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Advocate Aurora Health, located in the north‐central United States, is the result of a merger between two large health care organizations in April 2018. The health care system comprises 26 hospitals, offers more than 500 sites of care, and employs 75,000 team members. This article discusses the effects that coronavirus disease 2019 had on the perioperative services departments while directors and site leaders were still managing the complexities of the merger. Included are strategies used to address the challenges created by the pandemic, special considerations based on level‐of‐care capacity, the effect that the hold on elective surgeries had on staffing assignments, the reactivation process when elective surgery resumed, and the importance of keeping the perioperative team members informed and safe. It also illustrates how facing the challenges caused by the pandemic helped to solidify the merger of the two health care organizations.

Robotic surgery is a growing field that has introduced a new range of instruments, procedures, and protocols into the standard OR suite. The safety and efficiency of robotic assistance in surgical practice depend significantly on the presence of a consistent, trained, and experienced nursing staff and OR team. Establishing a robotic coordinator position goes a long way in optimal OR scheduling, timely procurement of instruments, training of nursing staff, and in collaborating between surgeons across multiple services.

Five elements have helped Advocate Lutheran General Hospital control the surgical quality, safety, and cost outcomes that are the focus of new payment models: Single-path scheduling, Document management, Presurgical testing, A daily huddle, Surgical safety initiative.