Continuous Decision Improvement (CDI): Improving Public Health Decision Making for Individuals, Groups, and Organizations

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Information about Continuous Decision Improvement (CDI): Improving Public Health Decision...
Health & Medicine

Published on May 9, 2014

Author: TomsJAragn

Source: slideshare.net

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Continuous Decision Improvement (CDI): Improving Public Health Decision Making for
Individuals, Groups, and Organizations

Continuous Decision Improvement (CDI): Improving Public Health Decision Making for Individuals, Groups, and Organizations Tom´as J. Arag´on, MD, DrPH Health Officer, City & County of San Francisco Director, Population Health Division (PHD) San Francisco Department of Public Health Email: tomas.aragon@sfdph.org Principal Investigator, Cal PREPARE Adjunct Faculty, Division of Epidemiology UC Berkeley School of Public Health Health blog: http://medepi.com May 10, 2014 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 1 / 20

Acknowledgments “Leadership is getting results in a way that inspires trust.” . . . Stephen M.R. Covey “Continuous improvement must not be considered or conducted separately from our work . . . continuous improvement is the work.” . . . Iman Nazeeri-Simmons, SF General Hospital Harvey Kayman Cindy Lambdin David Krauth Laura Gerhardt Wayne Enanoria Christine Siador Jeannie Balido Julia Dysart Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 2 / 20

Overview 1 Background and introduction Rational decision making Naturalistic decision making US Air Force Colonel John Boyd’s OODA Loop 2 What is Continuous Decision Improvement (CDI)? The effects of conflict and consensus The path to decision success Shaping quality processes and outcomes 3 Individual vs Group (Team) vs Organizational Challenges Individual Group (Team) Organizational Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 3 / 20

Background and introduction Challenges and Opportunities Challenges Increasing complexity Public Health Accreditation Health and socioeconomic inequities Aging and epidemic of chronic diseases Patient Protection and Affordable Care Act Opportunities Public Health Accreditation Patient Protection and Affordable Care Act “Collective impact” for community transformation Integration of epidemiology, quality improvement, decision, and complexity science approaches Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 4 / 20

Background and introduction Lessons learned from recent PHD re-organization “Leadership is getting results in a way that inspires trust.” . . . Stephen M.R. Covey Develop team-based leadership! 1 Building and restoring trust 2 Strategic decision making 3 Constructive conflict 4 Inspired commitment 5 Mutual accountability 6 Continuous process improvements 7 Delivering on results Reflections Without trust, the best intentions die. If we cannot build trust with our teams, we cannot build trust with communities. Continuous improvement in decision-making processes—individual, group, and organizational—can ensure delivering results! Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 5 / 20

Background and introduction Rational decision making Rational decision making Rational decision making Analyze Plan Do Re-analyse Example: Dialogue Decision Processa (a best practice decision process) 1 Assess situation (problem definition; framing) 2 Develop alternatives (solution design) 3 Evaluate alternatives (decision making) 4 Plan implementation (solution implementation) a Parnell GS, et al. Handbook of Decision Analysis. Wiley, 2013 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 6 / 20

Background and introduction Naturalistic decision making Naturalistic decision making Size-up Imagine Do Size-up Definition Framework for studying how people make decisions and perform cognitively complex functions in demanding, real-world situations. These include situations marked by limited time, uncertainty, high stakes, team and organizational constraints, unstable conditions, and varying amounts of experience. Examples Driving on city street when suddenly you hear a siren. Tomas’ story of emergency event at SF gas station. Fighter pilots in heat of aerial battle. Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 7 / 20

Background and introduction US Air Force Colonel John Boyd’s OODA Loop USAF Colonel John Boyd’s OODA Loop The decision cycle of observe, orient, decide, and act (OODA), developed by USAF Colonel John Boyd. Boyd applied the concept to the combat operations process, often at the strategic level in military operations. ORIENT Cultural Traditions Analysis & Synthesis Previous Experience New Information Genetic Heritage Decision (Hypothesis) Action (Test) Implicit Guidance & Control Unfolding Circumstances Outside Information Unfolding Interaction with Environment Unfolding Interaction with Environment Implicit Guidance & Control Observations Feed Forward Feed Forward Feed Forward Feedback Feedback OBSERVE DECIDE ACT Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 8 / 20

What is Continuous Decision Improvement (CDI)? What is Continuous Decision Improvement (CDI)? Quality improvement (QI) in public health* A continuous effort to achieve measurable improvements in process performance to improve the health of the community. Continous decision improvement (CDI) in public health A continuous effort to achieve measurable improvements in decision-making process performance to improve the health of the community. * Riley, Moran, Corso, et al. Defining Quality Improvement in Public Health. J Publ Health Management and Pract, Jan/Feb 2010 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 9 / 20

What is Continuous Decision Improvement (CDI)? What is Continuous Decision Improvement (CDI)? Observe Orient DECIDE Act Environmental Response Environmental Context PLAN DO STUDY ACT Assessment Alternatives SELECTION Implementation Environmental Response Environmental Context OODA Loop Dialogue Decision Process PLAN DO STUDY ACT Intuition Deliberation(Dual-Process Model) Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 10 / 20

What is Continuous Decision Improvement (CDI)? The effects of conflict and consensus The effects of conflict and consensus* * Roberto MA. Why Great Leaders Don’t Take Yes for an Answer: Managing for Conflict and Consensus. FTPress, 2013 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 11 / 20

What is Continuous Decision Improvement (CDI)? The effects of conflict and consensus Cognitive and affective conflict* * Roberto MA. Why Great Leaders Don’t Take Yes for an Answer: Managing for Conflict and Consensus. FTPress, 2013 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 12 / 20

What is Continuous Decision Improvement (CDI)? The path to decision success The path to decision success* * Roberto MA. Why Great Leaders Don’t Take Yes for an Answer: Managing for Conflict and Consensus. FTPress, 2013 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 13 / 20

What is Continuous Decision Improvement (CDI)? Shaping quality processes and outcomes Shaping quality processes and outcomes* Communication Context Composition Control Quality of Decision Process - Constructive Conflict - Management Consensus Quality of Decision Outcomes - Decision Quality - Implementation Effectiveness - Timeliness MANAGERIAL LEVERS DECISION PROCESS DECISION OUTCOMES * Roberto MA. Why Great Leaders Don’t Take Yes for an Answer: Managing for Conflict and Consensus. FTPress, 2013 Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 14 / 20

What is Continuous Decision Improvement (CDI)? Shaping quality processes and outcomes What kind of decisive leader are you? should you be? DECISIVE LEADERSHIP SOLUTION-ORIENTED What should we do? PROCESS-ORIENTED How should we decide? VERSUS Professor Michael Roberto: “Many leaders focus on finding the right solutions to problems rather than thinking carefully about what process they should employ to make key decisions. When confronted with a tough issue, we focus on the question, what decision should I make? We should first ask, how I should I go about making this decision?” (Source: The Art of Critical Decision Making—Course Guidebook) Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 15 / 20

Individual vs Group (Team) vs Organizational Challenges Individual Cognitive processes Cognitive biases and decision traps Framing matters Intuition—Recognizing patterns Reasoning by analogy Sensemaking in ambiguous situations Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 16 / 20

Individual vs Group (Team) vs Organizational Challenges Individual Cognitive biases Selected cognitive biases Overconfidence bias Confirmation bias Sunk cost effect Recency bias (type of availability bias) Anchoring bias Illusory correlation Avoiding decision-making traps Awareness!!! Test assumptions Seek unbiased input Constructive conflict Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 17 / 20

Individual vs Group (Team) vs Organizational Challenges Group (Team) Group (Team) dynamics Wisdom of crowds Groupthink Deciding how to decide Stimulating conflict and debate Keeping conflict constructive Creativity and brainstorming Procedural justice (fair and legitimate) Achieving closure through small wins Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 18 / 20

Individual vs Group (Team) vs Organizational Challenges Organizational Organizational history, systems, culture Theories Normal accident theory Normalizing deviance Allison’s model (3 lenses) Practical drift Ambiguous threats and recovery window Connecting the dots (sensemaking) Seeking out problems (problem finding) Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 19 / 20

Individual vs Group (Team) vs Organizational Challenges Organizational Summary of Continuous Decision Improvement (CDI) 1 Curriculum and tools to continuously improve the quality of decision processes and decision outcomes for individuals, groups (teams), and organizations 2 Incorporates public health considerations (ethics, politics, etc.) 3 Incorporates understanding of Dual-Process Model Observe Orient DECIDE Act Environmental Response Environmental Context PLAN DO STUDY ACT Assessment Alternatives SELECTION Implementation Environmental Response Environmental Context OODA Loop Dialogue Decision Process PLAN DO STUDY ACT Intuition Deliberation(Dual-Process Model) Tom´as J. Arag´on, MD, DrPH (SFDPH) Continuous Decision Improvement May 10, 2014 20 / 20

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