Matthew Tsuei, MD, FACS, is a general surgeon and president of Central Carolina Surgery in Greensboro, North Carolina. As a former chair of Cone Health’s surgical governance committee, Dr. Tsuei played a leading role in driving changes to operating room (OR) coordination and access across the five-hospital health system. In this Q&A, he shares how his team tackled longstanding inefficiencies and what others can learn from their experience.
Question: What initial barriers did you face that signaled it was time to rethink how your OR capacity and resources were being managed?
Dr. Matthew Tsuei: When I arrived at Cone Health in 2006, block scheduling was still done on paper, and there was no clear process for how surgeons obtained OR time. We faced major barriers to data visibility, scheduling efficiency, and stakeholder trust. We initially brought in consultants who helped us build an Excel-based report to monitor block utilization. While we used it to make decisions, the data was often messy, inaccurate, and obsolete by the time it was reviewed. That made it hard to justify block allocation changes and eroded surgeon buy-in.
Daily scheduling was just as challenging, handled entirely manually. Schedulers juggled phone calls, post-it notes, and emails to piece together schedules, often scrambling to accommodate urgent or add-on cases without clear visibility into available time or resources. Surgeons were frustrated, schedulers overwhelmed, and no one had access to reliable, consistent data. Surgical resources were underutilized despite the perception that the schedule was running at capacity.
Even after forming governance committees and implementing an electronic medical record (EMR) system, we still relied on printed Excel sheets distributed monthly. It became clear that we needed a more scalable, transparent solution if we wanted to improve access, accountability, and efficiency.
Q: What changes did you make to improve OR utilization and access—and what results have you seen?
MT: We started by modernizing our approach to scheduling and governance. That meant shifting from manual processes to a system that gave all stakeholders real-time, transparent access to scheduling data. We partnered with LeanTaaS to implement iQueue for Operating Rooms, which enabled us to right-size block allocations, increase open time, and streamline how block adjustments were made.
We developed stronger governance through surgeon-led executive committees, revised the block allocation policy, and created a data-driven process to identify underutilized time and reallocate it where it could be better used. Office schedulers gained the ability to view and request OR time in real time, reducing back-and-forth communication and delays.
With iQueue, we also got access to the Real-Time View feature, a mobile app with no PHI that allows multiple stakeholders—including surgeons, OR staff, and vendors—to monitor the live status of surgeries. Everyone gets real-time notifications and insight into the flow of their cases and broader OR activity. When I walk out of a room, I can look at it and instantly know what’s happening with my next case. Vendors love it because they’re not relying on phone calls anymore. It’s made everyone’s life easier and helped us run more efficiently.
The results have been substantial: over 220 labor hours saved per day systemwide, nurses gaining back an average of 65 minutes each shift, and a 98% reduction in vendor coordination calls. We also improved staffed room utilization and increased access for urgent cases—all without needing to add new ORs.
Q: How did this impact the day-of-surgery experience, especially for surgeons and support staff?
MT: For any of us who work in or around an OR, we know the schedule never runs exactly as planned. Cases run long, emergencies come up, or cancellations happen. Previously, when that happened, someone at the front desk would have to call five or six people just to update them. That’s not sustainable.
Now, we use a real-time coordination system that sends customizable alerts to everyone involved—surgeons, nurses, vendors. If I’m across the hospital, I get a notification when my patient is in the room. If equipment is ready, I know. I can see if someone is running over, so I can get more work done before I head over to the hospital instead of waiting in the surgeons’ lounge.
Q: Change management is often the hardest part. How did you gain buy-in from surgeons?
MT: Surgeons can be very territorial when it comes to block time, and we don’t like change, especially if we think we’re losing something. But once we showed everyone real, believable, transparent data, it changed the conversation.
Instead of arguing over whether someone deserved more time, we could show usage patterns and explain the concept of collectable time. A 15-minute gap doesn’t help anyone, but two hours? Another surgeon could probably get a case done during that time. The fairness and clarity of the system helped bring people on board.
Q: How did this affect coordination in your ambulatory surgery centers (ASCs)?
MT: ASCs present a different challenge. Surgeons often performed a few short cases in the ASC before heading to the main hospital for higher-acuity procedures, which left unused block time in the ASC schedule that were hard to backfill. These inefficiencies added up quickly, especially given the shorter case lengths. We used the same principles of transparency and flexibility to restructure blocks and offer open time to surgeons who needed it. If a surgeon used that time consistently, they could eventually earn block time.
As a result, we increased our staffed room utilization by 10% in ASCs and by 3% in our main ORs. We also saw a decrease in evening and weekend cases, which tells me we’re making better use of the time we already have, all without building more ORs.
Q: What advice would you give to health systems looking to tackle similar challenges?
MT: Start by mapping out your workflows—every touchpoint, every stakeholder. If it’s all phone calls, faxes, and emails, there’s room for improvement. You need a way for everyone to access the same, believable data in real time. That’s what allows for more agile decision-making.
Ultimately, it’s about shifting from a reactive mindset to a proactive one. We’ll always face constraints whether it’s staffing, resources, or unexpected disruptions, but having a system that helps us anticipate needs, see how things are trending in real-time, and adapt accordingly is critical. It allows us to make deliberate, data-informed decisions with confidence, rather than scrambling to put out fires.
Dr. Tsuei will dive deeper into this work at the upcoming Transform Hospital Operations Virtual Summit, which runs from June 10-11. Register here for access to more real-world success stories like this one.
