The effect of TeamSTEPPS® mobile-based learning on operating room efficiency

Optimizing operating room (OR) utilization is critical for enhancing healthcare delivery and minimizing costs. Poor teamwork and communication are significant barriers to OR efficiency. This study aims to determine the effect of a TeamSTEPPS® mobile-based learning intervention on key OR effectiveness indicators.

This study employed a quasi-experimental, pre-test/post-test design to measure the efficiency of ORs before and after an intervention in 2023. The research sample included all ORs and 105 OR staff members from six medical education centers of Iran University of Medical Sciences. The research tool included demographic characteristics and a researcher-made form to determine OR efficiency. To conduct the research, participants received the TeamSTEPPS® training content via links sent through Short Message Service (SMS) over five weekly sessions. Then, the data related to the efficiency of the OR were collected for two months before and two months after the educational intervention from the medical records archive unit. Finally, the data collected before and after the intervention were compared. Statistical analysis was performed using a paired t-test. The significance level was set at 0.05.

The results revealed a statistically significant improvement in the start time of the first surgery(p = 0.05). However, no significant changes were observed in other key indicators, including the rate of surgery cancellation (p = 0.09), case duration accuracy (p = 0.08) or turnover time (p = 0.67).

This study's findings should be interpreted in light of its pragmatic design, which balanced scientific rigor with the logistical and ethical realities of research in active clinical settings. Key limitations inform specific recommendations for future work. The study's participant scope was intentionally restricted to nursing and technical staff to ensure consistent intervention exposure amidst the scheduling complexities of a multidisciplinary team. This focus, however, narrows the generalizability of the findings. Future research should prioritize multidisciplinary inclusion, engaging surgeons, anesthesiologists and administrative staff to foster a shared mental model and assess the collective impact of teamwork training. The intervention employed a passive, text-based modality (SMS link to a PDF) to maximize scalability and minimize clinical disruption. While practical, this approach limited the ability to measure engagement. Subsequent studies should enhance training modalities by using interactive mobile-learning platforms with video, gamification and simulation to deepen learning and monitor outcomes. Methodologically, the quasi-experimental design and short-term follow-up were necessary for feasibility. To strengthen causal inferences and assess long-term impact, future work should adopt more rigorous study designs, such as stepped-wedge trials and implement longitudinal evaluation over extended periods (e.g. 6-18 months). Finally, while the standardized curriculum ensured consistency, a hybrid "core-plus-flex" training model that balances a standard core with locally adapted modules, integrated with organizational support mechanisms, is recommended to enhance relevance and translate learning into systemic improvements.

This paper aims to enhance the effectiveness of TeamSTEPPS® training, healthcare institutions should actively involve all critical OR personnel - including surgeons and anesthesiologists - in both training and evaluation phases. In-person, simulation-based sessions with real-time feedback may better reinforce team behaviors than mobile-only formats. Embedding training within broader organizational reforms - such as leadership support, performance-based incentives and infrastructure improvements - can drive sustainable change. Hospitals should also tailor training content to their specific cultural and operational contexts to improve staff engagement and program relevance. Finally, implementing long-term follow-up and monitoring mechanisms is essential for measuring true behavioral and operational impacts over time.

Although the TeamSTEPPS® mobile-based training did not yield measurable improvements in OR efficiency, its broader social implications remain significant. Enhancing team communication and collaboration in surgical settings can contribute to safer patient experiences, reduced interpersonal conflicts and improved job satisfaction among healthcare professionals. These outcomes, even if not immediately quantifiable, support a culture of mutual respect and shared responsibility. Promoting inclusive and context-sensitive training interventions can also help reduce hierarchical barriers and empower diverse staff roles, ultimately fostering a more equitable and resilient healthcare environment that benefits both patients and providers in the long term.

While a focused improvement was noted, this passively delivered, mobile-based training targeting a subset of OR staff did not yield widespread gains in operational effectiveness. The findings suggest that more interactive, inclusive and sustained training approaches may be necessary to achieve a broader impact on the complex dynamics of OR efficiency.