The cost of running an operating room is significant - it is estimated that the cost of the use of a routine operating room at UCSF Health System is $69/minute. This means that any unused operating room time is a significant loss of money. On any given day, an operating room is used for multiple cases. Once one case finishes, a cleaning staff comes into the OR to clear away trash and the OR staff takes away supplies from the previous case and sets up supplies for the next case. The anesthesia team also must prepare for their next case in having all of their supplies and medications ready.

Despite the fact that this "turnover" happens multiple times a day in every operating room in the hospital, turnover times vary widely. At times, turnover can happen in 10 minutes, whereas at other times (but under the same circumstances/same cases), those turnover times can exceed an hour. The cost from these lost minutes of OR time is astounding. That extra 50 minutes of unused OR time costs the hospital $3,450 - and this lost time is occurring in every operating room, multiple times per day. For example, choosing one random day to look at the Parnassus OR schedule, the mean turnover time for scheduled cases was 52.2 minutes, with a total of 1776 minutes of turnover time, costing $122,544 (if using the $69/minute cost). We know that turnover can happen much faster when people are properly incentivized.

I propose using a monetary incentive program to reward staff to decrease turnover times by providing a monetary reward for turnover times that are below a goal number of minutes. This incentive should be directed towards all members of the team to encourage buy-in and participation. This has been done in other hospitals and has been shown to significantly reduce turnover times and costs related to unused OR time. We could institute this at either San Francisco General Hospital, or UCSF Health System, or both.