Health information technology governance : a perspective on investment decision processes

Realizing value from IT investments continues to be a challenge for most healthcare organizations. IT governance (ITG) is envisaged to solve many of these challenges. ITG is the practice that establishes accountability framework for IT investments by allocating decision rights among major participants involved in IT decision processes. As ITG is relatively new in healthcare industry, it is expected that knowledge about how healthcare organizations govern their IT decisions is limited. This research aims to extend this knowledge and to assist both researchers and professionals by providing insights on how IT decisions are made and governed in healthcare organizations (HOs). This research adopts case-study methodology to investigate IT governance in two distinctly different HOs. The research findings indicate that HOs implement ITG to achieve alignment between business objectives and IT. Both HOs set up a five-stage IT decision process to identify, evaluate and prioritize IT investment ideas. They also established generic committee-structures that clearly defined roles and decision authorities to govern such process. It is suggested here that ITG in HOs is heavily influenced by strategic priorities, organizational structure, governance experience and governmental initiatives. Effective ITG in HOs is challenged by IT alignment, policy government, involvement of healthcare executives, and lack of business metrics to justify and evaluate decisions. The research proposes recommendations to address these challenges.

Decision making effectiveness in wildfire incident management teams

During large scale wildfires, suppression activities are carried out under the direction of an Incident Management Team (IMT). The aim of the research was to increase understanding of decision processes potentially related to IMT effectiveness. An IMT comprises four major functions: Command, Operations, Planning, and Logistics. Four methodologies were used to study IMT processes: computer simulation experiments; analyses of wildfire reports; interviews with IMT members; and cognitive ethnographic studies of IMTs. Three processes were important determinants of IMT effectiveness: information management and cognitive overload; matching component function goals to overall goals; and team metacognition to detect and counter task-disruptive developments. These processes appear to be complex multi-person analogues of individual Incident Command processes identified previously. The findings have implications for issues such as: creating IMTs; training IMTs; managing IMTs; and providing decision support to IMTs.

Computational aspects of the numerical solution of SDEs

In the last 30 to 40 years, many researchers have combined to build the knowledge base of theory and solution techniques that can be applied to the case of differential equations which include the effects of noise. This class of ``noisy'' differential equations is now known as stochastic differential equations (SDEs). Markov diffusion processes are included within the field of SDEs through the drift and diffusion components of the Itô form of an SDE. When these drift and diffusion components are moderately smooth functions, then the processes' transition probability densities satisfy the Fokker-Planck-Kolmogorov (FPK) equation -- an ordinary partial differential equation (PDE). Thus there is a mathematical inter-relationship that allows solutions of SDEs to be determined from the solution of a noise free differential equation which has been extensively studied since the 1920s. The main numerical solution technique employed to solve the FPK equation is the classical Finite Element Method (FEM). The FEM is of particular importance to engineers when used to solve FPK systems that describe noisy oscillators. The FEM is a powerful tool but is limited in that it is cumbersome when applied to multidimensional systems and can lead to large and complex matrix systems with their inherent solution and storage problems. I show in this thesis that the stochastic Taylor series (TS) based time discretisation approach to the solution of SDEs is an efficient and accurate technique that provides transition and steady state solutions to the associated FPK equation. The TS approach to the solution of SDEs has certain advantages over the classical techniques. These advantages include their ability to effectively tackle stiff systems, their simplicity of derivation and their ease of implementation and re-use. Unlike the FEM approach, which is difficult to apply in even only two dimensions, the simplicity of the TS approach is independant of the dimension of the system under investigation. Their main disadvantage, that of requiring a large number of simulations and the associated CPU requirements, is countered by their underlying structure which makes them perfectly suited for use on the now prevalent parallel or distributed processing systems. In summary, l will compare the TS solution of SDEs to the solution of the associated FPK equations using the classical FEM technique. One, two and three dimensional FPK systems that describe noisy oscillators have been chosen for the analysis. As higher dimensional FPK systems are rarely mentioned in the literature, the TS approach will be extended to essentially infinite dimensional systems through the solution of stochastic PDEs. In making these comparisons, the advantages of modern computing tools such as computer algebra systems and simulation software, when used as an adjunct to the solution of SDEs or their associated FPK equations, are demonstrated.

Defining Bonferroni means over lattices

In the face of mass amounts of information and the need for transparent and fair decision processes, aggregation functions are essential for summarizing data and providing overall evaluations. Although families such as weighted means and medians have been well studied, there are still applications for which no existing aggregation functions can capture the decision makers' preferences. Furthermore, extensions of aggregation functions to lattices are often needed to model operations on L-fuzzy sets, interval-valued and intuitionistic fuzzy sets. In such cases, the aggregation properties need to be considered in light of the lattice structure, as otherwise counterintuitive or unreliable behavior may result. The Bonferroni mean has recently received attention in the fuzzy sets and decision making community as it is able to model useful notions such as mandatory requirements. Here, we consider its associated penalty function to extend the generalized Bonferroni mean to lattices. We show that different notions of dissimilarity on lattices can lead to alternative expressions.

Hume's humanity: a nexus for global management

This chapter explains the development of the Human Nexus, being an original interpretation of ethics based on David Hume's exploration of morality. Recognizing the current moral malaise in global business practice, and searching for a contemporary approach to relational ethics, his elegant reasoning is concisely adapted for global managers. The Human Nexus is proposed as a tool for conveying humanism in global business decision-making today. A matrix of Humean variables from Hume's moral treatise counterbalances usefulness and agreeableness with considerations of self-interest, selflessness and the human connection with ecology. The analysis explores the interaction of variables, relationships and decision processes common in global management. A longitudinal reflective study underpins the research. The resultant construct is presented in context with foundational and emerging literature about the challenge of abstract moral perspectives for global managers, highlighting the desire for something more practical. The Human Nexus shows potential for pragmatically encouraging and enhancing humanistic engagement in ethical decision-making.

Policy recognition in the Abstract Hidden Markov Model

In this paper, we present a method for recognising an agent's behaviour in dynamic, noisy, uncertain domains, and across multiple levels of abstraction. We term this problem on-line plan recognition under uncertainty and view it generally as probabilistic inference on the stochastic process representing the execution of the agent's plan. Our contributions in this paper are twofold. In terms of probabilistic inference, we introduce the Abstract Hidden Markov Model (AHMM), a novel type of stochastic processes, provide its dynamic Bayesian network (DBN) structure and analyse the properties of this network. We then describe an application of the Rao-Blackwellised Particle Filter to the AHMM which allows us to construct an efficient, hybrid inference method for this model. In terms of plan recognition, we propose a novel plan recognition framework based on the AHMM as the plan execution model. The Rao-Blackwellised hybrid inference for AHMM can take advantage of the independence properties inherent in a model of plan execution, leading to an algorithm for online probabilistic plan recognition that scales well with the number of levels in the plan hierarchy. This illustrates that while stochastic models for plan execution can be complex, they exhibit special structures which, if exploited, can lead to efficient plan recognition algorithms. We demonstrate the usefulness of the AHMM framework via a behaviour recognition system in a complex spatial environment using distributed video surveillance data.

The decision-making processes adopted by rurally located mandated professionals when child abuse or neglect is suspected

The reporting of suspected child abuse and neglect is a mandated role of medical doctors, nurses, police and teachers in Victoria, Australia. This paper reports on a research study that sought to explicate how mandated professionals working in rural Victorian contexts identify a child/ren at risk and the decisions they make subsequently.

Generalized pseudo-likelihood estimates for markov random fields on lattice

In this paper we generalize Besag's pseudo-likelihood function for spatial statistical models on a region of a lattice. The correspondingly defined maximum generalized pseudo-likelihood estimates (MGPLEs) are natural extensions of Besag's maximum pseudo-likelihood estimate (MPLE). The MGPLEs connect the MPLE and the maximum likelihood estimate. We carry out experimental calculations of the MGPLEs for spatial processes on the lattice. These simulation results clearly show better performances of the MGPLEs than the MPLE, and the performances of differently defined MGPLEs are compared. These are also illustrated by the application to two real data sets.

A field test of the diversity-openness moderator model in newly formed groups: openness to diversity affects group decision effectiveness and interaction patterns

Detrimental effects of diversity in workgroups has frequently been observed but research identifying the factors that lead to negative or positive effects in heterogeneous groups is lacking. The perceived dissimilarity openness moderator model provides one explanation of the process by which diversity influences group affective, behavioral, and cognitive outcomes. Specifically the model identifies individual, group, and organizational openness as moderating the effects of diversity in workgroups. In this paper evidence is provided from a field study that increased openness to perceived dissimilarity leads to better outcomes in newly formed groups. This study also constitutes a significant building block toward the development of theory concerning the moderating variables of the relationship between diversity and group processes, and outcomes of organizations.

Vested interest in the decision to resolve social dilemma conflicts

This exploratory study investigated the degree of correspondence between individual and group interests in the decision to adopt a sanctioning system to manage a shared resource with social dilemma properties. Fifty-two groups of four people accessed a "free-running" computer-simulated shared resource and had either equal or unequal resource access and experienced either an equitable or inequitable sanctioning system. Consistent with past research, a worse group outcome and greater voting for system change was found under the equitable than under the inequitable sanctioning system. However, at the individual level of analysis, the results suggested that the sanctioning systems did not have the same implications for all group members and that some of those differences predicted voting for system change. The study suggests the need to investigate the various decision frames and inequitable implications associated with structural/institutional change and calls for further investigation of dependencies between micro- and macro-level units of analysis.

Piercing the decision-making sphere : happiness as the key to real shareholder participation

The purpose of this article is to explain why recent corporate governance reforms and initiatives proclaiming to enhance shareholder participation and elevate shareholder rights, do not go far enough. Indeed, it is suggested that corporate governance polices and reform programs, which have emerged across the world in response to a number of high-profile corporate collapses, act to re-emphasise the limited, 'passive' role which individual shareholders have traditionally experienced in public companies. Although increasing the amount information provided to shareholders about corporate decisions and strategies, and providing shareholders with a greater opportunity to participate in annual general meetings, do go some way in 'empowering' shareholders, it is argued that shareholders essentially remain passive observers, rather than becoming active participants. To become active participants, or corporate governance 'insiders " it is argued that corporate law needs to be directed at piercing the 'decision-making sphere' for individual shareholders in public companies. This involves accommodating an active role for shareholders in the actual decision-making processes of the corporation, rather than simply being informed of decisions that are made and being entitled to veto decisions at the annual general meeting. The second part of the article looks specifically at how the 'oppression' or 'unfair prejudice' remedy, the most commonly used shareholder remedy, is capable - if reformulated so that the pursuit of happiness, rather than vague notions of 'fairness' and 'justice' is the central objective of the remedy - of being used to influence a change of culture within public companies directed at facilitating an active participatory role for shareholders.

Haemodynamic instability after cardiac surgery: nurses` perceptions of clinical decision-making

Background. Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses’ perceptions of assuming responsibility for such patients. An nderstanding of nurses’ perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports.

Aim. The aim of this study was to describe critical care nurses’ perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period. Design. An exploratory descriptive study based on naturalistic decision-making.

Methods. Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called ‘Framework’ were used to analyse the interview transcripts.

Results. Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of
collegial assistance as important processes that impacted their decision-making.

Conclusion. Nurses’ previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time. Relevance to clinical practice. Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.

New forms of organising : changing structures, processes and boundaries in a public sector institution

Globalisation, deregulation, privatisation, and advances in communications technologies have intensified competition and impacted on the structures, processes and boundaries that define organisations. Increased competition at both the local and global level calls for increased responsiveness and flexibility, and continuous improvement and innovation. As organisations endeavour to become more attentive and responsive to environmental trends, and customer needs and expectations, they are experimenting with different forms of organising. This has included flattening structures, devolving decision-making responsibility and encouraging greater collaboration and knowledge transfer across functional areas.

The William Angliss Institute of TAFE operates in the post-secondary sector which has experienced significant changes over the past decade as a result of: wide-ranging public sector reforms imposed by successive governments; budgetary cutbacks; accountability and performance improvement pressures; increased national and international competition, industrial relations changes and more demanding, sophisticated customers. This paper draws on the INNFORM Study's three organisational design dimensions of structure, process, and boundaries to examine the nature and degree of change that has taken place at the Institute. Case study findings indicate that while William Angliss has implemetted changes across the three design dimensions, the depth and breadth of these vary and this has impacted on overall performance outcomes. Its experience suggests that even when an organisation adopts a systemic approach and implements changes simultaneously across structure, process and boundaries, optimal performance benefits will not accrue unless these elemental changes are mutually reinforcing and complementary. It also suggests that improvement to processes, particularly communications and human resources practices must be an overarching consideration, as complementary change across all three design dimensions depends ultimately on the contribution and commitment organisational members are prepared to make.

Strategic decision-making and emotions

Senior management decisions play a critical role not only in organizational performance but also in the competitiveness of Australia in the international arena. In this conceptual paper, I present a multi-level model of affect in strategic decision-making to understand the impact that emotions have on senior managements' decision-making processes. The aim of the model is to extent on current theory (specifically Affective Events Theory) to minimize the negative impact of emotions on decision-making to produce high quality decisions and, consequently, more effective and competitive organizations. Hypotheses, practical implications and future research opportunities are also discussed.