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... The complexity of such decision-making calls for the use of models. Models are abstractions of the problem and its interaction under consideration [9] [15]. Models can also be actual model instances of the abstraction schema [18]. ...
... A modelling process occurs when the decision maker defines and develops an abstraction of the real world problem in the form of a model so that s/he can decide and solve a problem under consideration [3]. Not only does the model act as a model schema [9] [15], but it is also a mathematical model [9] [20] that acts as an executable computer program module [18]. Often this modelling process is iterative and cyclical, and requires continuous adjustment and refinement. ...
... A modelling process occurs when the decision maker defines and develops an abstraction of the real world problem in the form of a model so that s/he can decide and solve a problem under consideration [3]. Not only does the model act as a model schema [9] [15], but it is also a mathematical model [9] [20] that acts as an executable computer program module [18]. Often this modelling process is iterative and cyclical, and requires continuous adjustment and refinement. ...
Decision making processes and systems to support the same have focused for the most part on narrow disciplines, paradigms, perspectives, and pre-determined processes. Apart from these most decision processes and systems are designed to solve simple problems and are therefore unable to support complex problems that consist of interrelated decisions that span multiple domains, paradigms, and/or perspectives. To address these problems we propose conceptual decision-making and modelling processes. A flexible object-oriented decision system framework and architecture was developed and implemented to support the proposed processes. Some of the key concepts that we have been able to explore and implement are generic modelling ideas, such as data-model, model-solver, model-model, solver-visualisation, and data-visualisation independences. Specifically we have been able to explore the integration of models of different types, levels of complexity, depths of integration (aggregation, pipelining, and splicing) and orientations (satisficing as well as optimising).
... To each event one can assign a probability that it occurs, provided a certain decision has been made. We exemplify this with Figure 3, based on a problem from Eppen et al. (1998). We have an outcome matrix, e.g. with the decisions on order quantity as rows (4–7) and the events (=demand) as columns (B-E). ...
In this paper we discuss how discrete event simulation (DES) was used in a course on decision analysis (DA). Against the background of the characteristics of the students and the purpose of the course, we discuss various types of problems and methods that were found suitable to include in the course, in order to show the place of DES in DA. We present a number of simple GPSS programs that have been used in the course and proved effective in promoting the students' understanding of DA.
... Theory suggests that durable organizational change of the kind required by CCM is most likely when stakeholders are involved in design and implementation [12,13]. Yet classical continuous quality improvement (CQI) for depression, which maximizes participation, does not improve outcomes [14,15]. ...
Meta-analyses show collaborative care models (CCMs) with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA). Evidence-based quality improvement (EBQI) uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness.
The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC) predilection to adopt CCM.For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months.
Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01), but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003).
Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed.
ClinicalTrials.gov: NCT00105820.
... Theory of decision-making has taken, as its subject matters how individuals and groups make decisions [2], [4], [5]. The goal for much of this work has been the production of a model of decision making -a model general enough to describe individual cases of decision making while drawing out important generalities across different individuals and situations. ...
Manager who is adjusted to think about decision process in the terms of intuitive process, rational model, and model of bounded rationality is usually confused with many technical details describing something he does not understand. To take more advantage of decision support tools managers need IT professionals to speak with the same language. This article represents an attempt how to use managerial language in order to describe decision support tools.
Recently, many universities in Korea have been faced with critical crisis such as the decrease in the number of freshmen, the pressure for tuition cuts, M&A between universities and so on. Nobody has expected that universities will have this kind of difficulties. The universities are making attempts to innovate the quality of education to secure high level of education and to meet social needs to overcome these internal and external environment of crisis. For this innovation, the universities have sought to reduce the budget as well as conducted the self-evaluation to figure out their relative positions annually. Innovations cannot have having the limitation without education funds. Budget spent in universities have influences directly or indirectly on the structural improvement of the finance and on the growth of universities. The purpose of this study is to explore the decision-making method to find the optimal budget allocation so as to minimize the execution budget and to maximize the management evaluation by taking the advantage to analyse the relationship between the evaluation and the budget. Therefore, in this paper, we implement the development of the mathematical model for the University Evaluation and Budget Allocation Optimization in the form of the linear programming.
Many studies have been devoted to representing, understanding and explaining organizational action. The purpose of this work is to contribute to the Theory of Operations Management. An understanding of the causal relationships between strategy, structure and performance is still of major importance in the area of 'Strategy and Organizations'. This paper discusses the theoretical assumptions of a reference framework that can be used in the construction of models aimed at studying organizational action from the standpoint of structuring, implementation and performance. The approach employed here is structuralism, into which concepts of resources and capabilities have been incorporated based on an approach centered on the development of organizational competences. The framework presented here is founded on the hypertext metaphor and interrelates the dimensions of organizational processes and structures in the context of organizational 'spaces'. The framework incorporates the dimensions of space, the structuralist approach founded on the definition of 'form', and the 'hypertext' architecture to integrate the dimensions. The framework articulates and represents the horizontal and vertical coordination of activities and processes in an integrated and coherent way within the context of participative management and knowledge management.
When a L-R fuzzy number is adopted as fuzzy data in fuzzy numbers, as this number shows the general model function containing trapezoidal and triangular fuzzy number it has been applied to various problems. In this study, the median of the L-R fuzzy number is proposed and indicated by using some numerical examples.
We study the broadcasting of messages in tree networks under edge reductions. When an edge is reduced, its cost becomes zero. Edge reductions model the decrease or elimination of broadcasting costs between adjacent nodes in the network. Let T be an n-vertex tree and B be a target broadcast cost. We present an O(n)-time algorithm for determining the minimum number of edges of T to reduce so that a broadcast cost of B can be achieved. We present an O(n log n)-time algorithm to determine the minimum number of edges to reduce so that a broadcast initiated at an arbitrary vertex of T costs at most B. Characterizations of where edge reductions are placed underly both algorithms and imply that reduced edges can be centrally located.
As more supply chains are becoming dependent upon suppliers, an interruption of supply networks can obstruct the functionality of the entire supply chain. The purpose of this paper is to present what we believe is a useful way to think about the number of suppliers needed in the presence of risks. We model the decision-making process using a decision tree approach. We consider catastrophic, “super-events,” which affect many/all suppliers, as well as “unique events” that affect only a single supplier. The probabilities of these events, the financial loss caused by disasters, and the operating cost of working with multiple suppliers are captured by decision trees, from which the expected cost function is obtained and the optimal number of suppliers is determined. Our methodology will help purchasing managers, materials management, as well as academics that are considering such issues.
With increasing attention directed at quality problems and medical errors in healthcare organizations, the ability of senior management to promote and sustain effective quality improvement efforts is paramount to their organizational success. We sought to define key roles and activities that comprise senior managers' involvement in improvement efforts directed at physicians' prescription of beta-blockers after acute myocardial infarction (AMI). We also developed a taxonomy to organize the diverse roles and activities of managers in quality improvement efforts and proposed key elements that might be most central to successful improvement efforts. Results are based on a qualitative study of 8 hospitals across the country and included in-depth interviews with 45 clinical and administrative staff from these hospitals. The findings help identify a checklist that senior managers may use to assess their own and others' participation in quality improvement efforts in their institutions. By reinforcing their current involvement or by identifying potential gaps in their involvement in quality improvement efforts, practitioners may enhance their effectiveness in promoting and sustaining quality in clinical care.
We sought to recommend an approach for minimizing preventable delays in door-to-balloon time on the basis of experiences in top-performing hospitals nationally.
Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity; however, door-to-balloon times often exceed the 90-min guideline set forth by the American College of Cardiology (ACC) and the American Heart Association (AHA).
We conducted a qualitative study using in-depth interviews (n = 122) of hospital staff at hospitals (n = 11) selected as top performers based on data from the National Registry of Myocardial Infarction from January 2001 to December 2002. We used the constant comparative method of qualitative data analysis to synthesize best practices across the hospitals.
Top performers were those with median door-to-balloon times of < or =90 min for their most recent 50 PCI cases through December 2002 and the greatest improvement in median door-to-balloon times during the preceding four-year period 1999 to 2002. Several critical innovations are described, including use of pre-hospital electrocardiograms (ECGs) to activate the catheterization laboratory, allowing emergency physicians to activate the catheterization laboratory, and substantial interdisciplinary collaboration throughout the process. In the ideal approach, door-to-balloon time is 60 min for patients transported by paramedics with a pre-hospital ECG and 80 min for patients who arrive without paramedic transport and a pre-hospital ECG.
Hospitals can achieve the recommended ACC/AHA guidelines for door-to-balloon time with specific process design efforts. However, the recommended best practices involve extensive interdisciplinary collaboration and will likely require explicit strategies for overcoming barriers to organizational change.
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