DECISION-MAKING IN HIGH DEPENDENCY ENVIRONMENTS - CAN WE LEARN FROM MODERN INDUSTRIAL-MANAGEMENT MODELS

Increasing complexity and increased restraints affect the task of pati ent management in High Dependency Environments, which has become intri cate and difficult. Medical knowledge alone is not enough any longer f or proper patient care. Management ability and facilities are required . Current medical knowledge;should be expanded by management methods a nd techniques. By looking at management models in the industry, we fou nd striking similarities between the industrial management situation a nd clinical patient management. Both systems share complexity in struc ture, complexity in interaction and evolutionary character. Clinical p atient management can be compared with a navigation process. The patie nt is steered by a control system, and course information is given by control dimensions. Clinical patient management becomes a succession o f steering activities influenced by the surrounding systems. This syst em can be structured in three interacting layers: an operational level , in which information is collected and actions executed; a strategic level in which strategies based on goal-oriented mental anticipation o f a probabilistic system are formulated; and a normative level at whic h principles and norms are defined. It is possible then, to define the tools which have to be developed and implemented to improve clinical management capabilities. At the operational level these tools are addr essed to improve clinical decision making by providing information in an ergonomical way. They include artifact elimination, data reduction, increase in meaningful information and unwanted data filtering. At th e strategic level, tools to check the feasibility of the applied strat egies have to be developed, such as: ideal patient course plots and in creased training in strategic thinking. At the normative level, strate gic management capabilities can be improved by compiling, processing a nd providing clinical context sensitive norms, to set up boundaries fo r strategies formulation.