Team-base Decision

Description

A team-based decision is a specialization of a multi-perspective decision. It involves multiple agents making the same decision, using individual -- but possibly overlapping – decision criteria, decision logic, and knowledge sources. Eventually, consensus must be reached, and possible conflict must be resolved before a final determination can be made.

Problem

Complex decisions often involve reaching consensus among decision-makers who bring different perspectives to the same decision. In healthcare, many decisions are made collaboratively.

For example, determining the best treatment approach for a patient may require the input of experts from multiple disciplines. In cancer care, tumor boards may be convened to determine the best therapy for a patient. The board could include a radiation oncologist, a medical oncologist, and a surgeon as well as other specialists. Each agent takes into account the patient data for the case and the published evidence, but each brings different experience and tacit knowledge to the decision. The ultimate decision is made by consensus.

Another example of the team-based decision in healthcare is shared decision-making. Shared decision-making plays an important role in patient engagement. Patients who participate in decision-making are more likely to be compliant with the selected therapy. Patients and clinicians consider treatment options using multiple criteria that are ranked based on patient preference.

Applicability

This pattern applies under the following conditions:

·       There are two or more distinct decision-makers trying to make the same decision in consultation with one another;

·       All decision-makers have access to a common set of information. In addition, each decision-maker may have access to unique information and use unique decision logic; and

·       The decision is reached collaboratively. There is only one conclusion.

Pattern

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Figure 1 – DMN – Team-based decision pattern

Create two or more decision elements with the same questions and answers, one from the perspective of each decision-maker. The decisions share common data inputs and knowledge sources, but each decision may have additional inputs unique to that decision. Each decision-maker has unique decision logic, reflecting the different individualities.

Consider the individual knowledge sources that each decision-maker might require in making the decisions. If there are data inputs that not available to all decision-makers, model those data inputs separately.

In DMN, closed loops are not supported. A closed-loop system can either converge (reach consensus), oscillate indefinitely (each agent remains on their own position), or diverge (the team members part way) and cannot be modelled. To produce a valid DMN model, the loop should be replaced by an aggregating Decision, based on the same shared question/answer. This approach effectively replaces the need to reach consensus by calling out an explicit "referee."

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Figure 2 – Team-based decision Generic Example

Specific Example

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Figure 3 – Team-based decision specific example 

In this example, an oncologist and a surgeon work together to reach consensus on the best treatment approach for a patient. Each makes a decision based on shared patient information, using different criteria and under the authority of different knowledge resources. They confer and reach consensus on optimal approach based on the individual perspectives.

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