Unit 2 Discussion
This Discussion is based on the article, “The Hidden Traps in Decision Making” by Hammond, Keeney, and Riaffa from Harvard Business Review, which can be found in your coursepack. Make sure to read this article before starting the Discussion.
Learning how to perform analytics is only step one in the road to making correct decisions. There are many traps along the way that may lead you down the wrong path, even if you know which analytical methodology you need to use. In this article, the authors describe various psychological traps that you may encounter. You will focus on seven: Anchoring, status quo, confirming evidence, framing, overconfidence and prudence, recallability. Please note that sunk cost trap is not included.
For this Discussion, select one of the seven traps listed above. Then, do the following:
- From your professional experience, provide a real, specific example where you believe decision makers (you or other managers) encountered the trap.
- Explain why you think your example fits the trap you selected. Remember, there are many bad decisions that are not the result of a decision trap. Does your example have the characteristics of the decision trap you selected?
- Provide specific recommendations to your organization to identify and prevent the trap in the future.
In your replies to fellow classmates, look for similarities to your organization. If you have experienced similar events, comment on how your organization handled the situation.
Please use the format below for your answers so everyone can easily follow your answers to all the questions (copy and paste to your post; using the template below is part of the requirements).
What happened: First, describe the event/situation.
Why it fits this trap: Explain why you think this situation fits the trap definition.
Recommendations: Describe how the situation can be identified in the future or what your organization should do to prevent it from happening again.
STUDENT #1 RESPONSE TO ORIGINAL QUESTION
Trap name: The Recallability Trap
One of the major components of my position, and the area that takes up most of my time, is managing the surgical supplies for the Mosaic Life Care OR suites and Labor and Delivery Unit. All of these items are set up and maintained on a par level, or a min/max amount on hand. Because the supplies for OR are so expensive, and because they do not have a long shelf life, we try to keep the minimum amount necessary on hand. This is the gray area where you need years of experience and a bit of luck on your side.
When the par levels are set for these items, we have to consider the following:
- How long it takes for the item to ship once an order is placed
- Item cost
- Shipping costs (standard and expedited)
- Item shelf life/expiration date
- Unit of measure – each/box/case (we may only want to keep 2 ea on hand, but we are required to order a box of 10)
Earlier this year, our OR saw a spree of AAA’s (Abdominal Aortic Aneurism). This is usually something that we see once a week, sometimes not even then. However, on one particular day several months ago, we saw 4 in one day. This procedure requires a huge amount of supplies and specialty items. So accommodating these 4 cases took absolutely everything we had available on the shelf in the storeroom. The following day, there was to be an AAA case that had been previously scheduled which we now had no specialty supplies for.
We had no choice in this situation but to order all of the necessary supplies with First AM Overnight shipping. The cost of this was astronomical, but because we try to keep as little as possible inventory on the shelf in an effort to avoid expirations we had no choice. As a result of this shortage, we now keep an overabundance of these supplies on hand just in case we have the same misfortune as we did that day. Unfortunately, this also means that we regularly expire some of these high value items. These items literally go straight into the garbage if they are not used in time and some of them are valued at over $1,200 apiece.
Why it fits this trap:
According to the article, “Because we frequently base our predictions about future events on our memory of past events, we can be overly influenced by dramatic events…”. This dramatic event has distorted our thinking. We now over-order items based on a freak event. As a result, our budget suffers and product is wasted.
The nature of the beast in the OR is unpredictability. There is absolutely no way to forecast what will walk through the door on any particular day. We can only prepare ourselves as best as we can based on previous experience, statistical information, and previously gathered analytical data. We still strive to keep assumed costs to a minimum while also keeping out patients needs the top priority. We have to walk a fine line between what amount on hand is safe and provides a cushion, and what amount on hand is too much and wasteful.
STUDENT #2 REPLY TO ORIGINAL QUESTION
Trap Name: Anchoring Trap
What Happened: First, describe the event/situation
At ECU Physicians, a 61-year-old man with a history of stroke presented himself to his primary care physician (PCP) complaining of burning pain and numbness in his left foot for one month. The PCP performed an exam that noted loss of sensation to his knee and a foot drop secondary to his prior stroke, but his pulses were intact with no other abnormalities noted. The PCP referred the patient to a podiatrist after attributing the patient’s pain and numbness to a peripheral neuropathy.
The patient presented himself four more times to his PCP and twice to urgent care with the same complaints of left foot pain. Each time he was referred to a podiatrist, but never went. During these visits, a complete extremity exam was not performed or documented, and the complaint was repeatedly attributed to his prior diagnosis of peripheral neuropathy.
After multiple visits to his PCP and urgent care over a two-month period, the patient presented himself to the Vidant Hospital emergency department with worsening conditions. The emergency department physician performed an exam on this left lower leg which was dusky in color with extreme tenderness to palpation and his pulses could not be palpated. A computed tomography angiogram revealed complete occlusion of the left superficial femoral artery secondary to atherosclerotic peripheral arterial disease. The patient required emergency vascular surgery of the left leg. Unfortunately, due to the lack of blood flow from the arterial disease of his left leg, he developed multiple infections postoperatively and ultimately required an above-the-knee amputation.
Why it fits this trap: Explain why you think this situation fits the trap definition
Anchoring appears to have been particularly strong in this case, where the patient presented himself six times over two months with worsening symptoms, yet the diagnostic impression did not change and the management plan was simply repeated.
In this case, my recommendation would have been to launch an exploration of other possibilities for the patient’s progressive severe unilateral foot pain such as vascular insufficiency, arthritis, or mononeuropathy.
To reduce anchoring decisions in the future, I would recommend that ECU Physicians implement and use a system-based intervention including structured diagnostic assessments, diagnostic decision support, or computerized expert diagnostic systems. I would also explicitly consider prior probabilities, sensitivity, and specificity of diagnostic tests and maneuvers when diagnosing common clinical conditions. Another recommendation would be to frame clinicians’ diagnostic thinking to avoid premature diagnostic labeling and share uncertainty.