<![CDATA[Start time delays in operating room services are a managerial problem that can disrupt the continuity of surgical schedules, reduce capacity utilization, and increase patient waiting time. This study aims to analyze the optimization of block scheduling implementation to minimize preoperative start time delays at RSI Yogyakarta PDHI, where the initial First Case On-Time Start (FCOTS) rate was only 45.00%, with productive time utilization of 60.99%. This study employed a qualitative approach with a descriptive-interpretive design. Ten informants participated in the study, consisting of the Head of the Central Surgical Installation, Head of the Operating Room, scheduling coordinators and their assistants, anesthesia nurses, and surgical nurses, selected using purposive sampling. Data were collected through in-depth interviews, observations, and document analysis, and were analyzed thematically through data identification, categorization, coding, reduction, pattern mapping, and synthesis. The findings show that cross-unit coordination has supported block scheduling implementation, but optimization remains constrained by changes in surgeons' schedules, surgical cancellations, patient unpreparedness, delays in information updates, and inconsistent release-time mechanisms. Optimization therefore requires stronger governance rather than replacement of the existing electronic system, particularly through disciplined data updating, interprofessional coordination, standardized release deadlines, and monitoring based on block utilization and FCOTS.]]>
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