A large midwestern hospital is expecting an increase in surgical caseload. New operating room (OR) capacity can be had by building new ORs or extending the working hours in the current ORs. The choice among these options is complicated by the fact that patients, surgeons and surgical staff, and hospital administrators are all important stakeholders in the health service operation, and each has different priorities. This paper investigates the trade-offs among three performance criteria (wait to get on schedule, scheduled procedure start-time reliability, and hospital profits), which are of particular importance to the different constituencies. The objective is to determine how the hospital can best expand its capacity, acknowledging the key role that each constituency plays in that objective. En route, the paper presents supporting analysis for process improvements and suggestions for optimal participation-inducing staff contracts for extending OR hours of operation.