Strategic options development and analysis

Strategic Options Development and Analysis (SODA) enables a group or individual to construct a graphical representation (map) or a problematic situation, and thus explore options and their ramifications with respect to a complex system of goals or objectives. In addition the approach aims to help groups arrive at a negotiated agreement about how to act to resolve the situation. It is based upon the use of causal mapping – a formally constructed means-ends network. Because the map has been constructed using the natural language of the problem owners it becomes a model of the situation that is ‘owned’ by those who define the problem. The use of formalities for the construction of the model makes it amenable to a range of analyses encouraging reflection and a deeper understanding. These analyses can be used in a ‘rough and ready’ manner by visual inspection or through the use of specialist causal mapping software. Each of the analyses helps a group or individual discover important features of the problem situation. And these features facilitate agreeing a good solution. The SODA process is aimed at helping a group learn about the situation they face before they reach agreements. Most significantly the exploration through the causal map leads to a higher probability of more creative solutions and promotes solutions that are more likely to be implemented because the problem construction process is more likely to include richer social dimensions about the blockages to action and organizational change. The basic theories that inform SODA derive from cognitive psychology and social negotiation, where the model acts as a continuously changing representation of the problematic situation (a transitional object) – changing as the views of a person or group shift through learning and exploration. This chapter jointly written by two leading practitioner academics and the original developers of SODA, Colin Eden and Fran Ackermann, describe the SODA approach as it is applied in practice

Effects of out-of-hours and winter admissions and number of patients per unit on mortality in pediatric intensive care

Objective: To investigate the effect of out-of-hours and winter admissions, and unit size on risk adjusted mortality in pediatric intensive care. Study design: A national pediatric intensive care clinical audit provided data on over 86 000 admissions to 29 pediatric intensive care units (2006-2011). Multivariate logistic regression modeled risk adjusted mortality prior to discharge with out-of-hours (night, weekend, public holiday) admissions, admissions per unit, winter admission, and potential confounders, overall and separately for emergency and planned admissions. Results: Nearly one-half (47.1%) of admissions were out-of-hours (n = 40 948) and 79.2% of those were emergencies. Mortality for all out-of-hours admissions was raised (OR 1.1; 95% CI 1.02-1.2; P =.013), accounted for by planned admissions (OR 1.99; 95% CI 1.67-2.37; P <.001) compared with a reduced risk for emergency admissions (OR 0.93; 95% CI 0.86-1.1; P =.07). Winter admissions were associated with increased risk. Unit size did not affect mortality. Conclusions: A child admitted to pediatric intensive care as an out-of-hours emergency is not at increased risk of dying compared with a weekday daytime admission, indicating pediatric intensive care units provide consistent quality of care around the clock. Excess mortality in planned out-of-hours admissions may be explained by admissions following complex operations where risk-adjustment models underestimate the true probability of mortality. In winter, a time of seasonally high bed occupancy, there was an increased mortality risk, an effect which requires further investigation. Despite the different characteristics of small units, the absence of any effect of unit size on mortality suggests that number of admissions per unit does not influence standards of care