Stakeholder Consultation as Social Mobilization: Framing Scottish Mental Health Policy

Public and stakeholder consultation is increasingly important in the policy process, both in the UK and elsewhere. Social scientists have considered consultation primarily in terms of how it relates to decision‐making – either as a means of involving a wider constituency of actors in the decision‐making process, or as a means of legitimizing the decisions taken by policymakers. This article shows that consultation can also serve a rather different role in relation to policy: as, in effect, the first stage in policy implementation. Based on direct observation of a stakeholder consultation on Scottish mental health policy that took place during late 2007 and early 2008, it draws on elements of social movement theory to show how that consultation served as a means of enrolling, orienting and mobilizing stakeholders to implement a largely pre‐existing set of policy aims.     

Beyond Condorcet: optimal aggregation rules using voting records

In certain judgmental situations where a “correct” decision is presumed to exist, optimal decision making requires evaluation of the decision-makers’ capabilities and the selection of the appropriate aggregation rule. The major and so far unresolved difficulty is the former necessity. This article presents the optimal aggregation rule that simultaneously satisfies these two interdependent necessary requirements. In our setting, some record of the voters’ past decisions is available, but the correct decisions are not known. We observe that any arbitrary evaluation of the decision-makers’ capabilities as probabilities yields some optimal aggregation rule that, in turn, yields a maximum-likelihood estimation of decisional skills. Thus, a skill-evaluation equilibrium can be defined as an evaluation of decisional skills that yields itself as a maximum-likelihood estimation of decisional skills. We show that such equilibrium exists and offer a procedure for finding one. The obtained equilibrium is locally optimal and is shown empirically to generally be globally optimal in terms of the correctness of the resulting collective decisions. Interestingly, under minimally competent (almost symmetric) skill distributions that allow unskilled decision makers, the optimal rule considerably outperforms the common simple majority rule (SMR). Furthermore, a sufficient record of past decisions ensures that the collective probability of making a correct decision converges to 1, as opposed to accuracy of about 0.7 under SMR. Our proposed optimal voting procedure relaxes the fundamental (and sometimes unrealistic) assumptions in Condorcet’s celebrated theorem and its extensions, such as sufficiently high decision-making quality, skill homogeneity or existence of a sufficiently large group of decision makers.     

Taste uncertainty and status quo effects in consumer choice

We use reference-dependent expected utility theory to develop a model of status quo effects in consumer choice. We hypothesise that, when making their decisions, individuals are uncertain about the utility that will be yielded by their consumption experiences in different ‘taste states’ of the world. If individuals have asymmetric attitudes to gains and losses of utility, the model entails acyclic reference-dependent preferences over consumption bundles. The model explains why status quo effects may vary substantially from one decision context to another and why some such effects may decay as individuals gain market experience.     

Failures of the reduction principle in an Ellsberg-type problem

Segal (1987) suggested that the Ellsberg paradox might be explained in terms of individuals mentally representing the decision problem as a two-stage lottery which they evaluated according to a non-expected utility model. This paper describes an experiment involving an explicitly two-stage analogue to an Ellsberg-type problem. This design substantially reduces the frequency of classic Ellsberg behaviour, but reveals other systematic violations of conventional theory. The paper discusses the particular patterns of choice and raises the more general problem of modelling individual decisions when the reduction principle does not hold.     

Decision‐making in child welfare services: Professional discretion versus standardized templates

The article explores differences in the assessment and decision‐making processes, in child welfare services where a standardized template is implemented and in services where it is not. Child welfare services in several countries use different approaches to assess children's and families' need for intervention. In Norway, as in other European countries, there is a shortage of knowledge about decision‐making strategies. The article examines how 36 child welfare caseworkers in 6 different teams in Norway investigate, assess, and make decisions at the phase of an incoming referral. The analysed data were collected by focus group interviews. We use decision theory as a theoretical frame of reference. The analysis shows variation in the assessment procedure at different points of the process, depending on which approach was used. Despite such differences, the final decisions made were almost identical. Even though the data has its limitations because of the small number of informants, the results indicate that choice of approach is not decisive for decision‐making in the child welfare services.     

The implications of irreversibility in emergency response decisions

The irreversibility effect implies that a decision maker who neglects the prospect of receiving more complete information at later stages of a sequential decision problem will in certain cases too easily take an irreversible decision, as he ignores the existence of a positive option value in favour of reversible decisions. This option value represents the decision maker's flexibility to adapt subsequent decisions to the obtained information. In this paper we show that the economic models dealing with irreversibility as used in environmental and capital investment decision making can be extended to emergency response decisions that produce important irreversible effects. In particular, we concentrate on the decision whether or not to evacuate an industrial area threatened by a possible nuclear accident. We show in a simple two-period evacuation decision model that non-optimal conclusions may be drawn when evacuation is regarded as a `now or never decision'. The robustness of these results is verified by means of a sensitivity analysis of the various model parameters. The importance of `options thinking' in this decision context is illustrated in an example.     

Decision,irreversibility and flexibility: The irreversibility effect re-examined

In a seminal article C. Henry (1974) presented the irreversibility effect, which pointed out that under uncertainty, the optimal sequence of decisions depends on not only the payoffs, but also the flexibility, in terms of availability of future options, associated with each decision. But the irreversibility effect pertained to certain particular conditions and definitions. In this paper, a more general model is developed to re-examine the notion of an irreversible decision, its relation with flexibility and the irreversibility effect. It is shown through two propositions that the irreversibility effect need not hold always and the notion of irreversibiity can be used only under certain circumstances to derive the optimal sequence of decisions ex-ante.     

Multiple-Stage Decision-Making: The Effect of Planning Horizon Length on Dynamic Consistency

Many decisions involve multiple stages of choices and events, and these decisions can be represented graphically as decision trees. Optimal decision strategies for decision trees are commonly determined by a backward induction analysis that demands adherence to three fundamental consistency principles: dynamic, consequential, and strategic. Previous research (Busemeyer et al. 2000, J. Exp. Psychol. Gen. 129, 530) found that decision-makers tend to exhibit violations of dynamic and strategic consistency at rates significantly higher than choice inconsistency across various levels of potential reward. The current research extends these findings under new conditions; specifically, it explores the extent to which these principles are violated as a function of the planning horizon length of the decision tree. Results from two experiments suggest that dynamic inconsistency increases as tree length increases; these results are explained within a dynamic approach–avoidance framework. This revised version was published online in June 2006 with corrections to the Cover Date.     

Decision Making in Three Modes

This paper presents an integrative framework for analyzing decisions. Three generic modes of decision making are identified: consequential choice (comparing alternatives in terms of expected consequences), matching (evaluating single options in terms of a certain criterion) and reassessment (re-evaluating an action to which one is already committed). The three generic modes are compared on a common set of attributes, and the conditions for their proper use are outlined. Two case analyses illustrate how the framework can be used to analyze specific decisions from multiple perspectives.     

Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?

This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic ‘interference’ in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions (‘the benefits package’), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision‐making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.     

Nonlinear social welfare functions

It is argued that Bayesian decision theory is a solution of an important philosophical problem, viz. the problem of how to define rational behavior under risk and uncertainty. The author has shown in earlier papers that if we take the Bayesian rationality postulates seriously, and take an individualistic point of view about social welfare, then our social welfare function must be a linear function of individual utilities: indeed, it must be their arithmetic mean. The present paper criticizes Diamond's and Sen's contention that one of the Bayesian postulates (viz. the sure-thing principle) does not apply to social decisions, even though it may apply to individual decisions. It also criticizes Sen's proposal of making social welfare a nonlinear function of individual utilities. The social welfare function proposed by the author depends on interpersonal utility comparisons. The use of such comparisons is defended. It is also argued that anybody who feels that the utilitarian (i.e., linear) form of the social welfare function is not egalitarian enough, should reject the author's individualism axiom, instead of trying to reject the Bayesian rationality axioms. However, this would be equivalent to giving egalitarian considerations a priority in many cases over humanitarian considerations. Finally, the paper discusses the reasons why even full agreement on the mathematical form of the social welfare function would not give rise to a Utopian state of moral consensus: moral controversies arising from disagreements about what predictions to make about future empirical facts would still remain.     

Status quo bias in decision making

Most real decisions, unlike those of economics texts, have a status quo alternative—that is, doing nothing or maintaining one's current or previous decision. A series of decision-making experiments shows that individuals disproportionately stick with the status quo. Data on the selections of health plans and retirement programs by faculty members reveal that the status quo bias is substantial in important real decisions. Economics, psychology, and decision theory provide possible explanations for this bias. Applications are discussed ranging from marketing techniques, to industrial organization, to the advance of science.     

Judges' Race and Judicial Decision Making: Do Black Judges Sentence Differently?

Objective. This study examines the effects of race of judge on sentencing decisions. Do black judges sentence offenders more severely/leniently than white judges, and do they use similar/different criteria in their decision making? Methods. Data are derived from two sources: (1) sentencing outcomes in Pennsylvania from 1991 to 1994 and (2) archival data on judge characteristics, such as race and time on the bench. Logit models were used to assess the effects of judges' race on the in/out or incarcerative decision, and ordinary least squares models were used to assess the effects on the length‐of‐term decision. Results. Results showed that black and white judges weighted case and offender information in similar ways when making punishment decisions, although black judges were more likely to sentence both black and white offenders to prison. Conclusions. The greater harshness of black judges suggests they may behave as “tokens” or that they have greater sensitivity to the costs of crime, in particular, within black communities. Although there were small race‐of‐judge effects, there also was much similarity in sentencing practices—suggesting that the job, not so much the individual, apparently makes the “judge.”     

Verbal and Behavioral Learning in a Probability Compounding Task

The conjunction fallacy occurs whenever probability compounds are thought of as more likely than its component probabilities alone. In the experiment we present, subjects chose between simple and compound lotteries after some practice. Depending on the condition, they were given more or less information about the nature of probability compounds. The conjunction fallacy was surprisingly robust. There was, however, a puzzling dissociation between verbal and behavioral learning: verbal responses were sensitive, but actual choices entirely insensitive, to the amount of verbal instructions being provided. This might reflect a dichotomy between implicit and explicit learning. Caution must be exercised in generalizing results from what people say to what people do.     

Health Policy and the Politics of Evidence

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence‐based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre‐eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision‐making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision‐making.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.