Monitoring clinical quality in rare disease services – experience in England

After some well-publicised problems with paediatric cardiac surgery, there has been great interest in England in monitoring clinical quality in specialised medical services. The National Commissioning Group plans, funds and monitors a set of highly specialised services for the National Health Service in England. We have developed systems for monitoring clinical quality that perform two interrelated but distinct functions: performance measurement and performance improvement. The aim is to collect information on all patients seen during each year – a 100% consecutive case series. Generally, there is no conceptual difficulty identifying an appropriate outcome for surgical interventions: the indication for surgery usually defines the outcome to monitor. This is not so for the medical and psychiatric services, where the relevant outcome to monitor is sometimes not obvious. There are a number of problems in interpreting, and acting on, outcome data for rare conditions and treatments. These problems include statistical problems due to small numbers, the need to risk adjust data and coding problems

Useful heuristics

Decision-making is one of the core tasks in project management. Traditionally, optimization methods have been developed to support managers in finding the best solutions. Alternatively, decisions can be based on simple rules of thumb, or heuristics. Even though simple heuristics only require little in the way of time and information, they have been shown to outperform optimization methods in complex decision tasks across a wide range of situations. This chapter outlines relevant decision heuristics commonly used, demonstrates situations in which they outperform more complex decision algorithms and explains why and when simple heuristics provide powerful decision tools

Information processing and intuitive decision-making on the fireground: towards a model of expert intuition

In addition to other cognitive tasks that need attending to, experienced fireground commanders are also faced with a crucial task of identifying various environmental and informational cues that could affect their performance on the fireground. Although these cues play a crucial role in activating the pattern recognition or intuitive decision-making process, the major challenge remains that they usually emerge from multiple sources, thereby increasing the cognitive load in working memory. Previous studies have shown that attending to multiple informational sources has serious implications for intuitive decision-making as it then becomes more difficult to select the most relevant cues amidst the rapidly evolving conditions. In order to determine how firefighters cope with this difficult task of processing information from multiple sources, 16 experienced fireground commanders were interviewed using a semi-structured critical decision method protocol. Following the insights derived from the knowledge elicitation process, this paper presents and describes an expert intuition model, which we termed the information filtering and intuitive decision-making model. The model attempts to conceptualize how experienced firefighters scan through multiple information sources from which they are then able to select the most relevant cues that eventually aid the development of workable action plans

Technology Assessment: Developing Geothermal Energy Resources for Supporting Electrical System in Oregon

This chapter presents a review of multi criteria decision models used in the energy sector and demonstrates application through the case of geothermal energy. The case is taken from Oregon which is located in teh pacific northwest region of the US. Experts are used to determine the criteria what is important for this application and the region