Inductive foraging: improving the diagnostic yield of primary care consultations.
Summary (2 min read)
1. INTRODUCTION
- Over recent decades, the development, spread and implementation of internationally accepted quality standards have gained increasing significance.
- The firm’s quality management system is then verified by a specialized third party, who issues a certificate of conformity when the requirements are met.
- The authors paper goes beyond this observation and provides the rationale that explains why interest in international standards certification has been growing in developing countries.
- Second, building on the literature concerning the impact of standards on the performance of firms, this study empirically tests the effects of certificate adoption on the productivity and growth of individual firms, using a wide set of countries, differing in the degree of their economic, social and institutional development.
- Section seven provides an elucidation of their findings and conclusions.
2. THE NET BENEFITS OF INTERNATIONAL STANDARDS CERTIFICATION (ISC)
- International management standards currently address a variety of issues including quality management, environmental management, social accountability and working conditions.
- Quality management reflects what the organization does to enhance customer satisfaction by meeting buyer requirements and expectations (ISO 2002).
- In 1996, addressing the need for a global system of environmental selfregulation, the environmental management system standard, ISO 14000, was introduced (Delmas, 2002).
- This view is strongly embedded in the New Institutional Economics perspective, which builds on the influential work of Coase (1937), who identified transaction costs as a factor explaining why some transactions take place within firms and not between firms – and Williamson (1975, 1985) who identified bounded rationality and individual opportunism as factors potentially raising those transaction costs.
- An efficient competitive market is considered the most powerful force for economic efficiency (Shleifer and Vishny, 1997).
3. HYPOTHESES
- An significant number of studies have investigated the impact of certification on firm performance.
- The absence of unequivocal results appears to be associated with variance in the data samples used and heterogeneity of the business contexts in which various companies operate.
- It is the process of competition and selection in the market that forces firms to respect minimum standards.
- Firms who intend to sell products to wider markets face more serious information problems since spatial, cultural and linguistic barriers complicate the buyer’s capacity to assess product quality (King, Lenox and Terlaak, 2005, Johnstone and Labonne, 2009, Potoski and Prakash, 2009).
- Unfortunately, some firms dropped out because information was missing on variables crucial to their analysis, such as employment, capital or sales.
WEGLATEN?
- The results of the instrumenting equation are in line with expectations.
- The results in Column (4) also show a substantially different coefficient for the interaction variable combining ISC with the institutional quality of the country.
- The authors tested the model for ‘trading across borders’, ‘contract enforcement’ and ‘protecting investors’ (Columns (1)-(3)) and extended the analysis by including two components of the Index of Economic Freedom ‘property rights’ and ‘corruption’ (Columns (4)-(5)).
- The authors find that the extra ISC effect on sales growth of firms in the least developed countries of their sample comes primarily from efficiency improvements.
SALES
- Age of the firm in t, in logarithmic terms 2.73 (0.75) D-foreign =1 if the firm is foreign owned 0.13 INSTWEAK Institutional weakness measured by the Ease of Doing Business 2008 overall ranking of the country where the firm is active; normalised variable; higher values imply lower institutional quality 0.45 (0.26).
- Contract Enforcement Institutional weakness measured by the EBD 2008 ranking on the subcomponent ‘Contract enforcement’, of the country where the firm is active; normalised variable, higher values imply lower institutional quality 0.44 (0.25).
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Frequently Asked Questions (14)
Q2. What is the main conclusion drawn from the Medical Inquiry Project?
The main conclusion drawn from the Medical Inquiry Project (1) is that a purely inductive method of data gathering is never used by physicians, but that hypotheses are formed early and guide further work-up.
Q3. What is the default assumption for a diagnosis of a disease?
As long as no departure from ‘ normal ’ is noticed, the default is the assumption that there is no pathology deserving further investigation, at least as long the problem space has been foraged to a suffi cient extent.
Q4. What is the definition of a premature closure?
DEDUCTIVE INQUIRY, INDUCTIVE FORAGING AND PREMATURE CLOSUREBy ‘ premature closure, ’ authors usually mean the end of a phase of specifi c hypotheses evaluation.
Q5. What is the important aspect of the foraging process?
Inductive foraging has universal application even beyond medical diagnosis (6), but it is especially suitable for primary care where the prevalence of serious disease is low but a wide range of possibilities must be explored.
Q6. What was the main conclusion drawn from the Medical Inquiry Project?
A strategy of inductive reasoning was associated with diagnostic success in a think-aloud study of paper cases for medical students and experienced gastroenterologists (9).
Q7. What is the title of the article?
Keywords: decision making , uncertainty , cognition , perception , judgement , diagnosis , general practice , family practiceConference Presentations : NDB presented parts of this article at the COGITA working group of the European General Practice Research Network, Z ü rich, Switzerland, October 2010.
Q8. What is the main reason for the inductive foraging?
From his analysis of Dutch general practitioners (GPs) working with simulated patients, Ridderikhof (7) concluded that inductive reasoning is the predominant mode of data collection and reasoning.
Q9. What is the common strategy used by GPs to test for hypotheses?
According to this strategy, individuals search for and examine instances in which the target behaviour, property, or event is expected to occur, as opposed to searching for instances where it is not expected to occur under the hypothesis entertained.
Q10. What is the meaning of the term deductive inquiry?
The authors suggest the term ‘ deductive inquiry ’ for this phase since reasoning goes from propositions (hypothesis) to data gathered by history taking or examination of the patient.
Q11. What is the background of the study?
Using the background of Popper ’ s theory of falsifi cation (15) as one benchmark within the context of discovery, numerous investigators have deplored the seemingly irrational behaviour of subjects confronted with ruleE urJ Gen Pra ctD ownl oade dfr omin form ahea lthca re.c omb yPr of.
Q12. What are the considerations referring to inductive foraging?
The considerations referring to inductive foraging are particularly relevant for the care of unselected populations, i.e. primary care or emergency department hospital settings (26).
Q13. What is the definition of premature closure?
Premature closure is said to occur when clinicians stop their data collection too early and, as a consequence, miss important information.
Q14. What is the effective way to diagnose a complaint?
complaints are often non-specifi c, and a large number of possible diagnoses must be screened; inductive foraging may be the most effi cient way to achieve this.