By Ashley Walsh, MHA

Over the past few months, hospitals and ambulatory surgery centers have postponed thousands of surgeries due to the COVID-19 pandemic. Rough estimates indicate that approximately 70% of elective surgeries in the United States have been put on pause. This decision has not only affected patients; it has also created remarkable complexities for hospitals that want or need their biggest revenue generator—the OR—to function at capacity.

As COVID-19 cases across the United States move closer to anticipated peaks, hospitals are beginning to consider when and how they should resume elective surgeries. While various medical societies have issued guidelines to plan for the resumption of elective surgeries, many hospitals remain overwhelmed by the actual tactics that should be executed in preparation for OR recovery. The following seven steps may aid in that effort:

1. Estimate Backlog

The first step is to gain clarity about the size of the backlog you have as a result of COVID-19 and how much time it may take to recover. To wade through the complexity and data involved in providing an estimate, free online tools are emerging that can calculate volume and dates that will align with when you can expect to return to capacity. Alternatively, you can pull data from existing systems and work with your data science team to create dynamic predictive models that you will revisit daily.


Consider the following factors:

  • baseline monthly surgery volume before COVID-19;
  • the percentage of baseline cases you are seeing during COVID-19;
  • the date when you started postponing elective surgeries;
  • the date when you expect to reach 50% capacity, 75% capacity and 100% capacity;
  • levers to accommodate surge volume;
  • the volume of new cases that you anticipate based on COVID-19 (e.g., surgeries resulting from car accidents have likely decreased because of fewer cars on the road); and
  • the volume of cases you expect to lose based on people losing their jobs and/or health insurance.

2. Identify Real Surgical Capacity

Think about potential constraints in terms of staffing and available beds. When doing so, factor in what is actually possible: Can you open up more rooms? Can you stay open longer hours or stay open on the weekends? Can you divert some procedures to other types of rooms?

When you look at which levers to pull, it is vital to consider your staffing model and all of the people it must accommodate, from the surgeons and nurses to the anesthesiology, support and supply teams. A good way to gauge what is realistic is to survey the people involved (Figure).

Figure. Biggest obstacles to restoring elective surgery caseload post COVID-19. In a recent survey by LeanTaaS of 425 respondents from the country’s top hospitals and health systems, staffing was the biggest concern for restoring elective surgery caseloads after COVID-19.

Once you understand staffing, you have to factor in bed availability. For example, how many standard versus surge/overflow beds do you have, and how many can you use? How many beds are “off-limits” because they are needed for other demand? Are there low-acuity/high length-of-stay patients who can be safely transferred to other facilities to free up beds? These are just some of the options to consider.

3. Rethink the Block Schedule

The goal is to maximize utilization. As such, reconsider a temporary and/or partial redo of the block schedule to put the ORs in a better position to catch up with your backlog. In doing so, think about the service lines or surgeons that are of strategic importance. You may want to prioritize their needs, or you might become stricter in terms of enforcing policies regarding room usage or robots.


Many facilities simply can’t change their block schedule, however. In these cases, increasing the auto-release lead time could be a way to free up more time sooner for others. Consider shifting to auto-release two-plus weeks out for as many blocks as possible, and use a waiting list to fairly allocate unblocked time.

4. Make It Easy for Clinics

To get back on track, providers need to know what is available to them. Clear communication is a must. You want to make it as simple as possible to understand what they can and cannot use, and what the rules are regarding space and time in this new normal.

Provide easy access to the right time for the right providers. Make it simple to request and gain approval for open times or release blocks that are not full. Also be sure to configure around your constraints.

5. Execute as One Team

Execution is as important as your strategy. Therefore, teamwork is a requirement within the perioperative team, across the hospital, and even with ancillary services and payors. Communicate the urgency and rally the team around a common goal. You may need a “war-room” mentality with multiple huddles to make decisions based on your constraints and changing daily dynamic, with those decisions clearly conveyed to all relevant parties.


On top of consistent huddles, making data available and transparent across departments can help increase the visibility and communication around surge needs.

6. Continuously Measure and Iterate

While you will likely be checking and updating key metrics daily, it’s important to review volume and the state of your backlog every few weeks to assess progress. You want to see the effect of the measures you are taking and determine whether they need to be adapted.

One thing you’ll want to pay particular attention to is staff morale. How are people doing? Are strategies such as extending the workday having a detrimental effect? You might need to reduce some extra shifts to preserve the quality of care.

7. Be Prepared for the Next Wave

No one knows what exactly will happen with COVID-19. Once social distancing restrictions ease, we may see additional surges, in which case plans will be reinstituted. The important thing is to learn from what your hospital has done. Execute plans and adapt as needed.

Ashley Walsh is the senior director of Client Services for LeanTaaS.