Improving Risk Management: From Lame Excuses to Principled Practice

The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame‐shifting “lame excuses” for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning—especially from near‐misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk‐reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management.     

Why Frequency is Not Well Defined for Engineering Systems with Nonexponential Failure Times

Dr. Yellman proposes to define frequency as “a time‐rate of events of a specified type over a particular time interval.” We review why no definition of frequency, including this one, can satisfy both of two conditions: (1) the definition should agree with the ordinary meaning of frequency, such as that less frequent events are less likely to occur than more frequent events, over any particular time interval for which the frequencies of both are defined; and (2) the definition should be applicable not only to exponentially distributed times between (or until) events, but also to some nonexponential (e.g., uniformly distributed) times. We make the simple point that no definition can satisfy (1) and (2) by showing that any definition that determines which of any two uniformly distributed times has the higher “frequency” (or that determines that they have the same “frequency,” if neither is higher) must assign a higher frequency number to the distribution with the lower probability of occurrence over some time intervals. Dr. Yellman's proposed phrase, “time‐rate of events … over a particular time interval” is profoundly ambiguous in such cases, as the instantaneous failure rates vary over an infinitely wide range (e.g., from one to infinity), making it unclear which value is denoted by the phrase “time‐rate of events.”     

Community Resilience and Decision Theory Challenges for Catastrophic Events

Extreme and catastrophic events pose challenges for normative models of risk management decision making. They invite development of new methods and principles to complement existing normative decision and risk analysis. Because such events are rare, it is difficult to learn about them from experience. They can prompt both too little concern before the fact, and too much after. Emotionally charged and vivid outcomes promote probability neglect and distort risk perceptions. Aversion to acting on uncertain probabilities saps precautionary action; moral hazard distorts incentives to take care; imperfect learning and social adaptation (e.g., herd‐following, group‐think) complicate forecasting and coordination of individual behaviors and undermine prediction, preparation, and insurance of catastrophic events. Such difficulties raise substantial challenges for normative decision theories prescribing how catastrophe risks should be managed. This article summarizes challenges for catastrophic hazards with uncertain or unpredictable frequencies and severities, hard‐to‐envision and incompletely described decision alternatives and consequences, and individual responses that influence each other. Conceptual models and examples clarify where and why new methods are needed to complement traditional normative decision theories for individuals and groups. For example, prospective and retrospective preferences for risk management alternatives may conflict; procedures for combining individual beliefs or preferences can produce collective decisions that no one favors; and individual choices or behaviors in preparing for possible disasters may have no equilibrium. Recent ideas for building “disaster‐resilient” communities can complement traditional normative decision theories, helping to meet the practical need for better ways to manage risks of extreme and catastrophic events.     

Barriers to Managing Coronary Artery Disease Among Older Women

Numerous barriers to managing coronary artery disease (CAD) among older women are reported in the literature; however, few studies adjust for demographic and health status differences. A survey assessing barriers and other factors was distributed to a stratified random sampling of older women with CAD. Factor analysis and multiple logistic regression procedures were used to estimate the impact of these issues on receiving a CAD-related office visit. The most problematic barriers included denial and low health literacy. Efforts to promote patient awareness of heart health and better communication between patients and clinicians may alleviate these barriers.     

Bayesian Classifiers Applied to the Tennessee Eastman Process

Fault diagnosis includes the main task of classification. Bayesian networks (BNs) present several advantages in the classification task, and previous works have suggested their use as classifiers. Because a classifier is often only one part of a larger decision process, this article proposes, for industrial process diagnosis, the use of a Bayesian method called dynamic Markov blanket classifier that has as its main goal the induction of accurate Bayesian classifiers having dependable probability estimates and revealing actual relationships among the most relevant variables. In addition, a new method, named variable ordering multiple offspring sampling capable of inducing a BN to be used as a classifier, is presented. The performance of these methods is assessed on the data of a benchmark problem known as the Tennessee Eastman process. The obtained results are compared with naive Bayes and tree augmented network classifiers, and confirm that both proposed algorithms can provide good classification accuracies as well as knowledge about relevant variables.     

Blood Transfusion in Room 223

How educators handle conflicting views of Populism is important in engaging students in critical thinking.     

Human Health Risk Assessment of Penicillin/Aminopenicillin Resistance in Enterococci Due to Penicillin Use in Food Animals

Penicillin and ampicillin drugs are approved for use in food animals in the United States to treat, control, and prevent diseases, and penicillin is approved for use to improve growth rates in pigs and poultry. This article considers the possibility that such uses might increase the incidence of ampicillin-resistant Enterococcus faecium (AREF) of animal origin in human infections, leading to increased hospitalization and mortality due to reduced response to ampicillin or penicillin. We assess the risks from continued use of penicillin-based drugs in food animals in the United States, using several assumptions to overcome current scientific uncertainties and data gaps. Multiplying the total at-risk population of intensive care unit (ICU) patients by a series of estimated factors suggests that not more than 0.04 excess mortalities per year (under conservative assumptions) to 0.14 excess mortalities per year (under very conservative assumptions) might be prevented in the whole U.S. population if current use of penicillin drugs in food animals were discontinued and if this successfully reduced the prevalence of AREF infections among ICU patients. These calculations suggest that current penicillin usage in food animals in the United States presents very low (possibly zero) human health risks.     

Cognitive-Behavioral Therapy for Bipolar Disorder: Implications for Clinical Social Workers

ABSTRACT

The purposes of this review article are to orient clinical social workers to cognitive-behavioral theory, intervention, and research on bipolar disorder (BD); identify pros and cons of applying cognitive-behavioral therapy (CBT) to social work clients with BD; and identify specific implications for clinical social work practice. Of the 545 articles that were obtained via the systematic review, 18 studies were identified as being potentially eligible for inclusion, and 9 of those studies ultimately satisfied the inclusion criteria. The results of each study were summarized via identifying statistically significant (p< .05) differences that existed between experimental cohorts who received CBT (plus pharmacotherapy) and control cohorts who received treatment as usual. Outcomes showed CBT cohorts as having significant improvement over their respective control groups. The review's implications for clinical social workers and the need for future research are discussed.     

Relationships among JIT practices: an interpretive modeling approach

Abstract

This research develops a model of relationships among components of Total-JIT, including JIT-information, JIT-manufacturing, JIT-purchasing, and JIT-selling, to establish an implementation hierarchy based on relative importance. The data collected relates to the relationships among JIT components and two performance measures, supply chain competency and organizational performance. Two groups are used in the research, one group of five operations management academics and another group of 30 practicing operations managers working in U.S. manufacturing firms. An interpretive structural modelling methodology is used to develop alternative structural models. The academics’ data show JIT-information emerging as lynchpin of relationships, directly impacting all other JIT practices and both performance measures. The practitioners’ data indicates that all JIT practices and performance measures are interactive as components and outcomes. This study is the first to apply interpretive structural modelling to investigate the interplay among total-JIT components and the performance measures of supply chain competency and organizational performance.