Clarifying Questions

• What is the primary goal: recovering lost margin, reducing the surgical waitlist, or both?
• Are all 14 ORs experiencing underutilization, or is the problem concentrated in certain rooms or service lines?
• Has utilization always been around this level, or is this a recent decline?

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Framework

Bucket 1: Block Time Allocation‍

Objective: Understand whether OR blocks are assigned to the right specialties and surgeons, since misallocation would mean high-demand services are capacity constrained while others sit underused regardless of execution quality.

• Block Assignment: which specialties hold which blocks and whether that reflects actual case volume
• Release Policy: how far in advance unused blocks become available to other surgeons
• Demand Forecasting: accuracy of volume projections used to set block schedules

Bucket 2: Day-of Execution

‍Objective: Understand whether scheduled cases are actually running on time and to full duration, since even a well-allocated block schedule loses value if cases start late, run long, or get cancelled.

• On-Time Starts: first case start rates by surgeon and OR, and root causes of delays
• Turnover Time: time to clean and prep the OR between cases
• Cancellations and Delays: frequency and root cause, broken down by patient, surgeon, anesthesia, and equipment

Bucket 3: Case Mix and Volume

‍Objective: Understand whether the OR is being used for the highest-value procedures, since low-margin or low-priority volume can fill blocks while higher-value cases sit on a waitlist.

• Margin by Specialty: contribution margin per OR hour across surgical service lines
• Waitlist Alignment: whether high-demand procedures are being deferred while lower-priority cases fill blocks
• Strategic Fit: how current block allocation maps to the hospital's priority service lines