2 Why do you think that it took so long for this to be adopted? Karolinska Hospital faced a crisis as the pressure on operating budgets was rising. This prompted an investigation as to how well expensive resources were being utilised. It was soon identified that operating theatres were not being used effectively. In fact, surgeons, operating theatre staff and of course the theatres themselves were idle for more than 50 per cent of the time. It soon became clear that the schedule of patients through the theatre needed to be managed more carefully. The scarce resource was time in the theatre itself, so the management looked at ways to reduce the time that patients spent in the theatre.

A significant step forward created a separate patient preparation area allowing this activity to be carried out in parallel rather than in sequence with surgery.