How to Improve Case Start Times and Communication Workflows in the Operating Room 

PerfectServe’s sixth annual Nurses of Note awards program honors exceptional nurses who demonstrate outstanding dedication and devotion to their field. Chosen from a large pool of nominees, these individuals regularly go above and beyond the call of duty, making a meaningful impact on their patients, colleagues, and communities every day. 

This year, grand prize winners were chosen in four categories, with a specific focus on recognizing nurse leaders. These are their stories.

The Nurse Flow Manager: Quality & Safety, Operating Room (Newton, MA) – Samantha Rovers, Care Team Communication Award

For Samantha “Sam” Rovers, BSN, RN, CNOR, nursing has always been about problem-solving, and it’s been a dream since she was just a little girl. She’s been a nurse for 15 years, and the last 14 have been spent in the operating room. But she wears an additional hat as the OR Flow Manager at Newton-Wellesley Hospital. In this role, she works closely with care teams to manage schedules and oversee patient flow throughout operating rooms.  

“I just love the variety of the OR,” Sam said. “I could be doing brain surgery one day and a total joint replacement the next.” 

For Sam, the most rewarding part of the job is knowing when a patient leaves the OR, she and her team have fixed a problem. That mindset has guided many recent projects, including efforts to improve first-case-on-time starts and communication workflows to ensure anesthesia technicians receive critical pages.

Putting the Patient at the Center 

One of Sam’s biggest projects over the last year was improving first-case-on-time starts (FCOTS) in the OR. It makes a lot of sense intuitively: When the first case of the day starts on time, the risk of having cascading delays throughout the rest of the day goes down. Efficiency and predictability are paramount in the OR, so FCOTS is a good leading proxy.

Sam’s team has also found that better start times decrease patient anxiety and uncertainty, because delays can leave patients wondering if something has gone wrong. Starting on time also helps family members who may be coordinating transportation or childcare around a patient’s procedure.  

And of course, this benefits the hospital as well. When operating rooms aren’t used to their full potential, there can be downstream financial implications. Sam found the financial argument wasn’t the best selling point for her staff, but they are inspired by providing the best patient care.  

“What we have found is if you frame it about the patient, all nurses went to school because they wanted to help someone,” she said. “We all want to be good patient advocates, and we all have that desire and that passion in us.”

That became a key theme for her projects. When asking nurses to change old workflows, it’s essential to connect the change back to why they became nurses in the first place.

Building Trust Around a New Workflow 

When the project began, adjusting established workflows was the biggest barrier. Everyone was used to the expectation that every patient required a face-to-face, nurse-to-nurse handoff. Other departments had already moved to electronic handoff tools, but the OR hadn’t quite made the change yet.  

Sam looked at the tools they already had in place and found a way to make them work. They created a series of checkpoints that would confirm everyone was ready: the OR nurse, surgeon, and patient. Once those boxes were checked, the patient’s stats would be visible on the OR snap board.  

Today, the new workflow is straightforward, and it sets everyone up for success. The next challenge was making sure everyone was comfortable, and it took a bit more time to complete. The new workflow required nurses to trust their colleagues on a deeper level, meaning they each completed all their checks before the patient’s status would be visible on the board. This meant a lot of background work had to be done, like having conversations with pre-op and OR nurses to address concerns early. Sam encouraged everyone to always work towards that same goal of providing safe, efficient care.  

The results speak for themselves. Since January of 2026, the team has improved its FCOTS metric by 15%, with a long-term goal of reaching 80% improvement.  

For Sam, this reinforced the idea that successful change management starts long before a new process goes live.

“We were able to hear the concerns months in advance when we just started talking about it,” Sam said. This gave her team ample time to discuss concerns and get on the same page.

When Better Communication Can Change an Outcome 

Another powerful change Sam made centered on the importance of communication. At Newton-Wellesley, anesthesia technicians support anesthesiologists throughout the hospital, serving as an extra set of hands to ensure providers have the supplies they need for cases. Despite close partnerships, their paging system wasn’t reliable enough, and it did a poor job facilitating useful, real-time communication. Technicians were overwhelmed with the sheer number of pages and notifications. Pages occasionally went to some techs and not others, and the team had a hard time determining which messages were actually being missed. 

Sam decided to partner with the hospital’s digital communications director to move those pages to a completely different messaging system. This would allow one streamlined form of communication for all technician pages. And, the changes worked! 

During one overnight code on the med-surg floor, an anesthesia technician received a message and was able to respond quickly with the correct supplies. The anesthesiologist later told the team that the technician’s presence may have helped secure the patient’s airway faster and prevent aspiration. 

For Sam, the outcome was a powerful reminder that communication is essential to patient care. Getting the right message to the right person can make a true difference in care delivery.  

“I think that communication strategies are not talked about enough and that they’re really vital to the success of a healthcare organization,” Sam said. “I don’t think you can minimize communication.” 

A Lesson for Nurses: Don’t Be Afraid to Ask Why 

Because of her success, we asked Sam for her advice for new and seasoned nurses alike. She said the most important thing is to ask a simple question: “Why?” 

“Memorizing the steps only gets you so far,” she said. Nurses are taught countless lessons and procedures, but they need to truly understand the “why” behind every step to apply their skills. It’s also a mindset that can help nurses become better problem-solvers and recognize when something isn’t working.  

Sam also had ideas for how the healthcare industry can better support nurses. She believes the nursing profession can do more to prepare new nurses for what their careers will actually look like. For nursing students interested in specialized areas of care, like the OR, there often aren’t a ton of opportunities to experience those environments before their first day on the job. Sam thinks organizations should create more opportunities for students to get experience in these areas while soaking up information from the nurses already on the floor.  

She saw the impact of this kind of exposure at a previous academic medical center. One cohort had retained only one out of five nurses after one year, but for the next year, the team changed its approach. They created opportunities for prospective nurses to meet the nurses who worked in their area of interest. Nurses, scrub techs, and service-line team members hosted stations, answered questions, and demonstrated some of the tools they used.

The results? Five nurses were hired, and four stayed.

“I think it really matters,” Sam said. “Having those conversations and really letting people know what to expect before they walk in the door.” 

Making a Real Difference 

After 15 years in nursing, Sam has learned that some of the most meaningful aspects of the profession aren’t always the most visible. She says nurses are typically humble and don’t seek recognition for their work, but Sam believes that makes recognition matter even more.  

“We all got into this because we wanted to make a difference and we wanted to help people,” she said. “And that’s ultimately why we’re all here.”

That attitude is one of many reasons why Sam is a deserving Nurses of Note honoree.

To learn more about Nurses of Note, and to see the rest of the 2026 winners, read the news release.