DB 1 -74
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MODULE1-Reading1.pptHCA 574
Decision Making in Healthcare
Reading #1
The Basics of DM Processes
Module 1: March 08 – 21, 2021
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Important Questions
How are decisions made in HC organizations?
What are the useful DM models?
Which DM model should I apply?
How can the DM process be managed?
How do consumers (patients) bear the burden of choice?
What is the influence of technology, culture, and ethics on DM?
How do different viewpoints on DM such as those of patients, providers or health executives consider important issues such as cost, quality and access in the DM process?
What causes poor decisions?
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How are Decisions Made in HC Organizations?
DECISION MAKING--Definition:
The process of choosing a course of action for dealing with a problem or an opportunity.
Or
The process through which alternatives are selected and then managed through implementation to achieve healthcare objectives.
What is your definition of DM? Why?
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How are Decisions Made?
Steps in Systematic DM and Analysis Process (DMAP)
Recognize and define the problem or opportunity.
Identify and analyze alternative courses of action, and estimate their effects on the problem or opportunity.
Choose a preferred course of action.
Implement the preferred course of action.
Evaluate the results and follow up as necessary.
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How are Decisions Made?
The systematic decision-making process may not be followed where substantial change occurs and many new technologies prevail.
New decision techniques may yield superior performance in certain situations.
Ethical consequences of decision making must be considered.
All applicable in health care? Why, Why Not?
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So DM is Important …
- To come to a decision, a series of events take place
Resources: Have to be in place, available at the right time
Processes: Have to be determined
DM: Has to be executed
Strategy: Has to be in place
Implementation: Can it work in all situations?
Returns: What are patient/organizational benefits?
- DM has to be part of strategic position for healthcare organizations
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How are Decisions Made?
DECISION ENVIRONMENTS INCLUDE:
Certain environments.
Risk environments.
Uncertain environments.
What’s the most dominant environment in health care? Why?
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How are Decisions Made?
CERTAIN ENVIRONMENTS
Exist when information is sufficient to predict the results of each alternative in advance of implementation.
Certainty is the ideal problem solving and decision making environment.
Examples in health care?
Whose perspective should take precedence in this environment? Why?
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How are Decisions Made?
RISK ENVIRONMENTS
Exist when decision makers lack complete certainty regarding the outcomes of various courses of action, but they can assign probabilities of occurrence.
Probabilities can be assigned through objective statistical procedures or personal intuition.
Give two examples in health care.
Whose perspective should take precedence in this environment? Why?
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How are Decisions Made?
UNCERTAIN EVIRONMENTS
Exist when there is so little information that one cannot even assign probabilities to various alternatives and possible outcomes.
Uncertainty forces decision makers to rely on individual and group creativity to succeed in problem solving.
Examples in health care?
Whose perspective should take precedence in this environment? Why?
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Uncertain Environments …2
Also characterized by rapidly changing:
External conditions.
Information technology requirements.
Personnel influencing problem and choice definitions.
These rapid changes are also called organized anarchy.
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How are Decisions Made?
TYPES OF DECISIONS
Planned Decisions
Involve routine problems that arise regularly and can be addressed through standard responses.
Non-planned Decisions
Involve abnormal problems that require solutions specifically tailored to the situation at hand
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Decision Making Models
Classical Decision Theory (CDT)
Views the decision maker as acting in a world of complete certainty.
Behavioral Decision Theory (BDT)
Accepts a world with bounded rationality and views the decision maker as acting only in terms of what he/she perceives about a given situation.
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CDT vs. BDT
CDT
The classical decision maker:
Faces a clearly defined problem.
Knows all possible action alternatives and their consequences.
Chooses the optimum alternative.
Is often used as a model of how managers should make decisions.
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CDT vs. BDT …2
BDT
Recognizes that human beings operate with:
Cognitive limitations.
Bounded rationality.
The behavioral decision maker:
Faces a problem that is not clearly defined.
Has limited knowledge of possible action alternatives and their consequences.
Chooses a satisfactory alternative.
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CDT vs. BDT …3
CDT
May not fit well in a chaotic world.
Can be used toward the bottom of many firms, even most high-tech firms.
BDT
Fits with a chaotic world of uncertain conditions and limited information.
Encourages satisficing decision making.
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Decision Making Models
The Garbage Can Model (GCM)
A model of decision making that views problems, solutions, participants, and choice situations as mixed together in the “garbage can” of the organization.
In stable settings, behavioral decision theory may be more appropriate.
In dynamic settings, the garbage model may be more appropriate.
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Decision Making Models
Implications of GCM
Choice making and implementation may be done by different individuals.
Because of interpretation, there is a risk that the actual implementation does not exactly match the choice.
Many problems go unsolved.
Think of an example in the US HC System which may represent a problem that has never been solved due to poor DM/poor alternative choices.
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Decision Making Models: A.D.P.I.E.
- The Assessment, Diagnosis, Planning, Implementation Evaluation (ADPIE) Model
Assessment
Evaluate
Diagnose
Planning
Implementation
On-going Assessment
On-going Diagnosis
On-going Planning
On-going Implementation
On-going Evaluation
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This model was developed as an on-going evaluation tool. The strategic plan is an ongoing living process. As soon as the organization initiates the assessment process and, therefore, determines the needs of the organization (diagnosis), it is time to move on to the planning phase where the stake holders determine (plan) the strategies to meet the needs of fixing or addressing the problems within the organization (diagnosis). After this phase is completed, it is time to put into action the plans (implement) determined by the organization’s stake holders. It is then imperative to see if the organization has met the goals of the plans and programs that were implemented (evaluate). Upon finishing the evaluation and discovering the success and failures of the implemented plans, (take note already a new organization is emerging), it is time to begin assessing the new organization with it’s new strengths and weaknesses that are a net result of implementing the initial ADPIE process. To do this effectively, it is necessary to initiate the ADPIE process again. At the end of this next ADPIE process, the result will again be a new organization with its new strengths and weaknesses that are a net result of implementing the second ADPIE process. ADPIE then starts again, and so on and so on…. This process is ongoing through out the life of the organization. This helps to prevent inertia, stagnation, and non-growth which is inherent in many organizations who have not put in place an on-going evaluation processes to use as a metric for the on-going outcomes measurements needed for the on-going success of the organization.
ADPIE …2
- Ongoing DM/Evaluation tool
- Phase by phase through A.D.P.I.E
- State the cycle after completing the initial ADPIE
- Ongoing throughout the life of HC organization
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Shared Decision Making Model
- SDM MODEL
Collaborative model—providers & patients/family
Applies the SHARE Approach (AHRQ)
Applies clinical evidence
Applies the principle of patient centeredness
What are the likely challenges in SDM?
Where/What is the place/role of healthcare executive in SDM?
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E.T.H.I.C.A.L. Model
- Applied in Ethical DM
Examine the ethical dilemma
Thoroughly comprehend the possible alternatives
Hypothesize ethical arguments
Investigate, compare, and evaluate the arguments for each alternative
Choose the alternative you would recommend
Act on your chosen alternative
Look at the ethical dilemma and examine the outcomes while reflecting on the ethical decision
- Use to arrive at rational and justifiable decisions
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Intuitive DM Model
- How the Intuitive Model Works
Consciously recalling gained knowledge
Based on formal/informal education and experience
Inexperienced: Take time to make decisions—step by step from assessment to implementation
Experienced: “Leap” from information gathering to implementation.
Good idea? Why? Why Not?
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DM Tools & Strategies
- SWOT Analysis
- Decision Matrix
- Decision Tree
- Pareto Diagram
- Cost-Benefit Analysis
- Discuss tools used by your organization in its DM processes.
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DM Realities
Decision makers face complex choice processes.
DM information may not be available
Bounded rationality and cognitive limitations affect the way DM parties define problems, identify alternatives, and choose preferred solutions
Most DM goes beyond step-by-step rational choice
Most DM falls between the highly rational and the highly chaotic
Decisions must be made under risk and uncertainty
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DM Realities …2
Decisions must be made to solve non-routine issues
Decisions must be made under time pressures
Decisions must be made under information limitations
Decisions should be ethical
What’s your pick as the best DM Model in health care environment in general? Why?
What’s your pick as the best DM Model in health care environment under the COVID-19 situation? Why?
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How to Manage DM Processes
CHOOSING PROBLEMS TO ADDRESS
Ask and answer the following questions:
Is the problem easy to deal with?
Might the problem resolve itself?
Is this my decision to make?
Is this a solvable problem within the context of the organization?
Apply to a specific health care problem
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How to Manage a DM Process …2
Reasons for DM Failure
Decision makers tend to copy others’ choices and apply them in their situation
Decision makers tend to emphasize problems and solutions rather than successful implementation
Decision makers use participation too infrequently
Any other reasons? Apply your HC experience.
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How to Manage a DM Process …3
WHO SHOULD PARTICIPATE IN DM?
Authoritative Decisions.
Made by authority without involving other parties and by using information on hand
Consultative Decisions
Made by one individual after seeking input from others
Group Decisions
Made by all affected/concerned parties collectively
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Influence of Culture, Technology and Ethics on DM
Information Technology and DM
Cultural Factors and DM
US culture stresses decisiveness, speed, and the individual selection of alternatives.
Other cultures place less emphasis on individual choice than on developing implementations that work.
Ethical Issues and DM
Ethical dilemmas: ethical/legal/right/beneficial decisions?
Watch the movie “John Q” https://www.youtube.com/watch?v=_l693tZkCio
Discuss the importance of cultural, technological and ethical factors in DM processes. Use views from your group perspective
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