“Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template

Taro Shimizu; Tow Keang Lim

doi:10.1515/dx-2022-0129

Article

“Pivot and Cluster Strategy” in the light of Kahneman’s “Decision Hygiene” template

Taro Shimizu and Tow Keang Lim

Published/Copyright: February 14, 2023

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From the journal Diagnosis Volume 10 Issue 3

Abstract

Pivot and cluster strategy (PCS) is a cognitive forcing strategy designed to achieve diagnostic accuracy through the analytical deployment of a cluster of differential diagnoses (Cluster) specific to the initial most likely diagnosis (Pivot) recalled by a clinical diagnostician. This approach has been widely implemented and has effectively decreased diagnostic errors. Kahneman et al. have introduced innovative notions of noise and decision hygiene. Noise refers to the variance of errors, with numerous individuals’ errors in judgment pointing in different directions. They suggest a “Decision Hygiene” (DH) template, w preventative technique meant to reduce noise in decision-making. This paper introduced an interpretation of the existing strategy of PCS from new perspectives of noise and DH, which would allow us to further understand the usefulness of PCS, thereby contributing to a positive effect on the quality of diagnosis.

Keywords: decision hygiene; diagnostic excellence; noise; pivot and cluster strategy

Corresponding author: Taro Shimizu, MD, PhD, MPH, MBA, Professor and Chairman, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Kitakobayashi 880, Mibu, Tochigi, 321-0293, Japan, E-mail: shimizutaro7@gmail.com

Research funding: None declared.
Author contributions: All the authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The approval of the local Institutional Review Board was waived because this paper is an opinion paper and does not involve human and animal subjects.

References

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Received: 2022-11-23

Accepted: 2023-01-05

Published Online: 2023-02-14

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Articles in the same Issue

https://doi.org/10.1515/dx-2022-0129

Keywords for this article

decision hygiene; diagnostic excellence; noise; pivot and cluster strategy