Promoting shared health care decision making using the analytic hierarchy process

Recent developments in medical technology and bioethics have led to a shift in the traditional framework of physician–patient responsibility in health care decision making. Patients are increasingly participating in serious health care decisions, resulting in a “shared decision-making model“ that both patients and their doctors agree is a significant improvement over the traditional system in which a doctor served as the primary decision maker. However, patients are finding they need to develop strategies that allow them to understand and evaluate their health care options in a clear manner. T.L. Saaty’s “Analytic Hierarchy Process” (AHP) is a decision methodology that has been successfully applied to a wide variety of situations and has great potential as a methodology for improved shared health care decision making. This paper reports the results of an experimental use of AHP as a tool to facilitate shared decision making for two specific health care populations. Both groups of patients were deciding amongst their options in terms of two important elective health care procedures: estrogen replacement therapy and cosmetic eyelid surgery. After using AHP, the majority of both patients and physicians agreed that this technique improved physician–patient communication, thus greatly assisting shared health care decisions. When considering other criteria in addition to physician–patient communication, including the entire physician–patient relationship, the patients felt that AHP was preferable to the conventional doctor-patient mode of decision making.     

Hospital ethics committees and the future of health care decision making

In an era of increased patient decision making and limited resources, the solving of ethical dilemmas requires more than the traditional top-down approach. This article examines the use of ethics committees in hospitals located in Alabama. A significant minority of the hospitals do not have committees, despite increasing calls for ethics committees in the literature and by regulatory and accreditation agencies. The article also describes the typical composition of a hospital ethics committee as well as the means by which hospitals without committees solve ethical problems.     

SIPP and health care issues.

There are three major areas in health care policy which can be addressed by the data elements in the Survey of Income and Program Participation (SIPP): (1) health insurance coverage and the stability of insurance over time; (2) health disability and its relationship to socioeconomic variables, including unemployment, over time; and (3) health care utilization. The survey does not, however, include information on health care expenditures or on details of visits to providers.     

Inflation and health care costs in metropolitan areas.

This paper reports on an examination of the relationship between increases in health care costs in 23 Standard Metropolitan Statistical areas and various other changes in these communities over the period 1969-1977. The other changes examined consisted of 145 variables divided into 7 categories. The categories were termed demographic, economic, community illness, prices of other goods and services, hospital, physician, and technology factors. The results show that there was little relationship between rates of medical and hospital inflation and the examined variables. Total hospital costs could be related to several of the factors, the most important of which were demographic, economic, and hospital factors.     

Applications of decision support and expert systems in flexible manufacturing systems

Flexible manufacturing systems (FMS) increase the efficiency of operations by improving cost, quality, and lead time while decision support and expert systems (DSS&ES) improve the effectiveness of manufacturing by assisting the decision maker in coordinating all the elements and increasing the overall utilization of the factory, particularly in managing a complex system of flexible manufacturing. This article surveys a number of available decision support and expert systems applications in flexible manufacturing after reviewing the features of each one and then proposes additional potential applications.It appears that what is holding back the widespread use of FMS is not the technology, but is some management issues. Application of DSS&ES enables a manager to obtain a full flexibility of equipment in terms of machine flexibility, product flexibility, process flexibility, operation flexibility, routing flexibility, volume flexibility, expansion flexibility, and production flexibility. Many decisions are made in planning and operating FMS that can be categorized into three classes of strategic, tactical, and operational decisions. Each class can be further categorized into structured, semistructured, and unstructured decisions. The article provides examples of FMS decision in each of nine groups and show that use of DSS&ES can be productive.Illustrative cases are categorized into (1) DSS in FMS, (2) DSS in related manufacturing operations, (3) ES in FMS, and (4) ES in related manufacturing operations. The cases described include ICAM, REACT, KEE, PADMS, IMS, FADES, GARI, TOM, ISIS, and GENPLAN.The article finally provides hints for successful DSS and ES implementation. Subjects include getting management involved, choosing a key application, manage vendor involvement, paying attention to maintenance, assigning qualified personnel, paying attention to training, and always reviewing the results.FMS is basically a computer-based system and so are DSS and ES. There is an increased trend of integrating independent computer-based systems to take advantage of the possible synergy of such integration. At present, there is only a little evidence of DSS and/or ES applications in FMS. However, there is increasing evidence of applications in related manufacturing areas. Furthermore, the planning and operations of FMS require considerable expertise; DSS and ES techniques are aimed at supporting or even replacing such expertise. Therefore, it seems that there is a considerable potential for further application of DSS and ES in FMS.     

A decision support system for selecting sanitation systems in developing countries

Due to the socio-economic inhomogeneity of communities in developing countries, the selection of sanitation systems is a complex task. To assist planners and communities in assessing the suitability of alternatives, the decision support system SANEX™ was developed. SANEX™ evaluates alternatives in two steps. First, Conjunctive Elimination, based on 20 mainly technical criteria, is used to screen feasible alternatives. Subsequently, a model derived from Multiattribute Utility Technique (MAUT) uses technical, socio-cultural and institutional criteria to compare the remaining alternatives with regard to their implementability and sustainability. This paper presents the SANEX™ algorithm, examples of its application in practice, and results obtained from field testing.     

High-risk clients and mental health care management.

A framework characterizing high-risk psychiatric patients by their probability of hospitalization and lengthy stay is introduced. Risk curves are then developed for each patient showing the potential impact of mental health case management on patient risk. Preliminary empirical analysis reveals that although most patients benefit from the case management intervention, some 30% of the client population may face an increase in risk of hospitalization and lengthy stay.     

Environmental laws in health care

Federal and state regulations regarding the management and disposal of medical waste are currently quite extensive and will only become more comprehensive in the future. The public's heightened awareness and concerns over infectious diseases and discoveries of medical waste on beaches in New Jersey, Alabama, and other states, as well as medical waste being found in open trash bins and at public landfills, has brought to the public's attention the need for governmental intervention into this growing area of concern. Because regulations originating from the local, state, and federal levels have the potential to significantly affect hospitals, it is important that a specific person or department within the organization have a clearly designated responsibility to stay informed and follow up on these regulations. The designated person or department must work closely with the hospital's attorney to make sure that he or she stays current on environmental laws and keeps the institution adequately advised of its legal responsibilities.     

Total quality in health care

Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects.     

Impacts of health maintenance organization growth on community health care costs.

The paper presents a model of health maintenance organization (HMO) growth, traditional health delivery system response, and total community health care costs. Simulations using a range of assumptions about the response of government and the traditional sector to HMO growth suggest three conclusions. First, HMO growth reduces total community health costs, but a substantial fraction of HMO subscribers' savings is added to the cost of other sector subscribers. Second, HMO cost savings depend as much on HMO control of inflation rates as on control of hospital utilization. Third, while HMOs can have significant impact even when they share hospital resources with the traditional sector, HMOs must control captive hospitals in order to achieve all of their potential savings, growth, and community impact.     

Trends in multiculturalism in health care

Materiel managers are faced with a shrinking world and changing work environment. The needs and expectations of the customer have shifted because of the increasing number of multicultural groups. These groups will continue to assert their right to culturally sensitive care. Materiel managers also need to learn to support and enhance the skills of a multicultural work force. One important tool for change will be technology. However, technology that brings the world closer together also creates new challenges for managers, who will have to deal with multicultural colleagues, buyers, sellers, and manufacturers of goods and services.