Towards the realisation of an integratated decision support environment for organisational decision making

Traditional decision support systems are based on the paradigm of a single decision maker working at a stand‐alone computer or terminal who has a specific decision to make with a specific goal in mind. Organizational decision support systems aim to support decision makers at all levels of an organization (from executive, middle management managers to operators), who have a variety of decisions to make, with different priorities, often in a distributed and dynamic environment. Such systems need to be designed and developed with extra functionality to meet the challenges such as collaborative working. This paper proposes an Integrated Decision Support Environment (IDSE) for organizational decision making. The IDSE distinguishes itself from traditional decision support systems in that it can flexibly configure and re‐configure its functions to support various decision applications. IDSE is an open software platform which allows its users to define their own decision processes and choose their own exiting decision tools to be integrated into the platform. The IDSE is designed and developed based on distributed client/server networking, with a multi‐tier integration framework for consistent information exchange and sharing, seamless process co‐ordination and synchronisation, and quick access to packaged and legacy systems. The prototype of the IDSE demonstrates good performance in agile response to fast changing decision situations

A participatory design approach for the development of support environments in eGovernment services to citizens

The introduction of eGovernment services and applications leads to major changes in the structure and operation of public administrations. In this paper we describe the work in progress in an Italian project called “SPO.T.” aimed at the analysis, development, deployment and evaluation of tools and environments to support the people who plan, deliver, use and evaluate user-centred provision of One-Stop-Shop services to citizens. The “SPO.T.” project has focused on two requirements: 1. the support tools and environments must facilitate the active involvement of all stakeholders in the definition and evolution of eGovernment applications and services, and it is argued that through participatory design changes of structure, process and culture can be delivered effectively; 2. they must embody a set of architecturally coherent resources which reflect the new roles and relationships of public administration and which are sufficiently generic to be relevant to a wide range of local contexts across the community

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Tax-aided financial services companies and the cost of capital

Over the past two decades, the governments of several European countries have implemented special tax devices to attract the finance centres of multinational companies. This paper determines how the cost of capital for investments made by multinationals is affected by the tax regimes, bringing into play the Irish financial services company, the Belgian co-ordination centre, the Dutch finance company and the Luxemburg company coupled with a Swiss finance branch. It gives evidence that intermediation of a tax-aided services company in the financing scheme of a foreign subsidiary provides an important tax saving. However, the home and source countries\' tax regimes influence the hierarchy of the less heavily taxed treasury and finance centres. The methodology relies on the marginal effective tax rates theory and consists of an extension of Alworth’s (1988) model to include treasury centres.

Integration of decision support systems to improve decision support performance

Decision support system (DSS) is a well-established research and development area. Traditional isolated, stand-alone DSS has been recently facing new challenges. In order to improve the performance of DSS to meet the challenges, research has been actively carried out to develop integrated decision support systems (IDSS). This paper reviews the current research efforts with regard to the development of IDSS. The focus of the paper is on the integration aspect for IDSS through multiple perspectives, and the technologies that support this integration. More than 100 papers and software systems are discussed. Current research efforts and the development status of IDSS are explained, compared and classified. In addition, future trends and challenges in integration are outlined. The paper concludes that by addressing integration, better support will be provided to decision makers, with the expectation of both better decisions and improved decision making processes

An integrated decision support environment for organisational decision making

Traditional decision support systems are based on the paradigm of a single decision maker working at a stand-alone computer or terminal who has a specific decision to make with a specific goal in mind. Organisational decision support systems aim to support decision makers at all levels of an organisation (from executive, middle management managers to operators), who have a variety of decisions to make, with different priorities, often in a distributed environment. Such systems are designed and developed with extra functionality to meet the challenge. This paper proposes an Integrated Decision Support Environment (IDSE) for organisational decision making. The IDSE is designed and developed based on distributed client/server networking, with a combination of tight and loose integration approaches for information exchange and communication. The prototype of the IDSE demonstrates a good balance between flexibility and reliability