Recommendation

Meridian should immediately reallocate underused OR block time to high-demand specialties and launch a structured first-case on-time start program. These two levers address the root causes of the utilization gap and together can recover $1 to $1.5M in annual contribution margin within two quarters, without capital investment.

Evidence

• Block time is structurally misallocated: Orthopedics and General Surgery are capacity constrained while Neurosurgery, GYN, and ENT leave an estimated 9 or more combined block hours idle per week
• The reallocation math is clear: shifting just 6 hours per week from Neurosurgery to Orthopedics alone recovers over $500K annually
• Day-of execution compounds the problem: a 54% first-case on-time start rate erodes hours even from blocks that are nominally filled, and is fixable through process and accountability changes rather than structural investment

Risks and Mitigations

• Surgeon resistance to block reallocation, particularly from specialties losing time: mitigate by tying reallocation decisions to transparent trailing utilization data reviewed in a formal committee setting rather than ad hoc decisions
• On-time start improvements stalling without sustained leadership pressure: mitigate by embedding the OR Performance Committee as a permanent governance structure with COO ownership, not a one-time intervention

Next Steps

Implement a 72-hour block release policy and initiate the first trailing 90-day utilization review to identify reallocation candidates. Stand up the OR Performance Committee within 30 days. Launch anesthesia pre-op and patient confirmation protocols in parallel, with surgeon scorecards going live to department chairs within 45 days.