Operational Excellence

Document Type


Publication Date

Summer 7-12-2019


Operational Excellence

MeSH Headings

patients, expenditures, urban health, accountability, goal, surgeons, root cause analysis, instituted, interdisciplinary


In an ambulatory surgical center, first case on-time starts directly affects the patient experience. In addition, in order to treat as many patients as possible, delays of first case on-time starts negatively impacts the rest of scheduled surgical patients and increases staff overtime expenditures. An ambulatory surgical team within a large urban health care system initiated a performance improvement initiative to enhance the patient experience, increase staff accountability and care team well-being.

The goal of this project was to start 70% or more first cases on time. Baseline metrics demonstrated that patients and surgeons were the largest cause of delay. Root cause analysis looked at a number of other variables affecting first case on-time starts and several interdisciplinary countermeasures were instituted.

Subsequent outcomes showed a dramatic improvement from 50.2% in October of 2018 to meeting the goal of 70% in May of 2019. Next steps include generating a plan to sustain success as well as ongoing assessment of delayed start times for the surgeons who do arrive on time