Operating room leaders across the country agree: Performance is being squeezed from every direction. Growing demand, workforce constraints and operational complexity are testing the limits of perioperative capacity. As a consequence, many organizations are rethinking scheduling, staffing models and technology investments to improve throughput and reliability.
The leaders featured below are speaking at Becker’s Perioperative Summit, Sept. 14-15, 2026, at the Hilton Chicago.
If you would like to join the event as a speaker, please contact Scott King at sking@beckershealthcare.com.
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their perspectives on key issues in the industry.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What constraint most limits OR performance today?
Donise Musheno, BSN, RN. Vice President of Perioperative Services for Lancaster (Pa.) General Health, Penn Medicine: Staffing — as reflected in vacancy rates, reduced experience levels and limited workforce agility — is the most significant constraint impacting OR performance today.
Vacancy: Vacancy rates remain elevated across key perioperative roles — particularly surgical technologists, anesthesia providers and sterile processing technicians. Declining enrollment in training programs, compensation trends that outpace general inflation and competition from less demanding entry‑level roles contribute to persistent shortages. These gaps reduce OR throughput, destabilize daily schedules and limit the organization’s ability to sustain consistent surgical access.
Experience: A growing share of the perioperative workforce is new to practice or has limited tenure within the organization. Lower experience levels result in longer room turnovers, greater variability in case durations and higher risk for process deviations. This variability directly weakens OR efficiency, workflow reliability and overall quality performance.
Agility: Workforce agility is increasingly difficult to maintain. Aligning staff availability with block schedules, emergent case demands and unplanned absences has become more complex. At the same time, growing interest in non‑traditional work hours complicates coverage models. These pressures limit the OR’s ability to flex capacity in real time and respond effectively to daily operational needs.
Jarrett Heard, MD. Medical Director of Ambulatory Perioperative Services and Director of Executive Leadership and Business for The Ohio State University Wexner Medical Center (Columbus): Time is the biggest constraint. Patients are typically scheduled for surgery before the perioperative process begins, putting us at risk for disruptions to getting patients ready, safely for surgery. Patient optimization, loss to insurer/prior authorization, pavilion scheduling, case length accuracy and OR turnover are all time-based limitations that are often addressed after a patient is scheduled for surgery. A paradigm shift in how we get patients ready for the OR, leveraging the electronic medical record using predictive algorithms and AI scheduling will be the solution to this long-standing problem.
Chris Hunt, BSN, RN. Associate Vice President of Perioperative Services for MultiCare (Tacoma, Wash.): Many operating rooms continue to try and manage access through traditional OR Committees and block time. When you allocate all available prime time, you’ve literally just blocked access to your OR. High-functioning ORs eliminate the word “block” from their vocabulary, have a foundation built on physician-led governance and transform data to actionable information to ensure the right amount of elective, open and add-on time for their facility.
Grace Lim, MD. Chair of Anesthesiology, Perioperative and Pain Medicine Department for University of Utah Health (Salt Lake City): OR performance today is constrained by a compound capacity problem: in some settings, physical space is limiting; in others, perioperative staffing and support capacity are the bottleneck. Across all settings, demand is growing faster than workforce supply and we have not sufficiently reimagined care models to close that gap. The result is a persistent supply-demand mismatch that caps OR performance.
Nakeisha Tolliver, DNP, RN. Director of Perioperative Services for Texas Children’s Hospital, Pavilion for Women (Houston): One of the greatest constraints limiting OR performance today is the widening gap between rising surgical demand and the workforce needed to support it across the full perioperative ecosystem, including nursing, anesthesia, sterile processing and support roles. We are also seeing a generational shift in the workforce, with clinicians prioritizing work-life balance and fewer pursuing traditional leadership roles, which challenges long-term succession planning. At the same time, surgical innovation, robotics and AI are advancing faster than many health systems’ budgets can keep pace, while costs continue to rise. Despite these pressures, perioperative teams continue to deliver exceptional outcomes every day through resilience, teamwork and innovation. The opportunity ahead is to redesign care models, leverage automation and predictive analytics, and create flexible career pathways that make perioperative care an exciting, sustainable place to work.
Mark-Alan Pizzini, MD. Vice President of Perioperative Services and Chief of Anesthesiology and Critical Care Division for Penn Presbyterian Medical Center (Philadelphia): Operating room performance today is most limited by workforce constraints, particularly shortages in anesthesia professionals and experienced perioperative nurses and technicians. Many hospitals cannot staff all available ORs, leading to underutilized physical capacity despite strong surgical demand. Inefficiencies in scheduling and case variability, such as late starts, turnover delays and inaccurate block time allocation, further reduce throughput. In addition, limited pre-op, [post-anesthesia care unit] and ICU bed availability often create downstream bottlenecks that slow case flow. Finally, fixed physical OR space in older facilities restricts expansion, making extended hours or capital investment the only options for increasing volume.
Sunitha Abraham, DNP, RN. Associate Vice President of Perioperative and Procedural services for Jackson Health System (Miami): A major constraint on OR performance today is the compounded impact of workforce instability and operational unpredictability. Staffing shortages, cross training gaps and rising cognitive burden slow teams down, increase turnover times and erode the reliability needed for high‑throughput surgical care. This is further strained by inconsistent patient optimization, especially for add‑on or late‑scheduled cases, where inadequate pre‑operative assessment leads to day‑of‑surgery delays and cancellations. At the same time, the lack of real‑time operational visibility means teams are often reacting to problems only after they have already cascaded; without shared, actionable data, delays, room bottlenecks and schedule disruptions go unaddressed until they become capacity‑limiting. Finally, instrument readiness remains a persistent friction point: missing sets, incomplete trays and reprocessing delays create avoidable idle time and force teams into workarounds that compound stress and variability. Together, these factors form a tightly interlocking set of constraints that limit OR performance far more than any single issue on its own.
Stephen Estime, MD. Associate Chair of Anesthesiology and Critical Care, UChicago Medicine: The biggest constraint in OR performance today is fragmented decision-making. Often surgeons focus on access, anesthesia on safe and efficient staffing, nursing on labor cost efficiency, and finance on margin. These are all important goals but are not always aligned. Incentives are often tied to short-term metrics that improve this month’s numbers but subtly undermine long-term priorities like workforce stability and predictable throughput. Strong systems align shared, durable metrics (block accuracy, turnover reliability and contribution margin per staffed hour) while also looking beyond dashboards. Structured operational debriefs, attention to workarounds and tracking workforce durability help identify fragility before it shows up in performance data. When incentives, governance and visibility are aligned then quality, safety, financial performance and throughput reinforce one another rather than compete.
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