THE USE OF LCA TO INTRODUCE LIFE-CYCLE THINKING INTO DECISION-MAKING FOR THE PURCHASE OF MEDICAL DEVICES IN THE NHS

2000 ◽  
Vol 02 (04) ◽  
pp. 453-476 ◽  
Author(s):  
ERICA ISON ◽  
ANNE MILLER
Keyword(s):  
Decision Making ◽  
Life Cycle ◽  
Medical Devices ◽  
Holistic Approach ◽  
Healthcare Sector ◽  
Life Cycle Thinking ◽  
Limited Information ◽  
Product Systems ◽  
Personal Opinion

In the NHS, criteria for the selection and purchase of medical devices tend to be restricted to concerns about any risks to patients and/or staff during clinical practice, and the purchase price. In addition, the basis for taking many of these decisions about purchase may be only that of personal opinion, anecdote or limited information. We report on the application of life-cycle assessment (LCA) to a particular medical device — the suction receptacle — as a case-study to determine the potential of LCA to improve the range and quality of information available for decision-making, and act as a framework for a more holistic approach. Using LCA, substantial environmental and economic burdens were found to be associated with the different product systems in use (durable versus disposable devices). We discuss the ways in which various stakeholders in the healthcare sector could use this information, at both a strategic and operational level. We also outline possible future developments of LCA that would support healthcare managers in the drive towards evidence-based decision-making.

Life Cycle Management and Sharing Economy

2020 ◽  
pp. 152-166
Author(s):  
Roberta Guglielmetti Mugion ◽  
Gabriella Arcese ◽  
Martina Toni ◽  
Luca Silvestri
Keyword(s):  
Life Cycle ◽  
Service Industry ◽  
Sustainability Assessment ◽  
Holistic Approach ◽  
Life Cycle Management ◽  
Sharing Economy ◽  
Management Tool ◽  
Life Cycle Thinking ◽  
Sustainable Value ◽  
Definition Of

The life cycle sustainability assessment based on Life Cycle Thinking is currently considered the most crucial paradigm that includes three kinds of sustainability variables. Life cycle management (LCM) is the most holistic approach in promoting sustainable value creation, embedding the social, economic, and environmental dimensions as a management tool. LCM is mainly applied in the manufacturing and products chain, whereas it is understudied in the service industry. This chapter proposes the development of the LCM general framework and the definition of indicators for the assessment of sustainability in the urban shared mobility. The research framework has been tested in the transportation sector focusing on car sharing context.

Decision Making in Acute Care: A practical framework supporting the ‘best interests’ Principle

2006 ◽  
Vol 13 (3) ◽  
pp. 284-291 ◽  
Author(s):  
Susan Bailey
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Acute Care ◽  
Best Interests ◽  
Limited Information ◽  
Life Saving ◽  
Pain And Suffering ◽  
Life Sustaining Treatment ◽  
The Individual

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a judgement about the future quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components - pain and suffering, body functioning, and autonomy - and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations.

scholarly journals Women’s participation in decentralized local governance: the case of pastoral and non-pastoral women in Kondoa local authority, Tanzania

Afrika Focus ◽  
2014 ◽  
Vol 27 (2) ◽  
pp. 87-97
Author(s):  
Haidari Pascal Misafi
Keyword(s):  
Case Studies ◽  
Local Authority ◽  
Local Governance ◽  
Holistic Approach ◽  
Limited Information ◽  
Theoretical Perspectives ◽  
Women's Participation ◽  
And Gender ◽  
Phd Thesis

This summary of my PhD thesis explains the reasons behind and the effects of pastoral and non-pastoral women’s participation in decentralized local governance in Tanzania. A body of knowledge exists on participation and gender in Tanzania. However, beyond plain statistics, there is limited information on women’s experiences in participation within decentralized local governance in the country. Two main theoretical streams exist in literature concerning participation and gender. One stream of literature argues that women’s descriptive participation leads to substantive women’s participation. The other stream argues that it is important to focus on what specific actors do to represent women’s concerns and not solely on women’s descriptive participation. The data analysed in this report were collected in Kondoa Local Authority, Tanzania. Within Kondoa, the two dominant women groups – pastoral women and non-pastoral women- were selected as case studies. Based on observations, interviews and focus group discussions, I have found that despite the presence of pastoral and non-pastoral women in governance, the quality of women participation is low. Both case studies reveal that women’s participation is mainly limited to their physical presence or the nominal level. Similarly, I have shown that the dynamics of women’s participation determine women’s descriptive and substantive participation in governance. Additionally, I have found that incentives, access to information and power relations significantly determine women’s presence in and contributions to governance. Moreover, women’s interest in local governance and their knowledge of the Kiswahili language are also determining factors behind their substantial participation in decision-making. Furthermore, I have found that women in governance have no impact on policy changes concerning women. A general conclusion in this report is that there is a mismatch between women in governance and participation. I argue that having women in governance does not guarantee participation. These results challenge both the women’s descriptive representation and women’s substantive representation theoretical perspectives. I therefore recommend that: (1) policies regarding women’s participation should be reconstructed to ensure not only an increase in women in governance but also that women in that position are able to act for women; (2) a holistic approach is required to understand underlying forces that determine the level and quality of women’s participation in governance; (3) interventions for enhancing women’s participation in governance should take into consideration unique dichotomies and peculiarities among women.

A prospective assessment of the quality of multidisciplinary tumor boards in Mexico and its relationship with decision making.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 188-188
Author(s):  
Raul Rogelio Trejo rosales ◽  
Enrique Soto Perez De Celis ◽  
Edgar Baltazar-Avalos ◽  
Yanin Chavarri Guerra
Keyword(s):  
Decision Making ◽  
Point Of View ◽  
Psychosocial Issues ◽  
Limited Information ◽  
Team Members ◽  
Tumor Boards ◽  
Prospective Assessment ◽  
Case Presentations ◽  
Developed Nations

188 Background: Multidisciplinary Tumor Boards (MDTB) allow the review of cases and have been associated with improved decision making and outcomes. There is limited information regarding the performance of MDTBs in developing countries. The aim of this study was to assess the quality of MDTBs and its relationship with decision making at an academic hospital in Mexico City. Methods: We used a validated tool (MTB-MODe) to prospectively assess the quality of MDTBs at our institution. MTB-MODe assigns a score of 1-5 to various aspects of case presentations at a MDTB, including the quality of the information presented and the performance of team members, which are then averaged to obtain a mean score. The scores of MTDBs which reached a decision were compared against those who failed to do so using Mann-Whitney U-test. Results: 100 cases presented at MDTBs between April and June 2015 were analyzed. Median patient age was 57 years (19 - 87). The most common diagnoses were hepatic (23%), breast (20%) and prostate cancer (15%). 50% of cases (n = 50) were localized. Mean MTB-MODe score was 3.27 (range 1.75-4.75), and a decision was reached in 83% of cases (n = 83). Cases in which a multidisciplinary decision was reached had a better MTB-MODe score than those without a decision (n = 17) (3.4 vs 2.8, p = 0.01). The ability of the MDTB to reach a decision was associated with the quality of case presentation (4.1 vs 3.2, p = 0.01), the presentation of comorbidities (3.5 vs 2.6, p = 0.006), better leadership of the coordinator (3.5 vs 2.5, p = 0.002) and better participation of team members (4.2 vs 2.9, p < 0.001). The patient’s point of view was discussed in only 8% of cases (n = 8), while psychosocial issues were only considered in 10% of cases (n = 10). Conclusions: We found that the quality of case presentations at MDTBs, and the performance of its members, are associated with the ability to reach multidisciplinary decisions. In contrast with reports from developed nations, we found that the patient’s point of view and psychosocial issues were not only largely ignored, but also irrelevant for decision making. The continuous evaluation and improvement of MDTBs is necessary for successful decision making in order to improve patient outcomes.

Performance Measurement in an Outsourcing Environment

2011 ◽  
pp. 220-230 ◽  
Author(s):  
Luke Ho ◽  
Anthony S. Atkins
Keyword(s):  
Decision Making ◽  
Information Technology ◽  
Quality Of Service ◽  
Holistic Approach ◽  
Financial Assessment ◽  
Strategic Direction ◽  
Business Information ◽  
The Uk ◽  
It Operations

In the UK, 88% of companies utilise some form of outsourcing of their Information Technology (IT) operations. The evidence from the literature indicates that approximately 50% of these outsourcing decisions results in complications and in some cases failure. There is a need for outsourcing management frameworks to provide strategic direction and guidance in the decision-making process. This chapter describes the application of one such framework, known as the Holistic Approach {Business, Information, Organisation} (HABIO) framework, to two major commercial organisations indicating financial assessment, monitoring information for performance and quality of service which can be incorporated into service operations and benchmarking criteria.

scholarly journals PP032 Holistic Patient Access Processes Of Medical Devices In South Korea

2017 ◽  
Vol 33 (S1) ◽  
pp. 85-86
Author(s):  
Sang-Soo Lee ◽  
Moo Yeol Lee ◽  
Veronica Kim ◽  
Kyungja Lee ◽  
Young-Kwan Kwon
Keyword(s):  
Decision Making ◽  
South Korea ◽  
Case Studies ◽  
Medical Devices ◽  
Risk Sharing ◽  
Lead Time ◽  
Holistic Approach ◽  
Patient Access ◽  
Coverage Decision

INTRODUCTION:Historically, patient access processes of new and innovative medical devices including in-vitro diagnostics are made in the sequence of regulatory approval, new Health Technology Assessment (nHTA) approval, reimbursement coverage and coding finally reaching the pricing approval stage in South Korea. Although the individual patient access process has its own distinct objective and perspective, there are still opportunities for the authorities or agencies in charge to streamline their processes by working together to promote earlier patient access of new and innovative medical devices to patients without impacting their own decision making.METHODS:This research examined and analyzed the current policies about: patient access processes with a holistic viewpoint, industry-wide survey about patient access practices; case studies of two innovative medical devices for patient access in South Korea and also proposed new or alternative programs which can contribute to patient access harmonization efforts with a holistic approach.RESULTS:Historically, health authorities play defensive strategies by delaying the adoption of new and innovative medical devices and implementing certain periods (that is, 2 to 5 years) for a patient's out-of-pocket payment scheme. It is well illustrated with the statistic that only twenty-nine percent of new and innovative medical technologies which have successfully gone through the nHTA process were determined for reimbursement coverage in the past 7 years.The survey by the medical device industry to determine the patient access lead-time of innovative medical devices with a holistic perspective indicated significantly delayed patient access even considerabley exceeding the legally required decision-making lead time. The in-depth case studies with two innovative devices indicated the disadvantageous patient access processes to the innovator in terms of both final approval timing and the price level.CONCLUSIONS:The concurrent review process for reimbursement coverage decision making for medical procedures, medical devices and reimbursement coverage payment guidelines committed within the Health Insurance Review and Assessment Service shall be created. New programs to deal with uncertainty in reimbursement coverage decision making shall be considered such as coverage with evidence development, performance-based risk-sharing arrangement, multi-criteria decision analysis and economic evaluation.

scholarly journals Ranking product systems based on uncertain life cycle sustainability assessment: a stochastic multiple criteria decision analysis approach

2020 ◽  
Vol 13 (4) ◽  
pp. 850-874
Author(s):  
Breno Barros Telles do Carmo ◽  
Manuele Margni ◽  
Pierre Baptiste
Keyword(s):  
Decision Making ◽  
Life Cycle ◽  
Decision Analysis ◽  
Sustainability Assessment ◽  
Multiple Criteria ◽  
Multiple Criteria Decision Analysis ◽  
Illustrative Case ◽  
Life Cycle Sustainability Assessment ◽  
Product Systems ◽  
Conflicting Objectives

Purpose – Life cycle sustainability assessment (LCSA) provides useful and comprehensive information on product system performance. However, it poses several challenges for decision-making process due to (i) multidimensional indicators, (ii) conflicting objectives and (iii) uncertainty associated with the performance assessment. This research proposes an approach able to account uncertain life cycle sustainability performances through multiple criteria decision analysis (MCDA) process to support decision-making.Design/methodology/approach – Our method is structured in three phases: i) assessing the uncertainty of LCSA performances, ii) propagating LCSA uncertainty into MCDA methods and iii) interpreting the stochastic results. The approach is applied on an illustrative case study, ranking four alternatives to biodiesel supply.Findings –The recommendation generated by this approach provides an information about the confidence the decision maker can have in a given result (ranking of solutions) under the form of a probability, providing a better knowledge of the risk (in this case due to the uncertainty of the preferred solution). As such, stochastic results, if appropriately interpreted, provide a measure of the robustness of the rankings generated by MCDA methods, overcoming the limitation of the overconfidence of deterministic rankings.Originality/value – The fundamental contributions of this paper are to (i) integrate LCSA uncertainty into decision-making processes through MCDA approach; (ii) provide a sensitivity analysis about the MCDA method choice, (iii) support decision-makers’ preference choices through a transparent elicitation process and (iv) provide a practical decision-making platform that accounts simultaneously uncertain LCSA performances with stakeholders’ value judgments.

BIM-enabled sustainability assessment of material supply decisions

2017 ◽  
Vol 24 (4) ◽  
pp. 668-695 ◽  
Author(s):  
Alireza Ahmadian F.F. ◽  
Taha H. Rashidi ◽  
Ali Akbarnezhad ◽  
S. Travis Waller
Keyword(s):  
Decision Making ◽  
Supply Chain ◽  
Life Cycle ◽  
Sustainability Assessment ◽  
Social Impacts ◽  
Life Cycle Thinking ◽  
Bottom Line ◽  
Content Type ◽  
Material Supply ◽  
Trade Offs

Purpose Enhancing sustainability of the supply process of construction materials is challenging and requires accounting for a variety of environmental and social impacts on top of the traditional, mostly economic, impacts associated with a particular decision involved in the management of the supply chain. The economic, environmental, and social impacts associated with various components of a typical supply chain are highly sensitive to project and market specific conditions. The purpose of this paper is to provide decision makers with a methodology to account for the systematic trade-offs between economic, environmental, and social impacts of supply decisions. Design/methodology/approach This paper proposes a novel framework for sustainability assessment of construction material supply chain decisions by taking advantage of the information made available by customized building information models (BIM) and a number of different databases required for assessment of life cycle impacts. Findings The framework addresses the hierarchy of decisions in the material supply process, which consists of four levels including material type, source of supply, supply chain structure, and mode of transport. The application is illustrated using a case study. Practical implications The proposed framework provides users with a decision-making method to select the most sustainable material alternative available for a building component and, thus, may be of great value to different parties involved in design and construction of a building. The multi-dimensional approach in selection process based on various economic, environmental, and social indicators as well as the life cycle perspective implemented through the proposed methodology advocates the life cycle thinking and the triple bottom line approach in sustainability. The familiarity of the new generation of engineers, architects, and contractors with this approach and its applications is essential to achieve sustainability in construction. Originality/value A decision-making model for supply of materials is proposed by integrating the BIM-enabled life cycle assessment into supply chain and project constraints management. The integration is achieved through addition of a series of attributes to typical BIM. The framework is supplemented by a multi-attribute decision-making module based on the technique for order preference by similarity to ideal solution to account for the trade-offs between different economic and environmental impacts associated with the supply decisions.

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