Decision quality, problem-solving, and data science

Lean concepts for human-centered, data-informed decision-making

Tomás J. Aragón, MD, DrPH

SFDPH Executive Meeting, San Francisco, CA, July 1, 2019
Health Officer, City & County of San Francisco
Director, Population Health Division (PHD)
San Francisco Department of Public Health
https://taragonmd.github.io/ (GitHub page)

PDF slides produced in Rmarkdown LATEX Beamer—Metropolis theme

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Decision making is our single, most important activity.
Lean concepts for human-centered, data-informed decision-making

Decisions drive vision, strategy, execution, evaluation, problem-solving, performance, and

continuous improvement.

A decision is an irrevocable commitment of time and resources.

Every decision has an opportunity cost—the loss benefit of the better option not
chosen or not considered.

Decision competent managers use and leverage data, information, and knowledge
management systems to improve decision quality, problem-solving, and performance.

Driven by decision makers’ priorities and questions, data scientists transform data into
information and actionable knowledge to inform, influence, or optimize decision making.

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What most people see is action and results—not decision and data processes.
In lean, we focus on improving processes to improve problem-solving and results

Frame

Information Choices Reasoning Commitment Prospects

Co Results, goals
ce nve
e r gen rg enc and impacts
Div e
Decision
Action Consequences

Trade-offs and
opportunity costs

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Decision quality value stream has six requirements (in blue)
Frame, information, choices, reasoning (analysis), commitment (people) & prospects (future state)

Frame

Information Choices Reasoning Commitment Prospects

e Co Results, goals
c nve
e r gen rg enc and impacts
Div e
Decision
Action Consequences

Trade-offs and
opportunity costs

Information & knowledge systems, & in data science capabilities connect to DQ at information
(data), choices (e.g., evidence-based), reasoning (analysis), & prospects (goals, predictions). 4
PSDA problem-solving includes decision processes — but it’s not apparent!

Probem solving involves PDSA:

Causes Problem Consequences
1. Plan: Problem definition
2. Plan: Consequence (risk) analysis
3. Plan: Root cause analysis Prevention Control Mitigation

4. Plan: Countermeasure design and testing Countermeasure(s)

5. Do: Countermeasure (CM) implementation

Figure 1: Problem-solving causal graph
6. Study: CM evaluation (causal analysis)
7. Act: Act on what you learn to improve.

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Decision quality value streams are embedded in PSDA problem-solving
Problem-solving is only as good as decision quality and support (data, systems, analysis, etc.)

Consequence Causal analysis Countermeasure

Problem definition
(risk) analysis (root & evalution) design & testing

DQ DQ DQ DQ
?P P ?R R ?C C ?S S

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Decision quality value stream supported by lean, data, information and knowl-
edgement management systems, and data and implementaions sciences

Decision quality Problem gaps (for A3 Problem Statement)

1 Frame decision competency in lean A3 Thinking & DMS1
2 Information data and information systems (Epic, Maven, CCMS, etc.)
3 Choices knowledge management (synthesis, translation, & integration)
4 Reasoning deduction and induction,2 data & implementation sciences
5 Commitment see Frame (includes involving implementers in decision making)
6 Prospects see Frame (includes visioning of future state)

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daily management system (standard work, visual mgmt, tiered reporting, team huddles, and staff dev.)
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causal and evidential reasoning (includes inter-causal reasoning)
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Population health data science

Table 2: Population health data science: Levels of analysis

Analysis Description
1 Description surveillance and early detection of events
prevalence and incidence of risks and outcomes
2 Prediction early detecting and targeting of interventions
3 Causal discovery of new causal effects and pathways
estimation of intervention effectiveness
4 Simulation modeling for epidemiologic or decision insights
5 Optimization1 informing or optimizing decisions, processes, or results

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decision analysis, cost-effectiveness/benefit analysis, operations research, etc.