I got the phone call from the ward sister at 11:05 am, and immediately drove the short distance back to our local hospital.  I checked on my patient in the ward, confirmed the bleed, and that she needed to go back to the OR.

By 11:20 my patient was in the OR and my anaesthesiologist was putting her to sleep.  By 11:40, the bleeding was controlled, my patient was waking up, and I was handing her over to the ward staff to be monitored.  She recovered completely.

Thirty five minutes was all it took, from receiving the phone call in my rooms to completion of the emergency procedure.  Not many hospitals can boast that level of efficiency and of those that can, very many are small hospitals.

Yes, we were fortunate in that the OR was open – there were no other surgeries that we needed to wait for, and my anaesthesiologist was still available.  But these are not the only causes of backlog and time delay in larger hospitals.

My general surgeon colleague affirmed my beliefs. He gets to do stabbed hearts in the middle of the night, and our little hospital’s response time is a life-saving fraction of that of the bigger hospitals with resident surgeons and theater staff always on the premises.  At another even smaller clinic I work at, one with a very low staff complement, the turnover of adenotonsillectomy cases has at times been as efficient as one case every twenty minutes, without compromise of patient safety or shortcuts in any way.  It is just that absolutely no time is wasted whatsoever.

One could argue that in small hospitals the distances between the wards and OR’s are shorter, or that there are fewer people in the chain of activity that have to be involved.  There may be less protocol, paperwork, or bureaucratic ritual in dealing with emergencies.  You do the work that has to be done yourself; roles are multifunctional.

It may also be that because the staff number is small, everyone knows one another and is accustomed to working as part of a small but efficient team.

And yet, I struggle to define why efficiency can be so much better in these smaller hospitals.  None of the explanations given above are enough.  Is it because smaller hospitals are simpler in all ways?

Or is it because of the old adage, “If you want something done quickly and efficiently, give it to a busy person to do?”  Whatever the reason, big hospitals would do well to look at their smaller siblings where this is the experience and to define reasons why in terms of efficiency bigger is not necessarily better.