Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

Searching for consensus in ahp-group decision making. A bayesian perspective

This paper sets out to identify the initial positions of the different decisionmakers who intervene in a group decision making process with a reducednumber of actors, and to establish possible consensus paths between theseactors. As a methodological support, it employs one of the most widely-knownmulticriteria decision techniques, namely, the Analytic Hierarchy Process(AHP). Assuming that the judgements elicited by the decision makers follow theso-called multiplicative model (Crawford and Williams, 1985; Altuzarra et al.,1997; Laininen and Hämäläinen, 2003) with log-normal errors and unknownvariance, a Bayesian approach is used in the estimation of the relative prioritiesof the alternatives being compared. These priorities, estimated by way of themedian of the posterior distribution and normalised in a distributive manner(priorities add up to one), are a clear example of compositional data that will beused in the search for consensus between the actors involved in the resolution ofthe problem through the use of Multidimensional Scaling tools

Group preference structures in AHP–group decision making

This paper presents a procedure that allows us to determine the preference structures(PS) associated to each of the different groups of actors that can be identified in a groupdecision making problem with a large number of individuals. To that end, it makesuse of the Analytic Hierarchy Process (AHP) (Saaty, 1980) as the technique to solvediscrete multicriteria decision making problems. This technique permits the resolutionof multicriteria, multienvironment and multiactor problems in which subjective aspectsand uncertainty have been incorporated into the model, constructing ratio scales correspondingto the priorities relative to the elements being compared, normalised in adistributive manner (wi = 1). On the basis of the individuals’ priorities we identifydifferent clusters for the decision makers and, for each of these, the associated preferencestructure using, to that end, tools analogous to those of Multidimensional Scaling.The resulting PS will be employed to extract knowledge for the subsequent negotiationprocesses and, should it be necessary, to determine the relative importance of thealternatives being compared using anyone of the existing procedures

Medical students' knowledge about end-of-life decision-making

The influence of medical students' knowledge concerning end-of-life care, considering ethical theories and clinical practice, remains controversial. We aimed to investigate medical students' knowledge of bioethical concepts related to moral kinds of death (euthanasia, disthanasia, and orthothanasia) and to analyze the influence of their clinical experience on practicing such approaches in a tertiary hospital in the state of São Paulo, Brazil. We interviewed 180 medical students [distributed in Group 1 (G1) - first to third- year students, and Group 2 (G2) - fourth to sixth-year students] to evaluate the influence of the course on "medical ethics" on ethical theories and clinical practice, using a closed questionnaire. The course on "medical ethics" did not distinguish the groups (P=0.704) in relation to bioethical concepts. Neologisms such as "cacothanasia" and "idiothanasia" were incorrectly viewed as bioethical concepts by 28% of the interviewees. Moreover, 45.3% of the sample considered health care professionals incapable of managing terminally ill patients, especially G2 (29%) as compared to G1 (16.5%, P=0.031). The concept of euthanasia was accepted by 41% of sample, as compared to 98.2% for orthothanasia. Among medical students that accepted ways to abbreviate life (22.9%), 30.1% belonged to G1, and only 16.1% to G2 (P=0.049). These medical students were unfamiliar with common bioethical concepts. Moreover, they considered healthcare professionals incapable of managing terminally ill patients. The ethical ideal of the "good death" reflects better acceptance of orthothanasia by medical students, suggesting a tendency to apply it in their future clinical practice.

Improving strategic decision-making with simulation based decision support systems

Combating climate change is one of the key tasks of humanity in the 21st century. One of the leading causes is carbon dioxide emissions due to usage of fossil fuels. Renewable energy sources should be used instead of relying on oil, gas, and coal. In Finland a significant amount of energy is produced using wood. The usage of wood chips is expected to increase in the future significantly, over 60 %. The aim of this research is to improve understanding over the costs of wood chip supply chains. This is conducted by utilizing simulation as the main research method. The simulation model utilizes both agent-based modelling and discrete event simulation to imitate the wood chip supply chain. This thesis concentrates on the usage of simulation based decision support systems in strategic decision-making. The simulation model is part of a decision support system, which connects the simulation model to databases but also provides a graphical user interface for the decisionmaker. The main analysis conducted with the decision support system concentrates on comparing a traditional supply chain to a supply chain utilizing specialized containers. According to the analysis, the container supply chain is able to have smaller costs than the traditional supply chain. Also, a container supply chain can be more easily scaled up due to faster emptying operations. Initially the container operations would only supply part of the fuel needs of a power plant and it would complement the current supply chain. The model can be expanded to include intermodal supply chains as due to increased demand in the future there is not enough wood chips located close to current and future power plants.

Effect of emotions on consumer decision-making in a high involvement product adoption context

This thesis was written in order participate in the emergent discussion on the role of emotions in consumer decision-making. The goal of the thesis was to find out which emotions affect consumer decision-making, how these emotions relate to traditional process models of consumer decision-making, and how emotions and other factors affect consumer decision-making. The thesis is placed into a context of high involvement product adoption. The empirical research was conducted according to a qualitative methodology, which combined video diaries and face-to-face or Skype interviews as data collection methods. The case product category was dancing poles, and four women participated in the study. The central results indicate that emotion and cognition walk hand in hand in consumer decision-making, that consumers experience a variety of emotions during a decision-making process, and that emotions have an important effect on consumer decision-making and consumer behavior.

Managerial decision-making style : India, Bangladesh, and Finland : cultural side of the game

Julkaisumaa Intia 356 IN IND

Immediate Decision-Making and Information Needs in Intensive Care Coordination

The aim of this study was to develop a theoretical model for information integration to support the deci¬sion making of intensive care charge nurses, and physicians in charge – that is, ICU shift leaders. The study focused on the ad hoc decision-making and immediate information needs of shift leaders during the management of an intensive care unit’s (ICU) daily activities. The term ‘ad hoc decision-making’ was defined as critical judgements that are needed for a specific purpose at a precise moment with the goal of ensuring instant and adequate patient care and a fluent flow of ICU activities. Data collection and research analysis methods were tested in the identification of ICU shift leaders’ ad hoc decision-making. Decision-making of ICU charge nurses (n = 12) and physicians in charge (n = 8) was observed using a think-aloud technique in two university-affiliated Finnish ICUs for adults. The ad hoc decisions of ICU shift leaders were identified using an application of protocol analysis. In the next phase, a structured online question¬naire was developed to evaluate the immediate information needs of ICU shift leaders. A national survey was conducted in all Finnish, university-affiliated hospital ICUs for adults (n = 17). The questionnaire was sent to all charge nurses (n = 515) and physicians in charge (n = 223). Altogether, 257 charge nurses (50%) and 96 physicians in charge (43%) responded to the survey. The survey was also tested internationally in 16 Greek ICUs. From Greece, 50 charge nurses out of 240 (21%) responded to the survey. A think-aloud technique and protocol analysis were found to be applicable for the identification of the ad hoc decision-making of ICU shift leaders. During one day shift leaders made over 200 ad hoc decisions. Ad hoc decisions were made horizontally, related to the whole intensive care process, and vertically, concerning single intensive care incidents. Most of the ICU shift leaders’ ad hoc decisions were related to human resources and know-how, patient information and vital signs, and special treatments. Commonly, this ad hoc decision-making involved several multiprofessional decisions that constituted a bundle of immediate decisions and various information needs. Some of these immediate information needs were shared between the charge nurses and the physicians in charge. The majority of which concerned patient admission, the organisation and management of work, and staff allocation. In general, the information needs of charge nurses were more varied than those of physicians. It was found that many ad hoc deci-sions made by the physicians in charge produced several information needs for ICU charge nurses. This meant that before the task at hand was completed, various kinds of information was sought by the charge nurses to support the decision-making process. Most of the immediate information needs of charge nurses were related to the organisation and management of work and human resources, whereas the information needs of the physicians in charge mainly concerned direct patient care. Thus, information needs differ between professionals even if the goal of decision-making is the same. The results of the international survey confirmed these study results for charge nurses. Both in Finland and in Greece the information needs of charge nurses focused on the organisation and management of work and human resources. Many of the most crucial information needs of Finnish and Greek ICU charge nurses were common. In conclusion, it was found that ICU shift leaders make hundreds of ad hoc decisions during the course of a day related to the allocation of resources and organisation of patient care. The ad hoc decision-making of ICU shift leaders is a complex multi-professional process, which requires a lot of immediate information. Real-time support for information related to patient admission, the organisation and man¬agement of work, and allocation of staff resources is especially needed. The preliminary information integration model can be applied when real-time enterprise resource planning systems are developed for intensive care daily management

Budgeting decision-making in Finnish municipalities

This master’s thesis examines budgeting decision-making in Finnish municipalities; an issue that has not received a lot of attention in the academic literature. Furthermore, this thesis investigates whether the current budgeting decision-making practices could be improved by using a new kind of budget decision-making tool that is based on presenting multiple investment or divestment alternatives simultaneously to the decision makers as a frontier, rather than one by one. In the empirical part of the thesis, the results from three case interviews are introduced in order to answer the research questions of the study. The empirical evidence of this thesis suggests that there is a need for the presented budgeting decision-making tool in Finnish municipalities. The current routine is seen as good even though the interviewees would warmly welcome the alternative method that would function as a linkage be-tween strategy and the budget. The results also indicate that even though municipalities are left with a lot of room in their budgeting decision-making routine, the routine closely, though not always purposely, follows given guidelines and legislation. The major problem in the current practices seems to be the lack of understanding, as the decision-makers find it hard fully to understand the multiplicative effects of the budget-related decisions.

Business intelligence viewpoint on managerial decision-making : Ill-structured problems and decision support systems

Vaikka liiketoimintatiedon hallintaa sekä johdon päätöksentekoa on tutkittu laajasti, näiden kahden käsitteen yhteisvaikutuksesta on olemassa hyvin rajallinen määrä tutkimustietoa. Tulevaisuudessa aiheen tärkeys korostuu, sillä olemassa olevan datan määrä kasvaa jatkuvasti. Yritykset tarvitsevat jatkossa yhä enemmän kyvykkyyksiä sekä resursseja, jotta sekä strukturoitua että strukturoimatonta tietoa voidaan hyödyntää lähteestä riippumatta. Nykyiset Business Intelligence -ratkaisut mahdollistavat tehokkaan liiketoimintatiedon hallinnan osana johdon päätöksentekoa. Aiemman kirjallisuuden pohjalta, tutkimuksen empiirinen osuus tunnistaa liiketoimintatiedon hyödyntämiseen liittyviä tekijöitä, jotka joko tukevat tai rajoittavat johdon päätöksentekoprosessia. Tutkimuksen teoreettinen osuus johdattaa lukijan tutkimusaiheeseen kirjallisuuskatsauksen avulla. Keskeisimmät tutkimukseen liittyvät käsitteet, kuten Business Intelligence ja johdon päätöksenteko, esitetään relevantin kirjallisuuden avulla – tämän lisäksi myös dataan liittyvät käsitteet analysoidaan tarkasti. Tutkimuksen empiirinen osuus rakentuu tutkimusteorian pohjalta. Tutkimuksen empiirisessä osuudessa paneudutaan tutkimusteemoihin käytännön esimerkein: kolmen tapaustutkimuksen avulla tutkitaan sekä kuvataan toisistaan irrallisia tapauksia. Jokainen tapaus kuvataan sekä analysoidaan teoriaan perustuvien väitteiden avulla – nämä väitteet ovat perusedellytyksiä menestyksekkäälle liiketoimintatiedon hyödyntämiseen perustuvalle päätöksenteolle. Tapaustutkimusten avulla alkuperäistä tutkimusongelmaa voidaan analysoida tarkasti huomioiden jo olemassa oleva tutkimustieto. Analyysin tulosten avulla myös yksittäisiä rajoitteita sekä mahdollistavia tekijöitä voidaan analysoida. Tulokset osoittavat, että rajoitteilla on vahvasti negatiivinen vaikutus päätöksentekoprosessin onnistumiseen. Toisaalta yritysjohto on tietoinen liiketoimintatiedon hallintaan liittyvistä positiivisista seurauksista, vaikka kaikkia mahdollisuuksia ei olisikaan hyödynnetty. Tutkimuksen merkittävin tulos esittelee viitekehyksen, jonka puitteissa johdon päätöksentekoprosesseja voidaan arvioida sekä analysoida. Despite the fact that the literature on Business Intelligence and managerial decision-making is extensive, relatively little effort has been made to research the relationship between them. This particular field of study has become important since the amount of data in the world is growing every second. Companies require capabilities and resources in order to utilize structured data and unstructured data from internal and external data sources. However, the present Business Intelligence technologies enable managers to utilize data effectively in decision-making. Based on the prior literature, the empirical part of the thesis identifies the enablers and constraints in computer-aided managerial decision-making process. In this thesis, the theoretical part provides a preliminary understanding about the research area through a literature review. The key concepts such as Business Intelligence and managerial decision-making are explored by reviewing the relevant literature. Additionally, different data sources as well as data forms are analyzed in further detail. All key concepts are taken into account when the empirical part is carried out. The empirical part obtains an understanding of the real world situation when it comes to the themes that were covered in the theoretical part. Three selected case companies are analyzed through those statements, which are considered as critical prerequisites for successful computer-aided managerial decision-making. The case study analysis, which is a part of the empirical part, enables the researcher to examine the relationship between Business Intelligence and managerial decision-making. Based on the findings of the case study analysis, the researcher identifies the enablers and constraints through the case study interviews. The findings indicate that the constraints have a highly negative influence on the decision-making process. In addition, the managers are aware of the positive implications that Business Intelligence has for decision-making, but all possibilities are not yet utilized. As a main result of this study, a data-driven framework for managerial decision-making is introduced. This framework can be used when the managerial decision-making processes are evaluated and analyzed.

Before internationalisation : reflections of lateral rigidity on managerial decision making

The purpose of the study is to analyse lateral rigidity in the framework of pre-internationalisation to find out its reflections on managerial decision making. The interest of the study lies in the intersection of the meaningful but relatively stagnant concept of lateral rigidity, and the pre-internationalisation phase of companies that has received only a limited amount of research attention. The theoretical basis for the study is drawn from managerial decision making and internationalisation literatures. Firstly, the study aims to define the concept of lateral rigidity in order to secondly find out how it influences managers’ pre-internationalisation decision making. The study is theoretical in nature, and is based solely on literature examination. Concept analysis method is used to determine the attributes of lateral rigidity for the purpose of recognising the concept in the pre-internationalisation framework. The attributes that are found to comprise lateral rigidity are culture, know-how, uncertainty and attitude. Furthermore, these attributes are more specifically found to consist of environmental, personal and operational matters. Through the analysis of the pre-internationalisation literature it is discovered that all the attributes appear there, and present a variety of influences on pre-internationalisation decision making that can be characterised as being negative. The study finds that culture influences managers’ decision making via subjective reasoning and behaviour that stem from a domestic inclination, and via unfamiliarity with foreign markets. Against assumption, home cultural factors, e.g. values and customs, do not appear to have an influence. Know-how is found to influence decision making via managers’ previous experiences, subjective abiding perceptions, and the usage of previous operation patterns. Uncertainty, then again, influences managers’ risk perception, unfamiliarity avoidance, and the scope of potential international operations. Attitude is found to have a robust influence on managerial decision making via the usage of familiar processes and decision regimes, subjective preference of convention, and plausible results of operations. Ergo, the effects of lateral rigidity on managers show to represent an encumbrance in the pre-internationalisation phase; even though internationalisation would take place, the related decisions and actions are highly constrained. Especially the subjectivity of managers is seen to have a meaningful role in the decision making process.