Högskolan i Skövde

Introduction: Emergency doctors routinely face uncertainty-they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored. We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs).

Methods: From May 2021 to February 2022, emergency doctors (specialty trainee 3 and above) from five Yorkshire (UK) departments completed an online questionnaire. This included a novel UT measure-an adapted Physicians' Reaction to Uncertainty scale collaboratively modified within our team according to Hillen et al's (2017) UT model. The questionnaire also included well-being-related measures (eg, Brief Resilience Scale) and assessed factors like doctors' seniority. Patient encounters involving prespecified 'uncertainty-inducing' problems (eg, headache) were analysed. Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes.

Results: 39 doctors were matched with 384 patients. The UT measure demonstrated high reliability (Cronbach's alpha=0.92) and higher UT was significantly associated with better psychological well-being including greater resilience (Pearson's r=0.56; 95% CI=0.30 to 0.74) and lower burnout (eg, Cohen's d=-2.98; -4.62 to -1.33; mean UT difference for 'no' vs 'moderate/high' burnout). UT was not significantly associated with resource use (eg, episode costs: beta=-0.07; -0.32 to 0.18) or patient outcomes including 30-day readmission (eg, OR=0.82; 0.28 to 2.35).

Conclusions: We developed a reliable UT measure for emergency medicine. While higher UT was linked to doctor well-being, its impact on resource use and patient outcomes remains unclear. Further measure validation and additional research including intervention trials are necessary to confirm these findings and explore the implications of UT in emergency practice.

Purpose

The purpose of this study is to gain an understanding of the different cognitive processes of buy-side and sell-side financial analysts and their use of investment beliefs and heuristics to mitigate risk and uncertainty when analyzing companies.

Design/methodology/approach

A mixed methods approach and a thematic analysis have been conducted based on 20 semistructured interviews with both buy-side and sell-side financial analysts. Using a think-aloud technique, the respondents formulated their thoughts aloud when analyzing a company and rated the importance of different financial and nonfinancial key measures along with their preferred analysis approaches, source preferences and information usage.

Findings

Buy-side and sell-side financial analysts share similar investment beliefs. Both perceive the stock market as irrational and unpredictable. Both groups also focus on companies’ nonfinancial information such as business models, ownership structure and governance while they distrust sustainability rankings. Buy-side analysts emphasized unpredictability and the limitations of expertise. Sell-side analysts focused on controlling corporate risks rather than reflecting on the limitations of the investment process to consider the systematic and inherent market risks. These differences are suggested to be explained by differences in scope and expertise – buy-side analysts being generalists and sell-side being specialists.

Originality/value

The present study is among the few that compares sell-side and buy-side financial analysts’ valuation processes by using semistructured interviews and a think-aloud approach. It shows that buy-side analysts share a skepticism toward sell-side analysts’ judgments and recommendations, and especially the credibility and validity of Environmental, Social and Governance issues (ESG) rankings. The study also reveals differences in cognitive approaches to valuation of companies.

Air pollution is a localised issue but negatively influences health and finance globally. Conurbations and regional governments struggle to find the best policy solutions to meet air quality limit levels while competing over resources and attempting to secure growth. As such, methods to increase the adoption of effective pollution-focused policies are warranted. This thesis has set out to create a framework for understanding the relationship between behaviour change of policy makers and the adoption of new air quality policies at regional levels of government. Chapter four of this thesis looked into the quality and results of previous literature through a systematic review (study 1), investigating how previous interventions have attempted to promote policy adoption. Within chapter five, a vignette study with policy practitioners (study 2; n = 15) was conducted to evaluate the use of intervention functions. Alongside the vignette study, an online questionnaire looked at perceived barriers to policy adoption. Data from both were amalgamated using thematic analysis. Finally, in chapter six, the use of interventions to promote air quality policy and the state of current UK air quality policy was reviewed (study 3). Collectively these studies have contributed to the understanding of how intervention functions influence policy intention formation and policy adoption. The combined outcomes of these studies suggest a) a need for increased education of policymakers and b) for councils to share learning and take inspiration from each other. Throughout the studies, key barriers to policy intentions and policy adoption were investigated, the most prominent being economic and administrative barriers. Within chapter seven, results are summarised and directions for future research and practice are suggested.