JMIR Publications

ABSTRACT

Background:

Humans currently dominate decision-making in both clinical health services and complex health services such as health policy and health regulation. Many of the assumptions inherent in health service models today are underpinned by Expected Utility Theory (Ramsey, 1926), a prominent theory in the field of economics that is rooted in rationality. Such rational, evidence-based metrics currently dominate the culture of decision-making in health policy and regulation. However, as the Covid-19 pandemic has shown, rational metrics alone may not suffice in making better policy and regulatory decisions – intuition is equally valuable. Nevertheless, rationality may well be entrenched and may influence the lexicon of our thinking about decision-making. Therefore, this scoping review has real-world, practical value, as it highlights the counter narrative of decision-making that is underpinned by the uniquely human attribute of intuition. This may have ramifications for decision-making in complex health services today. It may also point to the importance of incorporating both intuitive and rational attributes in programming and training artificial intelligence for the healthcare of the future.

Objective:

The aim is to map the attributes that influence human decision-making in complex health services.

Methods:

This scoping review was designed to answer the following research question: What attributes have been reported in the literature that influence human decision-making in complex health services? It provides a clear, reproducible methodology and is reported in accordance with the framework and recommendations by Peters et al. (2015). As the topic of interest merits broad review to scope and understand literature from a holistic viewpoint, a scoping review of literature was appropriate here. A database search within three search systems identified 140 potential records. Inclusion and exclusion criteria were developed. Based on these criteria, four articles were deemed relevant. Four additional articles were added through citation tracking.

Results:

The results of this review highlight key themes that underline the complex and nuanced nature of human decision-making. The results suggest that rationality may be entrenched, and may influence the lexicon of our thinking about decision-making. The results also highlight the counter narrative of decision-making that is underpinned by the uniquely human attribute of intuition. The review, itself, takes a rational approach, and the methods used were suited to this.

Conclusions:

This scoping review identifies and maps attributes that influence human decision-making in complex health services. The review itself has taken a rational approach, and the methods used were suited to this. However, there may be scope to take a more intuitive approach. The results of this review indicate that human decision-making is both complex and nuanced. Rationality has been so entrenched that it has influenced the lexicon of our thinking about decision-making. This review has highlighted the counter narrative of decision-making that is underpinned by the uniquely human attribute of intuition.