Category:DARM exercise

Case study exercise

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) actions and 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
• descriptions of assessment and variable objects
• 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 1: 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. The DA study plan can be structured e.g. according the following example:

1. Background description
   • purpose of the study
   • main question(s) considered in the study
   • the relation of the study to the whole swine flu/vaccination case
   • relevant actors related to the case/study
   • roles of different actors related to the case/study
   • timeline of the events considered in the study
   • expected outputs and possible impacts of the study
2. Decision analysis study plan
   • decisions and decision options considered in the study
   • outcomes of interest that the decisions (are considered to) have influence on
   • the relationships between the decisions and outcomes of interest (e.g. as a network of variables)
   • different sources of information needed/used in the study
   • analysis of the model and its parts (e.g. uncertainty, sensitivity, VOI, applicability, ...)

The groups should work on the plan gradually alongside the lectures and classroom exercises from the beginning of the course. The task may appear difficult grasp in the beginning, but should become clearer and clearer as the course progresses. The draft plans are presented and discussed in the lecture on 18.3. 13-16. The feedback from this session should guide the work on producing a full draft of the plan. Full drafts are presented in the lecture on 29.3. 9-12. (NOTE: Check the times and locations from the schedule on the course web-page in case of possible changes.) The full drafts will considered and tested for feasibility and executability by a skilled assessor. If possible, a model can be made and run, and analysis results produced. Based on the feedback from the session and the feasibility/executability tests, the DA study plan can be worked on all the way until the final seminar on 11.4. 9-12 and 12.4. 8-11, where both the DA study plans (+ possible corresponding model results) and the risk management option considerations will be presented.

Guidelines for presenting the DA study plans will be provided later on this page.

Part 2: Consideration of risk management actions and options

This part is intended as individual work, but builds on the group work done in the part 1 of the exercise. Note that the considerations need not be limited to the aspects considered in the group work that one was attending. Instead, it is recommended that in this part of the exercise students also take up aspects of the swine flu/vaccination case that are not addressed in the DA study plans. Again, however, feel free to focus on aspects according to your own interest.

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