RESUMO
In this paper, we propose a strategy to build a measurement system that helps improve on-time performance in health care organizations. We analyze the measurement system for monitoring the performance of daily start times of first surgeries in a U.S. hospital. Although surgeons appear to be the main cause of delay, efforts to improve their on-time performance alone are not sufficient to improve on-time performance for first surgeries. Therefore, working on the main source of delay to improve performance, as the Pareto principle suggests, does not always work in the health care context. Rather, we found that ameliorating the hospital's overall on-time performance achieves the desired result of improving surgeons' performance through a snowball effect (a self-reinforcing effect) and, consequently, the on-time performance for first surgeries also improves.