First-procedure delays in the OR result in loss of revenue and subsequent procedure delays for patients, staff members, and other surgeons. Members of a committee at New York University Medical Hospital determined that the major cause of the delays in the OR was late arrival of surgeons, and they developed a plan to reduce first-procedure delays in the OR through a physician accountability initiative. Committee members attempted to modify surgeon behavior by requiring the documentation of surgeons' arrival times and by reporting their daily attendance time. They sent daily e-mail reminders asking surgeons with scheduled procedures to arrive 20 minutes before the procedure. This resulted in a 13% decrease in first-procedure delays within two weeks and improvement continued. Overall, the plan improved first-procedure delays from an initial on-time start rate of 24% to 80%.