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

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