Few areas inside a hospital hold as much potential — or as much daily frustration — as the operating room. ORs account for nearly half of a hospital’s total costs and generate a disproportionately large share of revenue, yet many still struggle with the same challenges they faced a decade ago: unused block time, unpredictable schedules, staffing gaps, and avoidable delays. Most organizations are awash in data from EHRs, dashboards, and point solutions, but the daily friction persists.
This is the OR Efficiency Paradox. More data has not translated into smoother operations. What’s been missing is not information. It’s orchestration.
Leading health systems are beginning to break this cycle by embracing a new operating model powered by prediction, prescription, and automation. Early adopters have achieved significant gains without adding rooms or staff — averaging 7% increases in case volume, 5% in block utilization, and double-digit reductions in overtime and robot idle time (25% and 16%, respectively). These improvements come from shifting perioperative services into a unified, intelligent operational rhythm, one that proactively aligns the right rooms, staff, surgeons, and patients at the right time.
A New Operating Model: Predict, Prescribe, Automate
The next era of perioperative performance will be defined by an operating model rooted in sophisticated mathematics, AI-driven insight, and closed-loop automation. Here are the basics:
Predict: Predictive models forecast future case demand, identify idle time and bottlenecks, anticipate staffing needs by role and hour, and estimate case lengths with increasing accuracy. Natural language processing refines expected case durations by reading the surgeon’s description, allowing teams to schedule with greater confidence days or weeks in advance.
Prescribe: Using objective data, prescriptive algorithms recommend optimal actions: where block time should shift, how staffing should be adjusted, and which schedule changes will have the greatest impact. These recommendations reduce subjective debate and help leaders make defensible, transparent decisions.
Automate: Real-time orchestration engines carry out those actions — adjusting schedules, notifying staff, updating assignments, and syncing workflows across perioperative teams. Automation closes the loop so teams spend less time reacting and more time executing.
Together, these capabilities replace reactive firefighting with proactive alignment. Every role and downstream process becomes more predictable, coordinated, and stable.
How Orchestration Elevates Every Role
An orchestrated perioperative ecosystem positively affects every team member who touches the surgical day.
- Perioperative leaders gain predictive insight into access, utilization, and future demand. They can rebalance block time more equitably, improve anesthesia alignment, and standardize processes across hospitals and sites. This leads to measurable growth, stronger systemness, and more transparent governance.
- Surgeons see future open time sooner, receive nudges to release unused time, and gain easier access to additional OR capacity when they need it. With better visibility into patient readiness and day-of progression, they experience fewer late starts and more predictable days.
- Charge nurses and anesthesia board runners plan proactively instead of reshuffling at the last minute, aided by predictive staffing models that show exactly how many staff members are needed for each hour of the day. Automated updates reduce manual coordination and premium pay while supporting safer care.
- Schedulers gain a unified view of surgeon demand, room availability, and staffing constraints. Automated reconciliations and communication reduce errors and keep cases moving smoothly from request to room assignment.
- Clinic managers can identify missing authorizations or documentation earlier, prevent leakage, and accelerate time from consult to surgery with AI-powered readiness tracking. Automated outreach and centralized workflows keep patients informed and reduce preventable cancellations.
Across the board, orchestration improves daily flow, boosts staff satisfaction, and enhances the patient experience.
Proof in Practice
Two of the several organizations highlighted in our new white paper show how modern perioperative orchestration delivers measurable impact across roles and the organizations.
WakeMed Health & Hospitals illustrates orchestration vividly. As surgical and procedural volumes accelerated across its three-hospital system, its Chief Medical Officer knew the organization needed a clearer, more coordinated way to balance demand with available OR time. After unifying data and modernizing block and case management workflows with an AI-powered solution, WakeMed saw meaningful improvements over the course of three years, including an 11% increase in prime time OR case minutes, a 21% increase in prime time procedural minutes, and a 13.5% rise in proactively released block minutes.
And at Oregon Health & Science University (OHSU), the shift to automated staffing and best-fit assignment created meaningful change for its charge nurses in a little over 15 months. The organization saved 25 hours each week in staffing coordination, improved optimal staff allocation by 30%, and even saw average case duration drop as teams were matched more efficiently to the cases on deck.
Across the more than 550 hospitals and 5,600 ORs, organizations using this operating model consistently report higher utilization, reduced overtime, and meaningful ROI.
The Path Forward
Every unused block, idle robot, or preventable cancellation represents capacity hospitals already own but cannot access. In today’s environment of labor shortages, rising demand, and tighter margins, those losses add up.
By embracing a Predict-Prescribe-Automate operating model, health systems can unlock the full capacity of their perioperative ecosystem. Leaders gain visibility and control, surgeons secure reliable access, staffing becomes more balanced and predictable, and patients experience smoother preparation and clearer communication.
The entire system benefits when every role is connected by a shared operational rhythm.
To explore the full white paper — including detailed role-specific insights, more success stories, and a framework for implementing orchestration — download the complete report on Becker’s Hospital Review.
