For more than three decades, Randy Heiser, MA, BA, president of Sullivan Healthcare Consulting, has focused exclusively on advising hospitals and health systems that are looking to improve surgical performance, maximize resource use, and deliver better patient care. As the Closing Keynote speaker at Periop Leader Week 2026, he focused on what’s to come over the next decade in perioperative services.
Mr. Heiser opened with a self-deprecating acknowledgment of the assignment he’d been given. “I am a consultant. I have seen everything that could possibly go wrong in ORs in this country… I haven’t said anything positive in over 30 years, but I’m going to try to do my best today,” he told the audience, drawing laughter before launching into his forward-looking talk.
During his presentation, “The future of OR operations: From managing surgical services to engineering high-performance surgical ecosystems,” Mr. Heiser assured the assembled perioperative leadership community that demand for surgery will only continue to grow, and that perioperative teams will be able to amplify their abilities by balancing human connection and new technology. “We don’t need to be afraid of [tech],” he said. “We need to embrace it.” He urged the assembled perioperative leadership community to welcome technological change, data-driven decision making, and an evolving workforce model while keeping patient safety and teamwork at the core of everything they do.
He said that “high-performing ORs are going to be the most strategic assets that hospitals have,” noting that operating rooms currently contribute roughly two-thirds of the margin for a healthy hospital—a figure he expects to increase.
Technology featured prominently throughout Mr. Heiser’s address, as he briefly traced the arc of OR innovation from his earliest projects to today’s robotic platforms and minimally invasive techniques. To illustrate just how far surgical technology has come, and how quickly change can occur, he shared that “state-of-the-art when I first walked into the operating room was sterile fly swatters… Technologies that we can’t even imagine today are going to be in use in our ORs in 10 years.”
Mr. Heiser described a near future in which AI systems analyze scheduling histories, surgeon behavior patterns, and instrument availability to dynamically adjust OR schedules before problems ever materialize. He noted how many experienced OR leaders can look at a schedule and intuitively predict exactly where it will break down. AI, he said, will soon replicate and systematize that institutional knowledge at scale. “AI will be looking at that schedule, looking at the history, looking at all the things that have happened, and start making those decisions for you the day before or two days before,” he said.
Mr. Heiser forecasted significant structural changes in how perioperative services are organized and delivered, including a shift toward network-based care models in which hospitals, ASCs, procedural suites, and office-based settings operate collaboratively to route patients to the most clinically- and cost-effective site of care. Noting that the average anesthesia subsidy has roughly tripled since 2015 to approximately $350,000 per year per anesthetizing location, he anticipates that anesthesia models will expand and evolve out of necessity. Cross-trained perioperative teams that can move fluidly among pre-op, intra-op, and post-op roles will become more common, he predicted.
Remote and robotically-assisted procedures will continue to increase, he added. “There's robotic surgery being done today with thousands of miles between the surgeon and the patient,” he said. In remote northern Canada, he notes, there are ORs with robots, staff and a general surgeon for emergencies in the room while the operating surgeons work in Toronto or Hamilton. “They're doing surgery on a regular basis with 1,800 miles between them and the patient,” he said. “We're going to see more of that happening.”
Perhaps the most encouraging data point in Mr. Heiser’s speech had nothing to do with technology. Citing a study showing that the average age of perioperative staff has dropped by seven years over the last decade, he welcomes a meaningful influx of younger workers into the OR. “To me, that is wonderful,” he said. “We’re bringing new ideas in, new people. This is probably one of the things that I am the most excited about for the future. We’re attracting younger people. We’re attracting people into the OR, and for many years that wasn’t the case.”
Mr. Heiser was direct about how and why hospitals are losing ground and what must change. He called out turnover times as a persistent and correctable problem, noting that best-in-class facilities have achieved average turnover times of 14 to 15 minutes from patient out to next patient in, while most hospitals average 30 to 32 minutes.
He argued that capacity constraints will increasingly be solved through efficiency gains rather than construction, given that a new hospital OR costs approximately $5 million to build and hybrid rooms can run $8 to $9 million—capital that most health systems no longer have. “We’ve got to improve block utilization,” he said. “We’ve got to make that schedule as accurate as possible, and there can’t be white space in there anywhere.”
He addressed what the ever-evolving landscape of surgery is demanding of perioperative leaders, noting that clinical excellence alone will no longer be sufficient. “We can’t just be the best clinical person in the room,” he said. “We need to be operations specialists. We need to be change managers. We need to understand workforces and how to reconstruct them in different ways. We need to be using data to make our decisions as opposed to our gut.” He added that perioperative leaders will need to be early adopters of technology and must build genuinely collaborative governance structures with physicians and anesthesia providers.
He closed with a challenge and a call to action. “If you’re not designing it, it’s happening to you,” he told the audience. “Be the ones that it happens for, and not happens to.” For leaders willing to embrace and navigate the changes ahead—data, technology, the workforce evolution, new care models—he offered a confident prediction: “The leaders who can do these things are going to be the ones standing up here giving the closing keynote in 10 years, because they’re going to be the world experts.”
