Complex Decisions!

Decision making for a modern manager seems to be turning into learning how to sort wheat from chaff with regards to data. Although most data can have a use, that use can vary from the merely handy (the employees like the new yogurt bar) to the incredibly useful (the spending habits of our customers on our websites). All of it can serve a purpose, knowing that employees are happy can lead to other ways to keep them happy and thereby increase productivity and knowing buying habits is a power unto itself. However, all this data makes for a complex environment in which to operate. In previous weeks we spoke of decision support systems that are adaptive and can learn to make decisions on their own. However, these systems have their own peril as seen in the 2010 Flash Crash of the stock market. In the end, humans are involved in a great deal of the decision making process and most likely will be for the foreseeable future regarding company operations. At least until Skynet does its thing.

There a few strategies that are available and three areas of decision making layed out in Hoch et al's "Wharton on Making Decisions". Two of them are similar, environmental and complexity wherein the environment plays a role in complex decision making. For simplicity I have added environmental in the setion "do something about the weather" which is taking directly from Hoch. We will look at them from the perspective of my organization which is the largest integrated healthcare system in the US.

1. Complexity

A) Data-Rich Environments-Patient data can be overwhelming. A given provider can access medication histories, illnesses, treatments, demographic data, and even draw conclusions on socio-economic status by looking at billing and priority. It sounds like a great deal but the data is broken up into smaller sections which means that a person need not sort through all of it to find some answers. On the other hand, there are portions that are mired in useless data and make it difficult to find what you are after. For example, I work in rehabilitation, housing, and vocational services which is a subset of Behavioral Health. We are required to use a program that creates treatment plans and allows other providers to access the plans and add their treatments as well. This way all the treatment planning is on one living document which sounds just lovely. It's not.

The plans become gigantic and they publish data that is useless to our department such as medications from a year ago. This wouldn't be a factor if the data was published in a way that was easy to read. Instead we have to sort through reams of superfluous information to get to the treatment narratives. To make things worse the program is not user-friendly and was obviously built by the lowest bidder.

Complexity need not be as complex as it seems if there is a way of easily organizing data. Even large amounts of data and be sorted by programs however the user still needs to be intuitive enough to draw conclusions between seemingly unrelated data points. What makes matters worse than they need to be are systems that impede almost as much as they help.

B) Do Something About the Weather (Environmental)

The weather affects healthcare in many obvious ways. The homeless are at risk of freezing to death in my state so that is something that is planned for. But as for the day to day operations of the hospital we are required by law to keep supplies on hand, back-up power sources, and personnel ready at all times. Where Coca-Cola may lose money if their trucks are delayed, running out of something as simple as saline can cost lives so there are contingencies in place for stocks of supplies. Healthcare operates from a different mindset when it comes the environment. While it is possible for us to be overwhelmed by natural disasters the day to day weather isn't something that affects us a great deal.

C) Optimizing Power Pools

Going along with weather and complexity, we have the capability to provide our own electricity for critical machines and operating suites. Naturally we use commercial power for the day to day of the operation but energy independence can be gained as long as fuel supplies last in our generators. Should the fuel become an issue there are also battery backups for certain machines as well. If it all fails there are bigger concerns over just optimizing a power pool, it means the power pool is no longer there.


2. Multiple Stakeholders


A) Listening To Stakeholders- This seems obvious! However our major stakeholders are the patients and also taxpayers. And the messages they sometimes send are colored by not having all the information or in some cases a belief in alternative facts, which seems snarky but misinformation and lies do color some of the perceptions of the public regarding my organization. Managing out stakeholders is a very fine line and even now, writing a blog to be published, I am aware of how my words can be used. For such a large organization as mine it is imperative that the people within the organization are aware of the ambassador status they hold to the general public.

B) Behavioral Approaches-This, so far, does not seem to be something used by my organization. One doesn't need a strategy for removing a kidney and in mental health the prevailing illnesses often preclude being able to have predicted outcomes. We can come close, as mental illnesses do have symptoms but in the end it is still an art from different from a straightforward surgery. So for now this approach may not have much application though being able to model behavior has significant advantages. That being said, the flaw in this model is that is it predicated on the other parties behaving as you think they should.