Decision-making Meetings Research Articles

How might shared decision-making meetings reduce the need for children to be in care? A rapid realist review

Summary Meetings to enhance shared decision-making, such as family group conferences, potentially contribute to enhancing meaningful involvement of families. Such meetings are also claimed by some to reduce the need for children to be in care, either by increasing support from family for parents or by identifying care from within the family network. This rapid realist review aims to develop an understanding of how meetings that facilitate shared decision-making between professionals and families might work to safely reduce the need for children to be in care. It identifies mechanisms that are thought to make a difference and contextual factors that influence the impact of identified mechanisms. Findings A comprehensive search of academic and gray literature identified 64 documents spanning seven types of shared decision-making meetings. Data from these papers were collected using an iterative process of juxtaposition, comparison, contrast, and combination with a developing program theory. Data from the literature was supplemented with consultation to ensure relevance to the UK setting. The review identified three key mechanisms that made shared decision-making meetings more likely to be effective in safely reducing children's entry to care: enabling participation and engagement; building trust and reducing shame; enabling participation in decision-making processes. It describes how these work before, during, and after meetings. Applications The findings help us understand the complicated research findings about the relationship between meetings and care entry and provide a theory about what is needed to make such meetings work that is of practical use for practice and future research

Specifying cross-system collaboration strategies for implementation: a multi-site qualitative study with child welfare and behavioral health organizations

BackgroundCross-system interventions that integrate health, behavioral health, and social services can improve client outcomes and expand community impact. Successful implementation of these interventions depends on the extent to which service partners can align frontline services and organizational operations. However, collaboration strategies linking multiple implementation contexts have received limited empirical attention. This study identifies, describes, and specifies multi-level collaboration strategies used during the implementation of Ohio Sobriety Treatment and Reducing Trauma (Ohio START), a cross-system intervention that integrates services across two systems (child welfare and evidence-based behavioral health services) for families that are affected by co-occurring child maltreatment and parental substance use disorders.MethodsIn phase 1, we used a multi-site qualitative design with 17 counties that implemented Ohio START. Qualitative data were gathered from 104 staff from child welfare agencies, behavioral health treatment organizations, and regional behavioral health boards involved in implementation via 48 small group interviews about collaborative approaches to implementation. To examine cross-system collaboration strategies, qualitative data were analyzed using an iterative template approach and content analysis. In phase 2, a 16-member expert panel met to validate and specify the cross-system collaboration strategies identified in the interviews. The panel was comprised of key child welfare and behavioral health partners and scholars.ResultsIn phase 1, we identified seven cross-system collaboration strategies used for implementation. Three strategies were used to staff the program: (1) contract for expertise, (2) provide joint supervision, and (3) co-locate staff. Two strategies were used to promote service access: (4) referral protocols and (5) expedited access agreements. Two strategies were used to align case plans: (6) shared decision-making meetings, and (7) sharing data. In phase 2, expert panelists specified operational details of the cross-system collaboration strategies, and explained the processes by which strategies were perceived to improve implementation and service system outcomes.ConclusionsWe identified a range of cross-system collaboration strategies that show promise for improving staffing, service access, and case planning. Leaders, supervisors, and frontline staff used these strategies during all phases of implementation. These findings lay the foundation for future experimental and quasi-experimental studies that test the effectiveness of cross-system collaboration strategies.

Decision making processes and power dynamics in timber production co-management: A comparative analysis of seven Brazilian Amazonian community-based projects

Power asymmetries are a major obstacle to inclusive and robust decision making in collaborative management (or co-management), whereby multiple actors, principally government and local communities, jointly make decisions to achieve natural resource management goals. We compared seven community-based timber projects under different co-management arrangements within three Brazilian Amazonian extractive reserves to illuminate how decision making was organized (structure) and how it actually operated (function) with respect to power dynamics among multiple actors. Over a 15-month field season, we conducted participant observation and 52 semistructured interviews, systematically analyzed over 30 key timber management decision-making meetings, and employed Q-methodology to ascertain diverse actor perspectives of power dynamics. Our overall analysis revealed that decisions across all seven timber projects were gradually made through multiple meetings at community, extractive reserve, and beyond extractive reserve levels – a positive approach that can lead to continuous problem-solving. The 16 Q-sorters perceived decision making in these meetings to be participative, respectful of all actors' rights to speak, and allowed for some knowledge exchange, suggesting that unequal power dynamics (as observed in our study) does not necessarily prevent the opportunity to voice one's opinion. This participation also decentralized decision-making processes, boosting chances that community-level actors used their crucial local knowledge and advocated for their interests. Still, in one reserve, community members were ill prepared to make informed decisions, lacking sufficient technical training and trusted long-term support from non-governmental external actors. Furthermore, some Q-sorters noted insufficient community-level actors in decision-making processes, because deliberative spaces were beyond their physical reach. Yet in two reserves, innovative logistical strategies were developed to compensate and accommodate this challenge. In the third reserve, however, in the absence of intentional and creative solutions to geographical and cultural distances, there were limited interactions among the communities and external actors, giving rise to minimal information flow and weakened representation of community interests in decision making. We also demonstrated that actors in power (government forest administration officers) or those with perceived power (financial or forest technical providers, community leaders), sometimes acted strategically over other actors, particularly those perceived as without power (community residents), to alter their behavior, constrain their choices, and influence their expectations regarding decision outcomes. We conclude that power asymmetries can be overcome in natural resource co-management decision making, using deliberate, thoughtful, and creative participatory approaches.

A novel approach for assessing bias during team-based clinical decision-making.

Many clinical processes include multidisciplinary group decision-making, yet few methods exist to evaluate the presence of implicit bias during this collective process. Implicit bias negatively impacts the equitable delivery of evidence-based interventions and ultimately patient outcomes. Since implicit bias can be difficult to assess, novel approaches are required to detect and analyze this elusive phenomenon. In this paper, we describe how the de Groot Critically Reflective Diagnoses Protocol (DCRDP) can be used as a data analysis tool to evaluate group dynamics as an essential foundation for exploring how interactions can bias collective clinical decision-making. The DCRDP includes 6 distinct criteria: challenging groupthink, critical opinion sharing, research utilization, openness to mistakes, asking and giving feedback, and experimentation. Based on the strength and frequency of codes in the form of exemplar quotes, each criterion was given a numerical score of 1-4 with 1 representing teams that are interactive, reflective, higher functioning, and more equitable. When applied as a coding scheme to transcripts of recorded decision-making meetings, the DCRDP was revealed as a practical tool for examining group decision-making bias. It can be adapted to a variety of clinical, educational, and other professional settings as an impetus for recognizing the presence of team-based bias, engaging in reflexivity, informing the design and testing of implementation strategies, and monitoring long-term outcomes to promote more equitable decision-making processes in healthcare.

Health in global biodiversity governance: what is next?

The dependency of human health and wellbeing on nature is documented across disciplines, regions, cultures, and economies. Environmental degradation contributes substantially to the global burden of disease and concurrent global environmental changes are increasingly recognised as public health threats, worldwide. 1 Myers SS Gaffikin L Golden CD et al. Human health impacts of ecosystem alteration. Proc Natl Acad Sci USA. 2013; 110: 18753-18760 Crossref PubMed Scopus (268) Google Scholar The 196 parties to the UN Convention on Biological Diversity (CBD) have called for increased engagement on biodiversity and health since 2014, 2 Willetts L Nature negotiations: sharing responsibility for global health. Lancet Planet Health. 2022; 6: e554-e556 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar while calls from stakeholders for integrated decision making are similarly long standing. 3 Whitmee S Haines A Beyrer C et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. Lancet. 2015; 386: 1973-2028 Summary Full Text Full Text PDF PubMed Scopus (1125) Google Scholar Yet few civil society health organisations have historically engaged with the CBD and its intergovernmental negotiating process. 4 Willetts E Grant L Bansard J et al. Health in the global environmental agenda: a policy guide. International Institute for Sustainable Development. https://www.iisd.org/publications/health-global-environment-agenda-policy-guideDate: 2022 Date accessed: January 16, 2023 Google Scholar This situation is, however, changing. In 2022, civil society health professionals and organisations were involved in the CBD agenda-setting (intersessional subsidiary body) and decision-making (Conference of the Parties [COP]) meetings. Five civil society health organisations attended the 15th UN Biodiversity Conference (COP 15) in Montréal, Canada, as newly accredited delegations to the CBD. The new participation of these organisations in global biodiversity governance embodies the interdisciplinary work needed to take a whole-of-society approach to respecting planetary boundaries and prioritising the environmental determinants of health. The agenda of the UN CBD recognises and increasingly includes health. Now is the time to mobilise contributions from diverse health experts to inform integrated policy.

How an utterance is regarded as implying disagreement: an analysis of confirmation requests in Japanese decision-making meetings

Abstract This study describes how confirmation requests can be regarded as implying disagreement in Japanese decision-making meetings. By using the methodology of Conversation Analysis, I examined two specific sequential environments where participants in meetings are more likely to imply their disagreements through confirmation requests: (i) after a participant reports on his or her proposal and (ii) after a silence caused by a stalled discussion. The detailed analysis of the composition and sequential location of confirmation requests in these contexts revealed that linguistic items, vocal stress, or even conversational contexts can make a confirmation request heard as implying disagreement. In addition, choosing a confirmation request to imply disagreement is not a random decision but a thoughtful selection depending on the asymmetrical epistemic status or related to the management of topic progression in meetings.

Silence in WTO

The World Trade Organization’s expansion in terms of its activities is becoming increasingly demanding for Members. Members may not express their acceptance or rejection to every statement or action taking place in the WTO, and they may remain silent to intentionally signify their position. This article examines the legal significance of Members’ silence in the WTO, in particular in the consensus-based decision-making procedures, in committees and council meetings, in the determination of subsequent practice when interpreting WTO provisions, schedules and practices, and in the assessment of whether or not a WTO Member has relinquished its right to initiate WTO dispute settlement proceedings. A brief description of the state of play of silence in public international law serves as a reference point to guide the analysis of silence in WTO law, which highlights the fact-specific nature of silence in both fields. While this article reveals that silence plays a role in the consensus decision-making function of the WTO, whether silence can amount to acquiescence in the context of councils and committees meetings remains unclear. Similarly, the Appellate Body has left the door open to the possibility that Members’ silence may provide evidence of subsequent practice for purposes of treaty interpretation. Contrary to international law where it has been suggested that silence may lead to a waiver of a state’s right to invoke the responsibility of another State, a relinquishment of a WTO Member’s right to initiate WTO dispute settlement proceedings must be formulated in clear and unambiguous language. WTO, silence, protest, acceptance, relinquishment of rights, practice, decision-making, interpretation, subsequent practice

Novelties of Civil Legislation about Meetings and their Decisions

The changes in the civil legislation of Russia on the issues of assemblies and their decisions are systematized and analyzed. The legal nature and interrelation with other phenomena, categories are revealed: replacement of the term “voting” on the concept of “session” (from the standpoint of activity, legal facts, corporate governance, the rights of participants in corporations); the legalization three orders of magnitude of decision-making meetings (from the standpoint of legal logic and hierarchy of sources of law); the legalization of remote presence at the meeting (from the standpoint of digitalization); clarification of the rules on the protocols.Gaps and other problems in the updated norms related to the subject composition, the ratio of rights and obligations, information security, the system and hierarchy of normative sources of law are identified. Some ways of their solution are proposed.

Fuzzy Complex Proportional Assessment Applied in Location Selection for Installation of Photovoltaic Plants

This article proposes the application of a multi-criteria decision-making method based on fuzzy complex proportional assessment (COPRAS-F), applying business sustainability criteria, to rank alternative sites for the installation of photovoltaic plants, as selected from a geographic suitability index map of vast and heterogeneous regions in Southern Brazil, obtained from a geographic information system. As a key feature, the methodology serves the interests of stakeholders during decision-making meetings in a personalized manner, eliminating the need for consensus to overcome conflicts and antagonistic positions, allowing them to maintain a strictly professional view and to communicate in business language. The results indicate that the best location from a geographical viewpoint may not be the best location from a business viewpoint.

Team decision-making service planning for children and adolescents at risk for placement instability: Fidelity and initial outcomes

Child welfare standards of care emphasize service planning that provides an opportunity for meaningful participation of youth, caregivers, and family members. For youth who are at high risk for multiple moves while in foster care, participatory service planning can be difficult to achieve. This research focused on a statewide program that uses team decision-making meetings to identify needs and plan services for youth who are at risk for instability while in foster care. Results from meetings held for 364 children and adolescents over a six-week period affirm that use of team decision-making for youth experiencing placement stability can result in a collaborative planning process. Immediately after the meeting, most participants endorsed meeting qualities such as believing that their participation was valued and that the entire team would support the plan. At follow-up four months after the meeting, significant improvements had occurred in emotional and behavioral symptoms, caregivers’ need for child care support, and satisfaction with mental health services, suggesting that the meeting process, subsequent services, and placement decisions supported changes in some key areas of concern. Additional research using controlled research designs is needed to identify the unique effects of team decision-making processes and subsequent services on short- and long-term outcomes.

"There Is No Link Between Resource Allocation and Use of Local Data": A Qualitative Study of District-Based Health Decision-Making in West Bengal, India.

Background: Effective coordination among multiple departments, including data-sharing, is needed for sound decision-making for health services. India has a district planning process involving departments for local resource-allocation based on shared data. This study assesses the decision-making process at the district level, with a focus on the extent of local data-use for resource allocation for maternal and child health. Methods: Direct observations of key decision-making meetings and qualitative interviews with key informants were conducted in two districts in the State of West Bengal, India. Content analysis of the data maintained within the district health system was done to understand the types of data available and sharing mechanisms. This information was triangulated thematically based on WHO health system blocks. Results: There was no structured decision-making process and only limited inter-departmental data-sharing. Data on all 21 issues discussed in the district decision-making meetings observed were available within the information systems. Yet indicators for only nine issues—such as institutional delivery and immunisation services were discussed. Discussions about infrastructure and supplies were not supported by data, and planning targets were not linked to health outcomes. Conclusion: Existing local data is highly under-used for decision-making at the district level. There is strong potential for better interaction between departments and better use of data for priority-setting, planning and follow-up.

Patient-centered care's relationship with substance use disorder treatment utilization

BackgroundCalls for more patient-centered care are growing in the substance use disorder (SUD) treatment field. However, evidence is sparse regarding whether patient-centered care improves access to, or utilization of, effective treatment services. MethodsUsing nationally representative survey data from SUD treatment clinics in the United States, we examine the association between patient-centered clinical care and the utilization of six services: methadone, buprenorphine, behavioral treatment, routine medical care, HIV testing, and suicide prevention counseling. We measured clinics' practice of and emphasis on patient-centered care with two variables: (1) whether the clinic regularly invites patients into clinical decision-making processes, and (2) whether supervisors believe in patient-centered healthcare and shared decision-making practices within their clinics. ResultsIn 2017, only 23% of SUD treatment clinics regularly invited patients into care decision-making meetings when their cases were discussed. A composite variable captured clinical supervisors' own experience with and expectations for patient-clinician interaction within their clinics (Cronbach's alpha = 0.79). Results from regression models that controlled for several organizational and environmental factors show that patient-centered care was independently associated with greater utilization of four of six evidence-based services. ConclusionsA minority of SUD clinics practice patient-centered healthcare in the United States. Given the connection to evidence-based services, increasing participatory mechanisms in SUD treatment service provision can facilitate patients' access to appropriate and evidence-based services.

Unraveling the medical residency selection game

The diversity of modern society is often not represented in the medical workforce. This might be partly due to selection practices. We need to better understand decision-making processes by selection committees in order to improve selection procedures with regard to diversity. This paper reports on a qualitative study with a socio-constructivist perspective conducted in 2015 that explored how residency selection decision-making occurred within four specialties in two regions in the Netherlands. Data included transcripts of the decision-making meetings and of one-on-one interviews with committee members before and after the group decision-making meetings. Candidates struggled to portray themselves favorably as they had to balance playing by the rules and being authentic; between fitting in and standing out. Although admissions committees had a welcoming stance to diversity, their practices were unintentionally preventing them from hiring underrepresented minority (URM) candidates. While negotiating admissions is difficult for all candidates, it is presumably even more complicated for URM candidates. This seems to be having a negative influence on attaining workforce diversity. Current beliefs, which make committees mistakenly feel they are acting fairly, might actually justify biased practices. Awareness of the role of committee members in these processes is an essential first step.

COVID-19 and the General Surgical Department - Measures to Reduce Spread of SARS-COV-2 Among Surgeons.

COVID-19 and the General Surgical Department - Measures to Reduce Spread of SARS-COV-2 Among Surgeons.

Impact of Bilingual Language and Their Proficiency on Role Behaviors in Strategic Decision-Making Meetings

Impact of Bilingual Language and Their Proficiency on Role Behaviors in Strategic Decision-Making Meetings

Assessing Patient Confidence and Satisfaction about the Shared Decision-making Meetings for Planning Cancer Chemotherapy.

BackgroundPatients increasingly express the desire to be involved in their treatment decisions, especially in critical situations, such as cancer chemotherapy that increase a doctor's responsibility toward fulfilling these needs. This process may require more than one meeting with the patient to meet their expectations and satisfaction levels. This study aimed to assess the satisfaction levels in cancer patients, who received chemotherapy, about their decision-making and if they were able to make this decision during the first meeting with their physicians.MethodsA cross-sectional study was conducted in 2017 on 106 cancer patients aged 18 years or above who were receiving chemotherapy at the day-care unit of King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The data were collected by a direct or telephonic interview using a structured questionnaire. The variables were studied across two groups of patients based on the patient's ability to make decision in the first meeting with their physician. Data were expressed as frequencies (percentage) and Pearson Chi-Square test was used to assess the categorical variables.ResultsOut of the 106 patients, 42 (39.6%) of them were male. Ninety-one (85.8%) patients took the decision by themselves. Regarding the decision-making 90 (84.9%) patients were able to make the decision from the first meeting. Sixty-eight (64.2%) patients felt more satisfied if they had an additional session. There was a significant association between patients with the ability to make the decision during the first meeting and patients who took the decision by themselves (P = 0.033), patients with consideration of changing their decision if they had more meetings (P = 0.005), patients with consideration of withholding from chemotherapy in their mind (P = 0.019) and patients with thought that chemotherapy is affecting their life (P = 0.044).ConclusionThe majority of the patients felt that more than one meeting with their doctors would be helpful in improving their satisfaction level during the decision-making process, consideration of withholding from chemotherapy in mind and that chemotherapy is affecting their life style. Future protocol in which the patients will be encouraged to have a confidence role on their treatment decision is recommended.

Organic or organised: an interaction analysis to identify how interactional practices influence participation in group decision meetings for residency selection

ObjectivesThis study aims to shed light on interactional practices in real-life selection decision-making meetings. Adequate residency selection is crucial, yet currently, we have little understanding of how the decision-making process...

Making Medical Decisions for Incapacitated Patients Without Proxies: Part I.

To date no one has identified or described the population of incapacitated patients being treated in an inpatient setting who lack proxy decision-makers. Nor, despite repeated calls for protocols to be developed for decision-making, has any institution reported on the utilization of such a protocol. In 2005, our urban tertiary care hospital instituted a protocol utilizing community members of the ethics committee to meet with the medical providers and engage in shared decision-making for patients without proxies (PWPs). We conducted a retrospective chart review and in this paper describe nearly 200 patients who were identified and treated according to the protocol over a 12year period. After an aggressive search, family members were located for a surprising number of patients, leaving 80 patients who needed decisions to be made utilizing the PWP committee. We review the decisions required, the results of the shared decision-making meetings, and the patient outcomes. Our experience has shown that a protocol involving community volunteers to make decisions for PWPs in a timely manner is feasible and ethically defensible. The protocol has been accepted by physicians and utilized with increasing frequency. Because it was possible to gather at least minimal information on most patients, a standard of "informed best interest" was used to make decisions. PWP committee recommendations varied, but in all cases agreement was reached with the attending physicians.

Using Bayesian Network to Estimate the Value of Decisions within the Context of Value-Based Software Engineering: A Multiple Case Study

Context: Companies must make a paradigm shift in which both short- and long-term value aspects are employed to guide their decision-making. Such need is pressing in innovative industries, such as ICT, and is the core of Value-based Software Engineering (VBSE). Objective: This paper details three case studies where value estimation models using Bayesian Network (BN) were built and validated. These estimation models were based upon value-based decisions made by key stakeholders in the contexts of feature selection, test cases execution prioritization, and user interfaces design selection. Methods: All three case studies were carried out according to a Framework called VALUE — improVing decision-mAking reLating to software-intensive prodUcts and sErvices development. This framework includes a mixed-methods approach, comprising several steps to build and validate company-specific value estimation models. Such a building process uses as input data key stakeholders’ decisions (gathered using the Value tool), plus additional input from key stakeholders. Results: Three value estimation BN models were built and validated, and the feedback received from the participating stakeholders was very positive. Conclusions: We detail the building and validation of three value estimation BN models, using a combination of data from past decision-making meetings and also input from key stakeholders.

OP80 Impact Of Patient Group Participation At Scottish Medicines Consortium Committee Meetings

IntroductionThe Scottish Medicines Consortium (SMC) encourages patient group (PG) representatives to participate in the decision-making committee meetings, answering questions from committee members and providing points of clarity throughout discussions if required. In a continuous improvement approach the process and the participant experience is continually evaluated to monitor impact and emerging themes.MethodsThe interactions between committee members and PG representatives are recorded in writing by the public involvement team to monitor the questions or points of clarity raised. These interactions were analyzed using thematic analysis to look for emerging themes. Following the meeting, PG representatives are invited to complete an online survey on their experience of working with SMC.ResultsFrom July 2017 to October 2018, 36 PG representatives have attended committee meetings for the discussion of their submission. Committee members asked 17 PG representatives to contribute. Key themes that have emerged to date include insight into the impact of living with the condition on quality of life and how a new medicine may affect this. Survey feedback has been positive with participants reporting that patient engagement has been strengthened, and that the patient voice is heard, valued and supports committee members in making fully informed decisions. PG representatives expressed a willingness to participate again. Feedback also highlighted that the preparatory support offered to PG representatives by the public involvement team is highly valued.ConclusionsPatient group participation in committee meetings has been received positively by PG representatives. They report that discussions relating to quality of life impact of medicines on patients and carers better reflect the lived experience, enriching committee's deliberations. This demonstrates SMCs commitment to openness and transparency and has strengthened patient engagement in our processes.