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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Application of an integrated decision support process for supplier selection

In many firms the value of purchased materials and components accounts for 50–80% of total cost of goods sold. For those firms, purchasing decisions cause enterprise wide side effects, and, therefore, should be treated as an integration matter. Supplier selection is a problem that deals with both qualitative and quantitative issues that must be measured using information that is normally spread within the enterprise. To see how this problem was addressed in a small construction company in Brazil, an integrated procurement process, which is a simplification of a more complex methodology, is presented. The case study shows the importance of simpler, yet efficient, solutions to address the decision making problems of smaller enterprises in development countries—a research and commercial niche not well developed yet.     

Flood decision support system on agent grid: method and implementation

In this paper, we introduce the concept and architecture of agent grid. Agent grid is an intelligent platform that enables the independent operating entities (agents) to interact with one another to form dynamic services on the Grid. Under this view, we built an agent grid platform named AGrIP that includes four layers and several useful toolkits. With the platform support, we implemented the flood decision support system which combines the wireless sensor network for data acquisition and software agent technology for legacy system integration. Additionally, we developed a toolkit for programmers to visually develop software agents which makes the development process easier. Besides, the MWAC model proposed is for sensor network to save power which can transit the information for long distance. This system is now applied as a module in the city emergency interact project.     

Bi-objective decision support system for routing and scheduling of hazardous materials

This paper presents a Pareto-based bi-objective optimization of hazardous materials vehicle routing and scheduling problem with time windows and shows its application to a realistic hazardous material logistics instance. A meta-heuristic solution algorithm is also proposed, which returns a set of routing solutions that approximate the frontier of the Pareto optimal solutions based on total scheduled travel time and total risk of whole transportation process. It works in a single-step fashion simultaneously constructing the vehicle route and selecting the optimal paths connecting the routed locations from a set of non-dominated paths obtained in terms of travel time and risk value.     

A decision support system for area-wide water quality planning†

The Generalized Planning System is presented as the framework for implementation of a decision support system for area-wide water quality planning. Special attention is given to the method of data organization, a method of system interface for nonprogramming planners, and to the need for system flexibility that allows adaptation to changing conditions.     

多Agent智能电网调度决策支持系统研究

文章介绍了Agent技术和决策支持系统,针对电网调度的局限性提出了基于多Agent的智能调度决策支持系统,并详细阐述了系统的体系结构和各个Agent的功能。系统能够将位于网络上任何位置的Agent与现有电力信息系统有机地结合起来,共同高效、快速、可靠地为调度员提供决策支持。     

Strategic risk behaviour and its temporalities: between risk propensity and decision context

What are the determinants of strategic risk behaviour? Are they the dispositional characteristics of decision makers or the situational constraints? Or both? The empirical evidence is on all sides. We believe the issue has not been satisfactorily resolved so far because of the continued neglect of the fundamental role of time in risk behaviour. Given that risk is embedded in time, we need to recognize two critical aspects of the temporal dimension. The first is concerned with risk horizons, as in short‐range and long‐range risk horizons. The second temporal aspect relates to individual future orientations of the top managers, as in near‐future and distant‐future orientations. We propose in this article a temporal framework of strategic risk behaviour in which the two temporalities are integrated with risk propensity and perceived decision context. We then develop, based on this temporal framework, the contingent answers for the relative roles of dispositional characteristics and situational constraints in determining strategic risk behaviour.     

Aggregate nursing requirement planning in a public health care delivery system.

In this paper, we present an aggregate nursing requirement planning model for inpatient services to provide inputs for preparing yearly budgets in a public health care delivery system. A forecasting system using autoregressive integrated moving average time-series models forms the basis of project demands for nursing hours by medical specialities. These projections along with the institutional constraints and patient care requirements are all incorporated in a linear programming model for assessing needs for permanent staff, overtime pay and contracting temporary help—by medical service, nursing skill level and time period (month). We also expand the model to evaluate the sizing of a pool of float nurses. The model is developed within the framework of routine managerial planning process of the system under study (vis-à vis, the data base and the organizational structure). Historical data are used to estimate input parameters for the model. The staffing needs generated from the model for 1978 are compared with the actual system performance.     

A grant rationing model for a health care system.

Most public health programs are created through a political process and the health administrator's resource allocation decision is influenced not only by the relative performance of the subunits but also by political considerations. This paper presents a goal programming model for rationing available grants to competing health care subunits on the basis of performance subject to resource and political constraints. Performance is defined in terms of output adjusted for non-compliance on the identified quality of care and administrative efficiency criteria. The quality and efficiency criteria are those specified by the Federal agency as amended by local funding authorities and subunit administrators through a Delphi process. The model has the advantage of flexibility and can be easily adapted to suit prevailing financial and political conditions. In particular, it can be used as a viable analytical tool in health care and other public service agencies where political considerations are important in resource allocation decisions.