Referral to rehabilitation following traumatic brain injury: practitioners and the process of decision-making

The study aimed to examine the factors influencing referral to rehabilitation following traumatic brain injury (TBI) by using social problems theory as a conceptual model to focus on practitioners and the process of decision-making in two Australian hospitals. The research design involved semi-structured interviews with 18 practitioners and observations of 10 team meetings, and was part of a larger study on factors influencing referral to rehabilitation in the same settings. Analysis revealed that referral decisions were influenced primarily by practitioners' selection and their interpretation of clinical and non-clinical patient factors. Further, practitioners generally considered patient factors concurrently during an ongoing process of decision-making, with the combinations and interactions of these factors forming the basis for interpretations of problems and referral justifications. Key patient factors considered in referral decisions included functional and tracheostomy status, time since injury, age, family, place of residence and Indigenous status. However, rate and extent of progress, recovery potential, safety and burden of care, potential for independence and capacity to cope were five interpretative themes, which emerged as the justifications for referral decisions. The subsequent negotiation of referral based on patient factors was in turn shaped by the involvement of practitioners. While multi-disciplinary processes of decision-making were the norm, allied health professionals occupied a central role in referral to rehabilitation, and involvement of medical, nursing and allied health practitioners varied. Finally, the organizational pressures and resource constraints, combined with practitioners' assimilation of the broader efficiency agenda were central factors shaping referral. (C) 2004 Elsevier Ltd. All rights reserved.

Perceived dissimilarity and work group involvement: The moderating effects of group openness to diversity

Perceived dissimilarity and its association with work group involvement were examined in this study. Additionally, perceived group openness to diversity was examined as a moderator of this relationship. A longitudinal study was conducted with nurses in four departments of a public hospital. Results revealed that visible dissimilarity was negatively associated with work group involvement at both times, and informational dissimilarity was negatively associated with work group involvement at Time 1. Openness to diversity interacted with visible and informational dissimilarity in the prediction of work group involvement at both times. This interaction pattern showed that there was a negative relationship between dissimilarity and work group involvement when individuals perceived low group openness to diversity, whereas there was no relationship when individuals perceived high group openness to diversity. Results highlight the importance of managing perceptions of difference and introducing norms that encourage the active involvement of group members.

Information giving and decision-making in patients with advanced cancer: A systematic review

Patients with advanced, non-curable cancer face difficult decisions on further treatment, where a small increase in survival time must be balanced against: the toxicity of the treatment. If patients want to be involved in these decisions, in keeping with current notions of autonomy and empowerment, they also require to be adequately informed both on the treatments proposed and on their own disease status and prognosis. A systematic review was performed on decision-making and information provision in patients with advanced cancer. Studies of interventions to improve information giving and encourage participation in decision-making were reviewed, including both randomised controlled trials and uncontrolled studies. Almost all patients expressed a desire for full information, but only about two-thirds wished to participate actively in decision-making. Higher educational level, younger age and female sex were predictive of a desire to participate in decision-making. Active decision-making was more common in patients with certain cancers (e.g. breast) than others (e.g. prostate). A number of simple interventions including question prompt sheets, audio-taping of consultations and patient decision aids have been shown to facilitate such involvement. (c) 2005 Elsevier Ltd. All rights reserved.

Project risk management:a combined analytic hierarchy process and decision tree approach

Time, cost and quality achievements on large-scale construction projects are uncertain because of technological constraints, involvement of many stakeholders, long durations, large capital requirements and improper scope definitions. Projects that are exposed to such an uncertain environment can effectively be managed with the application of risk management throughout the project life cycle. Risk is by nature subjective. However, managing risk subjectively poses the danger of non-achievement of project goals. Moreover, risk analysis of the overall project also poses the danger of developing inappropriate responses. This article demonstrates a quantitative approach to construction risk management through an analytic hierarchy process (AHP) and decision tree analysis. The entire project is classified to form a few work packages. With the involvement of project stakeholders, risky work packages are identified. As all the risk factors are identified, their effects are quantified by determining probability (using AHP) and severity (guess estimate). Various alternative responses are generated, listing the cost implications of mitigating the quantified risks. The expected monetary values are derived for each alternative in a decision tree framework and subsequent probability analysis helps to make the right decision in managing risks. In this article, the entire methodology is explained by using a case application of a cross-country petroleum pipeline project in India. The case study demonstrates the project management effectiveness of using AHP and DTA.

A longitudinal study of Chinese managerial behaviour:an inside view of decision-making under the economic reform

This research compared decision making processes in six Chinese state-owned enterprises during the period 1985 to 1988. The research objectives were: a) To examine changes in the managerial behaviour over a period of 1985 to 1988 with a focus on decision-making; b) Through this examination, to throw light on the means by which government policies on economic reform were implemented at the enterprise level; c) To illustrate problems encountered in the decentralization programme which was a major part of China's economic reform. The research was conducted by means of intensive interviews with more than eighty managers and a survey of documents relating to specific decisions. A total of sixty cases of decision-making were selected from five decision topics: purchasing of inputs, pricing of outputs, recruitment of labour, organizational change and innovation, which occurred in 1985 (or before) and in 1988/89. Data from the interviews were used to investigate environmental conditions, relations between the enterprise and its higher authority, interactions between management and the party system, the role of information, and effectiveness of regulations and government policies on enterprise management. The analysis of the data indicates that the decision processes in the different enterprises have some similarities in regard to actor involvement, the flow of decision activities, interactions with the authorities, information usage and the effect of regulations. Comparison of the same or similar decision contents over time indicates that the achievement of decentralization varied according to the topic of decision. Managerial authority was delegated to enterprises when the authorities relaxed their control over resource allocation. When acquisition of necessary resources is dependent upon the planning system or the decision matter is sensitive, because it involves change to the institutional framework (e.g. the Party), then a high degree of centralization was retained, resulting in a marginal change in managerial behaviour. The economic reform failed to increase decision efficiency and effectiveness of decision-making. The prevailing institutional frameworks were regarded as negative to the change. The research argues that the decision process is likely to be more contingent on the decision content than the organization. Three types of decision process have been conceptualized, each of them related to a certain type of decision content. This argument gives attention to the perspectives of institution and power in a way which facilitates an elaboration of organizational analysis. The problems encountered in the reform of China's industrial enterprises are identified and discussed. General recommendations for policies of further reform are offered, based on the analysis of decision process and managerial behaviour.

Project risk management using multiple criteria decision-making technique and decision tree analysis:a case study of Indian oil refinery

This study proposes an integrated analytical framework for effective management of project risks using combined multiple criteria decision-making technique and decision tree analysis. First, a conceptual risk management model was developed through thorough literature review. The model was then applied through action research on a petroleum oil refinery construction project in the Central part of India in order to demonstrate its effectiveness. Oil refinery construction projects are risky because of technical complexity, resource unavailability, involvement of many stakeholders and strict environmental requirements. Although project risk management has been researched extensively, practical and easily adoptable framework is missing. In the proposed framework, risks are identified using cause and effect diagram, analysed using the analytic hierarchy process and responses are developed using the risk map. Additionally, decision tree analysis allows modelling various options for risk response development and optimises selection of risk mitigating strategy. The proposed risk management framework could be easily adopted and applied in any project and integrated with other project management knowledge areas.

Extreme events, organizations and the politics of decision making

Purpose – Threats of extreme events, such as terrorist attacks or infrastructure breakdown, are potentially highly disruptive events for all types of organizations. This paper seeks to take a political perspective to power in strategic decision making and how this influences planning for extreme events. Design/methodology/approach – A sample of 160 informants drawn from 135 organizations, which are part of the critical national infrastructure in the UK, forms the empirical basis of the paper. Most of these organizations had publicly placed business continuity and preparedness as a strategic priority. The paper adopts a qualitative approach, coding data from focus groups. Findings – In nearly all cases there is a pre-existing dominant coalition which keeps business continuity decisions off the strategic agenda. The only exceptions to this are a handful of organizations which provide continuous production, such as some utilities, where disruption to business as usual can be readily quantified. The data reveal structural and decisional elements of the exercise of power. Structurally, the dominant coalition centralizes control by ensuring that only a few functional interests participate in decision making. Research limitations/implications – Decisional elements of power emphasize the dominance of calculative rationality where decisions are primarily made on information and arguments which can be quantified. Finally, the paper notes the recursive aspect of power relations whereby agency and structure are mutually constitutive over time. Organizational structures of control are maintained, despite the involvement of managers charged with organizational preparedness and resilience, who remain outside the dominant coalition. Originality/value – The paper constitutes a first attempt to show how planning for emergencies fits within the strategy-making process and how politically controlled this process is.

Household pre-purchase practices and online grocery shopping

This paper explores household pre-purchase practices and their mediation by information and communications technologies (ICTs), specifically online grocery shopping. Drawing on practice theory, the impacts of ICTs on household grocery shopping behavior are conceptualized, and the concept of "front-loading" is introduced. Emerging themes generated from 31 semi-structured interviews conducted via Skype with Turkish consumers focusing on their experiences of online grocery practices are presented. To this end, the contribution of this paper is twofold. First, an understanding of the domestication of online grocery shopping and its affect on the dynamics of household decision making, information sharing, and responsibilities of tasks before the actual act of online shopping is developed. Second, how such pre-purchase practices undertaken by consumers act as a catalyst of change at the industry level is appraised.

The role of shared decision-making in audiologic rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making:a multi-perspective IPA design

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making. DESIGN: Multi-perspective interpretative phenomenological analyses. METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups. RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors. CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

Parent involvement on school advisory councils: A process evaluation at the middle school level

Increasing parental involvement was made an important goal for all Florida schools in educational reform legislation in the 1990's. A forum for this input was established and became known as the School Advisory Council (SAC). To demonstrate the importance of process and inclusion, a south Florida school district and its local teacher's union agreed on the following five goals for SACs: (a) to foster an environment of professional collaboration among all stakeholders, (b) to assist in the preparation and evaluation of the school improvement plan, (c) to address all state and district goals, (d) to serve as the avenue for authentic and representative input from all stakeholders, and (e) to ensure the continued existence of the consensus-building process on all issues related to the school's instructional program. ^ The purpose of this study was to determine to what extent and in what ways the parent members of one south Florida middle school's SAC achieved the five district goals during its first three years of implementation. The primary participants were 16 parents who served as members of the SAC, while 16 non-parent members provided perspective on parent involvement as “outside sources.” Being qualitative by design, factors such as school climate, leadership styles, and the quality of parental input were described from data collected from four sources: parent interviews, a questionnaire of non-parents, researcher observations, and relevant documents. A cross-case analysis of all data informed a process evaluation that described the similarities and differences of intended and observed outcomes of parent involvement from each source using Stake's descriptive matrix model. A formative evaluation of the process compared the observed outcomes with standards set for successful SACs, such as the district's five goals. ^ The findings indicated that parents elected to the SACs did not meet the intended goals set by the state and district. The school leadership did not foster an environment of professional collaboration and authentic decision-making for parents and other stakeholders. The overall process did not include consensus-building, and there was little if any input by parents on school improvement and other important issues relating to the instructional program. Only two parents gave the SAC a successful rating for involving parents in the decision-making process. Although compliance was met in many of the procedural transactions of the SAC, the reactions of parents to their perceived role and influence often reflected feelings of powerlessness and frustration with a process that many thought lacked meaningfulness and productivity. Two conclusions made from this study are as follows: (a) that the role of the principal in the collaborative process is pivotal, and (b) that the normative-re-educative approach to change would be most appropriate for SACs. ^

Deprofessionalization of curriculum decision -making

The purpose of this study was to analyze the evolution of Florida state level policy efforts and to assess the responding educational policy development and implementation at the local school district level. The focus of this study was the secondary language arts curriculum in Miami-Dade County Public Schools. ^ Data was collected using document analysis as a source of meaning making out of the language sets proffered by agencies at each level. A matrix was created based on Klein's levels of curriculum decision-making and Functional Process Theory categories of policy formation. The matrix allowed the researcher to code and classify specific information in terms accountability/high-stakes testing; authority; outside influences; and operational/structural organization. ^ Federal policy documents provided a background and impetus for much of what originated at the State level. The State then produced policy directives which were accepted by the District and specific policy directives and guidelines for practice. No evidence was found indicating the involvement of any other agencies in the development, transmission or implementation of the State level initiated policies. ^ After analyzing the evolutionary process, it became clear that state policy directives were never challenged or discussed. Rather, they were accepted as standards to be met and as such, school districts complied. Policy implementation is shown to be a top-down phenomenon. No evidence was found indicating a dialogue between state and local systems, rather the state, as the source of authority, issued specifically worded policy directives and the district complied. Finally, this study recognizes that outside influences play an important role in shaping the education reform policy in the state of Florida. The federal government, through NCLB and other initiatives created a climate which led almost naturally to the creation of the Florida A+ Plan. Similarly, the concern of the business community, always interested in the production of competent workers, continued to support efforts at raising the minimum skill level of Florida high school graduates. ^ Suggestions are made for future research including the examination of local school sites in order to assess the overall nature of the school experience rather than rely upon performance indicators mandated by state policy. ^

Using the Involvement Construct to Understand the Motivations of Customers of Casual Dining Restaurants in the USA

The purpose of this study was to investigate the motivations that push consumers to dine out and restaurant attributes that pull diners to a specific restaurant. Surveys were administered to a convenience sample of 559 respondents at a large university in the Southwest of the USA. Crosstabs, ANOVA, Correlations, Factor Analysis and Multiple Regression were employed to explore differences and relationships between variables. Findings identified a profile of diners at casual restaurants. Using the involvement construct, the push-pull motivational framework, and the hedonic and utilitarian motivational framework, results of this study indicate two primary reasons behind the decision to dine out at casual restaurants and six principal attributes that draw customers into these types of restaurants. In addition, diners were categorized into high/medium/low involvement categories and the linkages between involvement levels and motivations were explored. Both hedonic and utilitarian motivations were identified. Furthermore, motivational factors and restaurant attributes were found to predict diner loyalty. This paper provides the restaurant industry with insight and understanding as to what attracts diners into an establishment and what influences decisions behind dining out.

Deprofessionalization of curriculum decision-making

The purpose of this study was to analyze the evolution of Florida state level policy efforts and to assess the responding educational policy development and implementation at the local school district level. The focus of this study was the secondary language arts curriculum in Miami-Dade County Public Schools. Data was collected using document analysis as a source of meaning making out of the language sets proffered by agencies at each level. A matrix was created based on Klein's levels of curriculum decision-making and Functional Process Theory categories of policy formation. The matrix allowed the researcher to code and classify specific information in terms accountability/high-stakes testing; authority; outside influences; and operational/structural organization. Federal policy documents provided a background and impetus for much of what originated at the State level. The State then produced policy directives which were accepted by the District and specific policy directives and guidelines for practice. No evidence was found indicating the involvement of any other agencies in the development, transmission or implementation of the State level initiated policies. After analyzing the evolutionary process, it became clear that state policy directives were never challenged or discussed. Rather, they were accepted as standards to be met and as such, school districts complied. Policy implementation is shown to be a top-down phenomenon. No evidence was found indicating a dialogue between state and local systems, rather the state, as the source of authority, issued specifically worded policy directives and the district complied. Finally, this study recognizes that outside influences play an important role in shaping the education reform policy in the state of Florida. The federal government, through NCLB and other initiatives created a climate which led almost naturally to the creation of the Florida A+ Plan. Similarly, the concern of the business community, always interested in the production of competent workers, continued to support efforts at raising the minimum skill level of Florida high school graduates. Suggestions are made for future research including the examination of local school sites in order to assess the overall nature of the school experience rather than rely upon performance indicators mandated by state policy.

Parent involvement on school advisory councils: a process evaluation at the middle school level

Increasing parental involvement was made an important goal for all Florida schools in educational reform legislation in the 1990's. A forum for this input was established and became known as the School Advisory Council (SAC). To demonstrate the importance of process and inclusion, a south Florida school district and its local teacher's union agreed on the following five goals for SACs: (a) to foster an environment of professional collaboration among all stakeholders, (b) to assist in the preparation and evaluation of the school improvement plan, (c) to address all state and district goals, (d) to serve as the avenue for authentic and representative input from all stakeholders, and (e) to ensure the continued existence of the consensus-building process on all issues related to the school's instructional program. The purpose of this study was to determine to what extent and in what ways the parent members of one south Florida middle school's SAC achieved the five district goals during its first three years of implementation. The primary participants were 16 parents who served as members of the SAC, while 16 non-parent members provided perspective on parent involvement as "outside sources." Being qualitative by design, factors such as school climate, leadership styles, and the quality of parental input were described from data collected from four sources: parent interviews, a questionnaire of non-parents, researcher observations, and relevant documents. A cross-case analysis of all data informed a process evaluation that described the similarities and differences of intended and observed outcomes of parent involvement from each source using Stake's descriptive matrix model. A formative evaluation of the process compared the observed outcomes with standards set for successful SACs, such as the district's five goals. The findings indicated that parents elected to the SACs did not meet the intended goals set by the state and district. The school leadership did not foster an environment of professional collaboration and authentic decision-making for parents and other stakeholders. The overall process did not include consensus-building, and there was little if any input by parents on school improvement and other important issues relating to the instructional program. Only two parents gave the SAC a successful rating for involving parents in the decision-making process. Although compliance was met in many of the procedural transactions of the SAC, the reactions of parents to their perceived role and influence often reflected feelings of powerlessness and frustration with a process that many thought lacked meaningfulness and productivity. Two conclusions made from this study are as follows: (a) that the role of the principal in the collaborative process is pivotal, and (b) that the normative-re-educative approach to change would be most appropriate for SACs.