{"id":"https://openalex.org/W2002597787","doi":"https://doi.org/10.1097/00000542-200606000-00032","title":"The Elephant in the Operating Room","display_name":"The Elephant in the Operating Room","publication_year":2006,"publication_date":"2006-05-25","ids":{"openalex":"https://openalex.org/W2002597787","doi":"https://doi.org/10.1097/00000542-200606000-00032","mag":"2002597787"},"language":"en","primary_location":{"id":"doi:10.1097/00000542-200606000-00032","doi":"https://doi.org/10.1097/00000542-200606000-00032","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00000542-200606000-00032","pdf_url":null,"source":{"id":"https://openalex.org/S124035732","display_name":"Anesthesiology","issn_l":"0003-3022","issn":["0003-3022","1528-1175"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Anesthesiology","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5082759787","display_name":"Warren S. Sandberg","orcid":"https://orcid.org/0000-0002-9246-777X","observed_orcids":["https://orcid.org/0000-0002-9246-777X"]},"institutions":[{"id":"https://openalex.org/I136199984","display_name":"Harvard University","ror":"https://ror.org/03vek6s52","country_code":"US","type":"education","lineage":["https://openalex.org/I136199984"]},{"id":"https://openalex.org/I4210087915","display_name":"Massachusetts General Hospital","ror":"https://ror.org/002pd6e78","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210087915","https://openalex.org/I48633490"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Warren\u00a0S. Sandberg","raw_affiliation_strings":["Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts","Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts. wsandberg@partners.org"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts","institution_ids":["https://openalex.org/I136199984","https://openalex.org/I4210087915"]},{"raw_affiliation_string":"Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts. wsandberg@partners.org","institution_ids":["https://openalex.org/I136199984","https://openalex.org/I4210087915"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5047388048","display_name":"Bethany Daily","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Bethany Daily","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5069427200","display_name":"Marie T. Egan","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Marie Egan","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5026034059","display_name":"James E. Stahl","orcid":"https://orcid.org/0000-0001-9739-0583","observed_orcids":["https://orcid.org/0000-0001-9739-0583"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"James\u00a0E. Stahl","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5028529298","display_name":"Julian M. Goldman","orcid":"https://orcid.org/0000-0001-7740-0975","observed_orcids":["https://orcid.org/0000-0001-7740-0975"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Julian\u00a0M. Goldman","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5008141963","display_name":"Richard A. Wiklund","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Richard\u00a0A. Wiklund","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5012436791","display_name":"David W. Rattner","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"David Rattner","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.18684441,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"104","issue":"6","first_page":"1341","last_page":"1341"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11773","display_name":"Healthcare Operations and Scheduling Optimization","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11773","display_name":"Healthcare Operations and Scheduling Optimization","score":0.9990000128746033,"subfield":{"id":"https://openalex.org/subfields/3604","display_name":"Emergency Medical Services"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12871","display_name":"Healthcare Quality and Management","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11095","display_name":"Emergency and Acute Care Studies","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2711","display_name":"Emergency Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/operating-room-throughput","display_name":"operating room throughput","score":0.8619999885559082},{"id":"https://openalex.org/keywords/parallel-computing","display_name":"parallel computing","score":0.8019999861717224},{"id":"https://openalex.org/keywords/payer-mix","display_name":"payer mix","score":0.7149999737739563},{"id":"https://openalex.org/keywords/hospital-financial-impact","display_name":"hospital financial impact","score":0.5289999842643738},{"id":"https://openalex.org/keywords/operating-room-productivity","display_name":"operating room productivity","score":0.5299999713897705}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.957152783870697}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1097/00000542-200606000-00032","doi":"https://doi.org/10.1097/00000542-200606000-00032","is_oa":false,"landing_page_url":"https://doi.org/10.1097/00000542-200606000-00032","pdf_url":null,"source":{"id":"https://openalex.org/S124035732","display_name":"Anesthesiology","issn_l":"0003-3022","issn":["0003-3022","1528-1175"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-a","doyens","jufo-2","ki-jl-2","medline","norway-2","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Anesthesiology","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":1,"referenced_works":["https://openalex.org/W1999381539"],"related_works":["https://openalex.org/W2094450997","https://openalex.org/W2170488310","https://openalex.org/W1999381539","https://openalex.org/W2032281340","https://openalex.org/W2015950859","https://openalex.org/W2075456267","https://openalex.org/W2092004890","https://openalex.org/W2301894517","https://openalex.org/W2057361588","https://openalex.org/W1487286420"],"abstract_inverted_index":{"We":[0,165],"welcome":[1],"the":[2,16,30,46,93,114,131,147,153,196,201,219,226,253,260,268,296,303,314,325,331,342,376,385,431,462,467,475,478,546,558,574,578,588,602,610,617,635,638,646,649,664,678,688,694,715,742,748,797,800,843,856,875,892,896,914,950,953,959],"comments":[3,422],"of":[4,15,32,49,95,113,126,134,143,155,168,188,255,262,285,305,334,344,354,368,452,461,477,577,605,637,652,666,693,728,830],"Drs.":[5],"Dritz":[6,38,250,420],"and":[7,22,71,186,229,241,329,469,496,543,706,713,793,821,832,840,866,900,955,964],"Metz":[8,412,697,762],"on":[9,67,384,485,673,837],"our":[10,109,408,453,561,598,805,929],"recent":[11],"report1in":[12],"Anesthesiology.":[13],"All":[14],"points":[17,40,251],"they":[18],"raise":[19],"are":[20,166,190,232,247,572,868],"valid":[21],"must":[23,425,670],"be":[24,81,363,397,426,438,447,529,642,671,777,910],"considered":[25],"by":[26,212,365,841,846],"any":[27,50],"institution":[28],"considering":[29,482],"future":[31],"its":[33,68],"operating":[34,58],"rooms":[35],"(ORs).":[36],"Dr.":[37,411,630,761],"correctly":[39,701],"out":[41,252],"that":[42,54,77,157,176,295,336,361,393,423,560,634,669,733,825,904],"payer":[43,72,197,220,227,695],"mix":[44,198,221,228,495],"influences":[45,200],"cost\u2013revenue":[47],"balance":[48],"perioperative":[51,96,144,172,234,486,505,553],"system":[52,173,235,487,506,554],"redesign":[53,94,555],"increases":[55],"capital":[56,183],"or":[57,182,308,518,531],"costs.":[59],"If":[60,648],"a":[61,84,99,118,162,205,264,272,276,358,418,520,552,622,658,667,674,711,725,754,815,923,933],"hospital":[62,326],"is":[63,83,117,203,222,348,357,564,590,612,661,690,872],"barely":[64],"breaking":[65],"even":[66,161],"current":[69],"case":[70,494,498,608,655,668,744],"mix,":[73],"increasing":[74],"costs":[75,374,514,542],"so":[76],"more":[78,214],"cases":[79,215,293,527,886],"can":[80,362,446,776],"performed":[82,656,672,746],"poor":[85,206],"decision.":[86],"However,":[87,224,402,772],"we":[88,106,404,455,571,627,731,752],"would":[89,158,628],"not":[90,300,310,396,428,641],"recommend":[91],"abandoning":[92],"processes":[97],"as":[98,352,403,440,710,928],"means":[100],"to":[101,129,139,208,237,267,279,327,371,399,410,429,437,458,503,528,545,566,568,594,719,757,791,854,913,935,945],"improve":[102,400,946],"OR":[103,266,281,306,346,369,636,680,722,852,920],"throughput.":[104,834],"As":[105,350],"mentioned":[107],"in":[108,193,407,465,609,645,657,698,704,721,747,804,861,877,907],"Discussion,1the":[110],"Operating":[111],"Room":[112],"Future":[115,639],"(ORF)":[116],"single-OR":[119],"research":[120],"space":[121],"with":[122,275,388,887,922],"many":[123],"purposes,":[124],"one":[125,391,424],"which":[127,862],"was":[128],"assess":[130],"financial":[132,539,782],"impact":[133,383],"extensive":[135],"physical":[136,179],"plant":[137,180],"reconfiguration":[138],"support":[140],"parallel":[141,170,239,435],"processing":[142,171,240,436],"tasks.":[145],"Therefore,":[146,387,918],"ORF":[148,414,468,579,589,611,689,801,857,930],"gains":[149,433],"no":[150,178],"advantages":[151],"from":[152,160,434,449,882,895],"economies":[154],"scale":[156],"accrue":[159],"two-room":[163],"arrangement.":[164],"aware":[167],"several":[169,808],"design":[174],"initiatives":[175,415],"involve":[177,337],"modifications":[181],"equipment":[184],"purchases,":[185],"some":[187],"these":[189],"staff-level":[191],"neutral.2Even":[192],"such":[194,373,774,927],"instances,":[195],"strongly":[199],"results\u2014it":[202],"still":[204],"decision":[207,756],"lose":[209],"money":[210],"faster":[211],"doing":[213],"per":[216],"day":[217,274,676],"if":[218],"unfavorable.":[223],"when":[225,289],"revenue":[230],"profile":[231,957],"favorable,":[233],"redesigns":[236,488],"achieve":[238],"higher":[242],"throughput":[243,723],"at":[244,597],"modest":[245],"expense":[246],"clearly":[248],"advantageous.Dr.":[249],"value":[254,304],"block":[256,905],"booking":[257],"(i.e.":[258],",":[259],"practice":[261],"allocating":[263],"single":[265,717],"same":[269,743,749],"surgeon":[270],"for":[271,287,318,339,541,621,724,741,769,785,810,942,958],"complete":[273,525],"full":[277],"schedule)":[278],"enhance":[280,504],"productivity.":[282],"His":[283],"experience":[284,322],"waiting":[286,338],"surgeons":[288,291,709,735,765,944],"switching":[290],"between":[292,708],"suggests":[294],"surgical":[297],"staff":[298,853],"do":[299],"sufficiently":[301],"appreciate":[302],"time":[307,347,813,839,845,865,906],"were":[309,456],"well":[311],"informed":[312],"about":[313],"OR's":[315],"impending":[316],"readiness":[317],"their":[319,493,497,537],"cases.":[320,729],"This":[321,898],"should":[323,489,511,535],"prompt":[324],"seek":[328],"correct":[330],"root":[332],"cause":[333],"delays":[335],"surgeons,":[340],"because":[341,677],"cost":[343,356,360,575,582,591,604,651,665],"unused":[345],"prohibitive.":[349],"much":[351],"50%":[353],"this":[355,443,585,759],"variable":[359],"controlled":[364],"efficient":[366,916],"use":[367,459],"time.3Failure":[370],"control":[372],"degrades":[375],"hospital's":[377,960],"bottom":[378],"line":[379],"but":[380],"has":[381],"little":[382],"surgeon.":[386],"incentives":[389,783,809,941],"misaligned,":[390],"worries":[392],"it":[394,445,683],"might":[395],"possible":[398],"performance.":[401],"will":[405],"describe":[406],"response":[409],"below,":[413],"may":[416,640,787],"offer":[417],"solution.Dr.":[419],"further":[421],"careful":[427,457],"allow":[430,524],"productivity":[432,871,878],"lost":[439],"downtime.":[441],"Acknowledging":[442],"concern,":[444],"seen":[448],"table":[450],"2":[451],"work1that":[454],"all":[460,949],"9-h":[463],"workday":[464],"both":[466,492],"standard":[470,595],"ORs,":[471],"thus":[472],"fully":[473],"capturing":[474],"benefit":[476,894],"increased":[479],"capacity.":[480,507],"Hospitals":[481],"expending":[483,501],"resources":[484,502],"carefully":[490],"analyze":[491],"volume":[499],"before":[500,550],"The":[508],"additional":[509,526,607,654],"capacity":[510],"reduce":[512],"staffing":[513],"(by":[515],"eliminating":[516],"overtime":[517],"allowing":[519],"shorter":[521,888],"work":[522,686],"shift),":[523],"performed,":[530],"both.":[532],"Individual":[533],"hospitals":[534],"apply":[536],"own":[538],"frameworks":[540],"revenues":[544],"contemplated":[547],"workflow":[548,848],"changes":[549],"initiating":[551],"effort.To":[556],"address":[557],"concern":[559],"institution-specific":[562],"analysis":[563],"difficult":[565],"translate":[567,826],"other":[569,798,943],"settings,":[570],"reanalyzing":[573],"effectiveness":[576],"using":[580],"national":[581],"data.":[583],"In":[584,600],"new":[586],"analysis,":[587],"effective":[592],"relative":[593],"ORs":[596,926],"institution.":[599],"particular,":[601],"incremental":[603,650],"an":[606,653,859,919],"quite":[613],"small\u2014much":[614],"smaller":[615,662],"than":[616,663,850],"typical":[618,679],"net":[619],"margin":[620],"simple":[623,781],"general":[624],"surgery":[625],"case.4Therefore,":[626],"challenge":[629],"Dritz'":[631],"final":[632],"comment":[633],"economically":[643],"viable":[644],"present.":[647],"high-throughput":[659,908],"environment":[660,860],"different":[675,734,738],"cannot":[681],"accommodate":[682],"during":[684],"regular":[685],"hours,":[687],"advantageous":[691],"regardless":[692],"mix.Dr.":[696],"his":[699],"letter":[700],"identifies":[702],"differences":[703,720],"practices":[705],"performance":[707],"major,":[712],"frequently":[714],"largest,":[716],"contributor":[718],"given":[726,911],"list":[727],"Although":[730],"agree":[732],"have":[736],"drastically":[737],"operative":[739,770,812,889,947],"times":[740,824,890],"type":[745],"patient":[750,794,863],"population,":[751],"made":[753],"conscious":[755],"sidestep":[758],"issue.":[760],"endorses":[763],"rewarding":[764],"who":[766],"meet":[767],"benchmarks":[768],"time.":[771],"structuring":[773],"rewards":[775],"problematic.":[778],"For":[779],"example,":[780],"purely":[784],"speed":[786],"create":[788],"conflicts":[789],"related":[790],"quality":[792,956],"safety.":[795],"On":[796],"hand,":[799],"project":[802],"described":[803],"article":[806],"offers":[807],"superior":[811],"performance:":[814],"small,":[816],"dedicated":[817],"team,":[818],"rapid":[819],"turnovers,":[820],"brief":[822],"nonoperative":[823,838,844,884],"into":[827],"on-time":[828],"completion":[829],"workdays":[831],"extra":[833],"By":[835],"focusing":[836],"reducing":[842],"restructuring":[847],"rather":[849],"pressuring":[851],"hurry,":[855],"creates":[858],"contact":[864],"safety":[867,954],"preserved":[869],"while":[870,939,951],"enhanced.":[873],"Because":[874],"enhancement":[876],"comes":[879],"almost":[880],"exclusively":[881],"better":[883],"performance,":[885,938],"capture":[891],"most":[893,915],"ORF.":[897],"logical":[899],"inescapable":[901],"conclusion":[902],"dictates":[903],"environments":[909],"preferentially":[912],"surgeons.":[917],"suite":[921],"few":[924],"high-capacity":[925],"gives":[931],"administrators":[932],"tool":[934],"reward":[936],"desirable":[937],"creating":[940],"times,":[948],"preserving":[952],"patients.*Harvard":[961],"Medical":[962],"School":[963],"Massachusetts":[965],"General":[966],"Hospital,":[967],"Boston,":[968],"Massachusetts.":[969],"wsandberg@partners.org":[970]},"counts_by_year":[],"updated_date":"2026-09-22T06:50:58.402377","created_date":"2016-06-24T00:00:00"}