.” When it does move one, it becomes something leadership can get behind. A smaller but important detail: many hospitals told us they were not looking for more complicated forecasting tools as a top priority. In contrast, anything that reduces setup and processing burden tends to land quickly because it shows up in reliability and throughput.

Why Tray and Instrument Projects Fail

Most hospitals already believe trays are oversized and that reprocessing burden is higher than it needs to be. The reason tray optimization is still hard is not disagreement about waste. It’s the operational risk of being wrong.

The best one-sentence description we heard was from a leader whose job is tray optimization: the biggest obstacle is mistrust that instruments will be available when needed.

That mistrust has predictable causes:

• Exception handling isn’t designed upfront: If there’s no clear plan for rare-but-critical instruments, teams compensate by keeping everything on the tray. Peel packs exist, but many hospitals don’t have an explicit exception workflow that surgeons and staff trust.
• The “same instrument” is not the same instrument: In practice, instruments come in multiple sizes and variants, and naming differs across sterile processing, OR staff, and different sites. Many projects bog down in translation and version control rather than clinical debate.
• The work concentrates in the wrong place: When optimization depends on a few motivated people manually auditing trays and preference cards, the project becomes fragile. It progresses until those people get pulled into other priorities, then it drifts.
• Sterile processing constraints create hidden failure modes: Several teams described predictable error pressure during late-night SPD surges. When large volumes of trays must be reprocessed quickly to support early cases, complexity and instrument count directly increase the probability of errors and rework. In these environments, simplification is not only cost reduction, it is reliability engineering.

What sustainable change looks like in practice

Hospitals that successfully standardize trays tend to do three things consistently, regardless of whether the initiative is surgeon-led, nurse-led, or administratively driven.

• They make sure to design for potential exceptions: The question is never “can we remove instruments,” it is “how do we support the rare need without bloating every tray.” The hospitals that succeed define the exception pathway, stage the critical items appropriately, and decide who owns add-backs.
• They treat standardization as governance, not a one-time project: Even the best tray changes drift over time. The hospitals that keep gains build a cadence: periodic review, clear ownership, and a mechanism to incorporate new surgeons, new sites, and new techniques without re-inflating everything.
• They measure outcomes that matter beyond simple instrument counts: Instrument reduction is a means, not the end. Hospitals care about setup time, turnover time, counting burden, error reduction, and downstream sterile processing workload. Projects that connect those dots are the ones that earn executive support and survive leadership changes.

What can Hospitals Do?

If you’re running a tray optimization or instrument efficiency initiative, here is the approach that most consistently mapped to success in our interviews, plus the three accelerators we saw hospitals ask for repeatedly: objective data to drive buy-in, experienced support to avoid common failure modes, and a way to keep gains from drifting over time.

Start with objective usage data to earn trust

The fastest way to reduce debate is to replace opinion with evidence. Hospitals told us that buy-in hinges on answering, clearly and defensibly:

• What is actually used, case by case, and how often?
• Which “rare but critical” instruments truly need to stay on tray versus staged nearby?
• Where does variability come from: surgeon preference, site differences, or naming and variant confusion?

When teams can see real usage patterns, the conversation shifts from “I feel like we need it” to “here’s when we need it.”

Pick targets where you can win quickly and safely

High volume can increase savings, but it can also increase stakeholder complexity. A common tray used by a small group is often a better starting point than a tray touched by many service lines. Early wins build the confidence and governance muscle you need before you take on shared “major” trays.

Define success in metrics leadership already tracks

Perioperative leaders are accountable to a small set of operational outcomes. The most effective tray initiatives choose:

• One operational metric (setup time, turnover time, missing instrument events, assembly errors, wet trays, rework rates)
• One financial metric (processing cost per case, labor burden reduction, avoided maintenance/replacement)

This makes it easier to justify change, report progress, and decide whether to scale.

Design the exception pathway before you remove anything

Trust fails when exceptions are improvised mid-case. Hospitals that succeed define the safety net upfront:

• Which instruments remain on tray versus peel packs versus staged nearby
• Who can authorize add-backs
• How exceptions are captured and reviewed so learning is continuous

This is also where experienced guidance matters: teams that have done this before can help you avoid over-optimizing and removing the wrong “single point of failure” instruments.

Get help from people who have done it before

A recurring theme in interviews was that tray optimization looks simple on paper but gets hard in implementation, especially around variants, naming, shared trays, and preference cards. Hospitals valued partners who could:

• Help structure the committee and decision rules
• Anticipate the political blast radius of shared trays
• Standardize instrument language and variants across sites
• Build a repeatable process rather than a one-off project

In practice, this is the difference between a tray project that finishes and one that stalls.

Use technology to prevent drift and maintain gains

Nearly everyone who has done tray work knows the pattern: after the project ends, trays slowly re-accumulate instruments, and preference cards drift. The hospitals most likely to sustain results had a mechanism to keep visibility over time, including:

• Ongoing measurement of what’s actually used
• Routine review cadences driven by data rather than anecdotes
• A way to detect creep early and correct it before it becomes normal

This is where technology can turn tray optimization from periodic “spring cleaning” into continuous maintenance, especially in systems with multiple sites and rotating staff.

What This Means for the Perioperative Technology Market

From an adoption standpoint, perioperative leaders want the same things any operational leader wants:

• Clear measurement
• Low disruption
• Risk mitigation for exception cases
• Proof that results sustain beyond the first push

Technologies and programs that reduce “manual effort per tray,” and make evidence easy to share and defend, have a structural advantage. Systems especially value anything that is repeatable across sites and resilient to staff turnover.

About Mente

Mente is a surgeon-founded company building a data-driven operating room. We capture instrument usage automatically, then use that evidence to help hospitals and sterile processing teams supply fewer instruments while preserving clinical functionality and surgeon satisfaction.