As published in Canadian Healthcare Technology
Operating room (OR) scheduling is one of the most complex operational processes within healthcare organizations. Effective coordination among surgeons, anesthesiologists, nurses, administrative staff, and support services is essential to maintaining efficient surgical care. However, many existing scheduling systems remain fragmented, rely on outdated communication methods, and struggle to adapt to real-time changes such as staffing shortages, emergency cases, or equipment availability. These inefficiencies can result in delayed surgeries, scheduling conflicts, wasted resources, increased stress for healthcare providers, and poorer patient experiences.
To address these challenges, Drs. Tina Lefrancois and Jubin Payandeh, orthopedic surgeons at Thunder Bay Regional Health Sciences, and Dr. Bruce Pynn, an oral and maxillofacial surgeon at the hospital, initiated the C List project with support from the NOAMA AFP Innovation Fund.
The initiative aimed to create a user friendly digital application that centralizes emergency OR scheduling information and improves real-time communication among all stakeholders involved in surgical care. Unlike generic scheduling systems, the application was specifically designed to reflect the workflow and operational realities of the OR environment at Thunder Bay Regional Health Sciences Centre. The C List application was developed by Mitchell Pynn of Dogfish.dev in close collaboration with clinical users. A major strength of the project was its collaborative design approach.
Surgeons, nurses, OR managers, and administrative staff actively contributed to identifying operational challenges and shaping the application’s functionality. This co-design process ensured the platform addressed practical issues such as last-minute scheduling changes, staffing coordination, equipment requirements, and communication gaps between teams.
The application focuses on improving management of the OR emergency list process. During weekdays, separate emergency OR lists exist for general surgery and orthopedic surgery, involving approximately 44 surgeons.
On weekends, however, only one OR is available for emergency cases. The C List application allows surgeons and OR personnel to view, in real-time, the number of cases awaiting surgery and each case’s position within the surgical queue. This enhanced visibility supports better coordination, communication, and decision-making across teams.
The application also modernizes the process of adding cases to the emergency OR list. Previously, surgeons completed paper forms that were physically delivered to the OR clerk. With the new system, once a case is entered into the electronic medical record (EMR), it automatically appears within the C List application. This integration significantly improves efficiency and reduces communication delays.
Currently, the C List functions as a standalone mobile application used by surgeons, OR managers, and hospital leadership. Early adoption has been positive, with users reporting fewer phone calls to OR clerks to check case status. The system also provides timely updates when cases are sent for surgery, helping improve workflow coordination.
The project has four primary objectives. First, it aims to develop and implement a centralized digital platform that improves OR communication and scheduling coordination. Second, it seeks to reduce scheduling conflicts, delays, and cancellations through enhanced real-time information sharing.
Third, the project aims to improve workflow efficiency, staff satisfaction, and patient outcomes. Finally, it seeks to generate evidence and best practices that may support adoption of similar innovations in other healthcare organizations.
The work plan spans two years. During the first phase, the project team conducted a comprehensive needs assessment through interviews, surveys, and consultations with OR stakeholders. This process identified communication barriers, operational inefficiencies, and key functional requirements for the application.
Following the assessment, Mitchell Pynn and Dogfish.dev collaborated with clinical users to design, build, and test the platform. User feedback was incorporated throughout development to ensure the application remained practical and aligned with clinical workflows.
The application is currently undergoing pilot implementation in a controlled OR setting. During this phase, the project team is monitoring system usage, workflow integration, and communication effectiveness while collecting data on scheduling performance.
The pilot phase allows refinements prior to broader implementation. In the second year, the application will be fully implemented and formally evaluated using both quantitative and qualitative measures. Evaluation will focus on reductions in scheduling delays, conflicts, and surgical cancellations, as well as improvements in workflow efficiency, staff satisfaction, and patient care outcomes. The project will also assess long-term adoption and sustained use of the platform to determine its potential scalability to other departments or healthcare organizations.
Future development plans include automated patient care notifications related to NPO (nil per os) status. Managing NPO status is particularly challenging for emergency surgery patients because OR schedules change frequently. Automated notifications would help hospital wards determine when patients should or should not be fed in preparation for surgery, improving both patient experience and perioperative coordination.
The project has received strong institutional support from surgical leadership, research administration, and information technology services, reflecting its alignment with organizational priorities related to digital innovation, operational efficiency, and patient- and family-centered care.
Overall, the C List project represents an innovative and practical response to persistent OR scheduling challenges. By combining technology, stakeholder collaboration, and evidence-based evaluation, the initiative aims to improve communication, efficiency, staff experience, and patient outcomes while contributing to broader healthcare system innovation.
