At the Albany VA Medical Center we have established an OR efficiency workgroup. This workgroup meets once a week and is comprised of OR staff, a process improvement coach and the Director of our facility. At every meeting we spend thirty minutes focused on efficiency to improve the care for our Veterans. The process improvement effort of reducing the percent of OR cancellations 48-hours prior to surgery is an example of applying the Lean methodology to achieve operational excellence. As a workgroup we review data together looking for opportunities to improve. Once we identified that our cancellation rate 48-hours from surgery was high we discussed what type of process improvement approach would be the best. Given that both root cause and solution were not known, we decided to use the Lean 9 box A3 methodology. After completing a project charter which outlined the business case, goal, scope, team members and project timeline, we worked to understand and document the current state of our cancellations. This included data analysis, creation of a current state process map and identifying concerns on the process map. We then created a target state process map of how we wanted the process to look. Looking at both the current state and target state process maps together showed us the difference between where we are versus where we wanted to go. The next step was to conduct root cause analysis. We used a cause-and-effect diagram, to ensure we looked at the problem from all angles and drilled down to the root causes. Now that we had a higher resolution look at the 48-hour cancellation process, we were in a better position to brainstorm solutions to the root causes. Ultimately, we trialed four solutions which together brought us past our goal of 6%, and effectively lowered our 48-hour cancellation from 8% down to 4%. Thanks to this reduction we saved 2,586.00 in cost avoidance and improved the experiences for over a hundred Veterans.