November 2013 • Volume 117 • Number 5 www.anesthesia-analgesia.org 1221 Copyright © 2013 International Anesthesia Research Society DOI: 10.1213/ANE.0b013e3182a0eed1 1. INTRODUCTION A previous review considered why, if a neurological surgeon uses ≥11 hours of operating room (OR) time on more than two-third of Mondays, many managers (leaders) would still plan only 10 hours of stafing on Mondays for their OR. 1 Similarly, suppose that usually all other ORs inish earlier on Mondays and the anesthesia department uses teams on workdays (e.g., neurological versus regional anesthesia). Many anesthesia groups’ managers would not use these data when planning the staff schedule including who works late each day if necessary. 2 Although some may attribute manag- ers’ suboptimal decisions to “politics,” inertia, or other such factors, the evidence supports psychological bias. 2–12 Hospitals’ operational priorities can be inluenced both by lack of scientiic knowledge and psychological biases. For example, the fact that fewer than half of surgical cases take longer than scheduled was not known by most OR staff (32%, P = 0.008). 7 Also, none of the 32% of survey partici- pants who knew that most cases are completed within their scheduled times applied that knowledge to answer a ques- tion on late starts correctly (P = 0.0002). 7 The reason was that participants shared a psychological bias that surgical cases do not start early but either on time or late, as do clinic appointments and bus and train departures. 7,11 On the day of surgery, anesthesiologists and other decision-makers often make managerial decisions using common rules-of-thumb (i.e., “heuristics”). For example, consistent and rational management decisions on the day of surgery cannot be made other than based on reducing hours of overutilized time. 5,6,12–14,a Yet, even when educated that particular decision choices are optimal, clinicians persist in trying to keep each provider working continuously. 6,12 Such behavior, although optimal for an individual OR, is Because operating room (OR) management decisions with optimal choices are made with ubiq- uitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about deci- sions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem “close enough” (e.g., stafing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., stafing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans’ limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual inluence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions con- sidered unjust. In conclusion, leaders will ind the most success if they do not bring OR manage- ment operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science. (Anesth Analg 2013;117:1221–9) Review of Experimental Studies in Social Psychology of Small Groups When an Optimal Choice Exists and Application to Operating Room Management Decision-Making Andrew Prahl,* Franklin Dexter, MD, PhD,† Michael T. Braun, MA,* and Lyn Van Swol, PhD‡ From the *Department of Communication Arts, University of Wisconsin– Madison, Madison, Wisconsin; †Department of Anesthesia, Division of Man- agement Consulting, University of Iowa, Iowa city, Iowa; and ‡Department of Communication Arts, Center for Communication Research, University of Wisconsin–Madison, Madison, Wisconsin. Accepted for publication June 7, 2013. Funding: Departmental. Conlicts of Interest: See Disclosures at the end of the article. Some of the results in this paper will be presented at the INFORMS Annual Meeting 2013 meeting in Minneapolis, MN, November 2013. Reprints will not be available from the authors. Address correspondence to Franklin Dexter, MD, PhD, Department of Anesthesia, Division of Management Consulting, University of Iowa, 200 Hawkins Dr., 6JCP, Iowa City, IA 52242. Address e-mail to Franklin-Dexter@ UIowa.edu or www.FranklinDexter.net. REVIEW ARTICLE E a Reducing overutilized OR time is the same as reducing overtime provided staff schedules (shifts) match allocated hours of OR time; thus, we use the more general term “overutilized OR time.” Reducing the hours of overuti- lized OR time is a lower priority than performing scheduled cases, because otherwise absence of overutilized time would be assured by performing no surgery. 5,13 Reducing tardiness from scheduled start times is a lower prior- ity than reducing the hours of overutilized OR time, because otherwise long gaps would be scheduled between successive cases. 5,13,14 Increasing personal satisfaction (e.g., of surgeons) is a lower priority than reducing the hours of overutilized OR time, because otherwise all ORs would be available 24 hours a day, 7 days per week. 5,13