Maximizing operating room (OR) utilization requires effective scheduling of surgical cases. Ineffective schedules result in costly overtime and decreased patient satisfaction. The impact is magnified when the first surgical case is delayed which causes the other cases to be delayed as well. Moreover, scheduling first cases late results in low utilization of hospital resources and may impact the quality of care for patients. This paper investigates the first case scheduling process in a tertiary hospital in Pennsylvania, USA. Lean techniques and data analysis are utilized to analyze the scheduling inefficiencies and propose process improvement strategies. The proposed strategies resulted in significant improvement in the number of cases scheduled by 7:30 AM which reduced the amount of overtime and improved OR utilization.