Background The COVID-19 pandemic disrupted the delivery of elective surgery in the UK . The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic . We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the UK, with the aim of developing lessons for future major systems change . Methods Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic . We also carried out a policy review of the guidance developed for those delivering surgical services in pandemic conditions . We used framework analysis to organise and interpret findings . Results Staff discussed positive and negative experiences of rapid service organisation . Clinician-led decision making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation . The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started . Conclusion Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff . However, there was an absence of involvement of staff in wider system-level pandemic decision-making and competing guidance from national bodies . Involving staff in decisions about the organisation and delivery of major systems change is essential for the sustainability of change processes.