Consulta de ajuste con múltiples combinaciones

Tengo esta consulta ... 214 Ejecución / min, 44.42 Promedio de CPU (ms) ¿Hay alguna manera de hacerlo mucho más rápido?

SELECT        P.Id id0,
              P.ProgramId ProgramId1,
              P.ProgramName ProgramName2,
              P.ProgramLevel ProgramLevel3,
              P.Department Department4,
              P.Track Track5,
              P.AcademicYear AcademicYear6,
              P.StartTerm StartTerm7,
              P.Delivery Delivery8,
              P.Fee Fee9,
              P.City City10,
              P.STATE State11,
              P.StartDate StartDate12,
              P.Deadline Deadline13,
              P.DeadlineDisplay DeadlineDisplay14,
              P.ProgramType ProgramType15,
              O.Id as OrganizationId16,
              O.NAME OrganizationName17,
              P.ApplicationType ApplicationType18,
              P.Concentration Concentration19,
              P.ZipCode ZipCode20,
              P.Campus Campus21,
              P.WADisplayName WADisplayName22,
              P.UpdatedDate updateDate23,
              AF.Id InstanceId24,
              RD.Id stateId33
INTO #TempGetFullProgramSelectionInfo            
FROM    unicas_config..applicationForm AF  
  INNER JOIN UNICAS_CONFIG.. AcademicInstitution AI
           ON AF.casid=AI.casid 
  INNER JOIN UNICAS_CONFIG..Organization O 
           ON O.academicInstitutionid=AI.id   
  INNER JOIN UNICAS_CONFIG..AssociationOrg asOrg
           ON asOrg.FormId=AF.id
  INNER JOIN  UNICAS_CONFIG..Program P
           ON P.AssociationOrgId=asOrg.Id and asOrg.OrganizationId=O.id AND AF.Id = 6286
  INNER JOIN  unicas_config..ReferenceData RD 
                 ON P.STATE = RD.ValueId AND RD.ValueAbbr ='US'
  INNER JOIN  unicas_config..ReferenceDataSet RS  
           ON RD.ReferenceSetId = RS.SetId AND RS.NAME = 'LK_States'

Ahora esto si me divido en 2 consultas

select RD.ValueId, RD.id into #temp1
from   unicas_config..ReferenceData RD
INNER JOIN  unicas_config..ReferenceDataSet RS   ON RD.ReferenceSetId= RS.SetId AND RS.NAME= 'LK_States'
where RD.ValueAbbr='US';


SELECT        P.Id id0,
              P.ProgramId ProgramId1,
              P.ProgramName ProgramName2,
              P.ProgramLevel ProgramLevel3,
              P.Department Department4,
              P.Track Track5,
              P.AcademicYear AcademicYear6,
              P.StartTerm StartTerm7,
              P.Delivery Delivery8,
              P.Fee Fee9,
              P.City City10,
              P.STATE State11,
              P.StartDate StartDate12,
              P.Deadline Deadline13,
              P.DeadlineDisplay DeadlineDisplay14,
              P.ProgramType ProgramType15,
              O.Id as OrganizationId16,
              O.NAME OrganizationName17,
              P.ApplicationType ApplicationType18,
              P.Concentration Concentration19,
              P.ZipCode ZipCode20,
              P.Campus Campus21,
              P.WADisplayName WADisplayName22,
              P.UpdatedDate updateDate23,
              AF.Id InstanceId24,
              RD.Id stateId33
INTO #TempGetFullProgramSelectionInfo            
FROM    unicas_config..applicationForm AF  
  INNER JOIN UNICAS_CONFIG.. AcademicInstitution AI
           ON AF.casid=AI.casid 
  INNER JOIN UNICAS_CONFIG..Organization O 
           ON O.academicInstitutionid=AI.id   
  INNER JOIN UNICAS_CONFIG..AssociationOrg asOrg
           ON asOrg.FormId=AF.id
  INNER JOIN  UNICAS_CONFIG..Program P
           ON P.AssociationOrgId=asOrg.Id and asOrg.OrganizationId=O.id AND AF.Id = 6286
  INNER JOIN    #temp1 RD ON P.STATE= RD.ValueId;

utilizando la consulta recomendada por Frisbee

Utilizando Hash join

Pruébalo
Tienes algunas condiciones de unión (potencialmente) extraviadas

SELECT        P.Id id0,
              P.ProgramId ProgramId1,
              P.ProgramName ProgramName2,
              P.ProgramLevel ProgramLevel3,
              P.Department Department4,
              P.Track Track5,
              P.AcademicYear AcademicYear6,
              P.StartTerm StartTerm7,
              P.Delivery Delivery8,
              P.Fee Fee9,
              P.City City10,
              P.STATE State11,
              P.StartDate StartDate12,
              P.Deadline Deadline13,
              P.DeadlineDisplay DeadlineDisplay14,
              P.ProgramType ProgramType15,
              O.Id as OrganizationId16,
              O.NAME OrganizationName17,
              P.ApplicationType ApplicationType18,
              P.Concentration Concentration19,
              P.ZipCode ZipCode20,
              P.Campus Campus21,
              P.WADisplayName WADisplayName22,
              P.UpdatedDate updateDate23,
              AF.Id InstanceId24,
              RD.Id stateId33
INTO #TempGetFullProgramSelectionInfo            
FROM       UNICAS_CONFIG..Organization O                 
INNER JOIN UNICAS_CONFIG..AcademicInstitution AI
            ON AI.id = O.academicInstitutionid        
INNER JOIN unicas_config..applicationForm AF
            ON AF.casid = AI.casid  
           AND AF.Id = 6286   
INNER JOIN UNICAS_CONFIG..AssociationOrg asOrg
            ON asOrg.FormId         = AF.id
           and asOrg.OrganizationId = O.id
INNER JOIN UNICAS_CONFIG..Program P
            ON P.AssociationOrgId = asOrg.Id 
INNER JOIN unicas_config..ReferenceData RD 
            ON RD.ValueId = P.STATE  
           AND RD.ValueAbbr ='US'
INNER JOIN unicas_config..ReferenceDataSet RS  
            ON RS.SetId = RD.ReferenceSetId   
           AND RS.NAME = 'LK_States'

Si #temp tiene índices, clasifique el que tenga más sentido

Si eso no mejora la respuesta, simplemente fuerce una combinación hash en todos.
Todavía use la selección en mi respuesta: agregue el HASH a la consulta anterior

INNER HASH JOIN

Intente crear el siguiente índice (suponiendo que no exista)

CREATE INDEX ix_Organization_academicInstitutionid
    ON Organization(academicInstitutionid, Id) INCLUDE (Name)

Antes de realizar cualquier cambio en el script, solo haga un índice reconstruido en todas las tablas involucradas y vea si hay algún aumento significativo. (al menos, haga una reconstrucción de estadísticas a nivel de tabla con exploración completa)

[Programa] parece una gran tabla, asegúrese de que P.AssociationOrgId esté indexado.