Across the country, health systems continue to invest in operating rooms while surgeons still hear the same message: there isn’t enough OR time. Yet when organizations take a closer look, the story is often more complicated. The challenge is not always a lack of capacity. More often, it is knowing how to make existing capacity visible, accessible, and trusted.
Over the years, I have come to believe that many of our operating room challenges are not simply operational. They are behavioral. Surgeons make decisions based on experience, not spreadsheets. When access to OR time feels unpredictable or the rules seem unclear, people naturally protect what they have. That isn’t resistance to change. It’s a rational response to uncertainty.
That is the story I want to tell. Not a story about software or scheduling algorithms, but about trust. Because technology can reveal opportunity, but only people can unlock it. The real work is creating an environment where surgeons believe the system will work for them, not against them. Once that happens, capacity that always existed can finally be used to improve access for patient
Hoarding is a rational response to famine
When a surgeon protects block time, that is not selfishness. That is learned behavior, and we taught it. If you release time and cannot get it back when you need it, you learn not to release time. If the process for requesting open time is slow, opaque or politically expensive, you learn to build your own reserve. If every operational initiative you have lived through ended with you having less autonomy than before, you learn to treat the next one as a threat.
Block time can be a proxy for control. In an environment where surgeons control less and less of their working lives, a protected block is one of the few things that still feels like theirs.
When leaders stand up and complain about hoarding, they are complaining about a symptom while defending the disease. You do not fix hoarding with a memo about collaboration. You fix it by ending the famine, or by proving the famine was never real.
That distinction matters. Ours was never real. And demonstrating that, repeatedly, in ways surgeons could feel rather than read in a dashboard, was the entire job to improve access .
The moment we almost lost the room
Our most consequential change was not glamorous. We moved block auto-release deadlines to align with how far in advance cases were actually being scheduled. Our release timing had drifted badly out of sync with real scheduling behavior. Time was technically available and functionally invisible.
Surgeons heard something different. They heard, “We are taking your time away.”
They were not being irrational. They were pattern-matching against a decade of experience.
Here is where most leaders make the fatal error, and I have made it myself. They walk into the room and open with the technology. The moment you lead with the tool, you have told everyone in the room that this is being done to them. The tool becomes the antagonist and you become its representative. No amount of accuracy in the model will rescue that conversation.
Technology is infrastructure. It belongs in the plumbing, not on the stage. What belongs on the stage is a clinical leader saying, in plain language: this is about your patients getting to the OR sooner. It is not about taking your time.
And that message only lands if a surgeon delivers it. Not the CFO. Not the consultant. Not the vendor. Someone who has stood at that table at two in the morning and knows exactly what it costs to be told there is no room.
Trust followed the experience, not the argument
We did not convince surgeons with presentations or dashboards. We earned their trust by changing the experience.
Working with LeanTaaS, we used predictive analytics to understand how surgeons were actually scheduling cases, rather than how we assumed they were scheduling them. One insight stood out immediately: our block release deadlines were poorly aligned with real scheduling behavior. Operating room time was technically available, but it wasn’t being released early enough for another surgeon to realistically use it.
Instead of asking surgeons to simply “share more,” we redesigned the process. Using data from LeanTaaS iQueue for operating rooms, we adjusted automatic block release timing to match actual scheduling patterns and created a more transparent way for surgeons to see and request newly available time. The technology did not create more OR capacity. It made existing capacity visible and accessible when it could still make a difference.
That change mattered because surgeons experienced something they had not experienced before. A surgeon could release unused block time, and when they later needed additional access, the process to obtain it was predictable, timely, and fair. The system no longer penalized collaboration. Once that happened repeatedly, trust began to replace skepticism.
The operational results reflected that change. We increased released OR time by approximately 20%, with nearly half of that time backfilled by other surgeons. Release fill rates reached 46% across the OR and endoscopy and 51% within the OR alone. Among surgeons who actively requested open time, OR case volume increased by 8% and endoscopy volume by 13%, while prime-time utilization improved by 3%.
What I find most remarkable is not the numbers themselves. It is what produced them. We did not build another operating room. We did not hire more staff. We simply used data to better align policy with how surgeons actually work. Sometimes the greatest opportunity is not creating new capacity. It is finally making the capacity you already have work for your patients.
From ‘my block’ to ‘our patients’
The real transformation is not in that data I just quoted. It is in a sentence I now hear regularly and never used to: “I don’t need that block, give it to someone who does.”
That sentence is the whole project. It represents a shift from block time as property to block time as a shared clinical resource. From protecting my access to protecting our patients’ access. From a zero-sum reading of the schedule to something closer to a service line that behaves like a team.
And I want to be direct about why this matters beyond throughput. A scarcity mindset does not stay in the scheduling office. It metastasizes. It shows up as territorialism between services, as reluctance to cover a colleague, as the quiet erosion of the collegiality that makes a department safe to work in. It burns people out, and it does it slowly enough that nobody names the cause.
When you remove artificial scarcity, you are not just booking more cases. You are removing a standing reason for your surgeons to see each other as competitors.
What I would tell another leader
Diagnose the belief, not the calendar. Your utilization data tells you what is happening. It does not tell you why. The gap between perceived scarcity and actual access is where your problem lives, and you cannot see it in a report.
Never open with the technology. Lead with the patient, lead with access, lead with what your surgeons lose today. The tool should be almost boring by the time it is mentioned.
Put a clinician in front of the room. Credibility is not transferable. If the message needs to be heard by surgeons, it needs to come from one.
Make the first experience reciprocal. Nobody gives up perceived control on faith. They give it up after the system has proven, more than once, that giving is not punished.
Expect the skepticism and do not take it personally. It is earned. It is evidence that your colleagues have been paying attention. Treat it as data about your organization’s history rather than as an obstacle to your initiative.
Say the quiet part out loud. Surgeons are not resisting change. They are resisting loss. Name that, and you can actually have the conversation.
What ‘getting it right’ looks like at scale
Scaling this is not a matter of pushing the same tool into more service lines. It is a matter of keeping three things aligned: the technology, the clinical leadership, and the engagement of the people whose behavior actually determines whether any of it works. Drop any one and the other two stop mattering.
Getting it right at scale means access to care stops being something surgeons have to fight for. It means data-driven decisions become unremarkable, part of how Tuesday works rather than an initiative with a name and a steering committee. It means we extend this thinking past scheduling into perioperative flow more broadly, because the OR is one node in a system and optimizing it in isolation only relocates the constraint.
And it means we stop building for capacity we already have.
The time was always there. What changed is who we believed it belonged to.
Dr. Ferrada is chair of the department of surgery and medical director of perioperative services at Inova Fairfax Medical Campus, professor of medical education at the University of Virginia, and division and system chief of trauma and acute care surgery at Inova Health System.
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