The aim of this study was to assess procedures with high turnover time to procedure time ratios, estimate the effect of productivity changes on case efficiency, and determine causative factors. We specifically focused on suspension direct microlaryngoscopy (SML) (CPT 31526) cases because significantly greater productivity was possible for these cases in terms of ratios. After determining process times, we developed economic scenarios that employed time-reductions, and then assessed involved staff opinions using brainstorming and cause-effect methods. Improving all process times by 30% achieved up to a 50% improvement in revenue and the return on investment in additional scope equipment occurred within 2 months.