Block utilization can provide useful directional insight, but on its own, it can mask unused time, excess allocation and barriers to OR access. At an executive roundtable sponsored by LeanTaaS at Becker’s 2026 Perioperative Summit, three health system executives described how they are looking beyond the metric to identify hidden capacity, release block time earlier and improve access — and, in one case, helped grow elective volume about 7% against a 3% budgeted growth.
The roundtable panelists walked through block release policy, collectible time and when to open another OR. Speakers included:
- Ihab Dorotta, MD, chief of quality and patient safety, and chief of clinical operations at Loma Linda (Calif.) University Health
- Ben Hall, executive director of perioperative services at University of Iowa Health Care (Iowa City)
- Eric Danielson, administrative director of the procedural care unit at Silver Cross Hospital (New Lenox, Ill.)
- Scott Williams, director of customer outcomes, operating rooms, at LeanTaaS
LeanTaaS offers AI-based capacity management software for operating rooms, infusion centers and inpatient beds; its iQueue for Operating Rooms platform manages block and open time. Mr. Williams, who leads customer outcomes for the company’s OR clients, moderated and framed the session around what hospital administrators should start measuring or paying attention to versus what they should stop measuring or worrying about in the OR.
Below are four takeaways from the discussion.
Note: Quotes have been edited for length and clarity.
1. High utilization hides pockets of unused time.
UI Health Care runs about 75 ORs across three campuses, up from 50 on one campus two years ago; roughly 68 are open daily. Even at prime-time utilization in the mid-to-upper 70s, Mr. Hall shared that system-level numbers masked variation by location, surgeon, service, day of week and time of day. “Even within that high utilization rate, there are pockets of underutilized capacity,” he said.
Loma Linda University Health has about 65 ORs across a children’s hospital, main campus, satellites and a hospital 45 minutes away, and operates about 53 a day. Although additional rooms are available in a new building, Dr. Dorotta said the organization has held the number of open ORs steady while working to improve utilization of its existing staffed rooms.
2. Move the auto-release date, carefully.
UI Health Care’s three-day auto release was generous to block holders but left released time difficult to fill. The governance committee increased it to seven days, and later to 14. “It didn’t lead to the doom and gloom that all the block holders thought it would,” Mr. Hall said. Instead, the earlier release created more flexibility to backfill unused time with cases from other services.
Loma Linda moved its all-elective outlying sites to 21 days after finding that at 14 days, surgeons still couldn’t book another patient into the returned time. At 21 days, Dr. Dorotta said, the open time “started flooding” back into use. “It is a tool for the prepared,” he added, explaining that departments with patients ready to schedule claimed much of the newly available time.
Silver Cross Hospital — a 350-bed independent community hospital outside Chicago whose procedural care unit runs about 37,000 procedures a year — pushed proactive block release to 28 days during a full OR renovation, giving surgeons enough runway to release and giving the team enough lead time to redistribute it. “Because we’re a community hospital, there wasn’t always time, or there was no good way for us to get other surgeons always to fill that time,” Mr. Danielson said. Even while down capacity, prime-time utilization rose by more than 10 percentage points.
3. Collectible time changes what you can ask a surgeon.
Dr. Dorotta said block utilization had led to years of debate over what should count toward the metric. A single procedure that fills an eight-hour block, for example, can produce 100% block utilization without showing whether that time was used as productively as possible. Loma Linda instead set its collectible-time threshold at four hours, identifying specific portions of a block that remained unused and unreleased. That reframed every conversation: “Can you please explain to me why those four hours exist in your block that are still unused and unreleased?”
After reviewing the data with all nine surgical chairs, Loma Linda moved auto release to 21 days at its all-elective outlying sites. Elective volume at the outlying sites grew about 7% against a budgeted 3%, and the ROI he presents to system leadership moved from roughly 3x to 7x, largely because block time moved earlier.
4. Governance must be small and willing to reverse itself.
Loma Linda created an executive block allocation committee of five — the hospital holds at least three seats, plus an anesthesia member and a surgical chair — that reallocates block frequently in response to the LeanTaaS data, reclaiming time from some holders and granting it to others. When a call turns out to be wrong, Dr. Dorotta said, the committee corrects approximately three months later — and that willingness to adjust is the point.
UI Health Care built similar discipline into daily scheduling huddles that look at least 15 days out, ahead of the auto release, so patients booked further out can be pulled forward.
Dr. Dorotta said post-implementation support distinguished LeanTaaS; he still gets at least 15 hours a month, including meetings with every surgical chair. When asked by an audience CRNA about liability when AI errs, he said humans in pre-op make errors too, and the metric he will watch as Loma Linda pilots an AI patient-readiness tool is same-day cancellations.
What to measure instead
Regarding what not to measure, Mr. Hall advised against block utilization as a standalone metric. He said he tracks scheduling lead time, which should fall as access improves, plus elective case bumps and late-running rooms — the latter, measured at 7 and 9 p.m., improved 20% year over year at UI Health Care. Dr. Dorotta has dropped block utilization entirely in favor of collectible time. He also considers staffed-room utilization when deciding whether to open another OR; at Loma Linda, approaching 75% tends to trigger concerns about access.
Mr. Danielson pointed to a related blind spot: a strong block utilization number can still hide a surgeon sitting on far too much time. He described a general surgeon whose block utilization ran about 85% because he released blocks heavily; the more telling figure was how much of the surgeon’s total allocated block time was actually used, including the time he released.
“You might have a block utilization of 75% or 80%, but your total block allocation is only 55% or 50%,” he said. “If you’re only using 50% of the total block that’s allocated to you, you clearly have too much time.”
