Project risk management is a crucial activity in project management. Nowadays, projects are facing a growing complexity and are thus exposed to numerous and interdependent risks. However, existing classical methods have limitations for modeling the real complexity of project risks. For example, some phenomena like chain reactions and loops are not properly taken into account. This Ph.D. thesis aims at analyzing propagation behavior in the project risk network through modelling risks and risk interactions. An integrated framework of decision support system is presented with a series of proposed methods. The construction of the project risk network requires the involvement of the project manager and the team of experts using the Design Structure Matrix (DSM) method. Simulation techniques are used and several network theory-based methods are developed for analyzing and prioritizing project risks, with respect to their role and importance in the risk network in terms of various indicators. The proposed approach serves as a powerful complement to classical project risk analysis. These novel analyses provide project managers with improved insights on risks and risk interactions under complexity and help them to design more effective response actions. Considering resource constraints, a greedy algorithm and a genetic algorithm are developed to optimize the risk response plan and the allocation of budget reserves dedicated to the risk management. Two examples of application, 1) to a real musical staging project in the entertainment industry and 2) to a real urban transportation system implementation project, are presented to illustrate the utility of the proposed decision support system.

This thesis is a conversation analytic investigation of the social organisation of talk in telephone and computer-mediated calls to NHS Direct, a telephone health helpline in England. The data represent fifty-six routinely audio recorded telephone consultations between nurses and callers between June 2003 and June 2004 at one NHS Direct call centre. Data were transcribed using the Jefferson (2004) transcription system. Data analysis follows the broad trajectory of the call. Chapter three illustrates the overall structural organisation of the call as mediated by the Clinical Assessment System (CAS); Chapter four examines how CAS prompted history taking questions are tailoured and delivered by the nurse; Chapter five examines the delivery by the nurse, of the CAS output in the form of the 'disposition' or course of action the caller may take to manage their concern, and Chapter six examines caller's responses to the disposition. The results draw attention to the complexities of telephone and computer-mediated help in which nurses and callers must design their talk to take account of the CAS as a 'third party'. Analysis reveals that nurses typically orient to the CAS output as potentially troublesome. First nurses regularly deviate from and modify CAS prompted questions which works to 'cushion' the system and build rapport between the nurse and the caller. Second nurses regularly simultaneously produce and labour to deny hearably candidate diagnoses. Third callers regularly respond to the CAS produced disposition as dispreferred. In conclusion, this research has revealed how nurses and callers employ a range of interactional practices which work to skilfully tailor and fashion 'embodied help' from an otherwise disembodied CAS technical system. Thus, we can observe nurses and callers artfully displaying through talk the ordinary practical methods for accomplishing telephone and computer-mediated help in this setting.

Land is a finite natural resource that is increasingly getting exhausted as a result of land contamination. Land is made up of soil and groundwater, both of which have many functions for which we depend on, including provision of food and water, supporting shelter, natural flood defence, carbon sequestration, etc. Contaminants in land also pose a number of threats to public health and the environment; other natural resources; and have detrimental effects on property such as buildings, crops and livestock. The most effective method of dealing with these contaminants is to cleanup and return the sites to beneficial use. The cleanup process involves making a choice from amongst competing remediation technologies, where the wrong choice may have disastrous economic, environmental and/or social impacts. Contaminated land management is therefore much broader than the selection and implementation of remedial solutions, and requires extensive data collection and analysis at huge costs and effort. The need for decision support in contaminated land management decision-making has long been widely recognised, and in recent years a large number of Decision Support Systems (DSS) have been developed. This thesis presents the development of a Web-based knowledge-based DSS as an integrated management framework for the risk assessment of human health from, and sustainable management of, contaminated land. The developed DSS is based on the current UK contaminated land regime, published guidelines and technical reports from the UK Environment Agency (EA) and Department for Environment, Food and Rural Affairs (DEFRA) and other Government agencies and departments. The decision-making process of the developed DSS comprises of key stages in the risk assessment and management of contaminated land: (i) preliminary qualitative risk assessment; (ii) generic quantitative risk assessment; and (iii) options appraisal of remediation technologies and remediation design. The developed DSS requires site specific details and measured contaminant concentrations from site samples as input and produces a site specific report as output. The DSS output is intended to be used as information to support with contaminated land management decision-making.

The operational management of Water Distribution Systems (WDS), particularly under failure conditions when the behaviour of a WDS is not well understood, is a challenging problem. The research presented in this thesis describes the development of a methodology for risk-based diagnostics of failures in WDS and its application in a near real-time Decision Support System (DSS) for WDS’ operation. In this thesis, the use of evidential reasoning to estimate the likely location of a burst pipe within a WDS by combining outputs of several models is investigated. A novel Dempster-Shafer model is developed, which fuses evidence provided by a pipe burst prediction model, a customer contact model and a hydraulic model to increase confidence in correctly locating a burst pipe. A new impact model, based on a pressure driven hydraulic solver coupled with a Geographic Information System (GIS) to capture the adverse effects of failures from an operational perspective, is created. A set of Key Performance Indicators used to quantify impact, are aggregated according to the preferences of a Decision Maker (DM) using the Multi-Attribute Value Theory. The potential of distributed computing to deliver a near real-time performance of computationally expensive impact assessment is explored. A novel methodology to prioritise alarms (i.e., detected abnormal flow events) in a WDS is proposed. The relative significance of an alarm is expressed using a measure of an overall risk represented by a set of all potential incidents (e.g., pipe bursts), which might have caused it. The DM’s attitude towards risk is taken into account during the aggregation process. The implementation of the main constituents of the proposed risk-based pipe burst diagnostics methodology, which forms a key component of the aforementioned DSS prototype, are tested on a number of real life and semi-real case studies. The methodology has the potential to enable more informed decisions to be made in the near real-time failure management in WDS.

Bakgrund I svensk hälso- och sjukvård skall prioriteringar utgå från de tre principerna i den etiska plattformen. Habiliteringen i Västra Götaland har utvecklat ett beslutstöd för prioriteringar med utgångspunkt från den nationella modellen för öppna prioriteringar vars syfte är att omsätta den etiska plattformen till praktiken.   Syfte Syftet med förbättringsarbetet var att börja använda beslutsstöd vid val av behandlingsmetoder, och hypotesen var att om beslut tas strukturerat ökar förutsättningarna för en mer likvärdig vård. Studiens syfte var att beskriva medarbetarnas upplevelser av förbättringsarbetet.   Metod I det pågående förbättringsarbetet har Nolans förbättringsmodell använts. Studien genomfördes som en deskriptiv kvalitativ studie och fokusgrupper genomfördes i två omgångar med deltagande team.   Resultat Medarbetarna upplever att arbete utifrån prioriteringsriktlinjer är viktigt men är beroende av beslutsstödet utformning och yttre faktorer. Att prioritera blir enklare om åtgärderna på väntelistan är rangordnade. Det går än inte att utläsa att mer likvärdig vård uppnåtts men när medarbetarna får styra över förbättringsarbetet minskar väntetiden från beslut till behandlingsstart.   Slutsatser Nolans förbättringsmodell fungerar vid införande av beslutsstöd för prioritering. Det återstår att se om beslutsstödet bidrar till en mer likvärdig vård. / Background In Swedish health care priorities shall be based on the principles in the ethics platform. Habilitation Services in Västra Götaland has developed a decision support for priorities on basis of the national model of priorities aimed to translate the ethical platform to practice.   Purpose Improvement work aimed to start using decision support in the selection of treatment. The hypothesis was, if decisions are structured increases the prospects of a more equitable care. The purpose was to describe employees’ experiences of improvement work.   Method The ongoing improvement work have used Nolan's model of improvement. The study was conducted as a descriptive qualitative study with focus groups in two rounds.   Results Employees feel that work on the basis of priority guidelines are important, but are dependent on decision support design and external factors. Prioritizing becomes easier if the waiting list are ranked. It is not yet possible to say that a more equitable care has been achieved but when employees get control over the improvement work the waiting time from decision to treatment reduces.   Conclusions Nolan's model of improvement works at the introduction of decision support for priority. It remains to be seen whether decision support contributes to more equitable care.

Although Operational Research (OR) has successfully provided many methodologies to address complex decision problems, in particular based on the rationality principle, there has been too little discussion regarding their limited consideration in IT evaluation practice and associated decision making satisfaction levels in an organisational context. The aim of this paper is to address these issues through providing a current account of diffusion and infusion of OR methodologies in IT decision making practice, and by analysing factors affecting decision making satisfaction from a Technological, Organisational, and Environmental (TOE) framework in the context of IT induced business transformations. We developed a structural equation model and conducted an empirical survey, which supported four out of five developed research hypotheses. Our results show that while Decision Support Systems (DSS), holistic IT evaluation methods, and management support seem to positively affect individual satisfaction, legislative regulation has an adverse effect. Results also revealed a persistent methodology diffusion and infusion gap. The paper discusses implications in each of these aspects and presents opportunities for future work. (authors' abstract)

Bakgrund: Telefonrådgivning är en tillgänglig verksamhet som visat sig vara kostnadseffektiv för både uppringarna och samhället. De flesta uppringarna är nöjda med tjänsten när sjuksköterskorna låter dem vara delaktiga i samtalet samt respekterar dem. Sjuksköterskornas främsta uppgift i telefonrådgivning är bedömningar avseende uppringarnas behov av vårdnivå. Syfte: Att beskriva sjuksköterskors upplevelser av att tillhandahålla telefonrådgivning. Metod: En systematisk litteraturstudie med beskrivande syntes vilken baseras på tio stycken kvalitativa vetenskapliga artiklar.  Resultat: Att som sjuksköterska tillhandahålla telefonrådgivning innebär flera utmaningar. Vissa faktorer gällande samtalen komplicerade kommunikationen och sjuksköterskornas bedömningar. Flera krav ställdes på sjuksköterskorna som hanterade dessa med hjälp av kollegor och beslutsstöd. Arbetet i telefonrådgivningen gav kunskap och erfarenheter vilka bidrog till att sjuksköterskorna utvecklades i sin yrkesroll.  Slutsats: Sjuksköterskornas upplevelser är i stor grad relaterade till avsaknaden av den visuella kontakten samt de bedömningar de förväntas göra i sitt arbete. Mycket förväntas av sjuksköterskorna som upplever att de har ett stort ansvar gentemot uppringarna. / Background: Telenursing is a business that has proven to be cost-effective for both callers and society. Most callers are happy with the service when the nurses let them be involved in the conversation and respects them. The main role of nurses in telenursing is to assess the callers need out of level of care. Aim: The aim is to describe nurse’s experiences of providing telephone advice. Method: A systematic review of descriptive synthesis based on ten qualitative scientific articles. Result: To provide telephone advice involves several challenges. Some factors concerning the talks complicated communication and assessments for the nurses. Several requirements were on the nurses who handled these with the help of colleagues and decision support. The work provided knowledge and experiences which contributed to nurses in their professional role.  Conclusion: Nurse’s experiences are related to the lack of visual contact and the assessments they are expected to do in their work. Much is expected of the nurses who perceive that they have a great responsibility to the callers.

Quantitative risk assessments are a fundamental part of economic analysis and natural hazard risk management models. It increases the objectivity and the transparency of risk assessments and guides policymakers in making efficient decisions when spending public resources on risk reduction. Managing hazard risks calls for an understanding of the relationships between hazard exposure and vulnerability of humans and assets.   The purpose of this thesis is to identify and estimate causal relationships between hazards, exposure and vulnerability, and to evaluate the applicability of systematically collected data sets to produce reliable and generalizable quantitative information for decision support.   Several causal relationships have been established. For example, the extent of lake flood damage to residential buildings depends on the duration of floods, distance to waterfront, the age of the house and in some cases the water level. Results also show that homeowners private initiative to reduce risk, prior to or during a flood, reduced their probability of suffering building damage with as much as 40 percent. Further, a causal relationship has been established between the number of people exposed to quick clay landslides and landslide fatalities.   Even though several relationships were identified between flood exposure and vulnerability, the effects can only explain small parts of the total variation in damages, especially at object level. The availability of damage data in Sweden is generally low. The most comprehensive damage data sets in Sweden are held by private insurance companies and are not publicly available. Data scarcity is a barrier to quantitative natural hazard risk assessment in Sweden. More efforts should therefore be made to collect data systematically for modelling and validating standardized approaches to quantitative damage estimation. / Natural hazard damages have increased worldwide. Impacts caused by hydrological and meteorological hazards have increased the most. An analysis of insurance payments in Sweden showed that flood damages have been increasing in Sweden as well. With climate change and increasing populations we can expect this trend to continue unless efforts are made to reduce risk and adapt communities to the threats. Economic analysis and quantitative risk assessments of natural hazards are fundamental parts of a risk management process that can support policymakers' decisions on efficient risk reduction. However, in order to develop reliable damage estimation models knowledge is needed of the relationships between hazard exposure and the vulnerability of exposed objects and persons. This thesis has established causal relationships between residential exposure and flood damage on the basis of insurance data. I also found that private damage-reducing actions decreased the probability of damage to buildings with almost 40 percent. Further, a causal relationship has been established between the number of people exposed to quick clay landslides and fatalities. Even though several relationships have been identified between flood exposure and vulnerability, the effects can explain only small parts of the total variation in damages, especially at object level, and more effort is needed to develop quantitative models for risk assessment purposes.

Approved for public release; distribution is unlimited / Each inventory manager at the Aviation Supply Office Philadelphia, PA is presently required to manage approximately 700 line items. To allow the inventory manager a more efficient method of reviewing and using the data and reports from the Uniform Inventory Control Point (UICP) computer system, a distributed computer system is necessary. By downloading the the appropriate inventory data from UICP to a local computer system, a decision support system (DSS) can be be implemented using existing off the shelf hardware and software. The ability to replace the present copious paper reports with concise computerized information and import that data into electronic spreadsheets for further analysis can greatly improve the inventory manager's effectiveness. To this end, this thesis provides inventory managers at ASO with access to the following functions: Interactive access to the main UICP database. The ability to use UICP data with a decision support system. A user interface that is easy to understand and learn. A local data base which supports working group requirements. Basic office automation. This thesis will cover the selection of the hardware and software, data identification and management and DSS development. A prototype system called the IM Workstation was developed for this thesis and used to produce the thesis document. COBOL and ALIS ELF macro program listings are provided. / http://archive.org/details/inventorymanager00mare / Lieutenant, United States Navy

The task of ensuring Patient Safety is, more than ever, central in Healthcare. The report “To Err is Human” [Kohn et al. 2000], was revealing alarming numbers of incidents, injuries and deaths caused by deficiencies in healthcare activities. The book initiated assessment and change of Healthcare methods and procedures. In addition, numerous reports to Swedish HSAN (Medical Responsibility Board) have shown a high rate of information and communication deficiencies in Healthcare has a direct or indirect cause of incidents, injuries and deaths. Despite numerous of new sophisticated tools for information management in recent years, e.g., tools such as Electronic Health Records (EHR) and Clinical Decision Support Systems (CDSS), the threats to Patient Safety have not been redeemed. Rather to the contrary. Underlying reasons for this paradox are twofold. Firstly, advancements in diagnosing techniques have given rise to increasing volumes of data at the same time as the number of patients has increased due to demographic changes and advancements in treatments. Secondly, the information processing systems are far from aligned to related workflow processes. In short, we do not at present have interoperability in our Healthcare systems. In this doctoral dissertation, we present an in-depth analysis of two different “HSAN-typical” cases, where Patient Safety was jeopardized by incomplete information flows and/or information breakdowns. The cases are mirroring the apprehension of Simplicity, that is, Occam´s Razor of Diagnostic Parsimony. A well-known protocol used in Healthcare and implemented in most (knowledge based) CDSS. This rule of thumb is the foundation for the well-known adage: “when you hear hoof beats, think horses, not zebras”. Hickam´s Dictum is one well known objection to the simplifications of Occam´s Razor stating "Patients can have as many diseases as they damn well please". Of course, this Dictum is harder to implement effectively! In the thesis we suggest a visualization tool Visual Incidence Anamneses (VIA) to provide middle out compromise between Ockham and Hickam but providing means to increase Patient Safety. The findings of our Study for the thesis have resulted in a number of Aspects and Principles as well as Core-principles for future CDSS design, That is, tools and methodologies that will support designing and validating Interoperability of Healthcare systems across patient-centric workflows. The VIA tool should be used as the initiating point in a patient (individual) centered workflow, quickly visualizing vital information such as symptoms, incidents and diagnoses, occurring earlier in the medical history, at different times, to ground further vital decisions on. The visualization will enable analysis of timelines and earlier diagnoses of the patient, using visually salient nodes for visualization of causalities in context. Furthermore, support for customization of the tool to the views of stakeholders, members of healthcare teams and empowerments of the patient, is crucial.