Category:DARM exercise

Case study exercise

The plot

The global AH1N1 (swine flu) pandemic, vaccinations to fight the pandemic, and the side-effects of the vaccines have been topics of much debate during the last couple of years all over the world. In Finland the hottest debates have recently related to the suspected connection between the Pandemrix vaccine and the unexpected increase in the prevalence of narcolepsy among young people. The swine flu case provides an example of a complex, multifaceted decision problem in which there are multiple interrelated decisions to be made by multiple different decision makers, uncertainty about the outcomes of the decisions, and many possible points for conflict of values.

Various different points of views have been taken both to criticize as well as defend the decisions actions that were taken. Of course things could have gone other way as well, and with hindsight it is always easier to judge past decisions, when we already know more about the outcomes, i.e. what actually happened. The discourse goes on and opinions fly about, but not much systematic analysis yet exists about what could or should have been done and why?

Some possible questions for such a systematic analysis are: Based on the knowledge that existed at the time of the decisions, were the right decisions made?, If not, what decisions should have been made then? How could it have been made happen? Imagine that the Ministry of Social and Health affairs of Finland is asking you, an (future?) expert in protecting and promoting public health, these question. Consequently, you need to 1) plan a decision analysis study that can provide at least some answers to these questions, and 2) consider, point out, and argue how things could or should have been managed otherwise.

The case study exercise is done in two parts:

1. Decision analysis (DA) study plan (group work)
2. Consideration of risk management (RM) options (individual work)

It is probably impossible to provide a thoroughly conclusive answer to any of the above mentioned questions, but a lot can be learned by means of such an analysis. In making the exercises, feel free to focus on those aspects that are of most interest to you and your group members. There are no single right solutions, and it is only good if different groups/individuals come out with quite different kinds of plans and considerations.

In order to successfully accomplish the exercise consider making use of e.g.:

• the theory lectures and classroom exercises on decision analysis and risk management on this course
• classroom discussions on the swine flu case as a DA and RM problem
• related materials listed and linked to on the course web-page
• the demonstrator DA model
• other assessments in Opasnet
• all other related information e.g. on the web and libraries
• your own expertise and opinions
• other groups'/individuals' exercise works

The two parts of the exercise are explained in more detail below. Both parts of the exercise will be made in the Opasnet web-workspace. The basics of using Opasnet will be taught in the lecture on 3.3. 9-12 in computer classroom MC9.

Part one: Decision analysis study plan

This part is intended as group work (~3-4 people/group). It is preferred that there would be at least one person with fluency in Finnish as some materials related to the swine flu story are available only in Finnish. Otherwise there are no limits to the group formation.

Work out a decision analysis plan, according to which a skilled assessor can build a model, run the model, and produce results that are useful for answering the questions you are asked (see above). You may focus on certain specific aspect(s) of the complex swine flu/vaccination problem, but also remember to keep the big picture in mind as well. Once the

The DA study plan can be structured:

1. Background description
   • purpose of the study
   • main question(s) related to the case
   • relevant actors related to the case
   • roles of different actors related to the case
   • timeline of major events
   • expected outputs and impacts of the study
2. Decision analysis study plan
   • decisions considered
   • outcomes of interest that the decisions (are intended to) have influence on
   • the factors (variables) that link decisions to their (intended) outcomes
   • different sources of information
   • all the above at certain different timepoints along the progress of the case
     • which timepoints?
     • what knowledge emerged between different timepoints?
     • how does the model change from a timepoint to another?
   • analyses over the model and its parts

The DA study plans are intended to be worked on gradually alongside the lectures and exercises, and progress will be presented to and discussed with other students as well as lecturers in classroom a few times during the course. In the end of exercice part 1, the group will present the final plan to other students as well as lecturers in classroom. If possible, the final DA study plans will be, at least partly, executed by means of the demonstrator model that will be developed for demonstration purposes on the course. At least the possible results that could be achievable according to the plan will be discussed at the presentation of the plan. Results (actual or anticipated) are added to the plan.

(part 1 can be considered as corresponding roughly to the introduction and methods sections of a scientific article, or to the scope and definition attributes of an assessment object in open assessment)

Part two: Discussion and conclusions regarding risk management options and actions

Planned as individual work, but can also be combined as a part of the group work if so desired

Following the work done in exercise part 1, and taking account of the discussions regarding the plans by different groups in, consider what does (may) a decision analysis study tell, what can the results be used for, and how? Think that you are explaining the DA study results to the social and health minister.

1. What does the analysis tell?
   • were the right decisions made?
   • what decisions should have been made?
   • could things have gone in a different way?
   • what implications other courses of events would have had? What would it have required?
   • is possible that such could have happened in reality?
2. What can be concluded?
   • if anything, what went wrong? why?
   • if a somewhat similar situation occurred, what should be done?
   • if possible, what should be done in preparation?

Questions to consider are e.g.:

• Did something go wrong? If so, what, when, and why?
• How could have things been done better? What, when, and why?
• With the knowledge we have now in this situation, what could/should be done?
• What can be learned about this case regarding possible similar urgent public health risk management situations in the future?
• Are there any more general risk management or other lessons to learn from this case?

(part 2 can be considered as corresponding roughly to the discussion and conclusions sections of a scientific article, and also to the conclusions sub-attribute of an assessment in open assessment).

Basis for evaluating the case study exercises

The main point is not to write long and detailed texts of any specific topic within this course. Instead the idea is to try to make use of what has been taught on the course by combining them in relation to a practical question. Most important issues in evaluating the exercises are:

• general clarity of thought
• comprehension and description of the big picture
• meaningful connections between the aspects of the case
• application of the knowledge and methods provided in lectures, exercises and discussions along the course
• ability to argue for or against different statements or actions

Practical case study guidance

The DA study plans will be written in Heande, a password protected project-wiki, similar to Opasnet (this site). The writing can take place directly within Heande, or the text can be copied to Heande from external documents. However, the evaluation of the group's work will be done based only on the material on the group's Heande-page. The Heande-pages will be opened for each group, creation of user accounts, and the basics of wiki-editing will be taught in practical classroom exercises in the beginning of the course. In case of problems with Heande or just need of advice, feel free to contact the lecturers.

Also the individual discussions and conclusions regarding risk management options actions will be written and evaluated similarly in Heande.

The course participants are encouraged to actively discuss own and others work. In addition to oral classroom discussions the discussion can take place in Heande. Also the principles, tools, and practices of discussing in a wiki-system will be presented and instructed in practical classroom exercises during the course. Activity in discussing the exercise topics in Heande will be considered as a benefit in evaluating the group and individual works. Discussions may address the group's