After assessing their data, the team realized there was room for improvement regarding first-case on-time starts, which is the measurement of the percentage of the day’s first scheduled surgeries that begin at their scheduled time. To tackle this, a small workgroup led by Rose Allen, BSN, RN, CCRN, Staff Nurse IV came together to develop new standards of work. They started by setting realistic targets and developing PDSAs (Plan-Do-Study-Act cycles) to fit a specific intervention timeline, ensuring the new process would be both effective and sustainable for the staff. 

The result of this collaboration was a new routine called “The Morning Choreography: Strive to 08:30.” The process begins at 7:30 a.m. with the Desk RN coordinating reports to set the gears in motion. At 7:40 a.m., the team splits into two paths: most of the team attend a quick ten-minute “sprint” huddle, while the CT team skips the huddle and promptly welcomes their patient and prepares their room. By 7:50 a.m., transport teams and nurses fan out to greet and gather their patients, assembling in the holding area by 8 a.m. for team preparation. After the physician confirms patient consents at 8:10 a.m., the team begins the final step: bringing the patient into the room between 8:25 and 8:30 a.m., ensuring the day begins smoothly and on time. 

Overall Performance Trajectory 

The data demonstrates a significant and sustained improvement in performance percentages over the three-year period. What began as an inconsistent process in early 2023 has evolved into a high-performing, stable system in 2025. 

• 2025 (Optimization): This year represents the highest level of performance. The year kicked off at 86% and has hit a peak of 91% twice (July and October). Even the lowest performing months in 2025 (67%) matched the starting point of 2024, indicating a new, higher standard of work. 

Trend Analysis 

The continuous trend line for 2024–2025 indicates a clear positive trajectory. The overall direction of the metrics is upward, suggesting that the process changes (such as the “Morning Choreography”) are taking hold and yielding consistent results. 

This journey from an identified opportunity to sustained excellence highlights the true power of collaborative problem-solving. By working together to replace old habits with the precise “Morning Choreography,” the team transformed a chaotic morning routine into a reliable standard, elevating on-time starts from near zero in early 2023 to peaks of 91% in 2025. This achievement is not just a win for our operational metrics, but a promise kept to our patients: that we are ready, prepared, and focused on their care from the very first minute of the day.