It is no secret that operating rooms (ORs) nationwide are facing significant challenges as surgical demand continues to rise, cases become more complex and critical staffing shortages are stretching surgical and anesthesiologist teams to their limits.
Instead of accepting these limitations as inevitable, our team at MultiCare Health System chose to engineer a fundamental transformation that would redefine surgical efficiency.
The turning point came when our leadership recognized that traditional top-down administrative approaches were failing. The old model—with ORs locked in rigid block scheduling and hospitals treating resources as competitive rather than collaborative—was creating bottlenecks that limited patient access and frustrating both providers and administrators. MultiCare chose a new path, strategically leveraging predictive analytics and AI-driven scheduling as a catalyst to fundamentally reimagine our perioperative operations. The results were striking. Within just a few years, we achieved a 50% increase in annual surgical case volume, a 20% reduction in operating rooms used and a dramatic leap in pre-staffed OR cases from 500-600 to 900-1,000 annually. These weren't just numbers—they represented real improvements in patient access, provider satisfaction and healthcare delivery.
Shifting culture by investing in physician-led governance and data-driven decision making
MultiCare was no different than many other leading health systems across the nation a few years ago—our data was not believable or transparent, our ORs were locked in block and poor release times by surgeons left a lot of time on the table. OR access across our system was a touchy subject, with resources and equipment traditionally viewed in a competitive nature by the multiple hospitals in our health system. That was until our executive leadership team recognized that in order to break down these existing barriers, MultiCare needed to invest in a cultural shift—transitioning from a very top down administration and OR structure to one that put our physicians at the helm of decision-making. Shifting to physician-led governance and putting trust in our physicians to make the best decisions and drive what is right for the whole proved to be a cultural pivot point for MultiCare: we were finally bringing the “family” back into the OR. This was the key ingredient to start working more collaboratively across our health system.
Once our physicians started to feel heard, trusted and empowered by leadership, we were able to collectively focus on solving the challenges that persisted in our ORs like inefficient surgical scheduling and resource allocation, looking to data to drive in our decision-making processes. Partnering with LeanTaaS and leveraging tools like iQueue for Operating Rooms has been transformational and has allowed MultiCare to gain visibility into our daily metrics, surgical blocks, OR utilization, prime time utilization and staff room utilization for the first time. This new level of transparency has also allowed MultiCare’s physician-led committee to stop talking about blocks as the only way to access the OR.
These seemingly simple changes have also been instrumental in sharpening our focus on access and utilization, taking into account all competing perspectives across the OR—surgeons, anesthesiologists, nurses and hospital administration. By leveraging data, predictive analytics and AI-driven scheduling models, OR leaders at MultiCare now host weekly meetings with all OR stakeholders. These collaborative sessions allow us to identify emerging trends, share real-time insights across surgical teams, and make proactive, data-driven decisions that optimize OR access and utilization.
Aligning stakeholders around a shared definition of "good OR access” and planning for the “unplanned”
At the heart of any successful system change is securing buy-in from all stakeholder groups—including clinicians—and not just in areas like scheduling and resource allocation but on the overall philosophy of the data-driven approach. In our case, this came in the form of looking beyond improving OR access to determine and align on what “good” OR access actually meant at MultiCare. This type of alignment within the organization promoted a sense of ownership and accountability to ensure decisions reflect the interests of the entire hospital system while also significantly improving surgeon engagement.
Once our team was in agreement about shared definitions that would help advance our data-driven approach, we spent time really looking at the key performance metrics such as prime time and staff room utilization with surgeons to foster a more transparent dialogue around capacity, as well as block allocation alignment with budget projections. As an organization, we also stopped reviewing our hospital budgets, case volumes and allocation plans in isolation, and began considering how these elements intersected. For example, in urology, resources were under-allocated, while others such as orthopedics, were over-allocated. This created a disconnect that often led to missed opportunities for optimization. This exercise helped identify areas where adjustments were needed, allowing tools like iQueue to identify "collectable time"—or larger gaps in scheduling that can be better utilized and repurposed to realize more case volume.
When we started to bring real-time visibility to all available open time and look at the “balance sheet”—or our allocated time versus our open time versus our add-on urgent and emergent time—it was evident that we could now start to plan for what was previously “unplanned.” For example, at our hospital, MultiCare Tacoma General, we identified 20% of cases were urgent add-ons, but we were only allocating 5% of available time for such cases. Leveraging this data, Tacoma General shifted their allocated block time to create more flexibility for urgent cases, ensuring that both planned and unplanned cases were accommodated without disrupting scheduled procedures. This data-driven decision making on how to utilize time and resources has helped us more than anything.
Importance of system-wide standardization of processes to build resilience
On a system-wide level, MultiCare has made significant strides by adopting standardized processes across facilities such as regional scheduling protocols. The implementation of the new AI-powered platform at all locations ensures that everyone is working from the same data set and adhering to consistent scheduling standards. This standardization allows cases to be moved seamlessly between facilities based on available capacity, rather than being constrained by individual hospital schedules.
These same data-sharing and operational processes have also opened up more dynamic conversations among OR leaders across regions, creating forums for leaders to exchange best practices and solve problems together. These new processes haven’t just led to better conversations. Our health system has fundamentally changed with these implementations. We are no longer competing for volume across hospitals but rather collaborating on how to best use resources across the system.
Our investment in these system-wide changes has made us a stronger health system, fostering resilience and creating a solid foundation to handle whatever challenges come our way. As seen recently with the IV fluid shortage, our surgeons were able to take an active role in co-leading efforts to fairly distribute these scarce resources, ensuring patient needs were met and underscoring the importance of data-driven decision-making alongside active team engagement.
The future of surgical care delivery is collaborative
Driving meaningful change across a health system requires strong leadership and a deliberate focus on people, processes and programs. Success begins with placing the right individuals in the right roles, equipping them with effective processes, and providing the tools and support they need to excel. When programs are well-directed and aligned, teams can collaborate seamlessly, empowering health systems to confidently tackle any challenge.
MultiCare’s adoption of a data-driven and AI-powered approach has been crucial for us to stay competitive and meet the growing demand for surgical care, all while being more collaborative across the system than ever before. By embracing a culture of continuous improvement, healthcare organizations can shape the future of surgical care delivery.
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Chris Hunt and Dr. Wesley Hart sat down with Scott Becker to discuss MultiCare’s perioperative transformation in a recent episode of the Becker’s Healthcare Podcast. Listen to the podcast here.
Additionally, the MultiCare team presented this work at Transform Hospital Operations Virtual Summit on December 10, 2024. Watch the full virtual session on demand to learn how MultiCare’s proactive, data-driven approach to block management and regional scheduling structures transformed operational decision-making and how these successes can be replicated across other health systems.