Leslie Basham, President and CEO
The American Hospital Association has reported that hospitals continue to face rising costs, workforce shortages, supply chain pressures, inflation and inadequate reimbursement. Surgical services sit at the center of this pressure. They are among the most complex areas of hospital operations, but also among the greatest opportunities to improve access, capacity and financial performance.
In 2026, the organizations that perform best will use data, governance, workforce redesign and disciplined execution to create more capacity within the surgical enterprise they already have.
Seven forces are defining that shift.
Artificial Intelligence Moves from Experimentation to Operational Performance
Artificial intelligence has entered a new phase in healthcare. The question is no longer whether hospitals should explore AI, but where it can create measurable operational value.
Recent work in NEJM AI emphasizes that sustainable AI adoption requires more than technical sophistication. Health systems need governance, business implementation, value measurement, operations, culture and information architecture to move from isolated pilots to enterprise impact. Other healthcare AI literature has similarly emphasized trust, explainability, ethics, infrastructure and regulatory alignment.
In perioperative and anesthesiology services, AI’s highest-value applications may be operational before they are clinical. AI can help forecast case duration, identify scheduling gaps, model staffing needs, support documentation, strengthen revenue cycle workflows and improve decision making around OR utilization.
But the risk is fragmented adoption. If every department selects its own tools, hospitals may create challenges around HIPAA, cybersecurity, cost control, workflow variation and data governance. The most successful organizations will govern AI, measure it and connect it to the operational priorities that matter most: access, capacity, quality, staffing and margin.
CMS TEAM Raises the Standard for Surgical Episode Performance
The CMS Transforming Episode Accountability Model, known as TEAM, began in January 2026 and runs through 2030. It is a mandatory bundled payment model for selected surgical episodes, including lower extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedures.
The American College of Surgeons notes that TEAM requires more than 700 acute care hospitals in 188 markets to assume financial risk for five surgical episodes from admission through 30 days after discharge.
For perioperative leaders, TEAM is more than a reimbursement model. It is a performance model requiring stronger coordination before surgery, during the inpatient stay and after discharge, aligning surgeons, anesthesiology, nursing, care management, rehabilitation, post-acute partners and finance around a single episode of care.
Surgical performance no longer ends when the patient leaves the OR. Hospitals must manage variation, complications, length of stay, discharge planning and recovery with the same discipline they apply to intraoperative performance.
Workforce Shortages Are Becoming Labor Inflation
Workforce shortages remain one of the most significant pressures in perioperative and anesthesiology services. But in 2026, the issue is not only whether hospitals can find clinicians. It is whether they can afford the staffing models required to sustain surgical access.
The American Society of Anesthesiologists has warned that the imbalance between supply and demand for anesthesia clinicians poses a threat to the U.S. healthcare system, while its Center for Anesthesia Workforce Studies focuses on supply, demand, care delivery models and geographic access.
The financial impact is significant. In an internal Surgical Directions discussion, leadership cited an estimated $187,000 annual cost differential between a traveler CRNA and a W-2 CRNA. That type of premium labor dependence can quickly erode surgical margin.
The issue extends beyond anesthesia. A 2025 AORN Journal study found that the pandemic increased turnover among perioperative nurses who were already experiencing a workforce shortage.
Hospitals that treat staffing as a short-term scheduling problem will struggle. Sustainable workforce strategy requires retention, mentorship, onboarding, care model redesign, leadership development and reduced dependence on premium labor. The goal is to stabilize the workforce model that surgical access depends on.
Sterilization Quality becomes a Strategic Performance Issue
Sterile processing has historically been treated as a back-of-house function. That view is changing.
In 2026, sterile processing is increasingly recognized as a strategic driver of OR reliability, patient safety and surgical throughput. SPD resource constraints, high turnover and limited mentorship can create instrument quality problems, tray inaccuracies, delayed starts, case disruptions, rework and waste.
The transcript identified SPD turnover as a major concern, with estimated annual turnover in the 20 percent to 40 percent range, and emphasized education and mentorship as essential priorities.
When trays are incomplete, instruments are unavailable or reprocessing workflows are inconsistent, surgeons lose confidence, nurses lose time and patients may face delays.
Hospitals that want sustainable perioperative performance must invest in SPD as a critical operational partner by standardizing processes, strengthening training, building career pathways, improving OR-SPD communication and measuring instrumentation quality as a core performance indicator.
Waste Reduction Moves from Supply Chain Project to Margin Strategy
Waste reduction is becoming one of the clearest opportunities in perioperative services. Preference card optimization is a prime example.
A 2025 JAMA Surgery quality improvement study found that variation and excess supplies on surgical preference cards create meaningful opportunities to reduce cost and waste. A related commentary reported more than $1.1 million in reduced waste across three surgical specialties over five months through systematic preference card optimization.
For executives, this is not just a supply chain initiative. Preference cards affect room setup, picking accuracy, nursing workload, supply expense, inventory levels, waste disposal and case readiness.
Effective preference card work requires surgeon input, nursing engagement, SPD awareness and analytics that show what is actually opened, used, wasted and reordered.
Prime Time Utilization becomes the New Growth Strategy
Hospitals often assume surgical growth requires new operating rooms, new buildings or major capital investment. In many cases, the first opportunity is to improve utilization of existing prime time capacity.
Surgical Directions has noted that perioperative services represent one of the largest opportunities to improve financial performance. Its COO guide states that surgical services can represent up to 70 percent of hospital revenue while consuming significant labor and capital resources.
In one internal example, a hospital moving from approximately 53 percent prime time utilization to 74 percent could create capacity for roughly 160 additional cases per month. At an estimated contribution margin of $9,000 per case, that equates to approximately $17.3 million in annual contribution margin.
That example illustrates why utilization is becoming an executive-level metric. It is about creating access, increasing volume, improving surgeon satisfaction and generating financial return without immediately adding new fixed costs.
Technology can support this work, but technology alone will not solve it. Health systems need disciplined block governance, accurate case duration data, standardized scheduling rules, clear release policies, surgeon engagement and transparent performance dashboards. The hospitals that win on utilization will treat OR time as a strategic asset.
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Perioperative and anesthesiology performance can no longer be managed as separate operational issues. It must be treated as an integrated enterprise strategy.
Case Mix Strategy and Site Neutrality Redefine where Surgery Belongs
Health systems must become more intentional about which cases belong in which settings.
Site-neutral payment reform continues to gain attention as policymakers look to align payment across hospital outpatient departments, ambulatory surgery centers and physician offices. A 2024 KFF brief noted growing bipartisan interest in Medicare site-neutral payment reforms, while Health Affairs has examined how different policy options could affect Medicare outpatient payments. AHA has warned that additional site-neutral payment reductions could jeopardize access to hospital outpatient care.
For hospitals, the question is not whether more procedures will shift to ambulatory settings. The question is whether health systems will manage that shift strategically.
Case mix strategy requires leaders to protect hospital OR capacity for higher-acuity cases, complex patients, high-contribution service lines and procedures requiring hospital-level resources. Appropriate lower-acuity cases may need to move to ambulatory settings to improve access, reduce cost and free constrained hospital capacity.
Health systems must align surgeon access, service line growth, ambulatory strategy, anesthesia coverage, reimbursement economics and OR utilization into a single operating model.
The New Perioperative Mandate
The trends reshaping perioperative and anesthesiology performance in 2026 are connected. AI, TEAM, workforce shortages, sterile processing, supply chain waste, utilization and case mix strategy cannot be solved in silos.
The next generation of surgical performance will depend on integrated execution. Hospitals must know where capacity exists, where costs are rising, where variation is occurring and where cases should be performed. They must align clinicians, operators and executives around a shared strategy for access, margin and patient care.
The organizations that succeed will not be those that simply replace vendors, add staff or build more rooms. They will redesign the surgical enterprise to perform better with the resources they already have.
What Defines the Gold Standard in Perioperative and Anesthesia Consulting
Perioperative performance sits at the center of financial discipline, patient access and clinician alignment for hospitals, health systems and provider groups. Surgical volume remains one of the most consequential drivers of margin, yet the environment surrounding it has become harder to manage. Executives must contend with anesthesia shortages, pressure on reimbursement, limited clinical labor, uneven block utilization, case delays, sterile processing constraints and competing demands from outpatient sites. The issue is rarely a single department’s failure. It is the cumulative effect of many teams, schedules, incentives and decision rules not working from the same playbook.
A strong consulting partner in this field must begin by diagnosing the real source of constraint rather than treating visible symptoms. Low OR utilization may reflect poor scheduling discipline, but it may also be tied to PACU flow, bed availability, anesthesia staffing, sterile processing performance or unclear surgeon access rules. Executives need a partner that can identify where variation is actually occurring, separate local culture from system wide process gaps and prioritize the changes that will create the greatest clinical and financial effect. That discipline matters because executives cannot afford broad transformation agendas that diffuse attention across every complaint at once. They need analytical focus: a clear view of which access, staffing or throughput problems must be solved now, which can wait and which are symptoms of a deeper bottleneck elsewhere in the surgical pathway.
Depth of specialization is equally important. General healthcare consulting can struggle in perioperative environments because the work depends on credibility with surgeons, anesthesiologists, nursing leaders, sterile processing teams and administrators. Recommendations that look correct on paper can stall when they do not account for professional norms, clinical urgency, patient flow and the politics of block time. The stronger model pairs analytical review with peer-to-peer engagement, allowing clinical and administrative stakeholders to accept change because it is shaped by people who understand the work.
Executives should also look for sustained accountability, not a one-time report. Surgical services need governance structures that continue after the engagement, clear rules for access and utilization, transparent performance measures and a management cadence that keeps teams aligned. Data matters only when it is narrowed to the decisions leaders must make: staffing levels, first-case starts, turnaround time, utilization, cancellations, patient throughput and resource coverage. A consulting firm that combines analytics, implementation support and executive-level governance gives the organization a better chance of making improvement stick. This is relevant when anesthesia groups, employed physicians, independent surgeons and hospital leadership must share scheduling behavior consequences. Without trusted rules, access decisions become negotiated exceptions. A stronger model makes performance visible, ties access to use and gives leaders a fair basis for hard decisions.
Surgical Directions stands out for buyers that need a focused perioperative and anesthesia consulting partner rather than a broad advisory firm. Its work is centered on perioperative optimization, anesthesiology solutions, sterile processing, workforce support and Merlin predictive analytics, including diagnostic review, implementation, ongoing measurement and management. The model emphasizes clinician-led, peer-to-peer change, hands-on governance building, anesthesia staffing alignment, block access discipline and analytics that cut through excess data to guide decisions. For hospitals, health systems and provider groups looking to improve surgical access, staffing confidence, OR efficiency and procedural service performance, Surgical Directions is a well-aligned choice.
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