Open ended problems

1
Open ended problems

• Cannot be described completely.
• Have more than one solution option.
• Generate controversy, even amongst experts.
• Have incomplete information that has a variety of
  interpretations.
• Have a variety of solution options with unknown
  outcomes.
• Often need to be addressed repeatedly over time
  as conditions change and better information
  becomes available.
• Can be addressed through a problem solving
  process that uses information in increasingly
  complex ways.

2

• Sound familiar?
• That rather nebulous presentation that does not
  fit neatly?
• Exercise 1
• List some open-ended scenarios from your practice

3
Problem Solving Process

• Stages
• Identifying
• Framing
• Resolving
• Re-addressing

4
Identifying

• Identify relevant information.
• Articulate important and enduring reasons for
  disagreements about the problem.
• Articulate uncertainties related to the available
  information.

5
Framing

• Recognise and control for personal preferences
  and assumptions.
• Conduct a thorough analysis of the problem
  subparts, analyse important information by making
  legitimate, qualitative interpretations of the
  relevant information and different view points.
• Organise the available information into a
  meaningful description of the problems
  complexities.

6
Resolving

• Following adequate framing, establish relevant
  guidelines or principles for making sound
  judgements across the solution options.
• Use these guidelines in an objective manner,
  endorse the solution as most viable.
• Effectively communicate a well-founded
  justification in light of other options.

7
Re-addressing

• Acknowledge important factors, availability of
  new information or relative shifts in various
  factors.
• Viable process that moves forward better
  solutions with more confidence over time.

8
Is it open-ended?

• Is it possible to know if your conclusion is
  correct or not?
• How is it possible that there are differences of
  opinion about this problem?
• If there is a disagreement, is one solution right
  and another wrong? Or both partly right/wrong?
• Is one conclusion better than another?
• How do you decide which one is better?
• What else might change your conclusion?

9
Framing

• Recognise and control for personal preferences
  and assumptions.
• Conduct a thorough analysis of the problem
  subparts, analyse important information by making
  legitimate, qualitative interpretations of the
  relevant information and different view points.
• Organise the available information into a
  meaningful description of the problems
  complexities.

10
Preferences and Assumptions

• Starting with some ideas or preconceived notions
  that affect our personal point of view.
• Our ideas may have been adopted without careful
  thought or exploration of alternatives. We may
  ignore options that do not suite our ideas.
• Assumptions something that is accepted as true
  without verification.
• Assumptions allow us to move ahead in our
  thinking without any evidence.
• Assumptions are problematic when we are not aware
  of them. Cause us to ignore important
  alternatives and issues and act inappropriately.
• Awareness of assumptions allows us to consider
  whether to accept or reject them and to
  re-consider them in the light of new information.
  
• Assumptions are often un-stated. Recognising our
  own is even more difficult.
• Think beyond what is stated to understand the
  underlying ideas and related evidence more
  clearly.

11
Looking beyond the initial perspective

• Tend to jump to conclusions.
• Stack up evidence to support what we already
  believe.
• We ignore information that goes against what we
  believe.
• Should try to analyse the perspectives from a
  number of viewpoints.
• Expand out initial personal view.
• How do other people view the problem and the
  related evidence.

12
Analyzing Information

• Different views, recalled differently e.g.
  accidents, complaints.
• Variability increases with subjective topics.

13

• Exercise 3 Read the essay from question 2. What
  experiences might affect what you wrote. Talk
  with someone else and see if their views are
  different.
• Do you share the assumptions?
• In what way do other(s) understand the problem
  differently.
• How might you explore these further?

14
Exploring a Problems Complexities

• The more I know, the harder it is to make a
  decision.
• Ignorance is bliss.
• Once you become informed, you start seeing
  complexities and shades of grey.
• Nothing is as clear and simple as it first
  appears.

15
Empathy

• The notion of empathy indicates involvement in
  the sense of the professionals abilities to
  identify themselves with the patients situation.
  Seeks to understand the patients perspectives.
• Dilemma conflict between involvement and
  professional distance.
• Perhaps resonance is better as recognises the
  use of personal experience as a basis for
  understanding.
• Resonance can bridge the gap between illness and
  disease.

16
Personal Experience

• Sacks, a neurologist understood patients
  experiences after becoming a patient himself.
• Understood his patients feelings of helplessness
  and lack of autonomy.
• Do we have to become patients? We have all had
  some sort of illness, even a cold.
• The doctor cannot always see the headache or
  anxiety, but the patient can describe it and we
  can use it to understand how the patient feels.

17
Self knowledge

• Patients are different from each other.
• Doctors are different from each other.
• Doctors are not all the same backgrounds,
  personalities, attitudes.

18

• Exercise 4 From the previous exercise, what if
  anything has changed your view and why.