In an effort to increase review-quality and efficiency, research administration at Wake Forest School of Medicine initiated a change in the operational structure of the Institutional Review Board (IRB) via a reconfiguring of the boards and rescheduling of the convened meetings. The number of IRB Panels was doubled and each panel/board began meeting on alternating weeks, rather than once per month as they had previously done. The turn-around time for full board approvals was reduced by over 50% and the quality of review was increased due to the smaller agendas for each meeting, allowing all members the opportunity to more carefully review each submission. More time is now spent discussing each submission item than was possible in the past, yet meetings are much shorter than before, due to the smaller agendas. In addition to fostering higher quality human subject protection, both investigator and board member satisfaction has increased because of the change in the operational structure of the IRB. No additional funds or staff members were needed to carry out this successful change. IRB management at other institutions can replicate this process easily and at no significant cost. (Contains 4 figures.)