Decision-Making at the Front Line

2019 ◽  
pp. 200-216
Author(s):  
Andrew Weyman ◽  
Rachel O’Hara
Keyword(s):  
Decision Making ◽  
Front Line

scholarly journals Defeating information overload in health surveillance using a metacognitive aid innovation from military combat systems

2016 ◽  
Vol 14 (4) ◽  
pp. 371-388 ◽  
Author(s):  
Daniel C McFarlane ◽  
Alexa K Doig ◽  
James A Agutter ◽  
Jonathan L Mercurio ◽  
Ranjeev Mittu ◽  
...  
Keyword(s):  
Decision Making ◽  
Information Overload ◽  
High Volume ◽  
Health Surveillance ◽  
Simulated Patients ◽  
Naval Research ◽  
Hospital Nurses ◽  
Volume Data ◽  
Front Line ◽  
Training Requirement

Modern sensors for health surveillance generate high volumes and rates of data that currently overwhelm operational decision-makers. These data are collected with the intention of enabling front-line clinicians to make effective clinical judgments. Ironically, prior human–systems integration (HSI) studies show that the flood of data degrades rather than aids decision-making performance. Health surveillance operations can focus on aggregate changes to population health or on the status of individual people. In the case of clinical monitoring, medical device alarms currently create an information overload situation for front-line clinical workers, such as hospital nurses. Consequently, alarms are often missed or ignored, and an impending patient adverse event may not be recognized in time to prevent crisis. One innovation used to improve decision making in areas of data-rich environments is the Human Alerting and Interruption Logistics (HAIL) technology, which was originally sponsored by the US Office of Naval Research. HAIL delivers metacognitive HSI services that empower end-users to quickly triage interruptions and dynamically manage their multitasking. HAIL informed our development of an experimental prototype that provides a set of context-enabled alarm notification services (without automated alarm filtering) to support users’ metacognition for information triage. This application is called HAIL Clinical Alarm Triage (HAIL-CAT) and was designed and implemented on a smartwatch to support the mobile multitasking of hospital nurses. An empirical study was conducted in a 20-bed virtual hospital with high-fidelity patient simulators. Four teams of four registered nurses (16 in total) participated in a 180-minute simulated patient care scenario. Each nurse was assigned responsibility to care for five simulated patients and high rates of simulated health surveillance data were available from patient monitors, infusion pumps, and a call light system. Thirty alarms per nurse were generated in each 90-minute segment of the data collection sessions, only three of which were clinically important alarms. The within-subjects experimental design included a treatment condition where the nurses used HAIL-CAT on a smartwatch to triage and manage alarms and a control condition without the smartwatch. The results show that, when using the smartwatch, nurses responded three times faster to clinically important and actionable alarms. An analysis of nurse performance also shows no negative effects on their other duties. Subjective results show favorable opinions about utility, usability, training requirement, and adoptability. These positive findings suggest the potential for the HAIL HSI system to be transferrable to the domain of health surveillance to achieve the currently unrealized potential utility of high-volume data.

scholarly journals Balancing health worker well-being and duty to care: an ethical approach to staff safety in COVID-19 and beyond

2020 ◽  
pp. medethics-2020-106557 ◽  
Author(s):  
Rosalind J McDougall ◽  
Lynn Gillam ◽  
Danielle Ko ◽  
Isabella Holmes ◽  
Clare Delany
Keyword(s):  
Decision Making ◽  
Clinical Work ◽  
Well Being ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Healthcare Staff ◽  
Front Line ◽  
Specific Setting ◽  
Healthcare Work ◽  
Staff Protection

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment (PPE) in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff.

scholarly journals Homelessness and the ‘over-judicialisation’ of welfare

Legal Studies ◽  
2020 ◽  
pp. 1-16
Author(s):  
Emma Laurie
Keyword(s):  
Decision Making ◽  
Human Rights ◽  
Dispute Resolution ◽  
European Convention ◽  
Front Line ◽  
Procedural Safeguards

Abstract Members of the senior judiciary have expressed concern about the ‘over-judicialisation’ of welfare in the context of homelessness decision-making and adjudication. This paper examines how those fears have been manifested and makes a link with the concept of proportionate dispute resolution (PDR). It argues that the statutory scheme incorporates elements of PDR and judges should therefore refrain from introducing additional layers. The courts’ denial of the application of Article 6 of the European Convention on Human Rights to the homelessness context is disputed, and the paper makes the case for continuing rigorous judicial oversight of front-line decision-making, recommending that attention is focused on assessing procedural safeguards rather than disputing the ambit of Article 6.

A Comparative Approach to Administrative Adjudication

2020 ◽  
pp. 576-594
Author(s):  
Michael Asimow
Keyword(s):  
Decision Making ◽  
Judicial Review ◽  
Comparative Approach ◽  
Government Agencies ◽  
Entire System ◽  
Front Line ◽  
Initial Decision ◽  
The World ◽  
Administrative Adjudication

This chapter concerns administrative adjudication. The term ‘administrative adjudication’ means the entire system for individualized agency decision-making arising out of disputes between private parties and government agencies. The adjudicatory process begins with an administrative investigation of a claim or a violation and the agency’s preliminary or ‘front line’ determination, continuing through the process of an agency’s initial decision, reconsideration of that decision, and concluding with judicial review. The systems in place for resolving such disputes differ sharply around the world and are difficult to compare. This chapter highlights five models in use by various countries that should facilitate such comparisons.

scholarly journals Across the great divide:The impact of digital inequality on Scotland’s Gypsy/Traveller children and young people during the COVID-19 emergency

2020 ◽  
Vol 2 (2) ◽  
pp. 52
Author(s):  
Lynne Tammi
Keyword(s):  
Decision Making ◽  
Young People ◽  
Formal Learning ◽  
Front Line ◽  
Learning And Development ◽  
Digital Inequality ◽  
Children And Young People ◽  
Digital Devices ◽  
Front Line Workers ◽  
Development Workers

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­This article examines current Scottish national and local government awareness of, and responses to, the learning and development needs and entitlements of Gypsy/Traveller children and young people pre and during the COVID-19 pandemic.  A snapshot analysis of emerging testimony from Learning and Development Workers and parents and young people focuses on, and gives insight to, how the lack of access to digital devices and data and front-line workers’ discretionary decision making has impacted on young Gypsy/Travellers’ ability to access formal and non-formal learning and development during the pandemic.

scholarly journals The war of Brazilian Firefighters in the Fight Against Covid-19

2021 ◽  
Author(s):  
Renan Augusto Bortolassi de Oliveira ◽  
Rosângela de França Bail ◽  
Ariel Orlei Michaloski ◽  
João Luiz Kovaleski ◽  
Daiane Maria de Genaro Chiroli
Keyword(s):  
Decision Making ◽  
Health Professionals ◽  
Emergency Services ◽  
Behavioral Changes ◽  
Work Environments ◽  
Fire Departments ◽  
Front Line ◽  
Health Agencies ◽  
Work Routines ◽  
Health Institutions

Abstract IntroductionThe years 2020 and 2021 were marked by the pandemic of SARS-CoV-2, a virus that infected 167 million more people, causing about 3.4 million deaths worldwide. And, because of this, the main global health agencies (WHO, governments, emergency services, hospitals and other health professionals), sought means of protection for workers on the front line to combat the pandemic. The Fire Brigades of Brazil, had the need to adopt new protocols of actions, which would mitigate the progress of the disease, justifying the importance of curbing the effects of the pandemic in their corporations and other victims of COVID-19.Case descriptionThe objective of this work is to propose the systematization of control and combating future pandemics, seeking to contribute with a model of assistance protocol that adapts to the needs of health institutions. The study is a literature review and is based on data collected through a questionnaire applied to the Brazilian Fire Departments in the 26 states and the Federal District.Discussion and evaluationWith the mapping of the actions carried out, it was possible to identify which actions were implemented, which involve the creation and development of new service protocols such as the use of specific PPE, care with the disposal of contaminated materials and behavioral changes, avoiding contamination. Within the mapping carried out in the corporations, it is possible to obtain relevant data in the fight against the coronavirus, such as (use of new PPE, exclusive vehicles, testing of personnel, infected firefighters, number of deaths, stress, change in work routines).ConclusionsWith the coronavirus pandemic, the Fire Brigade promoted an alignment between needs and decision making, through internal protocols of related actions, which were essential in the search to mitigate the impacts caused by the pandemic. Such actions serve as a model to be used in other work environments.

scholarly journals Public agents of front line: the creator of administrative law

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Juliana Bonacorsi de Palma
Keyword(s):  
Decision Making ◽  
Public Policies ◽  
Administrative Law ◽  
Front Line ◽  
The Public ◽  
Public Action ◽  
Street Level ◽  
The Subject ◽  
Street Level Bureaucrats

<span>Abstract: The role of the front-line public agents in the implementation of the public policies created by the first-tier is the subject addressed by the author. From the notion of street-level bureaucrats, it seeks to identify the difficulties encountered by such public agents in decision-making and the need for standards that provide for institutes and administrative dynamics that in fact lead to more efficient, impersonal and guaranteeing public action to protect the well-intentioned front-line public agent to fully exercise the discretion he needs in case-by-case action.</span>

Protecting Children, Creating Citizens

2020 ◽  
Author(s):  
Katrin Križ
Keyword(s):  
United States ◽  
Decision Making ◽  
Young People ◽  
Child Protection ◽  
The United States ◽  
Participatory Approach ◽  
Front Line ◽  
Children And Young People ◽  
Child Protection Workers ◽  
Complex Boundaries

This book examines a participatory approach in child protection practices in Norway and the United States, exploring ways of empowering children. The book shows how children can be encouraged to develop and express their own opinions and explores tools for child protection workers to negotiate complex boundaries around the inclusion of children in decision-making. The goal of the book is to show in what ways child protection caseworkers employed by public child protection agencies in Norway and the United States can create citizens by promoting the participation of children and young people in their everyday practice. Public child protection agencies are only one part of the citizenship piece, but they are a salient one in the lives of children and young people who encounter them. Child protection caseworkers working in public child protection agencies, make very important decisions about children and young people's lives and provide children, youth, and families with pertinent services. The book presents valuable insights from front-line child protection professionals' unique perspectives and experiences within two very different systems, and evaluates the impacts of different organizational practices in promoting children's participation.

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