Why Health Systems Are Investing in OR Forecasting: What We’re Hearing from Leaders
By Caleb Lush, Chief Revenue Officer, ORlogic
I spend a lot of time on the phone with surgical service leaders, CFOs, and OR directors. And over the past year, the conversations have shifted in a noticeable way. It used to be that forecasting felt like a nice-to-have — something health systems might get around to once they’d tackled more pressing problems, or something that they think their current tech stack will eventually get around to. When I speak with these representatives of health systems, they often tell me they think their current stack should be able to tell them a more accurate forecast of how many rooms they’ll actually run, and whether or not they’re staffed to do so, but the simple fact is it doesn’t.
The short version: margin pressure and workforce strain have finally collided in a way that makes the operating room impossible to ignore. Surgical services can represent 60 to 70 percent of a hospital’s revenue, and yet most health systems are still managing their ORs with tools that weren’t built for the complexity they’re dealing with today. Leaders are starting to connect the dots between better forecasting and two things they can’t afford to lose: fiscal responsibility and the people who make the OR run.
The Financial Reality Has Changed
Every health system leader I talk to is navigating a version of the same story: margins that were already thin have gotten thinner. Reimbursement rates haven’t kept pace with the cost of delivering care. Labor expenses, particularly in surgical services and especially anesthesia, have climbed sharply. And the post-pandemic backlog that was supposed to generate revenue has been harder to clear than anyone anticipated.
What leaders already know is that the OR is where the biggest financial levers actually live. An underutilized OR block is revenue that simply evaporates. An understaffed shift that ends in a cancelled case is cost with no return. And the scheduling inefficiencies that have been tolerated for years — the gaps, the add-ons, the cases that run long and push everything else — add up to millions of dollars annually when you put a number to them.
Forecasting gives health systems the ability to get ahead of that. When you can predict case volume with reasonable accuracy and anticipate staffing needs before they become a crisis, you stop reacting and start managing. Directors up to the C-suites I’ve spoken with describe it as finally having a line of sight into surgical services that they didn’t have before. That visibility is worth a great deal when every percentage point of margin matters.
The Staffing Problem Is Driving Urgency
If the financial pressure is what gets the conversation started, the workforce crisis is what gives it urgency. OR staffing — nurses, surgical techs, anesthesia providers, support staff — is one of the most difficult and expensive staffing challenges in healthcare right now. The experienced people are burning out, retiring, or shifting to part-time work. Replacements are hard to find and expensive to onboard. And the nature of OR work means you can’t easily flex staffing up and down the way you might in other departments, without considerable dependence on locums.
What I hear from OR Directors is that unpredictability is the enemy. When their teams don’t know what to expect from one day to the next — when a Tuesday suddenly turns into a twelve-hour shift with three add-on cases, or when they come in staffed for a full schedule and half the cases cancel — it wears people down. When they have to call people in to cover, sure, they’ll often say yes – but silently, they’re frustrated. Over time, that unpredictability creates a retention problem. People leave for positions that feel more manageable, more predictable, more sustainable.
OR forecasting directly addresses this. When leaders can better anticipate case volume and case mix, they can staff more intelligently and with more foresight to proactively adjust instead of scrambling to make changes day of or the day before. They can build schedules that reflect what’s actually likely to happen, rather than planning for a best case that rarely materializes. They can reduce the number of times they’re calling staff in on short notice or sending people home early with no pay or having to pay out on hours that aren’t worked. This is the part of the conversation that resonates most — not because it’s just about money, but because they genuinely care about their teams and know that losing good people is a wound that’s hard to recover from. It wears on them to have to make these last-minute changes and potentially upset their staff as well.
Surgeons Are Part of the Equation Too
It’s easy to think about OR forecasting as a back-office problem — something that matters to finance and operations but doesn’t really touch the clinicians. That’s not what I’m hearing. Surgeons have their own frustrations with how ORs are managed, and those frustrations are increasingly becoming a recruitment and retention issue for health systems.
A surgeon who shows up for a scheduled case and finds the room isn’t ready, or the staff wasn’t called in, is a surgeon who loses confidence in the institution. These aren’t small things. Surgeon relationships are foundational to surgical volume, and surgical volume is foundational to financial performance.
When health systems invest in better forecasting, they’re also investing in the surgeon experience. When staffing is forecasted accurately, rooms are ready, teams are in place, and cases start on time. That means fewer delays, fewer scrambles, and fewer days that start already behind. These are the operational conditions that keep good surgeons engaged — and engaged surgeons bring their cases to your facility.
What “Good” Looks Like Is Getting Clearer
One thing that’s changed in recent years is that health system leaders have a much clearer picture of what effective OR management actually looks like. Benchmarking data has gotten better. Peer conversations at conferences are more candid. And a handful of health systems that have made serious investments in surgical analytics have started to share results that are hard to dismiss.
When leaders can see concrete examples of what’s achievable — meaningful reductions in case cancellations, improvements in first-case on-time starts, lower overtime costs, lower locum costs — it shifts the conversation from “is this worth doing?” to “what is it going to take?” That shift in framing is significant. It means the skepticism that used to slow these conversations down has largely been replaced by practical questions about implementation and return on investment. Saving just 1% on anesthesia costs, for example, can save a system $60,000–70,000 a year, per anesthesiologist.
For us at ORlogic, this is the part of the market moment that feels most meaningful. We’re not spending as much time explaining why OR forecasting matters — most leaders already understand that. We’re spending more time on the question of why doesn’t this already exist, how to do it well, how to integrate it into existing workflows, and how to make sure the insights are actually used by the people running the OR day to day.
The Leaders Who Are Moving Fastest Have One Thing in Common
Across all the conversations I’ve had, there’s one pattern that stands out in the health systems that are making real progress on OR forecasting: they have leaders who are willing to own the problem across organizational silos. OR efficiency isn’t just a nursing issue, or a finance issue, or an anesthesia issue, or a surgical scheduling issue. It sits at the intersection of all of those, which means solving it requires people who can work across those boundaries and align around a shared goal.
The most effective engagements I’ve seen have a champion who can connect the dots — someone who understands the clinical realities of the OR and can translate them into financial and operational terms that resonate in the boardroom. When that person exists, and when they have organizational support to make changes, the results tend to come faster and stick better.
That kind of leadership isn’t always easy to find, and it isn’t always easy to sustain. But health systems that have built it are seeing what’s possible when the OR is managed with the same analytical rigor that other parts of the enterprise take for granted. And they’re the ones who can see labor costs going down, case volumes going up, and provider satisfaction growing.
One More Hurdle: Technology Fatigue
There’s another thing I hear in these conversations that doesn’t always make it into the formal business case: exhaustion. Health system leaders are tired. Tired of multi-year EMR implementations that consumed enormous resources and delivered results that were slower to materialize than promised. Tired of scheduling software rollouts that required months of training and change management before anyone saw a benefit. Tired of being told that the next platform will transform operations — and then living through the reality of what that actually costs in time, money, and organizational goodwill.
That fatigue is legitimate, and it shapes how leaders approach any new technology conversation. The question isn’t just “will this work?” — it’s “what is this actually going to ask of my team?” When you’ve watched a large-scale implementation grind through your organization for two years, the bar for adding anything new to the stack gets understandably high.
This is why the implementation story matters as much as the product story. OR forecasting tools that require months of custom configuration, dedicated IT resources, and extensive staff retraining before they deliver value are going to face resistance — not because leaders don’t want better forecasting, but because they’ve been burned before. The tools that are gaining traction are the ones designed to integrate with existing systems without becoming a project in their own right. They work with the data health systems already have, layer on top of workflows that are already in place, and are built to show value quickly rather than after a lengthy onboarding process.
The most receptive leaders I speak with aren’t looking for another platform to manage. They’re looking for something that makes their current environment smarter — quietly, without drama, and without requiring a change management initiative to go along with it. That’s a meaningful design constraint, and it’s one that the best solutions in this space are taking seriously.
Where This Is Heading
The urgency around OR forecasting isn’t going to let up. The financial pressures on health systems aren’t going to disappear, and neither is the competition for skilled surgical staff. If anything, both are likely to intensify. The organizations that build strong forecasting capabilities now are building a structural advantage — in cost management, in staff retention, in surgeon satisfaction, and ultimately in their ability to serve patients.
What encourages me most is that the leaders I speak with aren’t approaching this as a technology problem to be solved. They’re approaching it as an operational capability to be built — one that requires the right data, the right tools, and the right people working together. That framing is the right one, and it’s what separates the health systems that will see lasting results from those that will cycle through point solutions without ever really solving the underlying problem.
The conversations I’m having today feel different from the ones I was having when I started with ORlogic. There’s more clarity, more urgency, and frankly more optimism about what’s achievable. That’s a good sign for the field — and an important one for the patients and caregivers who depend on the OR working the way it should.