The surgical service at the Philadelphia Department of Veterans Affairs Medical Center has been making a continuous effort toward improving efficiency in the operating room. A multidisciplinary task force was created in May 1994 to look at delays in operating room start times for the first case of the day. This article identifies problems that contributed to the delays and the changes implemented, along with a statistical analysis of the data collected. The team discovered that delays were related to system problems in the perioperative process and were not caused by any specific problem. Many of these problems proved correctable, as the statistical analysis shows, and the result was significant improvement in operating room efficiency.