Operating Room Staff Engagement in Design Planning: A Mixed Methods Study of Professional Perspectives in Australia

Purpose This study examines how operating room (OR) staff in Australia are engaged in OR design planning and how their professional experience shapes participation, safety considerations, and design priorities. Background The design of OR environments influences safety, efficiency, and workflow. Yet design processes are complex, requiring regulatory compliance, technical expertise, and integration of end-user perspectives. Methods A sequential exploratory mixed methods design was used. Phase one involved qualitative interviews with OR staff and design professionals ( n = 16) to explore experiences of design processes and perceptions of safety. Phase two involved a national cross-sectional survey ( n = 418) to assess broader patterns of engagement and role-based differences in safety and design priorities. Results Mixed methods integration showed that OR design in Australia is shaped by systemic and professional barriers, including fragmented communication, limited interdisciplinary engagement, and hierarchical decision-making. OR staff reported inconsistent or minimal involvement, while designers reported challenges embedding participatory approaches within project constraints. OR staff prioritized safety, ergonomics, and workflow efficiency, while designers focused more on regulatory and technical elements. Access to support, spatial layout, and ergonomic considerations emerged as top safety-related design features. Conclusions OR environments are shaped by the interaction of clinical, architectural, and institutional priorities, yet design processes often lack inclusive, safety-focused collaboration. Strengthening participatory mechanisms that integrate clinical expertise with technical and regulatory demands may improve the relevance and safety of surgical built environments. These findings can inform future policy, standards, and design frameworks to support more collaborative OR planning.