What supports sustainable pace in the operating room? A sequential explanatory mixed-methods study using self-determination theory.

backgroundOperating-room productivity is commonly pursued through throughput metrics, yet frontline staff point to organizational and interpersonal conditions that make a working pace sustainable. How everyday practices relate to staff motivation, and thereby to dependable workflow, remains underexplored. RESEARCH QUESTION: (1) What organizational and interpersonal conditions support or thwart a sustainable work pace among perioperative nursing staff? (2) How can these conditions be understood through Self-Determination Theory (SDT)?

methodsWe used a sequential explanatory mixed-methods design at two operating room units in a Swedish university hospital. In Phase 1 the Safety Attitudes Questionnaire-Operating Room version was administered (October 2022; n = 47) to profile contextual contrasts between units. In Phase 2, semi-structured interviews (December 2022-March 2025; n = 24) were analyzed with inductive qualitative content analysis, after which SDT was used to interpret the resulting categories. Qualitative reporting followed the COREQ.

resultsSurvey responses differed between units in safety climate (32% vs. 68%; P = .02), stress recognition (57% vs. 21%; P = .02) and perceptions of management (18% vs. 63%; P = .002). Interviews yielded four cross-cutting conditions: predictable workflow and usable tools; psychologically safe teamwork; participatory planning with visible follow-through; and learning structures for mastery, with workload as a boundary condition. The same families of practice appeared at both units but were described with differing emphasis. Interpreted through SDT, these conditions supported autonomy, competence and relatedness when present and thwarted them when absent; need-thwarting patterns (late list changes, parallel documentation, sharp communication, tokenistic consultation) co-occurred with workarounds and conditional intentions to stay.

conclusionAmong perioperative nursing staff, a sustainable pace was described less as working slowly than as predictable routines, professional judgement over timing, stable teamwork, and protected standards of care under pressure. Modest, auditable routines that jointly support autonomy, competence and relatedness offer transferable, hypothesis-generating design principles for dependable operating-room productivity, rather than a ranking of units.