UofL Health (Louisville, Ky.) operates a large, multi-site academic health system where meeting surgical demand takes more than capacity alone. It calls for alignment across people, processes, and data to ensure access, flow, and performance work together.
With nine hospitals, 59 operating rooms, 33 procedural rooms, and more than 34,000 surgeries annually, even small inefficiencies had an outsized impact. Variation across sites made it difficult to operate as a single, aligned system. And like many organizations, we found that when processes break down in perioperative services, the ripple effects are felt everywhere — from scheduling and staffing to patient access and financial performance.
What followed was a deliberate effort to bring structure, visibility, and alignment to our surgical operations.
When variation becomes the barrier to access
Before this work began, our perioperative environment was challenged by inconsistency.
Operational standards differed across sites. Metrics were not aligned. Block policies, vendor requirements, and case workflows differed from hospital to hospital. Even the process for scheduling a case could look completely different depending on where it was being booked.
That variation created friction at every step. Surgeons were often unsure where and when they could operate due to complex block structures that included service line, group, and individual allocations. Schedules were heavily blocked, which limited flexibility and made it harder to place cases efficiently.
At the same time, key workflows were fragmented. Pre-admission testing operated independently across sites, and scheduling teams worked in silos with limited visibility into the full picture. High volumes of add-on cases and last-minute changes meant teams were constantly reacting, shifting staff, and adjusting schedules in real time.
Compounding these challenges was a lack of confidence in the data. Information coming out of the EHR was not consistently trusted, making it difficult to share meaningful, surgeon-level insights or drive data-informed decisions. Manual processes, including CPT code capture, further limited auditability and left value on the table.
Taken together, this was fragmentation at scale. And in an environment of that size and complexity, fragmentation makes it nearly impossible to operate efficiently or expand access.
Building alignment through governance and standardization
Addressing these challenges required more than incremental change. It required alignment at every level of the organization.
We began with governance. Executive sponsorship was critical, with clinical, operational, and executive leadership aligned around a shared vision for transformation. A system-wide steering committee created the structure needed to drive decisions, maintain accountability, and keep standardization efforts front and center.
From there, we conducted a comprehensive, multi-site assessment to identify duplicative workflows, inconsistencies in block management, and variation in scheduling and data requirements.
Standardization became the foundation of execution. We aligned on system-wide definitions for key metrics, established consistent block policies, and standardized vendor requirements, cancel and reschedule workflows, and case booking processes. A single, standardized booking form replaced site-specific approaches, representing a significant cultural shift across the system.
At the same time, we centralized scheduling and restructured block utilization to improve visibility and access. Rather than operating in silos, teams began working from a shared, system-level view.
To support this transformation, we partnered with LeanTaaS to implement iQueue for Operating Rooms as a single source of truth for perioperative data. With AI-driven software enabling greater transparency into capacity and utilization, teams could begin to trust the data and act on it with confidence.
Technology enabled the work, but the real impact came from standardizing how we operated. Integration efforts improved CPT code capture and streamlined workflows, while automation began to reduce manual effort in staffing and scheduling. Just as importantly, ongoing executive engagement — including regular steering committee check-ins and consistent KPI tracking — ensured that progress was sustained and aligned with strategic priorities.
Turning operational discipline into measurable impact
As alignment and standardization took hold, the results followed.
Case volume grew by 4 percent year over year in the fourth quarter, increasing from 10,357 cases to 10,791, even as operational changes were being implemented. At the same time, primetime utilization improved by 3 percentage points across the system — a meaningful gain at scale.
One of the most significant shifts came from how we managed block time. By creating clearer processes for releasing and reallocating unused time, we were able to fill 27 percent of released OR capacity. Over time, this translated into more than 517,000 minutes of recaptured operating room time.
That additional capacity enabled more efficient scheduling and better use of existing resources. In total, more than 6,300 surgery requests were approved through standardized processes, representing over 668,000 minutes of booked OR time.
Perhaps most notably, these gains were achieved while reducing reliance on high-cost anesthesia locum coverage. By improving efficiency and aligning staffing more effectively, the organization realized approximately $1.5 million in monthly anesthesia savings. At the same time, five operating rooms were restored to the schedule at one facility, further expanding available capacity without new construction.
This combination of increased throughput and reduced cost is what health systems are ultimately striving for — doing more with the resources they already have, while improving financial performance.
Sustaining momentum and expanding what’s possible
This work is not a one-time initiative. It is a foundation for ongoing improvement.
With nurse staffing optimization already implemented, efforts are now advancing in anesthesia staffing and patient readiness. Each of these areas builds on the same principles: strong governance, standardized workflows, trusted data, and a disciplined approach to execution.
What we have learned is that transformation at this scale requires more than tools or isolated improvements. It requires operating as a connected system, where visibility, accountability, and alignment enable teams to move in the same direction.
For organizations facing similar challenges, the opportunity is significant. Many health systems have more capacity than they realize. Unlocking it requires the ability to see it clearly, trust the data behind it, and act on it consistently.
That is the shift we are continuing to make at UofL Health, and it is reshaping how we think about access, performance, and growth across our surgical services.
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