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.

Background: Tobacco smoke exposure (TSE) is unequivocally harmful to children's health, yet up to 48% of children who visit the pediatric emergency department (PED) and urgent care setting are exposed to tobacco smoke. The incorporation of clinical decision support systems (CDSS) into the electronic health records (EHR) of PED patients may improve the rates of screening and brief TSE intervention of caregivers and result in decreased TSE in children. Objective: We propose a study that will be the first to develop and evaluate the integration of a CDSS for Registered Nurses (RNs) into the EHR of pediatric patients to facilitate the identification of caregivers who smoke and the delivery of TSE interventions to caregivers in the urgent care setting. Methods: We will conduct a two-phase project to develop, refine, and integrate an evidence-based CDSS into the pediatric urgent care setting. RNs will provide input on program content, function, and design. In Phase I, we will develop a CDSS with prompts to: (1) ASK about child TSE and caregiver smoking, (2) use a software program, Research Electronic Data Capture (REDCap), to ADVISE caregivers to reduce their child's TSE via total smoking home and car bans and quitting smoking, and (3) ASSESS their interest in quitting and ASSIST caregivers to quit by directly connecting them to their choice of free cessation resources (eg, Quitline, SmokefreeTXT, or SmokefreeGOV) during the urgent care visit. We will create reports to provide feedback to RNs on their TSE counseling behaviors. In Phase II, we will conduct a 3-month feasibility trial to test the results of implementing our CDSS on changes in RNs' TSE-related behaviors, and child and caregiver outcomes. Results: This trial is currently underway with funding support from the National Institutes of Health/National Cancer Institute. We have completed Phase I. The CDSS has been developed with input from our advisory panel and RNs, and pilot tested. We are nearing completion of Phase II, in which we are conducting the feasibility trial, analyzing data, and disseminating results. Conclusions: This project will develop, iteratively refine, integrate, and pilot test the use of an innovative CDSS to prompt RNs to provide TSE reduction and smoking cessation counseling to caregivers who smoke. If successful, this approach will create a sustainable and disseminable model for prompting pediatric practitioners to apply tobacco-related guideline recommendations. This systems-based approach has the potential to reach at least 12 million smokers a year and significantly reduce TSE-related pediatric illnesses and related costs.

This thesis investigates computer-based support tools to facilitate decision-making in civilian and military operations. As flexibility is essential when preparing for unknown threats to society, this support has to be general. Further motivations for flexible and general solutions include reduced costs for technical development and training, as well as faster and better informed decision-making. We use the term Effects-Based Management of Operations to denote the accomplishment of desired effects beyond traditional military goals by the deployment of all types of available capabilities. Supporting this work, DISCCO (Decision Support for Command and Control) is a set of network-based services including Command Support, helping commanders in the human, collaborative and continuous process of evolving, evaluating, and executing solutions to their tasks, Decision Support, improving the human process by integrating automatic and semi-automatic generation and evaluation of plans, and a Common Situation Model, capturing the hierarchical structure of the situation regarding own, allied, neutral, and hostile resources. The use of the DISCCO has been investigated in three different applications: planning for establishing surveillance of an operation area, planning for NBC defense, and executing a riot control operation. Together, these studies indicate that DISCCO is applicable in many different classes of Effects-Based Management of Operations. Hence, this generic concept will contribute to the work of both the civilian and military defense in dealing with a broad range of current and future threats to the society.

Organizations that must respond quickly to environmental pressures look for tools to assist in that response. Information technology may be one tool to facilitate the response. In this study the possible effects of using information technology, specifically a decision support system, in the feedback segment of one organization's strategic management loop were examined. The organization was one region of the Board of Probation and Parole in a central state. Personnel included administrators, parole officers and clerical workers. The information technology was an off-the-shelf software product called PlanRight. This study is significant for two reasons: a new application for information technology was examined and the adequacy of a generic computerized tool designed to be suitable for various operations was explored. This study was a case study. Two months of data were taken prior to the implementation of the decision support system, and four months of data were taken after the system was implemented. Questionnaire data taken before system implementation provided descriptive characteristics of the organization. Follow-up surveys and interviews at the conclusion of the study were used to evaluate employee perceptions. The study was done in three phases. During phase one questionnaires were distributed and returned. During phase two, goals, plans and evaluation criteria were formulated and plans were implemented. Feedback was obtained and evaluated through the use of the decision support system enabling reaction to the feedback data. In phase three perceptions of administrators and parole officers were elicited using follow-up surveys and semi-structured interviews. Three propositions guided the evaluation of the study's outcomes. These propositions dealt with performance toward goal achievement, satisfaction with feedback processes and quality of plans formulated for the project. Performance was moderately successful. Satisfaction with processes was high. Speed of obtaining feedback was considered high by administrators and paroled officers. Quality of processes and outcomes was evaluated to be good.

Finding the optimal solution for the call-center scheduling problem can be done by using Microsoft Excel with an integer programming software add-in. Utilizing VBA, we are able to vary start, break, and lunch times as well as number of employees. By creating a list of all possible schedules that follow these requirements, we use the optimization engine to solve for the best possible combination of individual schedules. Custom programs for optimization such as this are becoming a vital part of the world today as decisions need to be made quickly. This flexible and easy to use scheduling tool saves time and effort while creating peace of mind knowing that the best possible solution has been found. Using this tool, we are able to decrease the amount of time to create schedules from approximately 15 hours of manual work to 25.2 seconds. Additionally, we are able to improve the accuracy of meeting the forecast – guaranteeing all manpower demand is met with an efficient and reliable tool. Accuracy, efficiency, and reliability are traits that anyone could wish for, and this tool makes that possible.

This dissertation explores reifying the management science concept of organizations as a collection of decisions. Organizational management entails resource allocation activities that can be formulated in terms of elementary relational functions. All elasticity-type formulations, most generic "production" functions, and various projection models that organizations might require (such as sales forecasts) can all be represented by elementary relational functions. Therefore, information systems in organizations can be representative of relationships between decision requirements, as theorized in relational model bases. A relational model-base structure acts as an integrative device by relating an organization's elementary relational functions to each other, with all that is kept for any model being the current values for coefficients and the now prevailing parametric values for the state variables of the model.Anchoring management information systems around relational model bases is particularly appropriate for organizations that have some reliance on real-time management decision making by providing the answer to two requirements for such organizations: one being the requirement for more accurate and current real-time, operational decision making within the organization; the other being the integration of functions for decision-making purposes within an organization. Relational model bases thus enable more dynamic management and become a central information system type for organizations that have dynamic resource allocation requirements that can employ technical tactics around such relational model bases. The relational model base would reflect revealed needs in an organization as opposed to projected needs, easing an organization's reliance on forecasting and moving it toward real-time decision making. The case for the introduction of these information systems is further strengthened by the fact that relational model base-type structures are already operating in production environments within organizations. The methodology used in this dissertation involved modeling organizational decision requirements in particular organizational cases to determine the behavior of relational model bases within those prototypical organizations and the application of relational model bases to real-time decision making. The first organizational scenario is a recursive agribusiness e-commerce case, with the target application being precision agriculture. The second scenario is a non-recursive ecological economics case, with the target application being preservation of biodiversity through land (habitat) protection.

This dissertation explores the potential for computational systems to analyze and support individual and collaborative human sense-making activities. In this context human sense-making refers to the act of mentally and physically relating pieces of information so as to develop an understanding of a particular situation. Human sense-making activities such as brainstorming, decision-making, and problem solving sessions often produce a lot of data such as notes, sketches, and documents. The participants of sense-making activities usually develop a good understanding of the relations among these individual data items. These relations define the context. Because the relations remain within the minds of the participants they are neither accessible to outsiders and computational systems nor can they be recorded or backed up. This dissertation outlines a first set of computational mechanisms that construct relations from the spatial arrangement, use, and storage of data items. A second set of computational mechanisms takes advantage of these relations by helping users to keep track of, search for, exchange, arrange, and visualize data items. The computational mechanisms are both adaptive and evocative, meaning that the computational mechanisms dynamically adapt to users and changing circumstances while also trying to influence the human sense-making process.

Dans le contexte de la planification de projet, l’objectif de cette thèse est de s’intéresser à la prise en compte, dès les phases de conception de projet, des différents aléas potentiels pouvant survenir au cours du projet. Nous proposons ainsi une approche permettant de fiabiliser les estimations nécessaires à la prise de décision. Cette approche vise à adresser deux problématiques bien spécifiques (i) comment, pour l’évaluation d’un projet, pourrait-on tenir compte de l’ensemble des éventualités, événements et situations que le projet pourrait rencontrer au cours de son déroulement et (ii) comment tenir compte des liens et relations qui peuvent exister entre les risques. Pour cela, un modèle d’évaluation des scénarios de risque projet en variables mixtes multi risques, multi impacts, multi stratégies de traitement, multi dépendances, est proposé. Le modèle développé est intégré à un cadre de simulation permettant de traiter le processus complet de planification de projet. Un prototype informatique supportant cette approche a ainsi été développé et appliqué sur un cas d’étude issue du secteur pharmaceutique (conduite d’une étude clinique). / In the context of project planning, the objective of this thesis is to focus on the consideration, from the design phase of the project, of the various potential hazards that may arise during the project. We propose an approach for reliable estimates needed for decision-making. This approach aims to address two specific problems (i) how to evaluate a project, one might consider all possibilities, events and situations that the project could encounter during its implementation and (ii) how to address the linkages and relationships that can co-exist between risks. For this, a model for assessing the scenarios of risk-project in the mixed variables of multi-risk, multiimpact, multi-strategy of treatments and multi-dependency, is proposed. The developed model is integrated into a simulation framework for handling the entire process of project planning. A prototype computer program that supports this approach has been developed and applied in a case study for the pharmaceutical sector (conducting a clinical study).

Call number: LD2668 .T4 1986 W37 / Master of Landscape Architecture

M.Comm. / Globalization initiates rapid change and innovation that is: “… no longer an option, but it has become a business imperative” (Grulke, 2002, p. 18). Innovative organizations have developed the ability to satisfy both the shareholders’ demand for wealth (Hamel, 2000) and the customers’ demand for more creative and innovative products that facilitate ease of use (Kelley, 2001) while at the same time ensuring business sustainability (Skarzynski & Gibson, 2008). The development of creative and innovative thinking and problem-solving skills are crucial for the survival of organisations in the 21st century. Creative problem-solving training was generally found to be the most effective when organizations wanted to equip their employees with creative and innovative thinking and problem-solving skills. A specific financial services organisation in South Africa realised that they had to join the innovation revolution in order to remain commercially competitive in the twentyfirst century. With retailers and other competitors such as the telecommunication role players entering the traditional financial services domain, the organisation recognised that they required a novel approach to conduct their business. The highly regulated and to some extent conformist environment of the financial services organization constitute the sphere within which the research problem is situated. The organisation commissioned the researcher to design a Creativity and Innovation Workshop with the intent to improve the creative and innovative thinking and problem-solving skills of their employees. The evaluation question that the study purports to address therefore is whether employees in a corporate context such as a financial services organisation can develop appropriate creative and innovative thinking and problemsolving skills through an intervention such as a workshop and can a benefit for the business unit and organisation be identified. The unit of analysis is a niche business unit in a South African financial services organization. The sample used in this study comprises of managers (employees) and senior or executive management of those employees who attended the Creativity and Innovation Workshop.