The efficiency of an Operating Room (OR) is directly correlated with the solvency of that OR's hospital. Inefficiencies, such as poor quality of care and delays, can be damaging to the profitability and reputation of a facility. These inefficiencies can be rectified by change management, which include instituted improvements on surgical case preparation, staff punctuality, and case scheduling. Change management resulted in a 16.6% increase in surgical on-time starts. Surgical on-time starts were found to improve over the 24 months; the sample size was not large enough to be statistically significant in a Z-test. Process improvements methods were able to identify surgeons' concerns and problems with the pre-admittance process. Process improvement methodologies were used to create new pre-anesthesia checklist for inpatients scheduled for surgery. The OR improvements, by way of culture change and the implementation of the pre-anesthesia checklist, resulted in an improvement of on-time surgical starts.