Strengthening Surgical Teams Through Repetition and Trust

A Case for Predictable Rotations to Improve Outcomes Across Microsurgical Specialties

Authored and reviewed by the DIN team, August 2025

Executive Summary

Surgical outcomes depend not only on individual skill, but on the strength of relationships within the operating team. Across specialties—including ophthalmology and ENT—research consistently shows that surgical teams who work together repeatedly experience fewer complications, greater efficiency, and better communication.

Despite this, many hospitals staff surgical teams on an ad hoc or rotating basis, making it difficult to build trust and rhythm. Predictable repetition—especially for rotating specialists—is a powerful but underutilized lever to improve safety and performance.

This white paper summarizes the evidence for team continuity and proposes actionable strategies for health systems. Doctors In Network (DIN) supports this shift through its operating model: DIN Rotating Surgeons return to the same hospitals on a regular cadence, allowing trust and familiarity to grow over time. These returning clinical relationships yield tangible improvements in care quality, efficiency, and team morale.

Introduction

Surgery is a team pursuit. While much attention is paid to individual skill, the outcome of any procedure depends heavily on how well the team functions as a unit. In high-precision specialties like ophthalmology and ENT, timing, coordination, and anticipation are especially critical.

In practice, many operating rooms rely on fluctuating team assignments. Circulating nurses, scrub techs, and anesthesiologists rotate between different surgeons and services, often without sufficient continuity to develop shared routines. These shifting dynamics can lead to delays, miscommunications, and avoidable complications.

This paper makes a clear case for structured repetition: returning the same people to the same teams on a predictable basis. The evidence supports this approach across a range of procedures and settings. And it’s precisely what DIN facilitates. Through regular, well-coordinated assignments, DIN Rotating Surgeons become integrated members of the surgical team, rather than one-off visitors. The results speak for themselves.

The Case for Familiarity

A landmark study by Huckman and Staats followed cardiac surgeons working across multiple hospitals. They found that performance improved primarily when the surgeon operated repeatedly with the same hospital team. The same surgeon, performing the same procedures at a different site, did not experience similar outcome improvements [1].

This pattern has been observed across a range of specialties and team configurations:

A systematic review of 16 studies linked team familiarity to shorter case durations, fewer intraoperative errors, improved communication, and reduced readmission rates [2].

Dedicated OR teams—where staff consistently work together—have been shown to reduce mortality, improve turnover efficiency, and enhance staff satisfaction, without increasing adverse events [3].

A 2025 analysis of more than 700,000 procedures found that each additional operation completed by a surgeon–anesthesiologist pair led to a measurable decrease in patient morbidity. Familiarity, not just experience, drove the improvement [4].

These findings have particular relevance in microsurgical specialties. In cataract surgery, for example, a scrub tech who anticipates the surgeon’s tempo can accelerate instrument transitions and reduce disruptions. Similarly, ENT procedures benefit when circulating nurses understand setup preferences and critical steps without requiring real-time explanation. These efficiencies come from repeated collaboration.

Communication and Psychological Safety

Team familiarity fosters trust, which in turn enhances communication. When team members know one another’s workflows and expectations, they are more likely to raise concerns, adapt in real time, and avoid preventable errors.

Psychological safety—a shared belief that one can speak up without fear of negative consequences—is strongly linked to performance in healthcare settings. Familiar teams are more likely to identify and report near-misses, and to recover gracefully from unexpected events [5].

In one observational study of over 2,000 surgical cases, teamwork ratings were significantly higher when teams remained stable throughout a procedure. When staff were swapped mid-case, teamwork scores among physicians dropped by over 70 percent [6]. These findings emphasize that high-functioning teams are not created overnight; they are built through repeated, intentional collaboration.

How DIN Rotating Surgeons Build Familiarity

DIN’s model is designed to preserve team continuity even within a flexible, cross-institutional framework. By coordinating DIN Rotating Surgeons to return to the same hospitals on predictable schedules, the model supports familiarity between visiting surgeons and the local surgical team.

Over time, these repeating assignments transform into working relationships. Local staff learn the surgeon’s flow, preferences, and instrumentation. Surgeons become accustomed to the team’s communication style and pacing. Everyone benefits from the reduced friction, greater confidence, and more efficient operations that follow.

Rather than offering one-time access to specialist care, DIN helps build enduring clinical partnerships. The structure of these rotations unlocks many of the same benefits as a permanent team—without requiring full-time co-location.

Recommendations for Hospitals

To promote trust and team familiarity across surgical services, hospitals and systems should consider the following strategies:

1. Preserve Consistent Teams
   Assign core groups of nurses, scrub techs, and anesthesiologists to work together regularly, especially for high-volume service lines. Avoid unnecessary staff substitutions mid-case.

2. Prioritize Repeat Pairings
   Surgeon–anesthesiologist and surgeon–scrub tech pairings have a measurable effect on communication and outcomes. Where possible, schedule them together across multiple sessions.

3. Support Predictable Rotations
   When engaging traveling or part-time surgeons, use structured rotation schedules. A monthly return pattern, for example, enables consistent collaboration without compromising coverage.

4. Track Team Stability Metrics
   Monitor the frequency of repeat staff pairings and stability across surgical teams. Include these indicators in performance and quality dashboards alongside case duration and outcomes.

5. Invest in Joint Training
   Encourage teams to participate in joint pre-briefs, post-op debriefs, and simulation training. These activities build shared mental models and prepare staff for high-reliability teamwork.

Conclusion

Clinical excellence is built on relationships. Familiar teams communicate more effectively, recover from disruptions more quickly, and deliver better outcomes for patients. These benefits are clear in the data and visible in the operating room.

By returning DIN Rotating Surgeons to the same sites regularly, DIN reinforces a model of consistency and trust, even in settings where permanent co-location isn’t feasible. This approach turns short-term access into long-term impact.

Hospitals that value quality should prioritize not only who is in the OR, but how often they’ve worked together. The answer isn’t always more people—it’s the right people, working together again.

Works Cited

1. Huckman RS, Staats BR. Learning from Experience, Vicariously: Evidence from Cardiac Surgery. Harvard Business School Working Paper, No. 09-019. 2009.

2. Stucky CH, De Jong MJ. Surgical team familiarity: An integrative review. AORN J. 2020;111(1):94–107.

3. Lentz CM, et al. Dedicated teams to optimize quality and safety of surgery: A systematic review. Int J Qual Health Care. 2022;34(2):1–10.

4. Hallet J, et al. Familiarity of the surgeon–anesthesiologist dyad and major morbidity after high-risk surgery. JAMA Surg. 2025;160(3):221–229.

5. Edmondson AC, Papaconstantinou HT. Psychological safety in the OR improves outcomes and performance. Bull Am Coll Surg. 2024.

6. Arad D, et al. Patient safety and staff psychological safety: A mixed methods study on teamwork in the OR. Front Public Health. 2022;10:1–9.