Role of Cognitive Mapping in Health Care Management Decision

Role of Cognitive Mapping in Health Care Management Decision Describe and discuss the role of cognitive mapping in health care management decision making. Description of Cognitive Mapping Cognitive mapping is an operational research technique that consists of creating a graphical representation of a persons (or groups) way of thinking about an issue, and where directionality within the map is assumed to imply perceived causality among the concepts (Eden, 2004). The proposed value of the graphical representation, as argued from the field of political science, is that it makes it easy to for anyone to see how concepts and causal relationships are related, and appreciate the overall structure of all the assertions (Eden 2004 cited Axelrod 1976, p. 676). It is one mechanism of system dynamics simulation modelling that generally came about as a reaction to failure of traditional approaches to capture interactions within complex problems in social systems (Edkins et al. 2007 cited Checkland 1981). It avoids the common research process pitfall of reductionism by allowing multiple conflicting views to be revealed and, providing a comprehensive picture of the participants perspectives but keeping all details to represent beliefs that are most important to stakeholders represented (Duryan, Nikolik, Merode, 2015; Eden Ackermann, 2004). Cognitive mapping was initially introduced as a method for problem analysis. But recognizing its value, it has then found roles in performance measurement, decision making, and strategy formulation. Eden and Ackermann (1991) expounded on the possible uses of this technique in becoming an instrument for developing consensus about shared goals, providing structure to multiple and conflicting aspects of an issue, informing negotiation, and suggesting actions to resolve issues. Use of Cognitive Mapping in Health Care Cognitive mapping is argued to be best for messy situations wherein stakeholders do not understand the problem or interpret them differently, and often do not realize it (Mingers 2008 cited Ackoff 1979a). Healthcare decision making falls into this realm as it has always been complicated by information asymmetry, trade-offs between efficiency and equity, or moral ambiguity that become legitimate sources of uncertainty and debate among stakeholders. In fact, the first uses of cognitive mapping in operational research were in healthcare, education, and defense (Eden Ackermann, 2004). Mingers (2008) described an example in 1997 Manchester, where the UK Health Authority commissioned the Salford Community Trust to develop an integrated approach to childrens services. Mingers argued that while the project seemed straightforward, it turned out to be a messy problem as there was no agreement on the definitions of service specifications, services to be included, direction of the strategy, and how the project should be tackled. There were also many stakeholders involved in the issue (i.e. government, doctors, patient groups, industry) that had very strong opinions about the project. If the group were to make a plan based on epidemiology, practice guidelines, budget constraints and other numerical factors alone, without taking into consideration the stakeholders differing views, the proposed program would likely fail during implementation. Situations like these are common in healthcare decisions given the complexity of issues faced at doctor-patient, organizational, and national-policy level. Mathematical and statistical methods provide a narrow focus on measurable aspects of decision that fails to catch the reasoning, motivations, and interactions relevant to achieving these outcomes. Problem structuring through cognitive mapping provides an opportunity for healthcare decision makers to systematically measure these missing interactions and assess their impact to the goal under assessment (Pidd, 2004). Sachdeva et al (2007) explored the added value of cognitive mapping from traditional approaches in understanding patient flow delays in a Pediatric Intensive Unit (PICU) of a Childrens Hospital in Wisconsin, USA. Hard operations research (OR) results using modelling were persuasive, but became inadequate to result to change given politically sensitive issues that arose. Soft OR using cognitive mapping that was done identified new issues and offered a more holistic and comprehensive understanding of the issues complexity that helped persuade decision makers to act on the recommendations. SODA The most common technique for cognitive mapping is the Strategic Options Development Method (SODA). SODA is an ethnographic method derived from interviews that are intended to represent the participants subjective worlds the theoretical basis of which is explained by personal construct theory (Eden 2004 cited Kelly 1995) wherein people make sense of their world by seeking to manage and control it. SODA uses a formal modelling technique with rules for its development as described by a user guide developed by Eden and Ackerman (Ackermann et al., 1991). The transcripts of the interviews are separated into short distinct phrases (nodes) that eventually get sorted as goals, strategic directions, or potential options. Fidelity in transcription is imperative to represent the participants intentions and to promote ownership of the resulting map created. The concepts are linked (arrows) to determine accurate subordination of concepts, directionality and opposing poles to create the overall structure. While the map is an important output of its own, these can also be subject to further analysis to gain deeper insight, such as: Analysis Map Characteristics Goals Head analysis Nodes with only incoming arrows To identify end goals or effects Density analysis Number of mentions of the concepts To determine potential key issues from the perspectives of the participants that may need further examination Centrality analysis Number of links to the concept, or ratio of arrows to concepts To measure the importance and complexity of the concepts implication chain Hierarchical cluster analysis Number of concepts in chain or arguments linked to option To identify most potent options or valued outcomes to influence on the goals Potency analysis Number of goals each option supports To prioritize options with consequences for the biggest number of key issues Composite tail analysis Ranking of potency analysis To determine the single action that may cause multiple goals to be achieved Source: Summary by Author Healthcare Example of Using SODA A case study by Duryan et al. (2015) on intellectual disability care in Netherlands made use of SODA to determine factors that adversely affect delivery of patient-centered care as evidence for future resource allocation. Following SODA guidelines, the team conducted one-on-one, semi-structured, hour-long interviews with the managers and patient group leaders within one division of a residential care facility. Initially, they were thought to have contrasting goals financial sustainability for the managers and quality of care from resource constraints for the patients. Using the Decision Explorer software, cognitive maps were created and merged to reflect the combined views. Key assumptions were then discussed and verified, and follow-up focus group discussions with different subgroups of the patients (young vs old) and their families were done to refine the ideas represented by the initial group. The merged map was then subject to head, domain, centrality, potency analysis, and comp osite tail analysis. Results showed that group leader freedom to make decisions, flexible shifts, and time spent with patients were the most potent options/solutions, and therefore needed quick action by the managers. According to the researchers, the exercise successfully facilitated critical analysis of the problem and fostered ownership of the proposed solutions by all stakeholders. Seeing the different/ opposing thoughts organized and their end-goals similar also helped reach consensus and manage disagreements. Expansions of SODA While SODA provides solutions to complex strategic processes, it lacks a mechanism to allow for agreement among the strategies to be developed. SODA was developed further into JOURNEY Making (JOintly Understanding Reflecting and NEgotiating strategY) to become a process-oriented and management-science strategy by using the composite map in a workshop setting as a tool to help negotiation and explore policy options that will allow the issue to be intelligently resolved (Mingers, 2008). Another method, the Oval Mapping Technique (OMT), creates a cognitive map but through a highly participative strategy workshops. White et al (2007) used JOURNEY Making to collect and define public values and voices among stakeholders involved in a community hospital project in South London. Intergroup workshops were done in phases to map/graph the issues and options related to the decision. The process resulted to wide acceptance of the recommendations and an official plan enacted by the Department of Health. This is one among many examples of the opportunity to use these newer OR tools in healthcare strategy management planning at both organizations and the national policy arena. Limitations Cognitive mapping provides an opportunity to deal with messy problems in a systematic way, but general acceptance of it as a method is still lacking. Mingers (2008) explains that especially in the United States, it is viewed as a soft OR method not regarded for publication in top journals nor teaching in courses among top schools. The concerns on subjectivity of results remain valid that even though the process is systematic and rigorous, they are still variable and dependent on both study design and recruitment. The cognitive maps developed will depend largely on the choice of participants, their active participation, their personal motivations, and the assumption that they are adequately informed of the problem. And the probability of one person skewing the result is high given the small sample (i.e. 4-10 people) used for these activities. The method also assumes adequate facilitation by the research team to determine the key nodes and domains, which may not always be the case. Also, while cognitive mapping provides a snapshot of the decision making, it does not promote understanding over time periods and cannot be used to derive numerical assessments of its impact (Pidd, 2004). Cross-validation or triangulation using many models of the same issue may be done to increase its validity (Abernethy et al, 2005). Combination of soft and hard methodologies is believed to increase acceptance and sustain organization change especially in healthcare settings (Sachdeva et al., 2007). And, it should always be used in conjunction with other methods for research data gathering, monitoring, performance measurement, or decision support. Lastly, for cognitive mapping to be useful in decision support, it requires the decision makers to understand the method/process, recognize the value of the issues at the front line, take the results seriously, and act on the recommendations. It is therefore crucial for any research team using this method to help the decision makers appreciate the approach and engage with the recommendations. Reference Abernethy, M. A., Horne, M., Lillis, A. M., Malina, M. A., Selto, F. H. (2005). A multi-method approach to building causal performance maps from expert knowledge. Management Accounting Research, 16(2), 135-155. https://doi.org/10.1016/j.mar.2005.03.003 Ackermann, F. ., Cropper, S. A., Eden, C. L. (1991). Cognitive Mapping for Community Operational Research-A Users Guide. (E. Munford, A., Bailey, T., Ed.), Operational research tutorial papers. Duryan, M., Nikolik, D., Merode, G. Van. (2015). Reflecting on the efficacy of cognitive mapping for decision-making in intellectual disability careà ¢Ã¢â€š ¬Ã‚ ¯: a case study. International Journal of Health Planning and Management, 30(August 2013), 127-144. https://doi.org/10.1002/hpm.2215 Eden, C. (2004). Analyzing cognitive maps to help structure issues or problems. European Journal of Operational Research, 159(3), 673-686. https://doi.org/10.1016/S0377-2217(03)00431-4 Eden, C., Ackermann, F. (2004). Cognitive mapping expert views for policy analysis in the public sector. European Journal of Operational Research, 152(3), 615-630. https://doi.org/10.1016/S0377-2217(03)00061-4 Edkins, A. J., Kurul, E., Maytorena-Sanchez, E., Rintala, K. (2007). The application of cognitive mapping methodologies in project management research. International Journal of Project Management, 25(8), 762-772. https://doi.org/10.1016/j.ijproman.2007.04.003 Mingers, J. (2008). Reaching the Problems that Traditional OR/MS Methods Cannot Reach. Centerbury. https://doi.org/10.1080/00369220601100075 Pidd, M. (2004). Systems Modelling Theory and Practice. Systems Modelling Theory and Practice. Retrieved from http://www.untag-smd.ac.id/files/Perpustakaan_Digital_1/DECISION MAKING Systems modelling, theory and practice.pdf#page=16 Sachdeva, R., Williams, T., Quigley, J. (2007). Mixing Methodologies to Enhance the Implementation of Healthcare Operational Research. The Journal of the Operational Research Society, 58(2), 159-167. https://doi.org/10.2307/4622680 White, L., Bourne, H. (2007). Voices and values: Linking values with participation in OR/MS in public policy making. Omega, 35(5), 588-603. https://doi.org/10.1016/j.omega.2005.11.002

Trinidad and Tobago and Monthly Production Target

Exercise: Chapter 1 Assignment 1 Application 14 Refer to figure 1. 4 on page 12 of your text. Use this figure to rate each of the following scenarios. Record beside each scenario your choice (a, b, c, d) and explain fully your choice. High in effectiveness and high in efficiency high in effectiveness and low in efficiency low in effectiveness and high in efficiency low in effectiveness and low in efficiencyScenario #1 : The Production Manager of Mom's Cookies had a monthly production target of 100,000 bags of cookies. His target for quality inspectors is to have the reject rate less than 2% of production. Both these targets were met for August. Labor costs are up 5% because overtime had to be incurred to complete some orders,Both goals were met but unfortunately labor costs went up. Scenario #2: The reject rate for Mom's Cookies was 8% this month. The normal target is less than 2%.The problem was traced too poorly maintained oven which burnt a number of batches before the problem was rectified. Addition costs were incurred to fix the equipment problem as well as extra costs associated with the Ingredients to make the replacement batches. The company however did make their monthly target of 100,000 bags of cookies. B,The company wasted resources but however they did reach their monthly goals which was 100,000 bag of cookies. Scenario #3: The month end reports for Mom's Cookies have Just been received by the ProductionManager. They show that during the month of September, the company product 101 ,050 bags of cookies. The reject rate was 1%. Labor and raw materials were within budgeted levels. No breakdown of equipment occurred. A,Goals were achieved no breakdown of the equipment,no wasted resources and high productivity. Scenario #4: to be hired. There was not enough time to train these people and projection levels suffered. Only 95,080 bags of cookies were produced this month. The reject rate was 1. 9%.Labor and raw materials were within budgeted levels. C,There was no wasted products but goals were not achieved. Scenario #5: Mom's cookies imports their chocolate chips from Trinidad and Tobago. Unfortunately their dollar has increased in value against the Canadian dollar which has driven up chocolate costs by 10%. In addition, gas prices have gone up and the company uses gas ovens and gas heating. This has added another 5% to the company's expenses. The reject rate was 1. 8% and the company produced 100,200 bags of cookies.

Ballads Case Essay

Ballads are poems that tell a story. These ballads are distinguished by such features as few characters, dramatic plots, and may include dialogue, as well as action because it tells a story. They are considered to be a form of narrative poetry. They are often used in songs and have a very musical quality to them. According to the dictionary, Ballad is a narrative poem, often of folk origin and intended to be sung, consisting of simple stanzas and usually having a refrain. It is the music for such a poem. It is also defined as a popular song especially of a romantic or sentimental nature. Here is an example: (Ballad of a Mother’s Heart) Origin There have been many theories about the originators of the ballads all of which have some validity when applied to the different types of ballad, the main ones are as follows:  · Minstrels: A minstrel is a musician or a poet. Originally, the minstrels were paid entertainers who worked for the Court and influential personages. They wrote songs about current events and historical victories of their patron and they included rewritings of old songs, legends and ballads in their theatre. The theory that the minstrels were the originators of the ballads was held for quite a long time. They are certainly a factor in the spreading of the ballads into the community; ballads were a stock item in the theatre of the minstrels even when their status had declined to that of street singers.  · – Dance: Certainly some of the ballads were tied to dances. The word ballad probably comes from medieval French dance songs or ballet (â€Å"ballares† dance).  · Ceremonial dance and songs. Some ballad refrains contain ceremonial chants and responses  · Monks: The monks were the amongst the few who could read and write in the early times of the ballad history and that it follows that they must have had a hand in the composition and writing of the ballads.  · Communal composition: It has been suggested that ballads may have developed as a communal effort; particularly those that contain refrains and rhythms that are connected with work such as weaving and spinning. Example is the walking songs of the Hebrides.  · Cante-fable. This is a story, which is classified with verses that are sung or chanted. Some ballads are distinctively English or Scottish in origin but the older ballads are more likely to have a European source as their beginnings, deriving from earlier poems and old folk tales brought into Britain by its many invaders, immigrants and soldiers returning from foreign wars. Composition Scholars of ballads are often divided into two: The ‘communalists’ who argue that ballads arose by a combined communal effort and did not have a single author. They tend to lead to the view that more recent, particularly printed broadside ballads are a debased form of the genre. The ‘individualists’ who assert that there was a single original author. They tended to lead to the view that later changes in the words of ballads are corruptions of an original text. More recently scholars have pointed to the interchange of oral and written forms of the ballad. Classification European Ballads have been generally classified into three major groups: traditional, broadside and literary. * Traditional ballads Traditional folk ballads exhibit certain characteristics which help to identify them as being genuine in origin. Traditional ballads or folk ballads were universal songs meant to be understood by everyone, so writers would choose words that even the uneducated might understand. Traditional ballads follow a standard format and tell lengthy stories that call on imagery. * Broadsides Broadside ballads are descriptive or narrative verses or songs sung or recited in public places or printed on broadsides for sale in the streets. It is commonly in a simple ballad form. Broadside ballads appeared shortly after the invention of printing in the 15th century and were hawked in streets, fairs, and marketplaces of Europe into the 19th century. Among the topics were love, religion, drinking-songs, legends, and early journalism, which included disasters, political events and signs, wonders and prodigies. * Literary ballads A literary ballad (also known as â€Å"art ballad†) is a narrative poem written in imitation of the old anonymous folk ballad; the author is most often a known professional poet. Usually the literary ballad is more elaborate and complex. Literary ballads were quite popular in England during the 19th cent. The literary ballad, unlike the traditional ballad and the broadside ballad, is a sophisticated rather than a popular form. Importance of Ballads Ballads are important to look at because they show how the form has developed over time. A ballad is not simply a romantic song, although that definition will still apply in the field of music. Romance can be infused into ballads, especially if they are a narrative tale of love (or hate) as seen in the ballad by the anonymous Spanish poet. However, they are so much more as well. Anyone who knows the ballad knows how complex the story is in terms of theme, imagery, characters, symbolism, and many other literary devices and significations.

Analysis Of Disney s Purchase Of Lucasfilm - 1181 Words

Building trust when bargaining is key to successful negotiation agreements. Negotiators that build trust and are better prepared have a numerous advantage in having the negotiations to go in their favor as well as for the other party. Preparations should take place before the negotiations even begin, this provides a more productive outcome. Disney’s purchase of LucasFilm in 2012 demonstrated how well prepared Disney came to the table for negotiations with George Lucas. Company Background The Walt Disney Company The Walt Disney Company, together with its subsidiaries and affiliates, is a leading diversified international family entertainment and media enterprise with five business segments: media networks, parks and resorts, studio entertainment, interactive media, and consumer products. Disney is a Dow company with revenues of over $40 billion in its Fiscal Year 2011. (Disney to Acquire Lucasfilm LTD 10/30/12) Lucasfilm LTD Founded by George Lucas in 1971, Lucasfilm is privately held, fully-integrated entertainment company. In addition to its motion-picture and television production operations, the company’s global activities include industrial Light Magic and Skywalker Sound, serving the digital needs of the entertainment industry for visual-effects and audio post production, LucasArts, is a leading developer and publisher of interactive entertainment software worldwide, Lucas Licensing, which manages the global merchandising activities for Lucasfilms entertainmentShow MoreRelatedDisney s Roster Of Heroes1013 Words   |  5 Pagesand Iron Man in Disney s roster of heroes (USA Today). 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