Why did Dr. Rogers feel this was such an important priority? He wanted to maintain and control all the related case data so that he could monitor surgeon scheduling requests and monitor block utilization. This was a new and revolutionary role for a department of anesthesia. His director of OR management, Dr. Robert Donham, was quoted as explaining that he had the necessary qualifications for the job. He was a board-certified anesthesiologist. He had a PhD in industrial engineering. And he was a retired Green Beret. So, he felt that he knew how to manage surgeons. The result was one of the most efficiently run operating room suites, according to most assessments.
Many years later, the co-chairs of anesthesiology at a large west coast practice negotiated a similar arrangement for their facility. They arranged for the department of anesthesiology to assume responsibility for OR management and for the entire OR team, including nursing. Their belief was that a unified management structure would allow for more effective and efficient OR management. Such a structure represented a dramatic paradigm shift for the department of anesthesiology, which raises the question of whether anesthesiologists are missing out by not exploring this greater role in OR management.
Distinct Objectives and Creating Value
OR management represents the intersection of two distinct organizations with two distinct sets of objectives. The OR scheduling team is the surgeons’ primary source of contact. Their goal is to fill the schedule while accommodating surgeon preferences as much as possible. In today’s competitive business environment, they strive to make surgeons as happy as possible so that they will continue to bring their cases to the hospital. From the administration perspective, this is always a top priority because every surgical case represents revenue to the facility.
Anesthesia departments have a different priority, which requires a unique strategy for success. Anesthesia is an expensive service to provide, especially given the rising cost for qualified providers. Their goal is to ensure that the revenue from surgical and obstetric cases covers the cost of providing the care, which is an ever-increasing challenge. As anesthesia departments renegotiate their contracts with the facilities they serve, budgeting becomes an ever-greater challenge. Although anesthesia subsidies keep increasing dramatically, managing the cost of anesthesia services is an ever-growing problem.
For anesthesia groups, leadership can make a real impact. By taking an active role in OR management, anesthesia departments can help create lean, profitable operating rooms—reducing inefficiencies, improving throughput, and ultimately helping control the need for stipends.
Why Anesthesia Should Lead OR Efficiency
While some practices hesitate to assume responsibility for OR scheduling, the upside is compelling. Anesthesia already holds the most accurate and detailed case data, including billing and time metrics. This positions anesthesia uniquely to:
- Leverage Data for Better Decisions – With comprehensive case-level insights, anesthesia can optimize scheduling and resource allocation.
- Improve OR Utilization – Accurate case duration estimates reduce delays and idle time, increasing productivity.
- Drive Financial Performance – Efficient ORs mean fewer wasted resources, stronger margins, and reduced subsidy pressure.
Data is the key to effective OR management—and anesthesia owns the data. By stepping into this role, anesthesia can strengthen its partnership with surgeons and facilities, enhance its value proposition, and help shape a more sustainable financial model for everyone involved.