Sense making in environments of endogenous and endogenous uncertainty: How multidisciplinary tumor bards Make treatment decision in condition of uncertainty
Barbara Oureilidis DeVivo
Westmount University, USA
: J Clin Exp Oncol
Abstract
Hospital Tumor Boards (TB) bring together multiple specialists in an effort to determine an optimal patient treatment program. However, previous research on Tumor Boards suggests that multidisciplinary TBs do not necessarily improve patient care, quality or survival. Drawing on insights from organizational theory and behavior, this research aimed to understand why Tumor Boards often fail to live up to their potential. The study used ethnographic methods including participant observation over three years of 44 Tumor Boards and 18 unstructured interviews at seven United States and United Kingdom research hospitals. The study found that several factors related to endogenous and exogenous sources of uncertainty in TBs contributed to sub-optimal treatment programs. Specifically, the study found that while the objective of TB meetings was to reach optimal patient treatment decisions, the decision-making processes tended to be obstructed by (a) hierarchical and nonhierarchical structures within the medical profession, (exogenous uncertainty) and (b) level of situational complexity of patient cases (endogenous uncertainty). Together, these factors influenced and obstructed the “sensemaking” of TB members. Future research should focus on better understanding how internal management policies derived from insights from organizational theory can better facilitate the decision-making process in TB structures in highly complex patient cases. Keywords: Tumor board, exogenous uncertainty, endogenous uncertainty, decision-making, ambiguity, narrative construction process, sensemaking, multidisciplinary physicians
Biography
Barbara DeVivo has spent her entire career in marketing management serving various executive global roles from market analysis and research, business development product management and professional relations. She serves as President and Founder of Extended Marketing Services, a real estate and healthcare consulting company. Ms. DeVivo has also held the position of Adjunct Professor of Marketing at the University of Memphis as well as Union Graduate College and has taught Marketing, Advertising and Brand Promotions, Market Research, and Negotiations. Furthermore, she has held the position of Executive Director of Marketing at the University of Memphis managing the operations. barbaradevivo@yahoo.com
