At first glance, the below image looks like a rather lacklustre collection of shops that you wouldn’t spare a second glance. Take a step back and change your perspective and you’re met with a different view.
It’s the same shops, but topped with the enchanting architecture of Oxford Street. This is the basic premise of the contextual decision-making dependency – by concentrating on a very narrow viewpoint, you can easily miss things. To make the best decision, you need to have a wide and varied perspective.Contextual decision-making, Aurora’s third Access All Areas dependency, is about taking the wider view and then reaping the benefits. In a complex system like the healthcare system, no party has full view of the whole system, so each tends to direct its efforts and resources to proximal areas of immediate concern. Like with the photos above, this means that parties can sometimes miss the bigger picture and lose out on opportunities they did not even know they had.
Looking at immediate concerns can also mean we miss forecasting barriers down the line. If you focus decisions too much on immediate, short-term concerns, you can run into a bigger one down the line or even create it yourself. Making decisions in context is about considering all the angles. On the surface it may seem like that will add unnecessary deliberations and time to decision making – but in the long run it will make decisions more efficient. By considering the context, these decisions are less likely to have unintended consequences.
It is also important to consider a wider stakeholder set in the decision-making process – due to the nature of the healthcare system, you cannot see how people’s actions influence a decision until you have taken a step back. Stakeholder mapping is necessary to improve understanding of the attitudes, beliefs, preferences and biases of the varying stakeholders. Increasing the stakeholder set can actually help identify access barriers for example ‘field experts’, jobbing healthcare professionals or even a company’s own sales team, have a view from the ground and thus much more insight about how decisions may impact patients’ lives and services. This approach brings into stark light that patients are a key stakeholder, often overlooked, whose opinion and experience should be considered in our decision-making.
You can start contextualising your decisions by considering your current perspective when it comes to decision-making:
- Are you concentrating on traditional points of influence or are you exploring different angles?
- How willing are you or your organisation at a local (or even global) level to extend the scope of your activities, or conversely let other parties into your domain?
- Be prepared to make trade-offs. Understanding the wider landscape will also mean having to make critical choices around what you can and cannot do within your constraints.
- Consider small experiments and pilot initiatives. Test the water with incremental steps, and learn from them.
- Accept that context is dynamic. The landscape is probably going to change faster than you might want it to. It is the nature of the system.
To find out more about this dependency and the other dependencies, read our Access All Areas paper, ‘Creating opportunities for improving patients’ access to medicines,’ available for download here.