Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illness

Background People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user’s lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.

A multi-organisational approach for disaster preparedness and response:the use of optimisation and GIS for facility location, stock pre-positioning, resource allocation and relief distribution

From 1992 to 2012 4.4 billion people were affected by disasters with almost 2 trillion USD in damages and 1.3 million people killed worldwide. The increasing threat of disasters stresses the need to provide solutions for the challenges faced by disaster managers, such as the logistical deployment of resources required to provide relief to victims. The location of emergency facilities, stock prepositioning, evacuation, inventory management, resource allocation, and relief distribution have been identified to directly impact the relief provided to victims during the disaster. Managing appropriately these factors is critical to reduce suffering. Disaster management commonly attracts several organisations working alongside each other and sharing resources to cope with the emergency. Coordinating these agencies is a complex task but there is little research considering multiple organisations, and none actually optimising the number of actors required to avoid shortages and convergence. The aim of the this research is to develop a system for disaster management based on a combination of optimisation techniques and geographical information systems (GIS) to aid multi-organisational decision-making. An integrated decision system was created comprising a cartographic model implemented in GIS to discard floodable facilities, combined with two models focused on optimising the decisions regarding location of emergency facilities, stock prepositioning, the allocation of resources and relief distribution, along with the number of actors required to perform these activities. Three in-depth case studies in Mexico were studied gathering information from different organisations. The cartographic model proved to reduce the risk to select unsuitable facilities. The preparedness and response models showed the capacity to optimise the decisions and the number of organisations required for logistical activities, pointing towards an excess of actors involved in all cases. The system as a whole demonstrated its capacity to provide integrated support for disaster preparedness and response, along with the existence of room for improvement for Mexican organisations in flood management.

Elemzés vagy megérzés: a stratégiai döntéshozatal gyakorlata Californiában és Magyarországon = Analysis or Intuition: Strategic decision making in California and Hungary

Stratégiai döntéseket jellemzően a vállalatok felsővezetői, vezérigazgatók és elnökök hoznak. Ennek szellemében 40 felsővezetőt kérdeztünk két nagyon különböző régióban (Kaliforniában és Magyarországon) egy összehasonlító kutatás keretében. A két országban tizenkét válaszadó vezérigazgató, elnök, alelnök, vagy felelős vezető volt (rájuk, mint Vezetőkre hivatkoztunk), miközben nyolcan alapítói és többségi tulajdonosai voltak saját vállalkozásuknak (őket nevezzük Vállalkozóknak). A kutatás három területre irányult: 1) Hogyan hoznak döntéseket a felsővezetők a valóságban a világ e két különböző táján; 2) Mennyiben különböznek - ha egyáltalán különböznek - a Vállalkozók és a Vezetők az alkalmazott döntéshozatali közelítésmódot tekintve, amikor az analitikus gondolkodást az intuícióikkal kombinálják; 3) Mik a hasonlóságok és a különbségek a menedzsment képességekben és a döntéshozatali rutinokban a Vállalkozók és a Vezetők között a vizsgált menedzsment kultúrákban. = Strategic decision making is usually conducted by a firm’s top management, led by the CEO or the President of the company. In keeping with this, 40 top level managers in two very different regions (California, USA and Hungary) were targeted in a comparative research study. In the two countries, twelve of the managers were CEOs, Presidents, Vice Presidents or Chief Officers (hereafter referred to as Executives) while eight were founders and majority owners of their own enterprises (hereafter referred to as Entrepreneurs). The research focused on the following 3 areas: 1) How top level managers really make strategic decisions in these two different parts of the world; 2) How Entrepreneurs and Executives differ, if at all, in their approach to strategic decision making when they combine analytical thinking with their intuition; 3) The similarities and differences in management skills and decision making routines between Entrepreneurs and Executives within the investigated management cultures.

Decision support system for production control: Multiple criteria decision making in practice

This paper presents a development of decision support systems for solving scheduling problems. It consists of two parts — the first describing the production processes which can be handled by the system and the second describing how the system works.

Menedzsmentképességek és döntéshozatali közelítésmódok longitudinális elemzése a versenyképesség-kutatások alapján (Longitudinal analysis of management capabilities and decision making approaches based on the competitiveness researches)

Számos korábbi kutatás – köztük a szerzők korábbi vizsgálatai is – azt mutatja, hogy a menedzsmentképességek és a vállalatok versenyképessége között pozitív kapcsolat áll fenn, a jobban teljesítő és a proaktívabb vállalatok rendre felkészültebb, jobb vezetői képességekkel bíró, kockázatvállalóbb vezetőkkel rendelkeznek. Az is megfigyelhető, hogy az ebből a nézőpontból sikeresebben működő vállalatok döntéseiben az átlagosnál is erősebben érvényesül a racionális közelítésmód, melynek alkalmazásával a menedzserek az optimális cselekvési alternatíva kiválasztására törekszenek. A cikkben a szerzők az elmúlt 15 év versenyképességi kutatásainak tapasztalatait összegzik, kiemelt hangsúlyt helyezve a legfrissebb felmérés eredményeire. ________________ The article summarizes the main findings of the Competitiveness Research Program with respect to the skills and capabilities of the Hungarian managers and the decision making approaches they use during their work. The results of the four surveys conducted in 1996, 1999, 2004 and 2009 are fairly stable over time: practice minded behavior, professional expertise, and problem solving skills are on the top of the list of the most developed skills of the Hungarian executives. The rational approach is the most popular among the most widespread decision making models in the authors’ sample which is rather alarming since the present turbulent economic environment may demand more adaptive and intuitive approaches.

Adaptív döntéshozatal a beszállítóválasztásban = Adaptive Decision-making in Supplier Selection

Herbert Simon, a korlátozott racionalitás elméletének megalkotója szerint a döntéshozatalunk hatékonyságát az határozza meg, hogy korlátozott kognitív kapacitásaink birtokában milyen stratégiákkal birkózunk meg a komplex környezet kihívásaival. Az erre az elméletre építő kutatások egyik alapvetése, hogy az egyéni problémamegoldási folyamat helyzetspecifikus és ez az idomulás kulcsfontosságú az eredményességben és hatékonyságban. A döntéshozó rendelkezik egy „adaptív szerszámosládával”, amelyből a megfelelő helyzetekben a megfelelő döntési eljárásokat választja. A tanulmányban a szerző egy kvalitatív kutatás eredményeire építve, a beszállítóválasztás példáján keresztül mutat be lehetséges válaszokat a keveset kutatott kérdésre: hogyan működik az adaptivitás folyamata? A tanulmány a döntési helyzethez való alkalmazkodás kialakulását vizsgálja a döntési folyamatok kognitív szintjén. ______ Herbert Simon, the author of theory of bounded rationality claimed that the results of our decision-making is defined by the approprietness of strategies with which we handle the complexity of the environment with our bounded cognitive capacities. One of the main issues or research programs building on this theory is that problem solving is situation-specific, and the adjustment of strategies to actual situational factors is crucial for the effectiveness and efficiency of decision-making. The decision-maker possesses an „adaptive toolbox”, from which he chooses the right decision tools in the right situations. The author, based on the findnings of a qualitative study, presents possible answers to the not well-elaborated question: how does the process of adaptivity work? Forming of an adaptive mechanism is in the focus.