Скачать презентацию Chapter 3 Decision Making in Healthcare Facilities What Скачать презентацию Chapter 3 Decision Making in Healthcare Facilities What

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Chapter 3. Decision Making in Healthcare Facilities What should I do? Chapter 3: Quantitatve Chapter 3. Decision Making in Healthcare Facilities What should I do? Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 1

Outline u u u u Decision Process What Causes Poor Decisions? The Decision Level Outline u u u u Decision Process What Causes Poor Decisions? The Decision Level & Decision Milieu Decision Making under Uncertainty – Payoff Table – Methods Decision Making under Risk – EVM, EOL, EVPI – Decision Tree Approach – Rollback Procedure What if Payoff Values are Cost? Decision Analysis with Non-Monetary Values & Multiple. Attributes – Dominance – Minimum Attribute Satisfaction – Most Important Attribute Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 2

The Decision Process u u u u Identification of the problem and its nature The Decision Process u u u u Identification of the problem and its nature Specification of objectives and decision criteria Development of alternatives Analysis and comparison of alternatives Selection of the best alternative Implementation of the choice Controlling and monitoring the results Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 3

What Causes Poor Decisions? ü Mistakes in the Decision Process ü Bounded Rationality: is What Causes Poor Decisions? ü Mistakes in the Decision Process ü Bounded Rationality: is the limits imposed on decision making by costs, human abilities and errors, time, technology, and the tractability of data. Suboptimization: is characterized by Decisions are often departmentalized as separate organizational units compete for scarce resources. Individual departments often seek solutions that benefit their own department, but not necessarily the healthcare organization as a whole. ü Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 4

Decision Theory represents a general approach to decision making which is suitable for a Decision Theory represents a general approach to decision making which is suitable for a wide range of operations management decisions, including: capacity, service design, location planning, equipment selection, etc. Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 5

The Decision Level & Decision Milieu Certainty-- Known values for parameters of interest ü The Decision Level & Decision Milieu Certainty-- Known values for parameters of interest ü Uncertainty-- Impossible to assess the likelihood of various possible future events ü Risk-- Certain parameters have probabilistic outcomes ü Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 6

Certainty ü Certainty rarely exists, especially in health care decisions. But if it does, Certainty ü Certainty rarely exists, especially in health care decisions. But if it does, simply choose the best available option (highest profit/least cost). Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 7

Decision Making under Uncertainty ØMaximin-- best of the worst (pessimist) ØMaximax-- best of the Decision Making under Uncertainty ØMaximin-- best of the worst (pessimist) ØMaximax-- best of the best (optimist) ØHurwitz-- allows you to adjust the probabilities/weighing between maximin and maximax or pessimist vs. optimist ØLaplace-- best average payoff ØMinimax Regret-- best of the worst regrets Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 8

Decision Tools Table 3. 1 Payoff Table Alternative State of Nature S 2 ……. Decision Tools Table 3. 1 Payoff Table Alternative State of Nature S 2 ……. Sn A 1 O 12 ……. O 1 n A 2 O 21 O 22 ……. O 2 n … ……. …. . Om 1 Om ……. Om Am S 1 2 Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan n 9

Example 3. 1: A major imaging center is not able to meet the increased Example 3. 1: A major imaging center is not able to meet the increased demand from patients for MRIs. The administration is willing to explore the possibilities by evaluating such alternatives as adding one or two additional units or out sourcing to other image centers and earning a commission of $30. 00 per MRI. A feasibility analysis showed that three major demand chunks could occur in the future, summarized as 500, 750 and 1000 additional MRI requests. The financial analysis of the potential business summarizes profits/losses under additional MRI demand chunks in a payoff table shown in Table below. 500 Cases 750 Cases 1000 Cases Buy One MRI Unit -15* 200 300 Buy Two MRI Units -150 100 725 15 22. 5 40 Alternatives Outsource * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 10

Maximin Solution Alternativ 500 750 1000 W es Cases ors s s t Buy Maximin Solution Alternativ 500 750 1000 W es Cases ors s s t Buy One MRI Unit -15* 200 300 -15 Buy Two MRI Units -150 100 725 15 0 Outsourc e 15 22. 5 40 15 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 11

Maximax Solution Alternativ es 500 750 1000 Bes Cases t s s Buy One Maximax Solution Alternativ es 500 750 1000 Bes Cases t s s Buy One MRI Unit -15* 200 300 Buy Two MRI Units -150 100 725 Outsource 15 22. 5 40 40 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 12

Hurwitz Solution For optimism with α = 0. 5. Then the HV value for Hurwitz Solution For optimism with α = 0. 5. Then the HV value for the three alternatives would be: HV (Buy one MRI unit) =. 5(300, 000)+(. 5)(-15, 000) = 142, 500. HV (Buy two MRI units)=. 5(725, 000)+(. 5)(-150, 000)= 287, 500. HV (Outsource) =. 5(40, 000)+(. 5)(15, 000) = 27, 500. α Decision Alternative 1. 0 725, 00 0* Buy Two MRI Units . 5 287, 500 Buy Two MRI Units . 4 200, 000 Buy Two MRI Units . 3 112. 500 Buy Two MRI Units . 2 4 Chapter 3: Quantitatve Methods in Health Care Management HV 60, 600 Buy One MRI Unit . 2 48, 000 Buy One MRI Unit . 1 17, 500 Yasar A. Ozcan Outsource 13

Opportunity Losses (Regrets) Alternatives 500 750 Cases 1000 Cases Wo rst Buy One MRI Opportunity Losses (Regrets) Alternatives 500 750 Cases 1000 Cases Wo rst Buy One MRI Unit 30* 0 425 Buy Two MRI Units 165 100 0 165 Outsource 0 177. 5 685 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 14

Laplace Strategy Probability 1/3 1/3 Alternatives 500 Cases 750 Cases 1000 Cases Buy One Laplace Strategy Probability 1/3 1/3 Alternatives 500 Cases 750 Cases 1000 Cases Buy One MRI Units -15* 200 300 161. 67 Buy Two MRI Units -150 100 725 225 15 22. 5 40 25. 89 Outsource Expected Value * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 15

Expected Value Model Once the healthcare manager has assessed the probability distribution, computation of Expected Value Model Once the healthcare manager has assessed the probability distribution, computation of the expected values for each alternative is straightforward, as follows: EMV(Ai) = Σj pj Oij Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 16

Payoff Table for EMV Probability . 2 . 6 . 2 1000 Cases Expe Payoff Table for EMV Probability . 2 . 6 . 2 1000 Cases Expe cted Valu e Alternatives 500 750 Cases Buy One MRI Unit -15* 200 300 177 Buy Two MRI Units -150 100 725 175 Outsource 15 22. 5 40 24. 5 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 17

Expected Opportunity Loss The probabilities can also be incorporated into the regrets (or opportunity Expected Opportunity Loss The probabilities can also be incorporated into the regrets (or opportunity losses) calculated earlier. In this way the healthcare manager can assess the expected losses and try to minimize them with proper decision. Calculations of expected opportunity loss follow the formula: EOL(Ai) = Σj pj Rij Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 18

Expected Opportunity Loss Probability . 2 . 6 . 2 Buy One MRI Unit Expected Opportunity Loss Probability . 2 . 6 . 2 Buy One MRI Unit 30* 0 425 91 Buy Two MRI Units 165 100 0 93 Outsource 0 177. 5 685 243. 5 Alternative Expecte d 500 750 1000 Opportu Cases nity Loss * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 19

Expected Value of Perfect Information (EVPI) EVPI = EVUC-EMV EVUC = Σj pj (Best Expected Value of Perfect Information (EVPI) EVPI = EVUC-EMV EVUC = Σj pj (Best Oij given Sj) Probability . 2 . 6 . 2 Alternatives 500 750 Cases 1000 Cases Buy One MRI Unit -15* 200 300 Buy Two MRI Units -150 100 725 Outsource 15 22. 5 40 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 20

Expected Value of Perfect Information (EVPI) EVPI = EVUC-EMV EVUC = Σj pj (Best Expected Value of Perfect Information (EVPI) EVPI = EVUC-EMV EVUC = Σj pj (Best Oij given Sj) EVUC = (. 2*15000) + (. 6*200000) + (. 2*725000) = 268000. EMV = $177, 000 EVPI = $268, 000 – $177, 000 = $91, 000 Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 21

What if Payoffs are Costs? Alternatives 500 750 Cases 1000 Cases Buy One MRI What if Payoffs are Costs? Alternatives 500 750 Cases 1000 Cases Buy One MRI Unit 2, 050 2, 075 * 2, 100 Buy Two MRI Units 4, 050 4, 075 4, 100 Outsource 5 10 15 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 22

Regret Table Using Costs Alternatives 500 Cases 750 Cases 1000 Cases Buy One MRI Regret Table Using Costs Alternatives 500 Cases 750 Cases 1000 Cases Buy One MRI Unit 2, 0502, 0752, 1005=2, 045* 10=2, 065 15=2, 085 Buy Two MRI Units 4, 0504, 0754, 1005=4, 045 10=4, 065 15=4, 085 Outsource 5 -5=0 10 -10=0 15 -15=0 * in $ 000 s Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 23

Decision Tools-- The Decision Tree Events Actions Event Node Outcomes 1 Outcome 1 2 Decision Tools-- The Decision Tree Events Actions Event Node Outcomes 1 Outcome 1 2 3 Action A Outcome 7 1 Decision Node Action B Outcome 4 Event Node 2 Outcome 5 3 1 Action C Event Node Chapter 3: Quantitatve Methods in Health Care Management Outcome 8 Outcome 3 2 3 Yasar A. Ozcan Outcome 6 Outcome 9 24

Figure 3. 1 Decision Tree -$15* =. 2 s, p ase C 500 750 Figure 3. 1 Decision Tree -$15* =. 2 s, p ase C 500 750 Cases, p=. 6 $200 100 0 C ase s, p =. 2 Bu y O ne M R IU ni t $300 500 -$150 =. 2 s, p se Ca 750 Cases, p=. 6 Buy Two MRI Units 100 0 C ase s, p $100 =. 2 $725 Ou tso ur ce $15 . 2 500 = s, p ase C 750 Cases, p=. 6 * in $000 Chapter 3: Quantitatve Methods in Health Care Management $22. 5 100 0 C ase s, p =. 2 $40 Yasar A. Ozcan 25

Analysis of the Decision Tree: Rollback Procedure -$15* =. 2 s, p ase C Analysis of the Decision Tree: Rollback Procedure -$15* =. 2 s, p ase C 500 177 750 Cases, p=. 6 $200 100 0 C ase s, p =. 2 Bu y O ne M R IU ni t $300 500 750 Cases, p=. 6 Buy Two MRI Units ║ 177 ║ -$150 =. 2 s, p se Ca 175 100 0 C ase s, p $100 =. 2 $725 Ou tso ur ce $15 . 2 500 = s, p ase C 750 Cases, p=. 6 * in $000 Chapter 3: Quantitatve Methods in Health Care Management 24. 5 $22. 5 100 0 C ase s, p =. 2 $40 Yasar A. Ozcan 26

Multi-attribute Decisions ó ó Dominance Procedure: compares a pair of alternatives attribute by attribute. Multi-attribute Decisions ó ó Dominance Procedure: compares a pair of alternatives attribute by attribute. Minimum Attribute Satisfaction Procedure: satisfactory levels are set for each alternative Most Important Attribute Procedure: attributes are ranked in order of importance Combination: combines two or more of the above procedures. Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 27

Decision Analysis with Non-Monetary Values and Multiple Attributes*  Alternative Cardinal Mc. Kesson Owens Decision Analysis with Non-Monetary Values and Multiple Attributes* Alternative Cardinal Mc. Kesson Owens & Minor Importance Ranking Minimum Acceptable Level Availability 7 7 7 1 >= 7 Reliability of IT Technology 7 5 7 2 >= 6 Quality of Products 8 9 8 3 >= 7 23, 749 24, 195 23, 688 5 <=25, 000 97% 95% 97% 4 >=95% Cost in $000 per year On Time Delivery *Attributes are scored on a 1 -10 scale (with the exception of those associated with costs and on-time-delivery percentage), score of 10 being most favorable. Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 28

The End Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 29 The End Chapter 3: Quantitatve Methods in Health Care Management Yasar A. Ozcan 29