Prioritisation
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Most cited papers in Prioritisation
Background: Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each... more
Background: Policies assigning low-priority patients treatment delays for care, in order to make room for patients of higher priority arriving later, are common in secondary healthcare services today. Alternatively, each new patient could be granted the first available appointment. We aimed to investigate whether prioritisation can be part of the reason why waiting times for care are often long, and to describe how departments can improve their waiting situation by changing away from prioritisation. Methods: We used patient flow data from 2015 at the Department of Otorhinolaryngology, Haukeland University Hospital, Norway. In Dynaplan Smia, Dynaplan AS, dynamic simulations were used to compare how waiting time, size and shape of the waiting list, and capacity utilisation developed with and without prioritisation. Simulations were started from the actual waiting list at the beginning of 2015, and from an empty waiting list (simulating a new department with no initial patient backlog).Results: From an empty waiting list and with capacity equal to demand, waiting times were built 7 times longer when prioritising than when not. Prioritisation also led to poor resource utilisation and short-lived effects of extra capacity. Departments where prioritisation is causing long waits can improve their situation by temporarily bringing capacity above demand and introducing “first come, first served” instead of prioritisation. Conclusion: A poor appointment allocation policy can build long waiting times, even when capacity is sufficient to meet demand. By bringing waiting times down and going away from prioritisation, the waiting list size and average waiting times at the studied department could be maintained almost 90% below the current level – without requiring permanent change in the capacity/demand ratio.
Prioritisation methods have been used in conservation planning for over 20 years. The scientific literature focuses on the technical aspects of prioritisation, providing limited information on factors affecting the uptake of priorities.... more
Prioritisation methods have been used in conservation planning for over 20 years. The scientific literature focuses on the technical aspects of prioritisation, providing limited information on factors affecting the uptake of priorities. We focused on the Back on Track species prioritisation program in Queensland, Australia, used to prioritise species conservation efforts across Queensland from 2005. The program had low uptake by intended users. Our study aimed to identify the perceived limitations in the technical-scientific quality of this species-based prioritisation process and its outcomes in terms of credibility (scientific adequacy of the technical evidence) and relevance (of information to the needs of decision-makers). These criteria have been used to understand the uptake of scientific information in policy. We interviewed 73 key informants. Perceptions of credibility were affected by concerns related to the use of expert judgement (rather than empirical evidence) to assess species, impressions that key experts were not included in the planning process, and the lack of confidence in the information supporting prioritisation. We identified several trade-offs and synergies between the credibility and relevance of priorities to potential users. The relevance of the output plans was negatively affected by the lack of clarity about who were potential users and implementers of the priorities identified. We conclude with recommendations to enhance the credibility and relevance of such initiatives.
- by Milena Kim and +1
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- Conservation planning, Prioritisation
Objectives: To determine whether a system originally developed to ascertain the appropriateness of cataract intervention may also be used to prioritize patients on cataract extraction waiting lists. Methods: The IRYSS-appropriateness of... more
Objectives: To determine whether a system originally developed to ascertain the appropriateness of cataract intervention may also be used to prioritize patients on cataract extraction waiting lists. Methods: The IRYSS-appropriateness of indication for cataract surgery tool and the IRYSS-Cataract Priority Score were applied to a sample of 5448 patients consecutively placed on waiting lists for cataract surgery. Clinical data were gathered by ophthalmologists, and patients self-completed the Visual Function Index-14. The general linear model (GLM) was used to assign scores to the categories of the appropriateness and priority criteria. The relationship between both systems was evaluated by correlating scores. To assess the validity of the new appropriateness and priority scores, correlations with visual acuity (VA) and visual function were calculated. Results: The GLM method generated highly similar scores for both appropriateness and prioritization systems. The correlation between scores was very strong (r = 0.96). The appropriateness scoring system correlated 0.29 with VA and 0.21 with gain in visual function. The priority system correlated −0.54 with VA and −0.28 with preintervention visual function. Conclusions: The new appropriateness scoring system strongly correlates with the priority scoring system. This easy-to-use appropriateness rating could serve as a tool for simultaneously assessing the appropriateness of cataract surgery and assigning priority.
Digital Libraries (DL) are offering access to a vast amount of digital content, relevant to practically all domains of human knowledge, which makes it suitable to enhance teaching and learning. Based on a systematic literature review,... more
Digital Libraries (DL) are offering access to a vast amount of digital
content, relevant to practically all domains of human knowledge, which makes it
suitable to enhance teaching and learning. Based on a systematic literature review,
this article provides an overview and a gap analysis of educational use of DLs.
content, relevant to practically all domains of human knowledge, which makes it
suitable to enhance teaching and learning. Based on a systematic literature review,
this article provides an overview and a gap analysis of educational use of DLs.
Foot argues that there are certain things that all human beings - perhaps all rational agents - need. This gives a sense in which certain values and disvalues can be called 'objective'. I suggest that, with certain relatively minor... more
Foot argues that there are certain things that all human beings - perhaps all rational agents - need. This gives a sense in which certain values and disvalues can be called 'objective'. I suggest that, with certain relatively minor adjustments, her argument can be made cogent but that it cannot be used to show that there are objective answers to questions about what one should do when values conflict. If Foot's own virtue ethics, utilitarianism, Kantian ethics or any other first-order moral system were to be established as objectively valid, this would require some completely different form of argumentation.
Almost sixty years ago Philippa Foot published an article that began: To many people it seems that the most notable advance in moral philosophy during the past fifty years or so has been the refutation of naturalism; and they are a little shocked that at this late date such an issue should be reopened. It is easy to understand their attitude: given certain apparently unquestionable assumptions, it would be about as sensible to try to reintroduce naturalism as to try to square the circle. Those who see it like this have satisfied themselves that they know in advance that any naturalistic theory must have a catch in it somewhere, and are put out at having to waste more time exposing an old fallacy. This paper is an attempt to persuade them to look critically at the premises on which their arguments are based. 1 The paper in question was one of a number written by Foot around the time that were highly successful in reopening the issue of naturalism in ethics. Nowadays no one can just take it for granted that naturalism has been refuted, that there is a sharp distinction (or indeed any clear distinction) between fact and value or that it is impossible to derive an 'ought' from an 'is'. This is not to say that the naturalists have been completely victorious, of course; only that naturalism is today a live option. I shall argue that Foot's paper contains an important insight and an equally important mistake; and that the insight and the mistake are linked. I believe that the thinking behind it has influenced the subsequent course of moral philosophy to a quite remarkable extent and that this has been in some ways beneficial and in some ways harmful – not surprisingly, if I am right in seeing it as containing both truth and error. I do not want to exaggerate the influence of this one paper 2 but I do not know of any other that so neatly encapsulates the coupled insight and mistake. The anti-naturalism that Foot is attacking she characterises as follows: It would not be an exaggeration to say that the whole of moral philosophy, as it is now widely taught, rests on a contrast between statements of fact and evaluations, which runs something like this: The truth or falsity of statements of fact is shewn by means of evidence; and what counts as evidence is laid down in the meaning of the expressions occurring in the statement of fact … It follows that no two people can make the same statement and count completely different things as evidence; in the end one at least of them could be convicted of linguistic ignorance. It also follows that if a man is given good evidence for a factual conclusion he cannot just refuse to accept the conclusion on the ground that in his scheme of things this evidence is not evidence at all. 3 But, on the view she is criticising, [w]ith evaluations, however, it is different. An evaluation is not connected logically with the factual statements on which it is based. One man may say that a thing is good because of some fact about it, and another may refuse to take that fact as any evidence, for nothing is laid down in the meaning of 'good' which connects it with one piece of 'evidence' rather than another. It follows that a moral eccentric could argue to moral conclusions from quite idiosyncratic premises; he could say, for instance, that a man was a good man because he clasped and unclasped his hands and never turned NNE after
Almost sixty years ago Philippa Foot published an article that began: To many people it seems that the most notable advance in moral philosophy during the past fifty years or so has been the refutation of naturalism; and they are a little shocked that at this late date such an issue should be reopened. It is easy to understand their attitude: given certain apparently unquestionable assumptions, it would be about as sensible to try to reintroduce naturalism as to try to square the circle. Those who see it like this have satisfied themselves that they know in advance that any naturalistic theory must have a catch in it somewhere, and are put out at having to waste more time exposing an old fallacy. This paper is an attempt to persuade them to look critically at the premises on which their arguments are based. 1 The paper in question was one of a number written by Foot around the time that were highly successful in reopening the issue of naturalism in ethics. Nowadays no one can just take it for granted that naturalism has been refuted, that there is a sharp distinction (or indeed any clear distinction) between fact and value or that it is impossible to derive an 'ought' from an 'is'. This is not to say that the naturalists have been completely victorious, of course; only that naturalism is today a live option. I shall argue that Foot's paper contains an important insight and an equally important mistake; and that the insight and the mistake are linked. I believe that the thinking behind it has influenced the subsequent course of moral philosophy to a quite remarkable extent and that this has been in some ways beneficial and in some ways harmful – not surprisingly, if I am right in seeing it as containing both truth and error. I do not want to exaggerate the influence of this one paper 2 but I do not know of any other that so neatly encapsulates the coupled insight and mistake. The anti-naturalism that Foot is attacking she characterises as follows: It would not be an exaggeration to say that the whole of moral philosophy, as it is now widely taught, rests on a contrast between statements of fact and evaluations, which runs something like this: The truth or falsity of statements of fact is shewn by means of evidence; and what counts as evidence is laid down in the meaning of the expressions occurring in the statement of fact … It follows that no two people can make the same statement and count completely different things as evidence; in the end one at least of them could be convicted of linguistic ignorance. It also follows that if a man is given good evidence for a factual conclusion he cannot just refuse to accept the conclusion on the ground that in his scheme of things this evidence is not evidence at all. 3 But, on the view she is criticising, [w]ith evaluations, however, it is different. An evaluation is not connected logically with the factual statements on which it is based. One man may say that a thing is good because of some fact about it, and another may refuse to take that fact as any evidence, for nothing is laid down in the meaning of 'good' which connects it with one piece of 'evidence' rather than another. It follows that a moral eccentric could argue to moral conclusions from quite idiosyncratic premises; he could say, for instance, that a man was a good man because he clasped and unclasped his hands and never turned NNE after
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