Building A Surgical Performance Program

  • April 24, 2020


A major metropolitan healthcare system – facing patient safety events and leadership and staff instability – was intent on assessing its surgical operations and culture. With ~35 operating rooms, 200 physicians and 1000 staff, this hospital wanted to understand how to hit “reset” and focus on performance as a platform to build an extraordinary team culture.


Arena Labs assembled a small team of world class experts across performance, design, and coaching. We got into scrubs and observed 129 surgeries, interviewed 121 leaders and staff, and engaged over 150 staff in ideation sessions.

Building exceptional levels of trust at every level of the hospital system, we developed with them an unparalleled understanding into the team and culture and what needed to be done to move it to a higher level of performance on every front. Our key Service inputs included:

  • Discovery: Our propriety process of assessment and insight for shifting from a technical paradigm to one that catalyzes performance.
  • The First Principles of High Performance Medicine™: an assessment and training rubric featuring the universal traits of all extraordinary teams across cultures and domains.
  • Workshops and candid presentations for cross-disciplinary groups to innovate solutions and make actionable decisions. These led to a new organization structure, the hiring of a Medical Director, VP of Business Services, and a new senior nursing role.
  • A Medical Performance Roadmap for this unique human system that focused on a tailored training program to ensure long-term focus on performance and non-technical elements of building a world-class program.
  • Coaching and advisory services to support reorganization and team performance, including up-close coaching with 27 leaders.


The result was a bespoke Medical Performance Roadmap to provide frontline staff with the tools, training, and technology for high performance at the individual + team level. Supported by our coaching and advisory services, the leadership team took on the bold challenges of implementation: they redesigned workflow across departments within its surgical component, making key operational changes to support staff availability and wellness.

Two years later, the surgical operations services was recognized as a role model system-wide. Key pillars included:

  • A new leadership structure, which provided enhanced stability and frontline focus, as evidenced by signals of staff appreciation for leadership attention and staff interest in solving problems and innovating at their level.
  • A revitalized surgical culture grounded in an ethos and actionable values created by staff, marked by an improvement in standards + key metrics – such as on-time starts, reduced average case cart processing time, and established handoff procedures for patients going directly from OR to ICU – and a decline in complaints about staff misbehavior being elevated to leadership.


Laurel Herchanova, Designer

“As a designer, I have partnered with many consultancy groups. Arena Labs was unique in that they did not walk in with a solution, rather, the magic was in obtaining perspectives and engagement in the problem solving. In this case, two other major consultancies had been there before us, yet it had all been C-level; none of the people on the ground had really interacted with them.

We got into scrubs and worked shoulder to shoulder with them on understanding and addressing the problem. We demonstrated consistency, candor, and courtesy.

Despite its flaws, this organization is a deeply human place. People were literally repairing gunshot wounds in children. We emulated that deep respect for humanity in our approach, which was the basis for effectively innovating solutions together.”