ERASMUS MEDICAL CENTER (EMC) is one of the largest hospitals in the Netherlands, situated in the densely populated region of Rotterdam-Rijnmond. During the first wave of the COVID-19 pandemic early 2020, EMC served as the national crisis centre from which hospital capacity in the Netherlands was centrally coordinated. As a tertiary university hospital, EMC’s Thoraxcenter is a supra-regional referral centre for cardiology and cardio-thoracic surgery. The Thoraxcenter experiences fierce competition, since eight other cardiac surgery centres are situated within an 80km radius. In order to attain economy of scale and to be able to provide the necessary regional cardiac surgical service, the EMC decided to increase the number of open heart surgeries (989 in 2015) with 150 extra in 2016, 2017 and 2018 (450 in total). After successful budget negotiations with EMC’s prevalent healthcare insurer, for 2016 a goal of 150 additional surgeries was indeed set. Here we describe how we were able to increase surgical productivity. For more detail, please see Zonderland et al (2020).