• Andrew Prahl, Franklin Dexter, Michael T Braun, and Lyn Van Swol.
• From the *Department of Communication Arts, University of Wisconsin-Madison, Madison, Wisconsin; †Department of Anesthesia, Division of Management Consulting, University of Iowa, Iowa city, Iowa; and ‡Department of Communication Arts, Center for Communication Research, University of Wisconsin-Madison, Madison, Wisconsin.
• Anesth. Analg.. 2013 Nov 1;117(5):1221-9.

AbstractBecause operating room (OR) management decisions with optimal choices are made with ubiquitous 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 decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing 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 influence 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 considered unjust. In conclusion, leaders will find the most success if they do not bring OR management 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.

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