Decision making to support an integrated infrastructure supply chain industrial ecological approach within public private partnerships

Supply chains are complex adaptive systems for which final performance depends upon numerous interdependent decisions made by numerous firms which synthesise inputs from various resources systems.  The dynamic interdependent behaviour of social, economic, material and informational resource systems within eco-industrial settings that support the built environment life cycle supply chains can be studied at the supply chain level.  The impact of megaprojects is significant and holds promise to explore the impact of decisions on various systems as it combines project and system boundaries.  Megaoprojects considered as major events within systems can produce critical revolutionary impacts on the systems within which they are embedded.  The decisions that are made on megaprojects are central to risk management.  typically major infrastructure projects are procured through a form of public private partnership (PPP).  The core principle of PPP is value for money which refers to the best available outcome attempting to take account of all benefits, costs and risks over the whole life of the procurement.  In this paper the focus is on Australia where there has been considerable acitivity in the use of PPPs.  With recent national infrastucture packages proposed to stimulate the economy due to the global financial crisis, decision modelling on risks is a revelant and critical matter not only in practice but also in the research community.  PPPs encourage the whole-of-lifecycle approach in the procurement and management of public sector assets by transparently recognising the costs and risks associated with the whole life of the required service or facility, thus integrated whole of life supply chains can be considered.  By creating a single point of responsibility for an entire project from inception through operation, a strong incentive is created for thinking about the effects that a design or construction decision will have on the effectiveness and efficiency of managing and maintaining a facility during its operational life.  The decision to procure holistic supply chains becomes a much more viable commercial reality in the PPP environment than previously considered in the usual commercial construction spot transactional approach.  These types of decisions tend to be imprecise, approximate and complex requireing justification and reasoning logic rather than the classical 'truth' logic.  The purpose of this paper is to develop a theoretical decision framework which combines interdependency and multi-values logic for supply chain procurement modelling.

NFC, moral position, socialisation and ethical decision-making

Absolutism (deontology and teleology), moral relativism (individual moral position), and individual and environmental factors are at the crossroads of descriptive ethics research. For several decades, researchers have espoused teleological aspects, such as the punitive influence of codes of ethics, as managerial tools that enhance ethical conduct in organisations. The current study modelled the individual factors of need-for-cognition (NFC), individual moral position, and occupational socialisation as influences on the work-norms of marketers. The findings from a survey of marketers suggest that NFC influences the ethical idealism, professional socialisation, and work-norms of marketers positively. The research identifies that encouraging cognitive activities among marketers may be a useful alternative when developing appropriate deontological work-norms and decision-making under ethical conditions in marketing.

Caprice versus standardization in venture capital decision making

This study examined the criteria used by venture capitalists to evaluate business plans in order to make investment decisions. A literature survey revealed two competing theories: 'espoused criteria' where evaluation decisions are based on what venture capitalists say are the decisive factors, versus the use of 'known attributes' that successful ventures actually possess. Brunswik's Lens Model from Social Judgment Theory guided an empirical investigation of several different evaluation methods based on information contained in 129 business plans submitted for venture capital over a three-year period. Data evaluation culminated in the comparison of the percentage of correct decisions ('hit rate') for each method. We found that decisions based on the known attributes of successful ventures have significantly better hit rates than decisions made using espoused criteria. Discussion centered on the goal of achieving consistency in the conduct of venture analysis. Process standardization can aid in the achievement of consistency. Future research will both deepen and broaden insights.

An exploration of clinical decision-making in mental health triage

Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

The influence of medical enduring power of attorney and advance directives on decision making by Australian intensive care doctors

OBJECTIVE: Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans.
DESIGN: We surveyed Australian intensive care doctors, using a hypothetical clinical scenario, to evaluate how potential end-of-life treatment decisions might be influenced by advance planning - the appointment of a medical enduring power of attorney (MEPA) or an advance care plan (ACP). Using open-ended questions we sought to explore the reasoning behind the doctors' decisions.
RESULTS: 275 surveys were returned (18.3% response rate). We found that opinions expressed by an MEPA and ACP have some influence on treatment decisions, but that intensive care doctors had major reservations. Most did not follow the request for palliation made by the MEPA in the hypothetical scenario.
CONCLUSIONS: Many intensive care doctors believe end-of-life decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.

Decisions, decisions, decisions : an exploration of clinical decision-making in mental health triage

This paper presents the findings of a project that investigated mental health triage/duty/intake practices across the five community mental health agencies of The Alfred Hospital, Melbourne. The overall aim of the project was to work collaboratively with clinicians to further develop the quality and consistency of mental health triage, duty, and intake clinical practice. The project was designed to facilitate the expansion of the mental health triage knowledge base, and thus contribute to the further development of triage clinical practice. One of the unique aspects of the project was its triangulation across the adult triage service (acute), the two Continuing Care Teams, and the specialist psychiatric services such as the Child and Adolescent Mental Health Service, the Homeless and Outreach Psychiatric Service, and the Mobile Aged Psychiatric Service. The project employed focus group method to collect in-depth, qualitative data. A series of nine focus groups were conducted at each site, which concentrated on eliciting data on the core areas of mental health triage practice such as telephone consultation skills, mental status examination, risk assessment, decision-making, negotiation, crisis assessment, secondary consultation, and documentation. The investigation produced a considerable amount of high quality, in-depth data that was analysed using content analysis methods. The focus of this paper is on presenting the data on clinical decision-making that was raised through the project.

Evaluation of a decision aid for prenatal testing of fetal abnormalities : a cluster randomised trial [ISRCTN22532458]

Background: By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a pamphlet, improves women's informed decision-making and decreases decisional conflict.

Methods/design: A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a pamphlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation.

The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost – to – follow up.

Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms.

Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors.

Discussion: The findings from this trial will make a significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information.

Critical care nurses' haemodynamic decision making

For cardiac surgical patients, the immediate 2-hour recovery period is distinguished by potentially life-threatening haemodynamic instability. To ensure optimum patient outcomes, nurses of varying levels of experience must make rapid and accurate decisions in response to episodes of haemodynamic instability. Decision complexity, nurses’ characteristics, and environmental characteristics, have each been found to influence nurses' decision making in some form. However, the effect of the interplay between these influences on decision outcomes has not been investigated. The aim of the research reported in this thesis was to explore variability in critical care nurses' haemodynamic decision making as a function of interplay between haemodynamic decision complexity, nurses' experience, and specific environmental characteristics by applying a naturalistic decision making design. Thirty-eight nurses were observed recovering patients in the immediate 2-hour period after cardiac surgery. A follow-up semi-structured interview was conducted. A naturalistic decision making approach was used. An organising framework for the goals of therapy related to maintaining haemodynamic stability after cardiac surgery was developed to assist the observation and analysis of practice. The three goals of therapy were the optimisation of cardiovascular performance, the promotion of haemostasia, and the reestablishment of normothermia. The research was conducted in two phases. Phase One explored issues related to observation as method, and identified emergent themes. Phase Two incorporated findings of Phase 1, investigating the variability in nurses' haemodynamic decision making in relation to the three goals of therapy. The findings showed that patients had a high acuity after cardiac surgery and suffered numerous episodes of haemodynamic instability during the immediate 2-hour recovery period. The quality of nurses' decision making in relation to the three goals of therapy was influenced by the experience of the nurse and social interactions with colleagues. Experienced nurses demonstrated decision making that reflected the ability to recognise subtle changes in haemodynamic cues, integrate complex combinations of cues, and respond rapidly to instability. The quality of inexperienced nurses' decision making varied according to the level and form of decision support as well as the complexity of the task. When assistance was provided by nursing colleagues during the reception and recovery of patients, the characteristics of team decision making were observed. Team decision making in this context was categorised as either integrated or non integrated. Team decision making influenced nurses' emotions and actions and decision making practices. Findings revealed nurses' experience affected interactions with other team members and their perceptions of assuming responsibility for complex patients. Interplay between decision complexity, nurses' experience, and the environment in which decisions were made influenced the quality of nurses' decision making and created an environment of team decision making, which, in turn, influenced nurses' emotional responses and practice outcomes. The observed variability in haemodynamic decision making has implications for nurse education, nursing practice, and system processes regarding patient allocation and clinical supervision.

Agent-based hybrid framework for decision making on complex problems

Electronic commerce and the Internet have created demand for automated systems that can make complex decisions utilizing information from multiple sources. Because the information is uncertain, dynamic, distributed, and heterogeneous in nature, these systems require a great diversity of intelligent techniques including expert systems, fuzzy logic, neural networks, and genetic algorithms. However, in complex decision making, many different components or sub-tasks are involved, each of which requires different types of processing. Thus multiple such techniques are required resulting in systems called hybrid intelligent systems. That is, hybrid solutions are crucial for complex problem solving and decision making. There is a growing demand for these systems in many areas including financial investment planning, engineering design, medical diagnosis, and cognitive simulation. However, the design and development of these systems is difficult because they have a large number of parts or components that have many interactions. From a multi-agent perspective, agents in multi-agent systems (MAS) are autonomous and can engage in flexible, high-level interactions. MASs are good at complex, dynamic interactions. Thus a multi-agent perspective is suitable for modeling, design, and construction of hybrid intelligent systems. The aim of this thesis is to develop an agent-based framework for constructing hybrid intelligent systems which are mainly used for complex problem solving and decision making. Existing software development techniques (typically, object-oriented) are inadequate for modeling agent-based hybrid intelligent systems. There is a fundamental mismatch between the concepts used by object-oriented developers and the agent-oriented view. Although there are some agent-oriented methodologies such as the Gaia methodology, there is still no specifically tailored methodology available for analyzing and designing agent-based hybrid intelligent systems. To this end, a methodology is proposed, which is specifically tailored to the analysis and design of agent-based hybrid intelligent systems. The methodology consists of six models - role model, interaction model, agent model, skill model, knowledge model, and organizational model. This methodology differs from other agent-oriented methodologies in its skill and knowledge models. As good decisions and problem solutions are mainly based on adequate information, rich knowledge, and appropriate skills to use knowledge and information, these two models are of paramount importance in modeling complex problem solving and decision making. Follow the methodology, an agent-based framework for hybrid intelligent system construction used in complex problem solving and decision making was developed. The framework has several crucial characteristics that differentiate this research from others. Four important issues relating to the framework are also investigated. These cover the building of an ontology for financial investment, matchmaking in middle agents, reasoning in problem solving and decision making, and decision aggregation in MASs. The thesis demonstrates how to build a domain-specific ontology and how to access it in a MAS by building a financial ontology. It is argued that the practical performance of service provider agents has a significant impact on the matchmaking outcomes of middle agents. It is proposed to consider service provider agents' track records in matchmaking. A way to provide initial values for the track records of service provider agents is also suggested. The concept of ‘reasoning with multimedia information’ is introduced, and reasoning with still image information using symbolic projection theory is proposed. How to choose suitable aggregation operations is demonstrated through financial investment application and three approaches are proposed - the stationary agent approach, the token-passing approach, and the mobile agent approach to implementing decision aggregation in MASs. Based on the framework, a prototype was built and applied to financial investment planning. This prototype consists of one serving agent, one interface agent, one decision aggregation agent, one planning agent, four decision making agents, and five service provider agents. Experiments were conducted on the prototype. The experimental results show the framework is flexible, robust, and fully workable. All agents derived from the methodology exhibit their behaviors correctly as specified.