Situations vs. standards in long-term, wide-scale decision-making: the case of the International Classification of Diseases

摘要

Presents a case study of the development and evolution of an organizational decision support system (ODSS) over a long period of time and wide geographical area. It uses the design of the International Classification of Diseases (ICD) to address issues of organizational decision-making in large, dispersed organizations. Special attention is paid to the tension between standards and local contingency in such systems. Four kinds of 'wins' are proposed in this type of decision setting: contingency wins, standardization wins, delegation wins, and translation wins. The study is based on a longitudinal analysis of the development of the system, currently administered by the World Health Organization (WHO). It looks at a number of strategies the designers of the system have attempted in balancing the need for a 'universal' classification scheme with the pluralism entailed by different medical specialties, different national medical cultures, a large, changing bureaucracy, and the evolution of computing.