Scheduling in hospital operating rooms (ORs) is chaotic due to most of the surgeries is not being performed on time. Unpredictable turnover times and delays in the first surgical care have been key factors in the delay of surgeries. A time study was conducted to investigate the detailed tasks and time spent during the preparation in the OR holding area. A follow-up focus group with OR staff and surgeons was conducted to discuss the root causes of delay in the early morning first case. In addition, potential solutions were discussed in the focus group to eliminate observed waste of time in the OR holding area. The main purposes of the study are to discuss the root causes of delays in the first surgical case and to seek a context-appropriate OR preparation workflow based on various surgical contexts, clinical workflow, and organizational policy and culture.