Braxton Carla C, Robinson Celia N, Awad Samir S
1Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.2Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Crit Care Med. 2017 Apr;45(4):e433-e436. doi: 10.1097/CCM.0000000000002261.
Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU. We hypothesize that factors previously identified in business and organizational psychology literature including self-justification, accountability, sunk costs, and cognitive dissonance result in escalation of commitment behavior in the surgical ICU setting resulting in increased utilization of resources and cost.
A descriptive case study that illustrates common ICU narratives in which escalation of commitment can occur. In addition, we describe factors that are thought to contribute to escalation of commitment behaviors.
Escalation of commitment behavior was observed with self-justification, accountability, and cognitive dissonance accounting for the majority of the behavior. Unlike in business decisions, sunk costs was not as evident. In addition, modulating factors such as personality, individual experience, culture, and gender were identified as contributors to escalation of commitment.
Escalation of commitment occurs in the surgical ICU, resulting in significant expenditure of resources despite a predicted and often known poor outcome. Recognition of this phenomenon may lead to actions aimed at more rational decision making and may contribute to lowering healthcare costs. Investigation of objective measures that can help aid decision making in the surgical ICU is warranted.
“承诺升级”是一个商业术语，描述的是即使在有客观证据表明项目即将失败的情况下，仍继续向该项目投入资源。承诺升级可能是导致危重病患者医疗成本高昂的一个因素，因为已有研究表明，尽管几乎注定徒劳无功，但大多数重症监护病房（ICU）的费用是在患者生命的最后一周产生的。我们的目的是确定承诺升级是否发生在医疗环境中，特别是在外科重症监护病房。我们假设，先前在商业和组织心理学文献中确定的因素，包括自我辩护、问责制、沉没成本和认知失调，会导致外科重症监护病房出现承诺升级行为，从而导致资源利用增加和成本上升。
一项描述性案例研究，阐述了可能发生承诺升级的常见重症监护病房情况。此外，我们还描述了被认为会导致承诺升级行为的因素。
观察到承诺升级行为与自我辩护、问责制和认知失调有关，这些因素占了大部分此类行为。与商业决策不同，沉没成本并不那么明显。此外，人格、个人经历、文化和性别等调节因素被确定为承诺升级的促成因素。
承诺升级发生在外科重症监护病房，尽管预后预计不佳且往往已知，但仍导致大量资源支出。认识到这一现象可能会促使采取旨在更合理决策的行动，并可能有助于降低医疗成本。有必要对外科重症监护病房中有助于辅助决策的客观指标进行研究。
