Group items tagged

A regional map, reproduced here (Exhibit 1), highlighted confusion over accountability between the company’s headquarters and a country office in the same region. T

Another map showed how the manufacturer’s supply chain employees were struggling with duplication that stemmed from confusing sales forecasting and from ordering processes that required decisions to pass through multiple loops (including time-consuming iterations with regional offices) prior to approval.

Of course, managers must be mindful that not all complexity is equally manageable, and proceed accordingly (Exhibit 2). Exhibit 2: Types of complexity Imposed complexity includes laws, industry regulations, and interventions by nongovernmental organizations. It is not typically manageable by companies. Inherent complexity is intrinsic to the business, and can only be jettisoned by exiting a portion of the business. Designed complexity results from choices about where the business operates, what it sells, to whom, and how. Companies can remove it, but this could mean simplifying valuable wrinkles in their business model. Unnecessary complexity arises from growing misalignment between the needs of the organization and the processes supporting it. It is easily managed once identified.

Whenever companies tackle complexity, they will ultimately find some individuals who seem less troubled by it than others. This is not surprising. People are different: some freeze like deer in the headlights in the face of ambiguity, uncertainty, complex roles, and unclear accountabilities; others are able to get their work done regardless.

This process can be very human-centered, as in a journal club, or highly technical, using computer programs and information techniques such as data mining.

Level III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Despite the differences between systems, the purposes are the same: to guide users of clinical research information about which studies are likely to be most valid. However, the individual studies still require careful critical appraisal.

The U.S. Preventive Services Task Force uses:[9] Level A: Good scientific evidence suggests that the benefits of the clinical service substantially outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level B: At least fair scientific evidence suggests that the benefits of the clinical service outweighs the potential risks. Clinicians should discuss the service with eligible patients. Level C: At least fair scientific evidence suggests that there are benefits provided by the clinical service, but the balance between benefits and risks are too close for making general recommendations. Clinicians need not offer it unless there are individual considerations. Level D: At least fair scientific evidence suggests that the risks of the clinical service outweighs potential benefits. Clinicians should not routinely offer the service to asymptomatic patients. Level I: Scientific evidence is lacking, of poor quality, or conflicting, such that the risk versus benefit balance cannot be assessed. Clinicians should help patients understand the uncertainty surrounding the clinical service.

AUC-ROC The area under the receiver operating characteristic curve (AUC-ROC) reflects the relationship between sensitivity and specificity for a given test. High-quality tests will have an AUC-ROC approaching 1, and high-quality publications about clinical tests will provide information about the AUC-ROC. Cutoff values for positive and negative tests can influence specificity and sensitivity, but they do not affect AUC-ROC.