Re: Fwd: Rule of Thumb?

["Anton O. Tolman, Ph.D." <ANTON@wsh.state.wy.us>]

JD Kromkowski wrote:

> I have no problem with the use of professional judgment where there is risk
> of life or serious injury.  (No need for the use of any statistics, just say
> I'm a professional and this is what my judgment is.)  But otherwise, I see
> what you have described as the same kind of rationale for tampering as well
> as labeling and self-fulfilling prophecies in industry, government and
> education.  By what method does one tell the difference between professional
> management judgment and management lack of understanding of variation?

Well, we are discussing different contexts here.  The purpose of an
evaluation is to make treatment recommendations or inform the court, or
something like that, about specific issues (in my case, the presence of
absence of mental illness, the degree of functioning of the person), in order
to provide customized care.  In this case, we are not talking about managing
a process or so forth.  Evaluations also differ in the particulars and that
is the reason for altering the alpha level depending upon the situation.
There are legal cases where it may be critical that I do not make a decision
or professional judgement without much more solid evidence and there are
situations where the evaluation is "exploratory."  I do not see this as
tampering because we are adapting the methods of the evaluation to match its
purpose or function.

My understanding of Deming's term "tampering" was that management was in the
habit of making decision in the absence of data, OR in the presence of data,
but without an understanding of variation.  When I do an evaluation, I am
specifically aware of variation; I can quantify the likely variation in a
person's test performance over time; if I have access to prior test data, I
can make more accurate predictions about the validity of the tests and the
person's stability in functioning.  A good assessment not only makes use of
the data of the test results, but also evaluates other factors in the
environment and in the history in a search for multi-modal conclusions
regarding functioning.  In my opinion, all of this is way, way beyond what
managers typically do in making management decisions.

To me this is not that substantially different from managers or employees
making decisions based upon process data and *process knowledge* that they
have gathered and learned over time.  It is very much a PDSA cycle or
multiple cycles occurring during the course of an evaluation.

I think we are moving away from the original "rule of thumb" discussion here
(which I saw as related to Theory of Knowledge issues) and wonder if further
discussion on this thread is useful......?  On the other hand, maybe it helps
DENizens better understand psychological assessment and healthcare!

Anton Tolman, PhD, CPHQ, Psychological Services Manager &
Quality Management Coordinator, Wyoming State Hospital
P.O. Box 177, Evanston, WY  82931-0177
Anton@wsh.state.wy.us    (307) 789-3464
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