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Article << Previous     |     Next >>   Contents Vol 36(1)

Adaptive decision-making: how Australian healthcare managers decide

Abdolvahab Baghbanian A B C D , Ian Hughes B , Ali Kebriaei A and Freidoon A. Khavarpour B

A Health Promotion Research Centre, Faculty of Health, Zahedan University of Medical Sciences, Mashahir Square, Zahedan, 98169-13396, Iran.
B Faculty of Health Sciences, Cumberland Campus, The University of Sydney, PO Box 170, Lidcombe, NSW 2141 Australia. Email: ian.hughes@sydney.edu.au; freidoon@tpgi.com.au
C Menzies Centre for Health Policy, Victor Coppleson Building (D02), The University of Sydney, NSW 2006, Australia.
D Corresponding author. Email: abag2253@uni.sydney.edu.au

Australian Health Review 36(1) 49-56 http://dx.doi.org/10.1071/AH10971
Submitted: 13 October 2010  Accepted: 20 June 2011   Published: 24 February 2012


 
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Abstract

Despite many calls for the utilisation of research evidence in health policy-making, it is not widely practised, and little is known about how decision-makers in healthcare organisations actually make decisions. We recruited a purposive sample of Australian healthcare decision-makers to complete a web-based survey. We then took a sub-sample from willing respondents for individual interviews. All interviews were audio-recorded, transcribed verbatim and coded thematically. We found that resource allocation decision-making varied greatly across the Australian healthcare system. Decision-making was highly dependent on the operational context in time, place and purpose, and that research evidence was rarely exploited to its full potential. Decision-making involved a multifaceted interplay of elements in situation of inquiry. All decisions were made by networks or collectives of people; and no instance of individual decision-making was reported. This varied, social and contextual nature of decision-making points to a complexity that is not reflected in systematic evidence-based reviews or evidence-based models for decision-making, and we did not discover an appropriate model to reflect this complexity in the health- related literature. We developed a model of ‘adaptive decision-making’ that has potential to guide robust decision-making in complex situations, and could have some value as an explanatory or theoretical model for teaching and practice.

What is known about the topic? The topic is certainly novel and original, relevant and timely for academics and healthcare decision-makers. Despite increasing calls for the use of systematic evidence-based reviews including economic evaluations, the way in which decision-makers arrive at their allocation decisions and how such decisions reflect concern for economic efficiency is often blurred. This topic is an important one for its relevance to the current difficulties in the complex situation of healthcare.

What does this paper add? This paper shows that decision-makers acknowledged the integration of economic principles as contextual realities into their decision-making activities, rather than utilising the results of ever-more seemingly ‘technically sound’ economic evaluations, which cannot address the inherent uncertainty attached to complex decision-making activities. We developed a novel adaptive model of decision-making generated by the interplay of multiple behaviours and factors in the situation of inquiry. The model is new and takes into account the complexity of the context in time, place, purpose and administrative location.

What are the implications for practitioners? This paper should be of interest to a broad readership including those interested in health economics, public health policy, healthcare delivery, healthcare resource allocation and decision-making. The adaptive decision-making model designed in this study has the potential as a guide or heuristic device for teaching and practice. Healthcare decision-makers need to be prepared for complexity and ambiguity and cannot expect the data to tell them everything they need to know. We expect to see a shift in the literature on healthcare decision-making, not away from evidence-based practice and economic evaluation, but towards contextualising these methods in broader, adaptive models of decision-making.

Additional keywords: economic evaluation, evidence-based decision-making, health (care) system, resource allocation.


References

[1]  Plsek PE. Complexity and the adoption of innovation in health care. In: Proceedings of Accelerating Quality Improvement in Health Care: Strategies to Speed the Diffusion of Evidence-Based Innovations; 27–28 January 2003; Washington, DC: National Institute for Health Care Management Foundation; 2003. p. 22.

[2]  Aktas E, Ulengin F, Onsel Sahin S. A decision support system to improve the efficiency of resource allocation in healthcare management. Socioecon Plann Sci 2007; 41: 130–46.
CrossRef |

[3]  Lomas J. Using ‘linkage and exchange’ to move research into policy at a Canadian foundation. Health Aff 2000; 19: 236–40.
CrossRef | CAS |

[4]  Hanney S, Gonzalez Block M. Building health research systems to achieve better health. Health Res Policy Syst 2006; 4: 10.
CrossRef | PubMed |

[5]  Weiss JA, Weiss CH. Social scientists and decision makers look at the usefulness of mental health research. Am Psychol 1981; 36: 837–847.
CrossRef | CAS | PubMed |

[6]  Innvær S. The use of evidence in public governmental reports on health policy: an analysis of 17 Norwegian official reports (NOU). BMC Health Serv Res 2009; 9: 177.
CrossRef | PubMed |

[7]  Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd edn. New York: Oxford University Press; 2005.

[8]  Hoffmann C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do health-care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value Health 2002; 5: 71–8.
CrossRef | PubMed |

[9]  Drummond MF, Dubois D, Garattini L, Horisberger B, Jonsson B, Kristiansen IS, Pen CL, Pinto CG, et al Current trends in the use of pharmacoeconomics and outcomes research in Europe. Value Health 1999; 2: 323–32.
CrossRef | CAS |

[10]  Hanney S, Gonzalez-Block M, Buxton M, Kogan M. The utilisation of health research in policy-making: concepts, examples and methods of assessment. Health Res Policy Syst 2003; 1: 28.

[11]  Weiss CH, Bucuvalas MJ. The challenge of social research to decision making. In: Weiss CH, editor. Using social research in public policy making. Lexington, MA: Lexington Books; 1977. pp. 1–22.

[12]  Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy 2008; 86: 129–41.
CrossRef | PubMed |

[13]  Williams I, Bryan S. Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework. Health Policy 2007; 80: 135–43.
CrossRef | PubMed |

[14]  Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks, CA: Sage Publications; 2006.

[15]  Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago, IL: Aldine Publishing Co.; 1967.

[16]  Baghbanian A, Hughes I, Khavarpour F. Resource allocation and economic evaluation in Australia’s healthcare system. Aust Health Rev 2011; 35: 278–83.
CrossRef | PubMed |

[17]  Baghbanian A. The emergence of adaptive decision-making in complex health systems: economics and resourcing of complex health systems: the emergence of adaptive decision-making in health care. LAP Lambert Academic Publishing; 2011.

[18]  Ashworth MJ, Louie MA. Alignment of the garbage can and NK fitness models: a virtual experiment in the simulation of organizations. Pittsburgh, PA: Carnegie Mellon University; 2002. Working paper.

[19]  Bavec C. On the modelling of management decision-making processes in organized anarchy. Informatica 2001; 25: 375–9.

[20]  Martin C, Barber KS. Adaptive decision-making frameworks for dynamic multi-agent organizational change. Auton Agent Multi Agent Syst 2006; 13: 391–428.
CrossRef |

[21]  Lal P, Lim-Applegate H, Scoccimarro M. The adaptive decision-making process as a tool for integrated natural resource management: focus, attitudes, and approach. Conserv Ecol 2001; 5(2): 11. Available at http://www.ecologyandsociety.org/vol5/iss2/art11/manuscript.html [verified 15 December 2011].

[22]  Lessard G. An adaptive approach to planning and decision-making. Landsc Urban Plan 1998; 40: 81–7.
CrossRef |

[23]  Miller SA, Forrest JL. Translating evidence-based decision making into practice: appraising and applying the evidence. J Evid Based Dent Pract 2009; 9: 164–82.
CrossRef | PubMed |

[24]  Nixon J, Phipps K, Glanville JM, Mugford M, Drummond MF. Using economic evidence to support decision making: a case study of assertive community treatment within the UK national service framework for mental health. Appl Health Econ Health Policy 2002; 1: 179–90.
| PubMed |

[25]  Hill CJ. The nature of problem recognition and search in the extended health care decision. J Serv Mark 2001; 15: 454–79.
CrossRef |

[26]  Stacey RD. The implications of complexity theory for psychoanalytic thinking about organizations. 1997. Available at http://www.ispso.org/Symposia/Philadelphia/97stacey.htm [verified 28 March 2009].

[27]  Weiss CH. The many meanings of research utilization. Public Adm Rev 1979; 39: 426–31.
CrossRef |

[28]  Weiss CH, Bucuvalas MJ. Truth tests and utility tests: decision-makers’ frames of reference for social science research. Am Sociol Rev 1980; 45: 302–13.
CrossRef |

[29]  Zimmerman B, Lindberg C, Plsek PE. Nine emerging and connected organizational and leadership principles. 2002. Available at http://www.plexusinstitute.org/edgeware/archive/think/main_prin8.html [verified 12 February 2008].

[30]  Kurtz CF, Snowden DJ. The new dynamics of strategy: sense-making in a complex and complicated world. IBM Syst J 2003; 42: 462–83.
CrossRef |

[31]  Innvaer S, Vist G, Trommald M, Oxman A. Health policy-makers’ perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 2002; 7: 239–44.
CrossRef | PubMed |

[32]  Weick KE, Sutcliffe KM. Organizing and the process of sense making. Organ Sci 2005; 16: 409–421.
CrossRef |

[33]  Snowden DJ. Multi-ontology sense making: a new simplicity in decision making. Inform Prim Care 2005; 13: 45–54.
| PubMed |

[34]  Lyons JE, Runge MC, Laskowski HP, Kendall WL. Monitoring in the context of structured decision-making and adaptive management. J Wildl Manage 2008; 72: 1683–92.
CrossRef |

[35]  Gregory R, Failing L, Higgins P. Adaptive management and environmental decision making: a case study application to water use planning. Ecol Econ 2006; 58: 434–47.
CrossRef |

[36]  Contemporary government challenges: delivering performance and accountability. Australian Public Service Commission; 2009. Available at http://www.apsc.gov.au/publications09/performanceandaccountability.htm [verified 2 February 2010].

[37]  Wenger E, McDermott R, Snyder WM. Cultivating communities of practice. Boston: Harvard Business School Press; 2002.

[38]  Dunn WN. The two-communities metaphor and models of knowledge use: an explanatory case study. Sci Commun 1980; 1: 515–36.
CrossRef |

[39]  Ross J. The use of economic evaluation in health care: Australian decision makers’ perceptions. Health Policy 1995; 31: 103–10.
CrossRef | CAS | PubMed |

[40]  Small N, Mannion R. A hermeneutic science: health economics and Habermas. J Health Organ Manag 2005; 19: 219–35.
CrossRef | PubMed |

[41]  Fantino E, Stolarz-Fantino S. Decision-making: context matters. Behav Processes 2005; 69: 165–71.
CrossRef | PubMed |

[42]  Leeder SR, Raymond SU, Greenberg HM. The need for leadership in global health. Med J Aust 2007; 187: 532–5.
| PubMed |

[43]  Gigerenzer G. Adaptive thinking: rationality in the real world. New York: Oxford University Press; 2000.

[44]  Falzer PR, Garman DM. Contextual decision making and the implementation of clinical guidelines: an example from mental health. Acad Med 2010; 85: 548–55.
CrossRef | PubMed |

[45]  Snowden DJ, Boone ME. A leader’s framework for decision making. Harv Bus Rev 2007; 85: 68–76.
| PubMed |

[46]  van Velden ME, Severens JL, Novak A. Economic evaluations of healthcare programmes and decision making: the influence of economic evaluations on different healthcare decision-making levels. Pharmacoeconomics 2005; 23: 1075–82.
CrossRef | PubMed |

[47]  National Institute for Clinical Excellence. Guide to the methods of technology appraisal. 2004. Available at http://www.nice.org.uk/niceMedia/pdf/TAP_Methods.pdf [verified 10 January 2012].

[48]  Guidelines for preparing submissions to the pharmaceutical benefits advisory committee. Canberra: Pharmaceutical Benefits Advisory Committee; 2006. Version 4.1. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/AECB791C29482920CA25724400188EDB/$File/PBAC4.2-3FINAL_13Mar08_.pdf [verified 29 March 2007].

[49]  Reeleder D, Goel V, Singer PA, Martin DK. Leadership and priority setting: the perspective of hospital CEOs. Health Policy 2006; 79: 24–34.
CrossRef | PubMed |

[50]  Apitz SE. Adaptive management principles and sediment management. J Soils Sediments 2008; 8: 359–62.
CrossRef |


   
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