Classifying clinical decision making:interpreting nursing intuition, heuristics and medical diagnosis

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated with nurses' decision making, is less rational and scientific than other approaches.

Study of management decision making by ward sisters in a hospital and the effects on decision making after the implementation of a decision support sytem

This thesis considers management decision making at the ward level in hospitals especially by ward sisters, and the effectiveness of the intervention of a decision support system. Nursing practice theories were related to organisation and management theories in order to conceptualise a decision making framework for nurse manpower planning and deployment at the ward level. Decision and systems theories were explored to understand the concepts of decision making and the realities of power in an organisation. In essence, the hypothesis was concerned with changes in patterns of decision making that could occur with the intervention of a decision support system and that the degree of change would be governed by a set of `difficulty' factors within wards in a hospital. During the course of the study, a classification of ward management decision making was created, together with the development and validation of measuring instruments to test the research hypothesis. The decision support system used was rigorously evaluated to test whether benefits did accrue from its implementation. Quantitative results from sample wards together with qualitative information collected, were used to test this hypothesis and the outcomes postulated were supported by these findings. The main conclusion from this research is that a more rational approach to management decision making is feasible, using information from a decision support system. However, wards and ward sisters that need the most assistance, where the `difficulty' factors in the organisation are highest, benefit the least from this type of system. Organisational reviews are needed on these identified wards, involving managers and doctors, to reduce the levels of un-coordinated activities and disruption.

Classifying clinical decision making:a unifying approach

This is the first of two linked papers exploring decision making in nursing which integrate research evidence from different clinical and academic disciplines. Currently there are many decision-making theories, each with their own distinctive concepts and terminology, and there is a tendency for separate disciplines to view their own decision-making processes as unique. Identifying good nursing decisions and where improvements can be made is therefore problematic, and this can undermine clinical and organizational effectiveness, as well as nurses' professional status. Within the unifying framework of psychological classification, the overall aim of the two papers is to clarify and compare terms, concepts and processes identified in a diversity of decision-making theories, and to demonstrate their underlying similarities. It is argued that the range of explanations used across disciplines can usefully be re-conceptualized as classification behaviour. This paper explores problems arising from multiple theories of decision making being applied to separate clinical disciplines. Attention is given to detrimental effects on nursing practice within the context of multidisciplinary health-care organizations and the changing role of nurses. The different theories are outlined and difficulties in applying them to nursing decisions highlighted. An alternative approach based on a general model of classification is then presented in detail to introduce its terminology and the unifying framework for interpreting all types of decisions. The classification model is used to provide the context for relating alternative philosophical approaches and to define decision-making activities common to all clinical domains. This may benefit nurses by improving multidisciplinary collaboration and weakening clinical elitism.

Strategic decision-making for technology implementation in developing countries

Researchers and managers stress the importance of long-term technology strategies to develop technological capabilities for global competitive advantage. This paper explores the relationship between technology decision-making and strategy in technology transfer (TT) in developing countries, with special reference to South Africa. Earlier research by the authors considered technology and operations integration in developing countries and identified factors that were important to managers in the management of technology. The paper proposes five decision-making levels as the basis of a framework for TT, and investigates the strategic issues pertaining to TT at these levels. Four South African cases studies are used to propose a framework that combines important items in technology transfer and levels of decision-making. The research suggests that technology plays a limited role in strategic decisions in developing countries, and that expectations from new technology are largely operational. Broader implications for managers are identified.

The effects of the menstrual cycle on social decision making

The cyclic change in hormonal profiles between the two main phases of the menstrual cycle mediate shifts in mate preference. Males who advertise social dominance are preferred over other men by females in the follicular phase of the cycle. The present study explored assignment of high or low status resources to dominant looking men by females in either phase of the menstrual cycle. Thirteen females who reported that they were free from any kind of hormonal intervention and experienced a 28 day cycle, were invited to participate in a mock job negotiation scenario. Participants were asked to assign either a minimum, low, high or maximum social status job package to a series of male 'employees' that were previously rated to look either dominant or non-dominant. The results showed that during the follicular phase of the cycle participants assigned dominant looking men more high status job resources than the non-dominant looking men. However, during the luteal phase the participants assigned low status resources to the non-dominant looking men. Females are not merely passive observers of male status cues but actively manipulate the environment to assign status. © 2006 Elsevier B.V. All rights reserved.

Integrated project evaluation and selection using multiple-attribute decision-making technique

The evaluation and selection of industrial projects before investment decision is customarily done using marketing, technical and financial information. Subsequently, environmental impact assessment and social impact assessment are carried out mainly to satisfy the statutory agencies. Because of stricter environment regulations in developed and developing countries, quite often impact assessment suggests alternate sites, technologies, designs, and implementation methods as mitigating measures. This causes considerable delay to complete project feasibility analysis and selection as complete analysis requires to be taken up again and again till the statutory regulatory authority approves the project. Moreover, project analysis through above process often results sub-optimal project as financial analysis may eliminate better options, as more environment friendly alternative will always be cost intensive. In this circumstance, this study proposes a decision support system, which analyses projects with respect to market, technicalities, and social and environmental impact in an integrated framework using analytic hierarchy process, a multiple-attribute decision-making technique. This not only reduces duration of project evaluation and selection, but also helps select optimal project for the organization for sustainable development. The entire methodology has been applied to a cross-country oil pipeline project in India and its effectiveness has been demonstrated. © 2005 Elsevier B.V. All rights reserved.

Multiple attribute decision making approach to petroleum pipeline route selection

Petroleum pipelines are the nervous system of the oil industry, as this transports crude oil from sources to refineries and petroleum products from refineries to demand points. Therefore, the efficient operation of these pipelines determines the effectiveness of the entire business. Pipeline route selection plays a major role when designing an effective pipeline system, as the health of the pipeline depends on its terrain. The present practice of route selection for petroleum pipelines is governed by factors such as the shortest distance, constructability, minimal effects on the environment, and approachability. Although this reduces capital expenditure, it often proves to be uneconomical when life cycle costing is considered. This study presents a route selection model with the application of an Analytic Hierarchy Process (AHP), a multiple attribute decision making technique. AHP considers all the above factors along with the operability and maintainability factors interactively. This system has been demonstrated here through a case study of pipeline route selection, from an Indian perspective. A cost-benefit comparison of the shortest route (conventionally selected) and optimal route establishes the effectiveness of the model.

Modelling and improving human decision making with simulation

Modelling human interaction and decision-making within a simulation presents a particular challenge. This paper describes a methodology that is being developed known as 'knowledge based improvement'. The purpose of this methodology is to elicit decision-making strategies via a simulation model and to represent them using artificial intelligence techniques. Further to this, having identified an individual's decision-making strategy, the methodology aims to look for improvements in decision-making. The methodology is being tested on unplanned maintenance operations at a Ford engine assembly plant

Linking the witness simulation software to an expert system to represent a decision-making process

Expert systems, and artificial intelligence more generally, can provide a useful means for representing decision-making processes. By linking expert systems software to simulation software an effective means of including these decision-making processes in a simulation model can be achieved. This paper demonstrates how a commercial-off-the-shelf simulation package (Witness) can be linked to an expert systems package (XpertRule) through a Visual Basic interface. The methodology adopted could be used for models, and possibly software, other than those presented here.

Knowledge based improvement:simulation and artificial intelligence for identifying and improving human decision-making in an operations systems

The performance of most operations systems is significantly affected by the interaction of human decision-makers. A methodology, based on the use of visual interactive simulation (VIS) and artificial intelligence (AI), is described that aims to identify and improve human decision-making in operations systems. The methodology, known as 'knowledge-based improvement' (KBI), elicits knowledge from a decision-maker via a VIS and then uses AI methods to represent decision-making. By linking the VIS and AI representation, it is possible to predict the performance of the operations system under different decision-making strategies and to search for improved strategies. The KBI methodology is applied to the decision-making surrounding unplanned maintenance operations at a Ford Motor Company engine assembly plant.

Selecting the most preferable alternatives in a group decision making problem using DEA

Group decision making is the study of identifying and selecting alternatives based on the values and preferences of the decision maker. Making a decision implies that there are several alternative choices to be considered. This paper uses the concept of Data Envelopment Analysis to introduce a new mathematical method for selecting the best alternative in a group decision making environment. The introduced model is a multi-objective function which is converted into a multi-objective linear programming model from which the optimal solution is obtained. A numerical example shows how the new model can be applied to rank the alternatives or to choose a subset of the most promising alternatives.

Multi-criteria decision making approaches for supplier evaluation and selection:a literature review

Supplier evaluation and selection problem has been studied extensively. Various decision making approaches have been proposed to tackle the problem. In contemporary supply chain management, the performance of potential suppliers is evaluated against multiple criteria rather than considering a single factor-cost. This paper reviews the literature of the multi-criteria decision making approaches for supplier evaluation and selection. Related articles appearing in the international journals from 2000 to 2008 are gathered and analyzed so that the following three questions can be answered: (i) Which approaches were prevalently applied? (ii) Which evaluating criteria were paid more attention to? (iii) Is there any inadequacy of the approaches? Based on the inadequacy, if any, some improvements and possible future work are recommended. This research not only provides evidence that the multi-criteria decision making approaches are better than the traditional cost-based approach, but also aids the researchers and decision makers in applying the approaches effectively.

An integrated multiple criteria decision making approach for resource allocation in higher education

Resource allocation is one of the major decision problems arising in higher education. Resources must be allocated optimally in such a way that the performance of universities can be improved. This paper applies an integrated multiple criteria decision making approach to the resource allocation problem. In the approach, the Analytic Hierarchy Process (AHP) is first used to determine the priority or relative importance of proposed projects with respect to the goals of the universities. Then, the Goal Programming (GP) model incorporating the constraints of AHP priority, system, and resource is formulated for selecting the best set of projects without exceeding the limited available resources. The projects include 'hardware' (tangible university's infrastructures), and 'software' (intangible effects that can be beneficial to the university, its members, and its students). In this paper, two commercial packages are used: Expert Choice for determining the AHP priority ranking of the projects, and LINDO for solving the GP model. Copyright © 2007 Inderscience Enterprises Ltd.