Theme	Category	Number of Participants mentioned	Definition/Phenomenon
Physician Unavailability	Inflexible scheduling	8	Physicians can often come in late from another procedure due to inflexible scheduling. This occurs when a physician is doing multiple cases in different rooms or cases are scheduled too close together.
	Personal reasons	8	The procedure cannot begin until the doctor is present at the procedure, ensuring that the entire schedule of the day is delayed if they are not present. This specific group accounts for general lateness on the part of the physician due to personal reasons, habitually arriving late in the morning, etc.
	Teaching load	4	Because of UCMC as a teaching hospital, residents are often doing procedures. Having residents help with procedures may significantly delay them.
Patient Delay and Variability	Patient additions	7	Patients are often added to the schedule unexpectedly, which can delay all future cases and throw off the entire schedule.
Patient Delay and Variability	Patient arrives late or no show	7	Patients can often arrive late for a procedure or not show up at all, which causes uncontrollable delay.
Suboptimal Teamwork and Coordination	Communication issues	8	Communication issues wit in a team and/or a lack of direct communication between team members in the endoscopy room can lead to delays.
	Inefficient room shifts	5	Schedules are often crammed with inefficient room shifts, which can contribute to delay as the delay caused by these room shifts can throw off the schedule.
	Room turnover	5	Delays in turning over rooms can resultantly throw off the entire schedule. This may be due to low staffing.
Issues with Supporting Tools	Issues with physical equipment	6	Delay can be caused when equipment malfunctions, is not properly cleaned, or has other issues.
	Supply issues/improper stocking	4	Often supplies are understocked or unnecessarily overstocked. The distance between Endo and the OR Pharmacy causes issues as it is difficult and time-consuming to check the cart for what supplies are already stocked and get the supplies necessary.
	EMR system malfunction	2	The EMR system is used for digital note-taking but has been described as “non-intuitive” and “painful” when it malfunctions. When EMR goes down, the notes must be manually entered, which is a major hindrance.