Adaptive decision-making: how Australian healthcare managers decide

作者：Baghbanian Abdolvahab^*; Hughes Ian; Kebriaei Ali; Khavarpour Freidoon A

来源：Australian Health Review, 2012, 36(1): 49-56.

DOI：10.1071/AH10971

• economic evaluation
• evidence-based decision-making
• health (care) system
• resource allocation

Despite many calls for the utilisation of research evidence in health policy-making, it is not widely practised, and little is known about how decision-makers in healthcare organisations actually make decisions. We recruited a purposive sample of Australian healthcare decision-makers to complete a web-based survey. We then took a sub-sample from willing respondents for individual interviews. All interviews were audio-recorded, transcribed verbatim and coded thematically. We found that resource allocation decision-making varied greatly across the Australian healthcare system. Decision-making was highly dependent on the operational context in time, place and purpose, and that research evidence was rarely exploited to its full potential. Decision-making involved a multifaceted interplay of elements in situation of inquiry. All decisions were made by networks or collectives of people; and no instance of individual decision-making was reported. This varied, social and contextual nature of decision-making points to a complexity that is not reflected in systematic evidence-based reviews or evidence-based models for decision-making, and we did not discover an appropriate model to reflect this complexity in the health-related literature. We developed a model of 'adaptive decision-making' that has potential to guide robust decision-making in complex situations, and could have some value as an explanatory or theoretical model for teaching and practice.

• 出版日期2012