Skip to main content Accessibility help
Hostname: page-component-55597f9d44-xbgml Total loading time: 1.53 Render date: 2022-08-18T19:48:18.919Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Section 2 - Economic Considerations, Efficiency, and Design

Published online by Cambridge University Press:  16 November 2018

Alan David Kaye
Louisiana State University
Richard D. Urman
Harvard Medical School
Charles J. Fox, III
Louisiana State University, Shreveport
Get access
Publisher: Cambridge University Press
Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Weingart, SN, Wilson, RM, Gibberd, RW, Harrison, B. Epidemiology of medical error. BMJ. 2000;320: 774–7.CrossRefGoogle ScholarPubMed
Leape, LL. Error in medicine. JAMA. 1994;272:1851–7.CrossRefGoogle ScholarPubMed
Kohn, LT, Corrigan, JM, Molla, S. To err is human. Medicine (Baltimore). 1999;126:312.Google Scholar
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm. A New Health System for the 21st Century. Washington, DC: National Academies Press, 2001.Google Scholar
Sanders, MS, McCormick, EJ. Human error, accidents, and safety. Hum. Factors Eng. Des. 1993:655–95.Google Scholar
Etchells, E, O’Neill, C, Bernstein, M. Patient safety in surgery: Error detection and prevention. World J. Surg. 2003:936–41.CrossRefGoogle ScholarPubMed
Reason, J. Human error – Models and management. BMJ. 2000;320:768–70.CrossRefGoogle ScholarPubMed
Reason, J. Human Error. Cambridge: Cambridge University Press, 1990, 1056–7.CrossRefGoogle Scholar
Wiegmann, DA, Shappell, SAS. A human error analysis of commercial aviation accidents using the Human Factors Analysis and Classification System (HFACS). Aviat. Space Environ. Med. 2001;72:117.Google Scholar
Zegers, M, de Bruijne, MC, de Keizer, B, et al. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Saf. Surg. 2011;5:13.CrossRefGoogle ScholarPubMed
Gawande, AA, Thomas, EJ, Zinner, MJ, Brennan, TA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999;126:6675.CrossRefGoogle ScholarPubMed
Catchpole, K, Mishra, A, Handa, A, McCulloch, P. Teamwork and error in the operating room: Analysis of skills and roles. Ann Surg. 2008;247:699706.CrossRefGoogle ScholarPubMed
Cesarano, FL, Piergeorge, AR. The Spaghetti syndrome. A new clinical entity. Crit. Care Med. 1979;7:182–3.Google ScholarPubMed
Arora, S, Sevdalis, N, Nestel, D, Woloshynowych, M, Darzi, A, Kneebone, R. The impact of stress on surgical performance: A systematic review of the literature. Surgery. 2010;318–30.CrossRefGoogle ScholarPubMed
Csikszentmihalyi, M. Flow: The Psychology of Optimal Experience. New York: Harper & Row, 1990.Google Scholar
Mirvis, PH. Flow: The psychology of optimal experience. Acad. Manag. Rev. 1991;16:636–40.CrossRefGoogle Scholar
Nakamura, J, Csikszentmihalyi, M. The concept of flow. Posit. Psychol. Collect. Work. 2014: 239–63.Google Scholar
Wiegmann, DA, ElBardissi, AW, Dearani, JA, Daly, RC, Sundt, TM. Disruptions in surgical flow and their relationship to surgical errors: An exploratory investigation. Surgery. 2007;142:658–65.CrossRefGoogle ScholarPubMed
Healey, AN, Sevdalis, N, Vincent, CA. Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics. 2006;49:589.CrossRefGoogle ScholarPubMed
Healey, AN, Olsen, S, Davis, R, Vincent, CA. A method for measuring work interference in surgical teams. Cogn. Technol. Work. 2008;10:305–12.Google Scholar
Parker, SEH, Laviana, AA, Wadhera, RK, Wiegmann, DA, Sundt, TM. Development and evaluation of an observational tool for assessing surgical flow disruptions and their impact on surgical performance. World J. Surg. 2010;34:353–61.CrossRefGoogle ScholarPubMed
Catchpole, KR, Gangi, A, Blocker, RC, et al. Flow disruptions in trauma care handoffs. J. Surg. Res. 2013;184:586–91.CrossRefGoogle ScholarPubMed
Silver, D, Kaye, A, Cornett, E, Fox, C, Slakey, D. Disruptions in surgical workflow: Perceptions and implications. Poster presentation. J. Am. Coll. Surg., 2017;225:108.CrossRefGoogle Scholar
Wadhera, RK, Parker, SH, Burkhart, HM, et al. Is the “sterile cockpit” concept applicable to cardiovascular surgery critical intervals or critical events? The impact of protocol-driven communication during cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg. 2010;139:312–9.CrossRefGoogle ScholarPubMed
Jain, AL, Jones, KC, Simon, J, Patterson, MD. The impact of a daily pre-operative surgical huddle on interruptions, delays, and surgeon satisfaction in an orthopedic operating room: a prospective study. Patient Saf. Surg. 2015;9:8.CrossRefGoogle Scholar
Wachtel, R. E., Dexter, F.. Difficulties and challenges associated with literature searches in operating room management, complete with recommendations. Anesth Analg 2013; 117: 1460–79.CrossRefGoogle ScholarPubMed
Dexter, F., Epstein, R. H., Traub, R. D., et al. Making management decisions on the day of surgery based on operating room efficiency and patient waiting times. Anesthesiology 2004; 101: 1444–53.Google ScholarPubMed
Dexter, F., O’Neill, L.. Weekend operating room on-call staffing requirements. AORN J 2001; 74: 666–71.CrossRefGoogle ScholarPubMed
Dexter, F., Epstein, R. H.. Holiday and weekend operating room on-call staffing requirements. Anesth Analg 2006; 103: 1494–8.CrossRefGoogle ScholarPubMed
Dexter, F., Maxbauer, T., Stout, C., Archbold, L., Epstein, R. H.. Relative influence on total cancelled operating room time from patients who are inpatients or outpatients preoperatively. Anesth Analg 2014; 118: 1072–80.CrossRefGoogle ScholarPubMed
Epstein, R. H., Dexter, F.. Management implications for the perioperative surgical home related to inpatient case cancellations and add-on case scheduling on the day of surgery. Anesth Analg 2015; 121: 206–18.CrossRefGoogle ScholarPubMed
Xiao, Y., Hu, P., Hao, H., et al. Algorithm for processing vital sign monitoring data to remotely identify operating room occupancy in real-time. Anesth Analg 2005; 101: 823–9.CrossRefGoogle Scholar
Dexter, F., Macario, A., Qian, F., et al. Forecasting surgical groups’ total hours of elective cases for allocation of block time. Application of time series analysis to operating room management. Anesthesiology 1999; 91: 1501–8.CrossRefGoogle ScholarPubMed
Donham, R. T., Mazzei, W. J., Jones, R. L.. Procedural times glossary. Am J Anesthesiol 1999; 23(5 Suppl): 412.Google Scholar
Strum, D. P., Vargas, L. G., May, J. H.. Surgical subspecialty block utilization and capacity planning. A minimal cost analysis model. Anesthesiology 1999; 90: 1176–85.CrossRefGoogle ScholarPubMed
Strum, D. P., Vargas, L. G., May, J. H., et al. Surgical suite utilization and capacity planning: A minimal cost analysis model. J Med Syst 1997; 21: 309–22.CrossRefGoogle ScholarPubMed
McIntosh, C., Dexter, F., Epstein, R. H.. Impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: Tutorial using data from an Australian hospital. Anesth Analg 2006; 103: 1499–516.CrossRefGoogle ScholarPubMed
Dexter, F., Ledolter, J., Wachtel, R. E.. Tactical decision making for selective expansion of operating room resources incorporating financial criteria and uncertainty in sub-specialties’ future workloads. Anesth Analg 2005; 100: 1425–32.CrossRefGoogle ScholarPubMed
Shi, P., Dexter, F., Epstein, R. H.. Comparing policies for case scheduling within one day of surgery by Markov chain models. Anesth Analg 2016; 122: 526–38.CrossRefGoogle Scholar
Dexter, F., Wachtel, R. E., Epstein, R. H.. Decreasing the hours that anesthesiologists and nurse anesthetists work late by making decisions to reduce the hours of over-utilized operating room time. Anesth Analg 2016; 122: 831–42.CrossRefGoogle ScholarPubMed
Epstein, R. H., Dexter, F.. Statistical power analysis to estimate how many months of data are required to identify operating room staffing solutions to reduce labor costs and increase productivity. Anesth Analg 2002; 94: 640–3.CrossRefGoogle ScholarPubMed
Sperry, R. J.. Of economic analysis. Anesthesiology 1997; 86: 1197–205.CrossRefGoogle ScholarPubMed
Wachtel, R. E., Dexter, F., Lubarsky, D. A.. Financial implications of a hospital’s specialization in rare physiologically complex surgical procedures. Anesthesiology 2005; 103: 161–7.CrossRefGoogle ScholarPubMed
Dexter, F., Abouleish, A. E., Epstein, R. H., et al. Use of operating room information system data to predict the impact of reducing turnover times on staffing costs. Anesth Analg 2003; 97: 1119–26.Google ScholarPubMed
Abouleish, A. E., Dexter, F., Whitten, C. W., et al. Quantifying net staffing costs due to longer-than-average surgical case durations. Anesthesiology 2004; 100: 403–12.CrossRefGoogle ScholarPubMed
Dexter, F., Traub, R. D.. How to schedule elective surgical cases into specific operating rooms to maximize the efficiency of use of operating room time. Anesth Analg 2002; 94: 933–42.CrossRefGoogle ScholarPubMed
Ozkarahan, I.. Allocation of surgical procedures to operating rooms. J Med Syst 1995; 19: 333–52.CrossRefGoogle ScholarPubMed
Wang, J., Dexter, F., Yang, K.. Behavioral study of daily mean turnover times and first case of the day tardiness of starts. Anesth Analg 2013; 116: 1333–41.CrossRefGoogle Scholar
Dexter, F., Macario, A., Epstein, R. H., et al. Validity and usefulness of a method to monitor surgical services’ average bias in scheduled case durations. Can J Anesth 2005; 52: 935–9.CrossRefGoogle ScholarPubMed
Dexter, F., Macario, A.. Changing allocations of operating room time from a system based on historical utilization to one where the aim is to schedule as many surgical cases as possible. Anesth Analg 2002; 94: 1272–9.CrossRefGoogle Scholar
Dexter, F., Blake, J. T., Penning, D. H., et al. Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: a case study. Anesth Analg 2002; 94: 138–42.Google ScholarPubMed
Dexter, F., Ledolter, H.. Managing risk and expected financial return from selective expansion of operating room capacity. Mean-variance analysis of a hospital’s portfolio of surgeons. Anesth Analg 2003; 97: 190–5.Google ScholarPubMed
O’Neill, L., Dexter, F., Wachtel, R. E.. Should anesthesia groups advocate funding of clinics and scheduling systems to increase operating room workload? Anesthesiology 2009; 111: 1016–24.CrossRefGoogle ScholarPubMed
Macario, A., Dexter, F., Traub, R. D.. Hospital profitability per hour of operating room time can vary among surgeons. Anesth Analg 2001; 93: 669–75.CrossRefGoogle ScholarPubMed
O’Neill, L., Dexter, F.. Tactical increases in operating room block time based on financial data and market growth estimates from data envelopment analysis. Anesth Analg 2007; 104: 355–68.Google ScholarPubMed
Blake, J. T., Dexter, F., Donald, J.. Operating room managers’ use of integer programming for assigning allocated block time to surgical groups: A case study. Anesth Analg 2002; 94: 143–8.CrossRefGoogle ScholarPubMed
Vanberkel, P. T., Boucherie, R. J., Hans, E. W., et al. Accounting for inpatient wards when developing master surgical schedules. Anesth Analg 2011; 112: 1472–9.CrossRefGoogle ScholarPubMed
McManus, M. L., Long, M. C., Cooper, A., et al. Variability in surgical caseload and access to intensive care services. Anesthesiology 2003; 98: 1491–6.CrossRefGoogle ScholarPubMed
Gallivan, S., Utley, M., Treasure, T., et al. Booked inpatient admission and hospital capacity: Mathematical modelling study. BMJ 2002; 324: 280–2.CrossRefGoogle ScholarPubMed
Meyfroidt, G., Guiza, F., Cottem, D., et al. Computerized prediction of intensive care unit discharge after cardiac surgery: Development and validation of a Gaussian processes model. BMC Med Inform Decis Mak 2011; 11: 64.CrossRefGoogle ScholarPubMed
Wachtel, R. E., Dexter, F.. Tactical increases in operating room block time for capacity planning should not be based on utilization. Anesth Analg 2008; 106: 215–26.CrossRefGoogle Scholar
Dexter, F., Epstein, R. H., Marsh, H. M.. Statistical analysis of weekday operating room anesthesia group staffing at nine independently managed surgical suites. Anesth Analg 2001; 92: 1493–8.Google ScholarPubMed
Casimir, R. J.. Strategies for a blind newsboy. Omega Int J Mgmt Sci 1999; 27: 129–34.CrossRefGoogle Scholar
Dexter, F., Macario, A., Traub, R. D., et al. An operating room scheduling strategy to maximize the use of operating room block time. Computer simulation of patient scheduling and survey of patients’ preferences for surgical waiting time. Anesth Analg 1999; 89: 720.Google ScholarPubMed
Dexter, F., Traub, R. D., Macario, A., et al. Operating room utilization alone is not an accurate metric for the allocation of operating room block time to individual surgeons with low caseloads. Anesthesiology 2003; 98: 1243–9.Google Scholar
Abouleish, A. E., Dexter, F., Epstein, R. H., et al. Labor costs incurred by anesthesiology groups because of operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency. Anesth Analg 2003; 96: 1109–13.Google Scholar
Freytag, S., Dexter, F., Epstein, R. H., et al. Allocating and scheduling operating room time based on maximizing operating room efficiency at a German university hospital. Der Chirurg 2005; 76: 71–9.Google Scholar
Lehtonen, J. M., Torkki, P., Peltokorpi, A., Moilanen, T.. Increasing operating room productivity by duration categories and a newsvendor model. Int J Health Care Qual Assur 2013; 26: 8092.CrossRefGoogle Scholar
Wachtel, R. E., Dexter, F.. Review of behavioral operations experimental studies of newsvendor problems for operating room management. Anesth Analg 2010; 110: 1698–710.CrossRefGoogle ScholarPubMed
Pandit, J. J., Dexter, F.. Lack of sensitivity of staffing for 8 hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues. Anesth Analg 2009; 108: 1910–15.CrossRefGoogle ScholarPubMed
Prahl, A., Dexter, F., Braun, M. T., Van Swol, L.. Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making. Anesth Analg 2013; 117: 1221–9.CrossRefGoogle ScholarPubMed
Dexter, F., Weih, L. S., Gustafson, R. K., et al. Observational study of operating room times for knee and hip replacement surgery at nine US community hospitals. Health Care Manag Sci 2006; 9: 325–39.CrossRefGoogle Scholar
Dexter, F., Dutton, R. P., Kordylewski, H., Epstein, R. H.. Anesthesia workload nationally during regular workdays and weekends. Anesth Analg 2015; 121: 1600–3.CrossRefGoogle ScholarPubMed
Dexter, F., Masursky, D., Wachtel, R. E., Nussmeier, N. A.. Application of an online reference for reviewing basic statistical principles of operating room management. J Stat Educ 2010; 18(3).CrossRefGoogle Scholar
Wachtel, R. E., Dexter, F.. Curriculum providing cognitive knowledge and problem-solving skills for anesthesia systems-based practice. J Grad Med Educ 2010; 2: 624–32.CrossRefGoogle ScholarPubMed
Marcon, E., Dexter, F.. Observational study of surgeons’ sequencing of cases and its impact on post-anesthesia care unit and holding area staffing requirements at hospitals. Anesth Analg 2007; 105: 119–26.CrossRefGoogle Scholar
Junger, A., Benson, M., Quinzio, L., et al. An anesthesia information management system as a tool for controlling resource management of operating rooms. Meth Inform Med 2002; 41: 81–5.CrossRefGoogle ScholarPubMed
Epstein, R. H., Dexter, F.. Uncertainty in knowing the operating rooms in which cases were performed has little effect on operating room allocations or efficiency. Anesth Analg 2002; 95: 1726–30.CrossRefGoogle ScholarPubMed
Abouleish, A. E., Hensley, S. L., Zornow, M. H., et al. Inclusion of turnover time does not influence identification of surgical services that over- and underutilize allocated block time. Anesth Analg 2003; 96: 813–18.Google Scholar
Dexter, F., Traub, R. D.. Lack of systematic month-to-month variation over one year periods in ambulatory surgery caseload application to anesthesia staffing. Anesth Analg 2000; 91: 1426–30.CrossRefGoogle ScholarPubMed
Masursky, D., Dexter, F., O’Leary, C. E., Applegeet, C., Nussmeier, N. A.. Long-term forecasting of anesthesia workload in operating rooms from changes in a hospital’s local population can be inaccurate. Anesth Analg 2008; 106: 1223–31.CrossRefGoogle Scholar
Farnum, N. R., Stanton, L. W.. Quantitative Forecasting Methods. Boston: Kent, 1989.Google Scholar
Dexter, F., Epstein, R. H.. Calculating institutional support that benefits both the anesthesia group and hospital. Anesth Analg 2008; 106: 544–53.CrossRefGoogle ScholarPubMed
Dexter, F., Epstein, R. H.. Typical savings from each minute reduction in tardy first case of the day starts. Anesth Analg 2009; 108: 1262–7.CrossRefGoogle ScholarPubMed
Dexter, F., Traub, R. D., Macario, A.. How to release allocated operating room time to increase efficiency. Predicting which surgical service will have the most under-utilized operating room time. Anesth Analg 2003; 96: 507–12.Google Scholar
Dexter, F., Macario, A., Traub, R. D.. Which algorithm for scheduling add-on elective cases maximizes operating room utilization? Use of bin packing algorithms and fuzzy constraints in operating room management. Anesthesiology 1999; 91: 1491–500.CrossRefGoogle ScholarPubMed
Dexter, F., Macario, A.. When to release allocated operating room time to increase operating room efficiency. Anesth Analg 2004; 98: 758–62.Google ScholarPubMed
Dexter, F., Shi, P., Epstein, R. H.. Descriptive study of case scheduling and cancellations within one week of the day of surgery. Anesth Analg 2012; 115: 1188–95.CrossRefGoogle Scholar
Dexter, F., Macario, A., Lubarsky, D. A., et al. Statistical method to evaluate management strategies to decrease variability in operating room utilization. Application of linear statistical modeling and Monte-Carlo simulation to operating room management. Anesthesiology 1999; 91: 262–74.CrossRefGoogle ScholarPubMed
Dexter, F., Wachtel, R. E., Epstein, R. H.. Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data. BMC Med Inform Decis Mak 2011; 11: 2.CrossRefGoogle ScholarPubMed
Dexter, F., Willemsen-Dunlap, A., Lee, J. D.. Operating room managerial decision-making on the day of surgery with and without computer recommendations and status displays. Anesth Analg 2007; 105: 419–29.CrossRefGoogle ScholarPubMed
Dexter, F.. A strategy to decide whether to move the last case of the day in an operating room to another empty operating room to decrease overtime labor costs. Anesth Analg 2000; 91: 925–8.CrossRefGoogle Scholar
Dexter, F., Macario, A., O’Neill, L.. A strategy for deciding operating room assignments for second-shift anesthetists. Anesth Analg 1999; 89: 920–4.CrossRefGoogle ScholarPubMed
Dexter, F., Traub, R. D.. Statistical method for predicting when patients should be ready on the day of surgery. Anesthesiology 2000; 93: 1107–14.CrossRefGoogle ScholarPubMed
Dexter, F., Traub, R. D.. Sequencing cases in operating rooms: Predicting whether one surgical case will last longer than another. Anesth Analg 2000; 90: 975–9.CrossRefGoogle Scholar
Babineau, T. J., Becker, J., Gibbons, G., et al. The “cost” of operating training for surgical residents. Arch Surg 2004; 139: 366–70.CrossRefGoogle ScholarPubMed
Eappen, S., Flanagan, H., Bhattacharyya, N.. Introduction of anesthesia resident trainees to the operating room does not lead to changes in anesthesia-controlled times for efficiency measures. Anesthesiology 2004; 101: 1210–14.CrossRefGoogle Scholar
Dexter, F., Epstein, R. H.. Associated roles of perioperative medical directors and anesthesia: Hospital agreements for operating room management. Anesth Analg 2015; 121: 1469–78.CrossRefGoogle ScholarPubMed
Wachtel, R. E., Dexter, F.. Influence of the operating room schedule on tardiness from scheduled start times. Anesth Analg 2009; 108: 1889–901.Google ScholarPubMed
Wachtel, R. E., Dexter, F.. Reducing tardiness from scheduled start times by making adjustments to the operating room schedule. Anesth Analg 2009; 108: 1902–9.Google ScholarPubMed
Dexter, F., Epstein, R. H., Bayman, E. O., Ledolter, J.. Estimating surgical case durations and making comparisons among facilities: Identifying facilities with lower anesthesia professional fees. Anesth Analg 2013; 116: 1103–15.CrossRefGoogle ScholarPubMed
Dexter, F., Epstein, R. H., Lee, J. D., Ledolter, J.. Automatic updating of times remaining in surgical cases using Bayesian analysis of historical case duration data and instant messaging updates from anesthesia providers. Anesth Analg 2009; 108: 929–40.CrossRefGoogle ScholarPubMed
Tiwari, V., Dexter, F., Rothman, B. S., Ehrenfeld, J. M., Epstein, R. H.. Explanation for the near constant mean time remaining in surgical cases exceeding their estimated duration, necessary for appropriate display on electronic white boards. Anesth Analg 2013; 117: 487–93.CrossRefGoogle ScholarPubMed
Dexter, F., Ledolter, J.. Bayesian prediction bounds and comparisons of operating room times even for procedures with few or no historical data. Anesthesiology 2005; 103: 1259–67.CrossRefGoogle ScholarPubMed
Dexter, F., Ledolter, J., Tiwari, V., Epstein, R. H.. Value of a scheduled duration quantified in terms of equivalent numbers of historical cases. Anesth Analg 2013; 117: 204–9.CrossRefGoogle ScholarPubMed
Dexter, F., Macario, A.. What is the relative frequency of uncommon ambulatory surgery procedures in the United States with an anesthesia provider? Anesth Analg 2000; 90: 1343–7.CrossRefGoogle ScholarPubMed
Dexter, F., Traub, R. D., Fleisher, L. A., Rock, P.. What sample sizes are required for pooling surgical case durations among facilities to decrease the incidence of procedures with little historical data? Anesthesiology 2002; 96: 1230–6.CrossRefGoogle ScholarPubMed
Dexter, F., Dexter, E. U., Ledolter, J.. Influence of procedure classification on process variability and parameter uncertainty of surgical case durations. Anesth Analg 2010; 110: 1155–63.CrossRefGoogle ScholarPubMed
Epstein, R. H., Dexter, F., Piotrowski, E.. Automated correction of room location errors in anesthesia information management systems. Anesth Analg 2008; 107: 965–71.CrossRefGoogle ScholarPubMed
Brewer, P. C., Garrison, R. H., Noreen, E. W.. Managerial Accounting, 14th edn. New York: McGraw-Hill, 2012.Google Scholar
Cachon, G., Terwiesh, C. Matching Supply with Demand: An Introduction to Operations Management, 3rd edn. Boston: McGraw-Hill, 2011.Google Scholar
Gabel, R. A., ed. Operating Room Management. Chicago: Butterworth-Heinemann, 1999.Google Scholar
Harris, A. P., Zitzmann, W. G.. Operating Room Management: Structure, Strategies, & Economics. St. Louis: Mosby, 1998.Google Scholar
Pandit, J. J., Westbury, S., Pandit, M.. The concept of surgical list “efficiency”: A formula to describe the term. Anaesthesia 2007; 62: 895903.CrossRefGoogle ScholarPubMed
Macario, A.. Are your operating rooms efficient? A scoring system with eight performance indicators. Anesthesiology 2006; 105: 237–40.CrossRefGoogle ScholarPubMed
Pandit, J. J., Stubbs, D., Pandit, M.. Measuring the quantitative performance of surgical operating lists: Theoretical modelling of “productive potential” and “efficiency.” Anaesthesia 2009; 64: 473–86.CrossRefGoogle Scholar
Litvak, E., Long, M.. Cost and quality under managed care: Irreconcilable differences? Am J Manag Care 2000; 6: 305–12.Google ScholarPubMed
NHS Institute for Innovation and Improvement. The seven wastes of lean. 2008. (accessed May 2, 2012).Google Scholar
Marjamaa, R., Torkki, P., Hirvensalo, E., Kirvela, O.. What is the best workflow for an operating room? A simulation study of five scenarios. Health Care Manag Sci 2009; 12: 142–6.CrossRefGoogle ScholarPubMed
Sandberg, W., Daily, B., Egan, M., et al. Deliberate perioperative systems design improves operating room throughput. Anesthesiology 2005; 103: 406–18.CrossRefGoogle ScholarPubMed
Smith, M., Sandberg, W., Foss, J., et al. High-throughput operating room system for joint arthroplasties durably outperforms routine processes. Anesthesiology 2008; 109: 2535.CrossRefGoogle ScholarPubMed
Guidelines for Design and Construction of Health Care Facilities. Chicago, IL. Facility Guidelines Institute, 2014.Google Scholar
Joint Commission. Planning, Design, and Construction of Health Care Facilities, 3rd edn. Oakbrook Terrace, IL: Joint Commission, 2015.Google Scholar
Association for Professionals in Infection Control and Epidemiology. Guidelines and standards. Scholar
Worley, DJ, Hohler, S. OR construction project: From planning to execution. AORN J. 2008;88:917–41.CrossRefGoogle ScholarPubMed
Saver, C. Tips for surviving an OR building project. OR Manager. 2008;24(2):18, 21.Google ScholarPubMed
Palmer, G, Abernathy, JH, Swinton, G, et al. Realizing improved patient care through human-centered operating room design. Anesthesiology. 2013;119:1066–77.CrossRefGoogle ScholarPubMed
Center for Health Design. Scholar
American Society of PeriAnesthesia Nurses. Perianesthesia Nursing Standards, Practice Recommendations, and Interpretive Statements: 2015–2017. Cherry Hill, NJ: ASPAN, 2015. www.aspan.orgGoogle Scholar
Association of periOperative Registered Nurses. Guidelines & clinical resources. Scholar
Association for the Advancement of Medical Instrumentation et al. Immediate-Use Steam Sterilization. Arlington, VA: AAMI, 2011. www.aami.orgGoogle Scholar
Brogmus, G, Leone, W, Butler, L, et al. Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls. AORN J. 2007;86:384–94.CrossRefGoogle ScholarPubMed
American Society for Healthcare Engineering et al. Joint ASHE, APIC, and SHEA response to electronic faucet technology. June 23, 2011. Scholar
Bartley, JM. APIC state-of-the-art report: The role of infection control during construction in health care facilities. Am J Infect Control. 2000;28:156–69.CrossRefGoogle ScholarPubMed
Bartley, JM, Olmsted, RN, Haas, J. Current views of health care design and construction: Practical implications for safer, cleaner environments. Am J Infect Control. 2010;38:S1–S12.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Guideline for Environmental Infection Control in Healthcare Facilities. Atlanta, GA: CDC, 2003. Scholar
Peck, RL, Powers-Jones, S. Staying up-to-date on life safety. Healthcare Building Ideas. November 1, 2010. Scholar
National Fire Protection Association. NFPA 101: Life Safety Code. Quincy, MA: NFPA, 2015.Google Scholar
Hsiao, KC, Machaidze, Z, Pattaras, JG. Time management in the operating room: An analysis of the dedicated minimally invasive surgery suite. JSLS. 2004;8:300–3.Google ScholarPubMed
Van Det, MJ, Meijerink, WJ, Hoff, C, et al. Ergonomic assessment of neck posture in the minimally invasive surgical suite during laparoscopic cholecystectomy. Surg Endosc. 2008;22:2421–7.CrossRefGoogle ScholarPubMed
Eder, P, Register, JL. Ten management considerations for implementing an endovascular hybrid OR. AORN J. 2014;100(3):260–70.CrossRefGoogle Scholar
Van Pelt, J. Hybrid ORs: What’s behind the demand? OR Manager. 2011;27(5):710.Google ScholarPubMed
ECRI Institute. What Is a Hybrid OR? Should Your Facility Have One? Plymouth Meeting, PA: ECRI Institute, 2015. www.ecri.orgGoogle Scholar
Bonatti, J, Lehr, E, Vesely, MR, et al. Hybrid coronary revascularization: Which patients? When? How? Curr Opin Cardiol. 2010;25:568–74.CrossRefGoogle Scholar
Mathias, J. Planning and staffing a hybrid OR. OR Manager. 2011;27(5):1012.Google ScholarPubMed
Urbanowicz, JA, Taylor, G. Hybrid OR: Is it in your future? Nurse Manage. 2010;41(5):22–7.Google ScholarPubMed
American Society of Anesthesiologists. Operating Room Design Manual. Scholar
Miller, R. D., Eriksson, L. I., Fleisher, L. A., Wiener-Kronish, J. P., Young, W. L.. Miller’s Anesthesia, 7th edn. New York: McGraw-Hill, 2008.Google Scholar
Springman, S.. Ambulatory Anesthesia: The Requisites in Anesthesiology. New York: Mosby, 2006.Google Scholar
Frey, R.. Ambulatory surgery centers. Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. (accessed May 10, 2012).Google Scholar
Barash, P. G., Cullen, B. F., Stoelting, R. K., Cahalan, M., Stock, M. C.. Clinical Anesthesia, 6th edn. Baltimore, MD: Lippincott Williams & Wilkins, 2009.Google Scholar
Jahnle, C., Rebane, K. A.. Ambulatory surgery centers – Fragmented industry poised for consolidation. Ambulatory Surgery Center Business Review. Winter 2003.Google Scholar
Ambulatory Surgery Center Association. Ambulatory surgery centers: A positive trend in health care. (accessed November 30, 2016).Google Scholar
Medicare Payment Advisory Commission. A data book: Healthcare spending and the Medicare program. June 2016. (accessed December 1, 2016).Google Scholar
Dexter, F, Epstein, RH, Traub, RD, et al. Making management decisions on the day of surgery based on operating room efficiency and patient waiting times. Anesthesiology 2004; 101: 1444–53.Google ScholarPubMed
Glossary of times used for scheduling and monitoring of diagnostic and therapeutic procedures. AORN J 1997; 66: 601–6.Google Scholar
Luedi, MM, Kauf, P, Mulks, L, et al. Implications of patient age and ASA physical status for operating room management decisions. Anesth Analg 2016; 122: 1169–77.CrossRefGoogle ScholarPubMed
Escobar, A, Davis, EA, Ehrenwerth, J, et al. Task analysis of the preincision surgical period: An independent observer-based study of 1558 cases. Anesth Analg 2006; 103: 922–7.CrossRefGoogle ScholarPubMed
Doll, D, Wieferich, K, Erhart, T, et al. Waiting for Godot: An analysis of 2622 operating room turnover times. Eur J Anaesthesiol 2014; 31: 388–9.CrossRefGoogle ScholarPubMed
Dexter, EU, Dexter, F, Masursky, D, et al. Prospective trial of thoracic and spine surgeons’ updating of their estimated case durations at the start of cases. Anesth Analg 2010; 110: 1164–8.Google ScholarPubMed
Junger, A, Klasen, J, Benson, M, et al. Factors determining length of stay of surgical day-case patients. Eur J Anaesthesiol 2001; 18: 314–21.CrossRefGoogle ScholarPubMed
Bravo, F, Levi, R, Ferrari, LR, et al. The nature and sources of variability in pediatric surgical case duration. Paediatr Anaesth 2015; 25: 9991006.CrossRefGoogle ScholarPubMed
Dexter, F. Regional anesthesia does not significantly change surgical time versus general anesthesia – A meta-analysis of randomized studies. Reg Anesth Pain Med 1998; 23: 439–43.Google Scholar
Williams, BA, Kentor, ML, Williams, JP, et al. Process analysis in outpatient knee surgery: Effects of regional and general anesthesia on anesthesia-controlled time. Anesthesiology 2000; 93: 529–38.CrossRefGoogle ScholarPubMed
Armstrong, KP, Cherry, RA. Brachial plexus anesthesia compared to general anesthesia when a block room is available. Can J Anaesth 2004; 51: 41–4.CrossRefGoogle ScholarPubMed
Beaussier, M, Decorps, A, Tilleul, P, et al. Desflurane improves the throughput of patients in the PACU. A cost-effectiveness comparison with isoflurane. Can J Anaesth 2002; 49: 339–46.CrossRefGoogle ScholarPubMed
McIntosh, C, Dexter, F, Epstein, RH. The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: A tutorial using data from an Australian hospital. Anesth Analg 2006; 103: 1499–516.CrossRefGoogle ScholarPubMed
Marcon, E, Dexter, F. Impact of surgical sequencing on post anesthesia care unit staffing. Health Care Manag Sci 2006; 9: 8798.CrossRefGoogle ScholarPubMed
Torkki, PM, Marjamaa, RA, Torkki, MI, et al. Use of anesthesia induction rooms can increase the number of urgent orthopedic cases completed within 7 hours. Anesthesiology 2005; 103: 401–5.CrossRefGoogle ScholarPubMed
Roberts, TT, Vanushkina, M, Khasnavis, S, et al. Dedicated orthopaedic operating rooms: Beneficial to patients and providers alike. J Orthop Trauma 2015; 29: e18–23.CrossRefGoogle ScholarPubMed
van Veen-Berkx, E, Elkhuizen, SG, Kuijper, B, et al. Dedicated operating room for emergency surgery generates more utilization, less overtime, and less cancellations. Am J Surg 2016; 211: 122–8.CrossRefGoogle ScholarPubMed
Heng, M, Wright, JG. Dedicated operating room for emergency surgery improves access and efficiency. Can J Surg 2013; 56: 167–74.CrossRefGoogle Scholar
Lehtonen, JM, Kujala, J, Kouri, J, et al. Cardiac surgery productivity and throughput improvements. Int J Health Care Qual Assur 2007; 20: 4052.CrossRefGoogle ScholarPubMed
Kain, ZN, Vakharia, S, Garson, L, et al. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014;118(5):1126–30.CrossRefGoogle ScholarPubMed
Vetter, TR, Boudreaux, AM, Jones, KA, Hunter, JM, Jr., Pittet, JF. The perioperative surgical home: How anesthesiology can collaboratively achieve and leverage the triple aim in health care. Anesth Analg. 2014;118(5):1131–6.CrossRefGoogle ScholarPubMed
Schweitzer, M, Vetter, TR. The perioperative surgical home: More than smoke and mirrors? Anesth Analg. 2016;123(3):524–8.CrossRefGoogle ScholarPubMed
Cannesson, M, Kain, Z. The perioperative surgical home: An innovative clinical care delivery model. J Clin Anesth. 2015;27(3):185–7.CrossRefGoogle ScholarPubMed
Vetter, TR, Goeddel, LA, Boudreaux, AM, Hunt, TR, Jones, KA, Pittet, JF. The perioperative surgical home: How can it make the case so everyone wins? BMC Anesthesiology. 2013;13:6.CrossRefGoogle Scholar
Goeddel, LA, Porterfield, JR, Jr., Hall, JD, Vetter, TR. Ethical opportunities with the perioperative surgical home: Disruptive innovation, patient-centered care, shared decision making, health literacy, and futility of care. Anesth Analg. 2015;120(5):1158–62.CrossRefGoogle ScholarPubMed
Vetter, TR, Ivankova, NV, Goeddel, LA, McGwin, G, Jr., Pittet, JF. An analysis of methodologies that can be used to validate if a perioperative surgical home improves the patient-centeredness, evidence-based practice, quality, safety, and value of patient care. Anesthesiology. 2013;119(6):1261–74.CrossRefGoogle ScholarPubMed
Vetter, TR, Barman, J, Hunter, JM, Jr., Jones, KA, Pittet, JF. The effect of implementation of preoperative and postoperative care elements of a perioperative surgical home model on outcomes in patients undergoing hip arthroplasty or knee arthroplasty. Anesth Analg. 2016.Google Scholar
Kinsman, L, Rotter, T, James, E, Snow, P, Willis, J. What is a clinical pathway? Development of a definition to inform the debate. BMC Med. 2010;8:31.CrossRefGoogle ScholarPubMed
Schrijvers, G, van Hoorn, A, Huiskes, N. The care pathway: Concepts and theories: An introduction. Int J Integr Care. 2012;12:e192.CrossRefGoogle Scholar
Ljungqvist, O. Sustainability after structured implementation of ERAS protocols. World J Surg. 2015;39(2):534–5.CrossRefGoogle ScholarPubMed
Press, MJ, Rajkumar, R, Conway, PH. Medicare’s new bundled payments: Design, strategy, and evolution. JAMA. 2016;315(2):131–2.CrossRefGoogle Scholar
Center for Medicare & Medicaid Services. Medicare program: Comprehensive care for joint replacement payment model for acute care hospitals furnishing lower extremity joint replacement services. Final rule. Fed Regist. 2015;80(226):73273–554.Google Scholar
Porter, ME. What is value in health care? N Engl J Med. 2010;363(26):2477–81.CrossRefGoogle ScholarPubMed
Vetter, TR, Jones, KA. Perioperative surgical home: Perspective II. Anesthesiol Clin. 2015;33(4):771–84.CrossRefGoogle ScholarPubMed
Vetter, TR, Pittet, JF. The perioperative surgical home: A panacea or Pandora’s box for the specialty of anesthesiology? Anesth Analg. 2015;120(5):968–73.CrossRefGoogle ScholarPubMed
Sisko, AM, Keehan, SP, Cuckler, GA, et al. National health expenditure projections, 2013–23: Faster growth expected with expanded coverage and improving economy. Health Aff (Millwood). 2014;33(10):1841–50.CrossRefGoogle ScholarPubMed
Health Care Cost Institute. Health care cost and utlization report 2015. December 12, 2016. Scholar
Weiss, AJ, Elixhauser, A, Andrews, RM. Characteristics of operating room procedures in U.S. hospitals, 2011. Statistical Brief #170. 2014.Google Scholar
Cormier, JN, Cromwell, KD, Pollock, RE. Value-based health care: A surgical oncologist’s perspective. Surg Oncol Clin N Am. 2012;21(3):497506.CrossRefGoogle ScholarPubMed
Fry, DE, Pine, M, Jones, BL, Meimban, RJ. The impact of ineffective and inefficient care on the excess costs of elective surgical procedures. JACS. 2011;212(5):779–86.Google ScholarPubMed
Burwell, SM. Setting value-based payment goals – HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897–9.CrossRefGoogle ScholarPubMed
Clough, JD, McClellan, M. Implementing MACRA: Implications for physicians and for physician leadership. JAMA. 2016;315(22):2397–8.CrossRefGoogle ScholarPubMed
Health Care Transformation Task Force. Major health care players unite to accelerate transformation of the U.S. health care system. Washington, DC: Qorvis MSLGROUP, 2015. Scholar
Macario, A, Vitez, TS, Dunn, B, McDonald, T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995;83(6):1138–44.CrossRefGoogle ScholarPubMed
Macario, A. Are your hospital operating rooms “efficient”? A scoring system with eight performance indicators. Anesthesiology. 2006;105(2):237–40.CrossRefGoogle ScholarPubMed
Macario, A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4):233–6.CrossRefGoogle ScholarPubMed
Park, KW, Dickerson, C. Can efficient supply management in the operating room save millions? Curr Opin Anaesthesiol. 2009;22(2):242–8.CrossRefGoogle ScholarPubMed
Harders, M, Malangoni, MA, Weight, S, Sidhu, T. Improving operating room efficiency through process redesign. Surgery. 2006;140(4):509–14; discussion 14–6.CrossRefGoogle ScholarPubMed
Schweikhart, SA, Dembe, AE. The applicability of Lean and Six Sigma techniques to clinical and translational research. J Investig Med. 2009;57(7):748–55.CrossRefGoogle ScholarPubMed
McDaniel, RR, Jr., Lanham, HJ. Evidence as a tool for managerial action: A complex adaptive systems view. Health Care Manage Rev. 2009;34(3):216–8.CrossRefGoogle ScholarPubMed
Cima, RR, Brown, MJ, Hebl, JR, et al. Use of Lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg. 2011;213(1):8392; discussion 34.CrossRefGoogle Scholar
Leader, S, Moon, M. Medicare trends in ambulatory surgery. Health Aff (Millwood). 1989;8(1):158–70.CrossRefGoogle ScholarPubMed
Chartbook 2016: Trends affecting hospitals and health systems. Washington, DC: American Hospital Association. (accessed January 31, 2107).Google Scholar
Ambulatory Surgery Center Association. Ambulatory surgery centers: A positive trend in health care 2012. Scholar
Szabad, M, Freerks, M, Bushee, MM. Reverse migration? A trend of ASC conversion to HOPD2013. Scholar
Munnich, EL, Parente, ST. Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Aff (Millwood). 2014;33(5):764–9.CrossRefGoogle ScholarPubMed
Centers for Medicare and Medicaid Services. 42 CFR Part 416: Medicare Program; Update of Ambulatory Surgical Center List of Covered Procedures; Interim Final Rule. Scholar
Erhun, F, Malcolm, E, Kalani, M, et al. Opportunities to improve the value of outpatient surgical care. Am J Manag Care. 2016;22(9):e329–35.Google ScholarPubMed
Prielipp, RC, Morell, RC, Coursin, DB, et al. The future of anesthesiology: Should the perioperative surgical home redefine us? Anesth Analg. 2015;120(5):1142–8.CrossRefGoogle ScholarPubMed
Warner, MA, Apfelbaum, JL. The perioperative surgical home: A response to a presumed burning platform or a thoughtful expansion of anesthesiology? Anesth Analg. 2015;120(5):1149–51.CrossRefGoogle ScholarPubMed
Kain, ZN, Hwang, J, Warner, MA. Disruptive innovation and the specialty of anesthesiology: The case for the perioperative surgical home. Anesth Analg. 2015;120(5):1155–7.CrossRefGoogle ScholarPubMed
Holt, NF. Trends in healthcare and the role of the anesthesiologist in the perioperative surgical home – The US perspective. Curr Opin Anaesthesiol. 2014;27(3):371–6.CrossRefGoogle ScholarPubMed
American Society of Anesthesiologists Committee on Standards and Practice Parameters. Practice advisory for preanesthesia evaluation: An updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology 2012; 116(3): 522–38.Google Scholar
American Society for Gastrointestinal Endoscopy Committee on Standards of Practice. Routine laboratory testing before endoscopic procedures. Gastrointest Endosc 2014; 80(1): 2833.CrossRefGoogle Scholar
Vargo, JJ, Zuccaro, G, Dumot, JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: A prospective, randomized trial. Gastroenterology 2002; 123(1): 816.CrossRefGoogle ScholarPubMed
Sipe, BW, Rex, DK, Latinovich, D, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: Administration by nurses supervised by endoscopists. Gastrointest Endosc 2002; 55(7): 815–25.CrossRefGoogle ScholarPubMed
Day, LW, Belson, D, Dessouky, M, Hawkins, C, Hogan, M. Optimizing efficiency and operations at a California safety-net endoscopy center: A modeling and simulation approach. Gastrointest Endosc 2014; 80(5): 762–73.CrossRefGoogle Scholar
Cravero, JP, Blike, GT, Beach, M, et al. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: Report from the Pediatric Sedation Research Consortium. Pediatrics 2006; 118(3): 1087–96.CrossRefGoogle ScholarPubMed
Dexter, F., Ledolter, J., and Wachtel, R. E., Tactical decision making for selective expansion of operating room resources incorporating financial criteria and uncertainty in subspecialties’ future workloads. Anesth Analg, 2005; 100(5): 1425–32, table of contents.CrossRefGoogle ScholarPubMed
Strum, D. P., Vargas, L. G., and May, J. H., Surgical subspecialty block utilization and capacity planning: A minimal cost analysis model. Anesthesiology, 1999; 90(4): 1176–85.CrossRefGoogle ScholarPubMed
Goleman, D., What makes a leader? Harv Bus Rev, 1998; 76(6): 93102.Google ScholarPubMed
Wachtel, R. E., and Dexter, F., Tactical increases in operating room block time for capacity planning should not be based on utilization. Anesth Analg, 2008; 106(1): 215–26, table of contents.CrossRefGoogle Scholar
Stepaniak, P.S., et al., The effect of the operating room coordinator’s risk appreciation on operating room efficiency. Anesth Analg, 2009; 108(4): 1249–56.CrossRefGoogle ScholarPubMed
Five approaches to effective budgeting and forecasting in healthcare. axiomEPM, 2016. Scholar
A primer on hospital accounting and finance for trustees and other healthcare professionals (4th ed.). Kaufman Hall, 2009. Scholar
Does your budgeting process lack accountability? How effectively you monitor variances will tell you. Kaufman Hall, 2016. Scholar
Newbert, A, Sutton, J. Has the annual budget outlived its usefulness? February 23, 2016. Healthcare Connection, Crowe Horwath.Google Scholar
Pyhrr, PH, Zero-base budgeting. Harvard Business Review 1970; 48(6): 111–21.Google Scholar
Yaisawarng, S, Burgess, JF. Performance-based budgeting in the public sector: An illustration from the VA health care system. Health Economics 2006; 15(3): 295310.CrossRefGoogle ScholarPubMed
Robinson, M, Duncan, L. A basic model of performance-based budgeting. International Monetary Fund, Fiscal Affairs Department. Technical Notes and Manuals 2009, 09/01: 1–16.CrossRefGoogle Scholar
Birshan, M, Engel, M, Sibony, O. Avoiding the quicksand: Ten techniques for more agile corporate resource allocation. McKinsey Quarterly 2013. Scholar
The World Bank, Poverty Reduction and Economic Management Network (PREM) notes. February 2003, 78: 1–4.Google Scholar
Akten, MGM, Scheiffele, MA. Just-in-time budgeting for a volatile economy. Mckinsey Quarterly 2009. Scholar
Meyers, R. Budgets on a roll. Journal of Accountancy 2001. Scholar
Miller, D, Fau, AM, Fau, SS, Hackman, T. How rolling forecasting facilitates dynamic, agile planning. Healthcare Financial Management 2013; 67(11): 80–2, 84.Google ScholarPubMed
Ellison, A. This health system threw out its annual budget – Here’s why. Becker’s Hospital Review. Scholar
Berger, S. Knowing the limitations: Rolling forecasts and hospital financial planning. Healthcare Insights. Scholar
Teach, E. No time for budgets: Yesterday’s budgets are too slow for today’s volatile world. Here’s how to pick up the planning pace. May 27, 2014. Scholar
Zeller, TL, Metzger, LM. Good bye traditional budgeting, hello rolling forecast: Has the time come? American Journal of Business Education 2013; 6(3): 299.Google Scholar
Johnson, H. Rolling budgets catching on: More efficient and flexible forecasting tools. Crain’s New York Business 2011. Scholar