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The Quarterly 2011

Dear Editor,

I read with interest the article titled "Enhancing our clinical and managerial competency" by Dwyer. The article was published in the September 2010 edition of The Quarterly1.

Decision-making is the cognitive process of identifying problems and opportunities, and selecting a course of action from several alternatives2. The rational decision-making model describes how individuals should make decisions to maximise the decision outcome3. However, this approach to decision-making is based on a number of assumptions. These include problem clarity, known options and the absence of time constraints4.

In a hospital setting, many decisions are made under time pressure and in situations that are perceived as being stressful. In these circumstances, the decision-making process often deviates from the rational model and is associated with:

• the potential to disregard important information5;
• decreased effort in identifying and evaluating decision alternative6;
• increased risk-taking7;
• the use of intuition, satisficing and heuristics8.

This departure from the rational decision-making model can have a negative impact on decision quality and patient outcomes8, 9. Accordingly, there is a need to improve the quality of decision-making by clinicians. One of the most effective ways to improve the quality of decision-making is by reflecting on the outcomes of past decisions through a peer review process10. Peer review encourages individuals to consider the process they used to reach a particular decision and enables participants to learn from the experiences of their colleagues. Furthermore, peer review can be effective in guarding against overconfidence by allowing doctors to reflect on any errors that were made and to develop a better understanding of their strengths and weaknesses11.

As is the case with clinicians directly involved in patient care, medical administrators are called upon to make decisions under various constraints. However, because medical administrators often work in isolation, there are limited opportunities for us to reflect on past decisions in conjunction with our peers and to learn from their experiences. This has the potential to compromise the quality of our decision-making.

Accordingly, there is a need to establish a formal peer review mechanism for medical administrators in each RACMA jurisdiction. The process would seek to review the outcomes of past decisions in a confidential environment, and to reflect on the decision-making processes that led to those outcomes. In this way, we can learn from each other and enhance our performance by improving the quality of our decision-making.

Dr Daniel Heredia
RACMA Candidate

1 Dwyer, Alison, "Enhancing our clinical and managerial competency", The Quarterly, vol 43, September 2010 http://www.racma.edu.au/index.php?option=com_content&task=view&id=499&Itemid=523
2 Samson, D & Daft, R 2003, Management, Thompson, Southbank.
3 Buchanan, L & O’Connell, A 2006, 'A brief history of decision making', Harvard Business Review, vol. 84, no. 1, pp. 32-41.
4 Davis, J & Devinney, T 1997, The Essence of Corporate Strategy, Allen and Unwin, Sydney.
5 Yoo, S, Rothrock, L & Park, S 2008, 'Human Decision Process toward AHP Under Time-pressed Multicriteria Decision Problem', International Industrial Engineers Annual Conference Proceedings, pp. 1214-1219. Available from: Proquest. [18 June 2011].
6 Meyer, ME, Sonoda, KT & Gudykunst, WB 1997, 'The effect of time pressure and type of information on decision quality', The Southern Communication Journal, vol. 62. no. 4, pp. 280-292. Available from: Proquest. [19 June 2011].
7 Johnson, J & Bruce, A 2008. Decisions: Risk and Reward. Routledge, Oxon.
8 Cohen, I 2008, 'Improving Time-Critical Decision Making in Life-Threatening Situations: Observations and Insights', Decision Analysis, vol. 5, no. 2, pp. 100-110. Available from: Proquest. [18 June 2011].
9 Maule, AJ, Hockey, GR & Bdzola, LL 2000, 'Effects of time-pressure on decision-making under uncertainty: changes in affective state and information processing strategy', Acta Psychologica, vol. 104, no. 3, pp. 283-301. Available from: Science Direct. [18 June 2011].
10 Croskerry, P & Norman, G 2008, 'Overconfidence in Clinical Decision Making', The American Journal of Medicine, vol. 121, no. 5A, pp. S24-S29. Available from: Science Direct. [19 June 2011].
11 Berner, ES & Graber, ML 2008, 'Overconfidence as a Cause of Diagnostic Errors in Medicine', The American Journal of Medicine, vol. 121, no. 5A, pp. 2-23. Available from: Science Direct. [18 June 2011].

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