Major outpatient surgeries have been shown to be cost-effective models of care compared to surgeries requiring hospitalization - they reduce hospital costs, make it possible to focus limited resources on more severe cases, help reduce the waiting list, and allow patients to recover at home by eliminating the risk of nosocomial infections. The Costa Rican Social Security Fund progressively increased the percentage of major outpatient surgeries to more than 43% of the major surgeries performed in the system. With the increase in outpatient major surgeries, Costa Rica reduced by 60% the waiting time (days) for other major surgeries. Motivation for waiting list reduction, communication, and collaboration between levels of care and implementing centers, and the identification and utilization of available infrastructure and resources have been key to the increase in major outpatient surgeries.The implementation of changes in the delivery of health services can present significant challenges due to the standardization of clinical guidelines and the approval of operating manuals