Table 2. Summary of challenges and enablers across the process steps of the existing surgical schedule system.

Context (surgical scheduling process steps)	Challenge themes: subthemes	Main challenge themes	Main enabler themes
Master grid set-up and access (steps 1–2)	Functionality related: system usability Process related: schedule coordination; users’ scheduling skills	Reliance on Word and manual processes; inconsistent communication of closures; block allocation constrained by limited OR time, staffing and historical patterns rather than optimal use.	Centralised control of master schedule edits supports version control and organisation; use of personal scheduling tools assists allocation.
Prescheduling and waitlist management (steps 1–2)	Functionality related: priority and surgical codes Process related: process adherence; schedule coordination	P1–P4 urgency codes lack granularity; inconsistent waitlist updating; absence of central intake leads to variable wait times across surgeons.	None reported.
Booking on grid (step 3): prediction and information	Functionality related: predicted surgery duration; access to scheduling information	Prediction algorithm uses outdated, averaged historical data; does not incorporate team efficiency, turnover, teaching, anaesthesia input or detailed patient risk; limited access to timely data on beds, case durations, teaching status, cancellations and equipment.	System provides core information (wait times, preferences, history, equipment, pre-op status, Bayview schedule, case notes) and allows documenting case-specific needs.
Booking on grid (step 3): codes, usability and data quality	Functionality related: surgical codes and priority; system usability Process related: data quality and process adherence	Limited, outdated procedure codes; key factors (risk profile, BMI, insurance, revision type, history) not reflected; perceived miscoding to increase booked cases; PICIS is slow, text heavy and cumbersome; schedule sharing relies on printing; data may be inaccurate, contributing to delays, overtime and cancellations.	System flags some equipment conflicts; experienced AAs and schedulers work around system limitations and troubleshoot issues.
Booking on grid (step 3): coordination and resources	Process related: schedule coordination; human and physical resources	Late scheduling reduces flexibility; increased workload with electronic and 7-day scheduling; complex case mix; manual assessment of bed needs; limited relationships and equipment (eg, imaging, power tools) constrain scheduling; limited overtime flexibility.	Longer operating days can support more efficient OR use.
Schedule review and finalisation (steps 4–5)	Process related: schedule coordination	Specialised equipment needs may be reported late; difficult to refill last-minute cancellations.	Strong culture of high OR utilisation; unbooked blocks reallocated ≥10 days in advance; multiple pre-op reviews and experienced staff support daily schedule adjustments.
Day-of-surgery execution (step 6)	Functionality related: surgical codes Process related: process adherence; schedule coordination; human resources	Inability to correct codes retrospectively; lateness and poor practices cause delays; wrong codes lead to wrong equipment; anaesthesia delays, overtime, recovery bottlenecks and late anaesthesia changes drive cancellations; staffing shortages (nurses, cleaning staff) slow turnover.	None reported.
Evaluation and cross-cutting workflow (steps 1–6)	Evaluation related: metrics and reporting Process related: schedule coordination and information flow	Limited, fragmented metrics; manual data extraction; poor interoperability and reporting; key drivers of OR time not captured; heavy reliance on manual tracking and multiple data sources across the pathway.1	Some OR utilisation, costing and item-usage reports are available; existing processes and central contacts provide a practical gateway to perioperative planning and troubleshooting.

AAs, administrative assistants; BMI, body mass index; OR, operating room.