Decision Making Decision-Making Scenario Anderson Children\'s Hospital

Decision Making

Decision-making

Scenario

Anderson Children's Hospital (ACH) is an internationally known and recognized pediatric hospital that provides the full range of services from primary to critical care units, located in San Francisco, CA with affiliated care centers throughout the Bay Area. The board of directors at ACH would like to create a mobile-crisis program to be piloted in the City of San Francisco and eventually grow to service the entire Bay Area. The following sections present the process through which the Board of Directors is trying to navigate towards its final decision.

Core question

At the core of the following proposal is this 2-part question: Should ACH create a mobile crisis program to be piloted in the City of San Francisco for (up to) one year with the intent of expanding its funding, personnel, and service area over the next 3-5 years throughout the entire Bay Area and if so, what does the process look like?

Within this core question arise several questions to be addressed by the decision-making process, and those questions are listed as follows:

(1) What services will be offered by this program? Who will benefit from its services? Who will be involved with the provision of these services?

(2) Who will be in charge?

(3) What are the risks of these services? Who is liable should such risks be realized? What risk management procedures will be employed?

(4) How much funding is necessary for up to one year of a pilot program? (a) How many personnel and what levels of credentials are necessary for those implementing the program? (b) What resources are needed to ensure that personnel are more than prepared for any situation and what are the proposed hours of operation?

(5) How will contracts be created to incorporate this role into the existing contractual agreements for personnel? Or should entirely separate contracts be designed?

(6) What are the regular intervals for evaluation of the program up to one year? What is the plan for expansion if the program far exceeds expectations? What is the plan if the program becomes unmanageable before one year?

Proposal

We, the Board of Directors of Anderson Children's Hospital, propose the creation of a mobile crisis program in collaboration with local psychiatric professionals and SFPD/SFFD, and the Mayor's office, through which crisis-intervention and wraparound services will be provided in the City of San Francisco for up to one year with the intent of slowly expanding the program throughout the Bay Area in collaboration with ACH affiliated offices and other local PD/FD. Should the program exceed all expectations, the expansion process will begin early. Periodic evaluation will take place in the year period and a plan will be in place to cut the program should it become unmanageable (as determined by measurable criteria) before the one-year period.

Section II: Decision making

Roles and strategy

The intent of the mobile-crisis program is to enhance the level of crisis-intervention and ongoing wraparound services for the entire San Francisco community and hopefully decrease the amount of emergencies and injuries caused by emergencies by intervening at moments in which a crisis can be de-escalated. These services are intended for situations that involve one or any number of minors. Services will be rendered in teams with the following personnel on each team: One psychological professional with required credentials; One allied health professional with required credentials; One SFPD officer; One driver trained in crisis management/intervention procedures. Teams will be equipped with the resources necessary to deal with any and all circumstances in the field as well as radio connection with SFFD to request fire/paramedic services directly. Personnel on each team will be rigorously trained and vetted to ensure their safety and the safety of individuals and families they encounter on the job.

Statistical & probability analysis

Using Bayesian methods in the calculation of point estimates and Poisson Distribution, the Board of Directors and the team they create to work on this decision-making process, ran through every imaginable scenario for which this program could be useful and; thus, develop training curriculum, necessary credentials for dealing with such scenarios, job descriptions for hiring personnel, criteria for contractual agreements with personnel, evaluation strategies for both measurable and seemingly immeasurable outcomes, and risk management strategies.

Liese and Miescke (2008) suggest that the use of probability density functions can account for multiple point estimates and use statistical inference to assess the probability that a hypothesis may in fact be true. This process required the Board and their team to do rigorous research to generate observed evidence for the actual calculations. The following formulas were/are applied in the decision making process and will continue to be applied in the evaluation strategies to ensure constant improvement is occurring and risk management strategies are being applied: P (E) = sum P (E|H_i)P (H_i) and P (H|E) = frac{P (E|H);P (H)}{P (E)} (Bernardo & Smith, 2000). The Poisson distribution is applied as a more discrete probability distribution that is focused less on the nature of the team and the work and more focused on the services rendered and its impact on the larger community. It will also be used to assess probability analysis as these services are to be spread to more locations throughout the Bay Area. The following formula is applied as replicated from Ahrens & Dieter (1982): f (k, lambda)=frac{lambda^k e^{-lambda}}{k!}.

Statistical and probability analysis is necessary because of the nature of the work that the program is created for and the inherent risks it involves as well as the massive amount of both human and physical resources it will require. ACH has determined to create the program but needs to ensure its success with physical evidence to get the SFPD and Mayor's office on board as well as to receive major funding for personnel and resources. The program will also need to be marketed to the larger community and accessibility options will need to be clear and easy.