2. If other surgeon want to post his case, priority to be given to the surgeon whos OT day is originally 3. Even though allotted OT day, surgeon should post cases in defined time.( not at 11pm n claim that its his OT day) 4. OT assistant should have defined roles and rotation department wise 5. Responsibility of management of OT drugs and sutures should be allotted to specific person to specific OT and OT manager is responsible for all OTs. 6. Anesthesia fitness some defined duration should be specified i.e. 1 pm to 2pm likewise 7. In case of minor and day care surgery some arrangement for taking advance payment ( to avoid drop out and smooth OT allocation) 8. Monthly one meeting of anesthesiologist, surgeon, OT manager till Ot is functioning smoothly 9. Behavior training of OT staff regarding soft skills 10. Role defining and each person should know what he is supposed to do during the case. 11. Comfortable working environment (as it is high risk area and everybody is stressed ) 12. if case is decided two or three days prior then some arrangement to enter its name in OT list a day prior ( single point contact, now have to contact multiple persons and yet not clear whether its included in the list or not) 13. night OT boy 14. in case of emergency, single point contact to arrange everything 15. If one surgeon operating two case, those cases should be given in same OT one by one . In case other OTs are free then only second case should started in other OT. 16. OT no 2 can be used for non-ortho non-infective cases. 17. In case of emergency , available OT can be utilised as patient's life is priority 18. Anesthesia rates should be reviewed and some guidelines if it is high risk how much increase in anaesthesia charges will occur so that estimate giving to patient will be easier 19. preoperative fitness guidelines should be defined according to anesthesiologist, surgeon, physician and should be realistic. If it is going to cause financial increase for patient then it has to be policy decision by institute. 20. Some guidelines regarding management of high risk patients and some criteria for high risk, shifting of patient from OT to ICU 21. good recovery room where postoperative monitoring is good and responsible person to manage it. 22. Availability of backup instrument in case of malfunctioning of any instrument 23. all should follow the rules 24. Some exceptions can be made with consideration of other associated persons