The list starts late for boring reasons
First-case on-time start is the single number that predicts the day. The delay is rarely surgical — it is consent not signed, investigations not traced, or the patient not wheeled. Each is a desk fix, not a doctor fix.
Turnover time is a chain, not a room
Between cases, cleaning, instrument sets, and the next patient’s readiness run in sequence when they could overlap. Mapping who waits for whom, once, usually finds thirty minutes a day without anyone working faster.
| Item | Standard | Consequence / owner |
|---|---|---|
| First-case start | Consent, NPO, files verified evening before | Ward + OT desk |
| Turnover gap | Overlap cleaning with next-case prep | OT coordinator |
| Same-day cancellation | PAC at T-72h, not T-0 | Anaesthesia + scheduling |
| Emergency squeeze | Protected elective blocks | OT committee |
| Instrument delay | Set inventory matched to list, day before | CSSD |
Cancellations are the expensive silence
A same-day cancellation wastes the slot, the team, and often a bed-night that preceded it. Most trace to a pre-anaesthesia check that could have happened seventy-two hours earlier. The fix is scheduling, not surgery.
What to do on Monday
- Measure first-case on-time start for two weeks; publish it.
- Move the pre-anaesthesia check to seventy-two hours out.
- Map one day’s turnover chain: who waited for whom.
Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.