Heuristics in managing complex clinical decision tasks in experts decision making

pre-printBackground: Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective: The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method: After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results: We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trad e-offs, managing uncertainty and generating rule of thumb. Conclusion: Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application: Understanding comp lex decision making processes can help design allocation based on the complexity of task for clinical decision support design

ChoiceMates: Supporting Unfamiliar Online Decision-Making with Multi-Agent Conversational Interactions

Unfamiliar decisions -- decisions where people lack adequate domain knowledge or expertise -- specifically increase the complexity and uncertainty of the process of searching for, understanding, and making decisions with online information. Through our formative study (n=14), we observed users' challenges in accessing diverse perspectives, identifying relevant information, and deciding the right moment to make the final decision. We present ChoiceMates, a system that enables conversations with a dynamic set of LLM-powered agents for a holistic domain understanding and efficient discovery and management of information to make decisions. Agents, as opinionated personas, flexibly join the conversation, not only providing responses but also conversing among themselves to elicit each agent's preferences. Our between-subjects study (n=36) comparing ChoiceMates to conventional web search and single-agent showed that ChoiceMates was more helpful in discovering, diving deeper, and managing information compared to Web with higher confidence. We also describe how participants utilized multi-agent conversations in their decision-making process

Vista goes online: Decision-analytic systems for real-time decision-making in mission control

The Vista project has centered on the use of decision-theoretic approaches for managing the display of critical information relevant to real-time operations decisions. The Vista-I project originally developed a prototype of these approaches for managing flight control displays in the Space Shuttle Mission Control Center (MCC). The follow-on Vista-II project integrated these approaches in a workstation program which currently is being certified for use in the MCC. To our knowledge, this will be the first application of automated decision-theoretic reasoning techniques for real-time spacecraft operations. We shall describe the development and capabilities of the Vista-II system, and provide an overview of the use of decision-theoretic reasoning techniques to the problems of managing the complexity of flight controller displays. We discuss the relevance of the Vista techniques within the MCC decision-making environment, focusing on the problems of detecting and diagnosing spacecraft electromechanical subsystems component failures with limited information, and the problem of determining what control actions should be taken in high-stakes, time-critical situations in response to a diagnosis performed under uncertainty. Finally, we shall outline our current research directions for follow-on projects

GPs' decision-making when prescribing medicines for breastfeeding women: Content analysis of a survey

<p>Abstract</p> <p>Background</p> <p>Many breastfeeding women seek medical care from general practitioners (GPs) for various health problems and GPs may consider prescribing medicines in these consultations. Prescribing medicines to a breastfeeding mother may lead to untimely cessation of breastfeeding or a breastfeeding mother may be denied medicines due to the possible risk to her infant, both of which may lead to unwanted consequences. Information on factors governing GPs' decision-making and their views in such situations is limited.</p> <p>Methods</p> <p>GPs providing shared maternity care at the Royal Women's Hospital, Melbourne were surveyed using an anonymous postal survey to determine their knowledge, attitudes and practices on medicines and breastfeeding, in 2007/2008 (n = 640). Content analysis of their response to a question concerning decision-making about the use of medicine for a breastfeeding woman was conducted. A thematic network was constructed with basic, organising and global themes.</p> <p>Results</p> <p>335 (52%) GPs responded to the survey, and 253 (76%) provided information on the last time they had to decide about the use of medicine for a breastfeeding woman. Conditions reported were mastitis (24%), other infections (24%) and depressive disorders (21%). The global theme that emerged was "<it>complexity of managing risk in prescribing for breastfeeding women"</it>. The organising themes were: <it>certainty around decision-making; uncertainty around decision-making; need for drug information to be available, consistent and reliable; joint decision-making; the vulnerable "third party" </it>and <it>infant feeding decision</it>. Decision-making is a spectrum from a straight forward decision, such as treatment of mastitis, to a complicated one requiring multiple inputs and consideration. GPs use more information seeking and collaboration in decision-making when they perceive the problem to be more complex, for example, in postnatal depression.</p> <p>Conclusion</p> <p>GPs feel that prescribing medicines for breastfeeding women is a contentious issue. They manage the risk of prescribing by gathering information and assessing the possible effects on the breastfed infant. Without evidence-based information, they sometimes recommend cessation of breastfeeding unnecessarily.</p

Optimal Decision-Making under Uncertainty - Application to Power Transmission Investments

Economists define investment as the act of incurring immediate costs with the expectation of future returns. An investment project, as every asset has a value. For successfully investing in and managing these assets is crucial not only recognizing what the value is but also the sources of this value. Most investment decisions share three characteristics in different degrees. First, investments are partially or totally irreversible. Roughly speaking, the initial investment cost is at least partially sunk; i.e. it is impossible to recover all the expenditures if the decision-maker changes his mind. Second, there is uncertainty in the revenues from the investment, and therefore, risk associated with this. Third, all decision-making has some leeway about the timing of the investment. It is possible to defer the decision making to get more information about the future. These three features interact to determine the optimal decisions of investors on a given investment project. Transmission utilities are faced with investment projects, which hold these three characteristics: irreversibility, uncertainty and the choice of timing. In this context, an efficient decision making process is, therefore, based on managing the uncertainties and understanding the relationships between risks and opportunities in order to achieve a well-timed investment execution. Therefore, strategic flexibility for seizing opportunities and cutting losses contingent upon the market evolution is of huge value. Strategic flexibility is a risk management method that is gaining ongoing research attention as it enables properly managing major uncertainties, which are unsolved at the time of making decisions. Hence, valuing added flexibility in transmission investment portfolios, for instance, by investing in power electronic-based controller meanwhile transmission line projects are deferred, is necessary to make optimal network upgrading. Nevertheless, expressing the value of flexibility in economic terms is not a trivial task and requires new, sophisticated valuing tools, since the traditional investment theory has not recognized the important implications of the interaction between the three aforementioned investment features. Any attempt to quantify investment flexibility almost naturally leads to the concept of Real Options (RO). The RO technique provides a well-founded framework –based on the theory of financial options, and consequently, stochastic dynamic programming- to assess strategic investments under uncertainty. In the first RO applications, valuation was normally confined to the investment options that can be easily assimilated to financial options, for which solutions are well-known and readily available. Nevertheless, an investor confront with a diverse set of opportunities. From this point of view, investment projects can be seen as a portfolio of options, where its value is driven by several stochastic variables. The introduction of multiple interacting options into real options models highly increases the problem complexity, making traditional numerical approaches impracticable. However in the recent years, simulation procedures for solving multiple American options have been successfully proposed. One of the most promising approaches is the Least Square Monte Carlo (LSM) method proposed by Longstaff and Schwartz in 2001. LSM method is based on stochastic chronological simulation and uses least squares linear regression to determine the optimal stopping time (optimal path) in the decision making process. This chapter lays out a general background about key concepts -uncertainty and risk- and the most usual risk management techniques in transmission investment are provided. Then, the concept of strategic flexibility is introduced in order to set its ability for dealing with the uncertainties involved in the investment problem. In addition, new criteria and advantages of ROV approach compared with classical probabilistic choice are presented, by exposing a LSM-based method for decomposing and evaluating the complex real option problem involved in flexible transmission investments under uncertainties. The proposed methodology is applied in a study case which evaluates an interconnection reinforcement on the European interconnected power system, by showing how the valuation of flexibility is a key task for making efficient and well-timed investments in the transmission network. The impact of two network upgrades on the system-wide welfare is analyzed. These upgrades are the development of a new interconnected line and the installation of a power electronic-based controller. Both upgrades represent measures to strengthen the German-Dutch interconnections due to the fact that these are among the most important corridors within the Central Western European (CWE) region. Hence, an interconnection project, which is currently under study, is compared to flexible investment in order to shed some light on the influence of the strategic flexibility on the optimal decision-making process. The research is focused on assessing the impact of different wind power in-feed scenarios in detail as well as the uncertainty of the demand growth, generation cost evolution and the installed wind capacity on the decision-making process. The presented approach might serve as a basis for a decision-making tool for regulatory agencies in order to quantify the necessity for network upgrades.Fil: Blanco, Gerardo. Universidad Nacional de Asunción; ParaguayFil: Olsina, Fernando Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina. Universidad Nacional de San Juan. Facultad de Ingeniería. Instituto de Energía Eléctrica; Argentin

Customer Enquiry Management in a Global Competitive Context: A Comparative Multi-Case Study Analysis

Business-to-Business (B2B) relationships, such as between a manufacturer and a customer, are increasingly important during the Customer Enquiry Management (CEM) process, particularly so for non-Make-To-Stock (non-MTS) companies operating in industrial markets. Few empirical studies have explored the CEM practices adopted by firms in practice. A study of the Italian capital goods sector by Zorzini et al. (2007) is a recent exception. Moreover, most studies have approached CEM from a cross-department integrated perspective but in the digital economy, and with globalization, outsourcing and extended supply chains, CEM needs to be approached from a broader supply chain-oriented perspective, incorporating B2B exchanges. This paper builds on the study by Zorzini et al. (2007) by conducting multi-case study research with seven UK-based companies in the capital goods sector, including three sales and support companies with offshore manufacturing. By adopting a cross-national research perspective, it assesses whether the proposed theory applies to other capital goods firms outside Italy. By also adopting a supply chain perspective of CEM it investigates current industry practice in B2B markets and explores whether cross-functional coordination and formalization issues can be extended into a global context. Evidence from the UK generally supports prior theory, confirming links between high levels of coordination, formalization of the CEM process and improved performance. Some refinements are proposed, for example, in order to make the theory suitable for a global context. The characteristics of a supply chain are important factors that affect CEM. This research has managerial implications for improving the CEM process in non-Make-To-Stock (non-MTS) capital goods companies from both an intra and an inter-organisational (B2B) perspective. Coordination with partners along the supply chain is needed at the enquiry stage and constraints linked to global customers should be considered when structuring the

Supply chain uncertainty:a review and theoretical foundation for future research

Supply-chain uncertainty is an issue with which every practising manager wrestles, deriving from the increasing complexity of global supply networks. Taking a broad view of supply-chain uncertainty (incorporating supply-chain risk), this paper seeks to review the literature in this area and develop a theoretical foundation for future research. The literature review identifies a comprehensive list of 14 sources of uncertainty, including those that have received much research attention, such as the bullwhip effect, and those more recently described, such as parallel interaction. Approaches to managing these sources of uncertainty are classified into: 10 approaches that seek to reduce uncertainty at its source; and, 11 approaches that seek to cope with it, thereby minimising its impact on performance. Manufacturing strategy theory, including the concepts of alignment and contingency, is then used to develop a model of supply-chain uncertainty, which is populated using the literature review to show alignment between uncertainty sources and management strategies. Future research proposed includes more empirical research in order to further investigate: which uncertainties occur in particular industrial contexts; the impact of appropriate sources/management strategy alignment on performance; and the complex interplay between management strategies and multiple sources of uncertainty (positive or negative)

A list of websites and reading materials on strategy & complexity

The list has been developed based on a broad interpretation of the subject of ‘strategy & complexity’. Resources will therefore more, or less directly relate to ‘being strategic in the face of complexity’. Many of the articles and reports referred to in the attached bibliography can be accessed and downloaded from the internet. Most books can be found at amazon.com where you will often find a number of book reviews and summaries as well. Sometimes, reading the reviews will suffice and will give you the essence of the contents of the book after which you do not need to buy it. If the book looks interesting enough, buying options are easy

Illuminating the Naturalistic Decision-Making Processes of Anesthesia Providers to Inform Medication Error-Reducing Interventions

Medication errors in anesthesia are prevalent and efforts to address medication errors bring with them new potential avenues of failure, especially when the work system and ‘work as done’ are not considered in the design of the intervention. I employed two methodologies in interviews of anesthesia providers to help further understand the context of anesthesia ‘work as done’ to inform the design of future medication error-reducing interventions. Results of the first interview methodology, the critical decision method, revealed a diverse array of challenging scenarios in which ‘work as done’ often deviates from ‘work as imagined.’ Results of the second interview methodology, vignette-based interviews, revealed how the decision-making processes of anesthesia providers may vary even when managing an identical case. These interviews provide context to the otherwise nebulous ‘variability’ of anesthesia provider ‘work as done.’ This context highlights the potential unforeseen dangers that may occur with the addition of future interventions and suggests avenues in which future interventions may fit better into the workflow of the anesthesia provider with design considerations. Future design efforts should focus on supporting the resilience of anesthesia providers: the information seeking and problem anticipation which are used to safely manage the uncertainty and complexity of their work. Future work should assess how ‘work as done’ may vary in different hospitals, and additionally focus on how ‘work as done’ influences the process of medication administration