How Alameda Health System Turned Underused ORs into a High-Performing Perioperative Program

Facing post-pandemic staffing challenges and financial pressures, Alameda Health System (AHS) identified its perioperative departments as a key opportunity to drive systemwide operational improvements and cultural change. AHS partnered with FTI Consulting to restructure and redesign its perioperative operations. This transformation focused on establishing a governance structure, aligning block schedules with true service-level demand, creating a culture of accountability through transparent data and consistent policy enforcement, and achieving a positive financial impact.

Setting the Stage: AHS' Operating Room (OR) Utilization Gap

As the primary safety net provider serving Alameda County, Calif., AHS operates a network of five hospitals and four wellness centers, including Highland Hospital, a level I trauma center, and San Leandro Hospital. Before its optimization initiative, AHS perioperative teams faced inconsistent scheduling practices, limited visibility into data, consistently low utilization, and ad hoc after-hours case planning. The absence of clear governance structures led to inefficiencies, unpredictable daily workflows, and staff frustration.

Three Steps to a Smarter OR Schedule

The initiative began with a workforce and operational assessment that revealed three critical needs to help support a block schedule and staffing schedule redesign:

1. An enterprise-level governance structure (see Fig. 1 for established governance structure)
2. A comprehensive scheduling policy
3. Clear and trusted performance metrics

AHS and FTI Consulting developed and implemented a new systemwide scheduling and governance policy, which:

• Defined prime-time hours and expectations for surgeon arrival and booking
• Introduced processes to reduce inappropriate after-hours and weekend cases
• Codified performance management expectations.

The team also launched an executive-level perioperative dashboard and dynamic surgeon scorecard to track utilization, on-time starts, and turnover times (see Fig. 2 for image of sample surgeon scorecard). These tools enabled the governance committee and executive leaders to use accurate and clear data for decision-making and maintain fairness and transparency in scheduling.

Results: Increased Utilization, Predictability, and Engagement

Since implementing its new perioperative governance, scheduling policies, and data tools, AHS has realized a reduction of more than 100 staffed OR hours per week and an increase in block utilization of approximately 10-20 percentage points at both Highland and San Leandro Hospitals. Services that previously were scheduled only one to two weeks in advance are now being booked several weeks out, improving access and predictability for patients and staff alike.

"Our staff now come in knowing that every OR will be in use each morning-it's created consistency across the department," said Laura Lang, MD, chief of perioperative services at Alameda Health System.

To sustain these gains, AHS continues to refine perioperative operations by reducing turnover times through process redesign, expanding surgeon scorecards across all service lines, optimizing open scheduling, and maintaining an engaged, empowered OR governance structure to reinforce accountability and adherence to policy.

Three Takeaways for Essential Hospitals

As AHS continues its transformation journey, its perioperative redesign demonstrates how collaborative governance and operational discipline can enhance efficiency and financial performance across essential hospitals.

AHS' experience offers a blueprint for peer systems:

1. Align block schedules to true demand using historical data and service-level analytics.
2. Create clear governance structures with transparent key performance indicators.
3. Integrate cultural and operational change to sustain surgeon and workforce engagement and long-term efficiency gains.

To learn more, reach out to FTI Consulting's health care business transformation experts, Chris Sdao and Leisa Maddoux.

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