1. Introduction

2. Related Work

2.3. Factors that affect the development of decision support framework

There are several factors that can impact the development of a proper decision support framework. These factors can include the culture and values of the organization, how hard it is to make decisions, the quality and availability of data, and the skills and knowledge of the team that is in charge of putting the framework into place among others [14] [15] .

One of the major elements that can affect the development of a proper DSS framework is the team skills and knowledge. Setting up a new system requires the team to have the necessary skills and knowledge to understand its importance and how to use it [16] [17] [14] [18] [15]. Decision making in an organization is a team job as the person making the final decision requires the input of others within the team and at different levels within the organization. Consequently, it is critical for the organization to have individuals with the necessary team skills to operate the framework efficiently. In addition to the skills needed, the technical requirements of the project also affect its success. An extensively technical system may be challenging to implement and might also require intensive training for the users [19] [20].

A competent framework's ability to be developed might also be impacted by other significant factors, like the quality and availability of data. DSS rely on data to make decisions, Therefore the effectiveness of the system can be significantly impacted by the correctness and dependability of the data used by DSS [11] [21] [22] [15]. Organizations need to ensure that they have access to high-quality data that is relevant to the decisions being made and that they have systems in place to regularly review and update the data used by DSS [22]. Therefore, successful implementation also requires the organization to invest in data collection and management systems, which guarantee quality. Another critical factor is the complexity of the decision-making process which can impact the development of a proper support framework. According to [23] states that, DSS work best when used to support relatively simple and structured decision-making processes. When the DSS framework developed is complex with multiple connecting points, it might be impossible to operate for employees and potential users [16] [23] [20]. When designing a framework, it is critical that it be made as simple as possible, and also involve the users during the process to ensure they understand how it will integrate into their way of operating. The framework should be made in a way that it improves service delivery and decision-making and not making operations challenging for the users [23].

Another element relates to the cost-benefit analysis of the decision made. The financial element of such a project as per the decision made determines its potential to implement and sustain in an organization. When developed for a specific organization, the system needs to have positive cost-benefit analysis [9] [19] [20]. In addition to all the factors, the leadership support is also required [13] [16]. Most DSS frameworks are meant for use by the leaders to inform their decision-making processes. Therefore, when the leaders support the implementation, there is potential for the successful implementation of the project.

According to [14]Organizations with a strong culture of data-driven decision-making may be more likely to adopt and effectively implement DSS [14]. On the other hand, organizations with more traditional or reactive approach to decision-making may be less receptive to have the decision support framework or may struggle to effectively integrate the system into their decision-making processes. It is important for organizations to consider their culture and values when developing the decision support framework and to ensure that the framework is aligned with these values and is able to effectively support the organization's decision-making processes [14].

Finally, the time is an essential factor in the framework implementation [16]. The framework or the system require to be a timely nature to allow analysis of the data and allow decision-makers to get solutions. in addition, when the system saves time, it is easily integrated into the organization [16]. Ultimately, these factors are critical in the ultimate implementation and it may not be easy to work with them in isolation. A system must support or align to most, if not all these factors.

Table 1. Summary of the factors that affect the development of decision support framework.

Table 1. Summary of the factors that affect the development of decision support framework.

Factor Name	Definition	Source
Team skills and knowledge	Skills and knowledge developed towards the use of the new framework.	[16] [17] [14] [18] [15]
Quality of Data Available	The value added by available data and its reliability	[11] [21] [22] [15]
Complexity	The complication of the decision-making process	[16] [23] [20]
Cost-benefit analysis	The decision made needs to compare with the benefits it gives	[9] [19] [20]
Leadership Support	Leadership understanding and support of the whole process	[13] [16]
Communication	Interrelationship among the parties involved	[16] [24] [25]
Technical requirements	Systems and installations needed for the system to operate	[19] [20]
Organizational data- driven culture and values	The way of doing things within the organization	[14]
Time	Adequate factor analysis time	[16]

2.4. Decision support framework case studies

Informed decision support frameworks are designed to assist individuals or organizations in making informed decisions by providing relevant information, analysis, and recommendations. These frameworks can be applied in a wide range of contexts, including healthcare, finance, education and technology. Below are several case studies of informed decision support frameworks from around the world. Understanding these applications is critical in identifying the gap, which is needed for further research in Saudi Arabia.

The United Kingdom Environmental Observation Funder (UK-EOF) is an organization that has set up its decision support framework with the intent of improving the decision-making processes with the public sector, and especially in environmental management. Its overall purpose and benefit are outlined in Figure 1 [26].

The decision support framework for the UK- EOF shown in Figure 2 is a process that captures and summarizes the key evidence needed to make a decision based on a set of common criteria or issues. The process involves input from a variety of organizations and is coordinated by a central support body, such as the UK-EOF secretariat. The process has six stages, including proposal initiation, evidence gathering, discussion forum, outputs formulated, decision made, and observation activity catalogue modification [26].

The framework begins with proposal initiation, where the proposing organization or funder assigns a member of the organization to lead the proposal. The next stage is evidence gathering, where the proposing organization or funder provides the required supporting activity description and completed draft activity scorecard, which is then circulated to external organizations for comment and scoring. The central support body then gathers the evidence, sets up a discussion forum, and provides a summary of informed responses for the proposing organization to use in making a decision. The discussion forum is the next stage, where a summary scorecard is produced using the evidence gathered. The outputs are then formulated, and the proposing organization or funder makes a decision based on the informed advice provided by the central support body and supporting organizations. The final stage is the observation activity catalogue modification, where the funder is encouraged to make any necessary changes [26].

Marušák et al. [19] discussed a DSS approach implemented in the Czech Republic as presented in Figure 3. The system was named optimal, and its logical structure was based on the need of its application, which was within the forest management sector. It involved making the necessary data inputs, which included the forest stand map and forest inventory data at the start before adding information on the systems requirements, and it gave the potential harvest units [19]. It was noted as a powerful system for harvest scheduling. The authors also added that the system allowed forest managers to change the parameters and create various scenarios within a matter of minutes to find the best solutions based on specific needs [19].

Another case of the informed decision framework, the decision support framework shown in Figure 4 for improving Evidence-Informed Decision-Making (EIDM) in health service management is a comprehensive framework that takes into account all the relevant factors that influence the practice of EIDM in different types of organizations [27]. This framework is designed to provide guidance on the strategies that need to be developed and evaluated to improve EIDM in health service management. The framework is based on an understanding of the various factors that interact to influence EIDM and the relationships between these factors [27].

The framework takes into consideration all factors relevant to the various types of organizations that play a significant role in influencing EIDM. These organizations include government departments, healthcare organizations, professional and training organizations, and university and research institutions. Within each type of organization, there are various factors that affect the practice of EIDM, but it is clear that the factors relevant to each type of organization are interrelated. Therefore, to best influence the practice of EIDM amongst health services managers, changes should be introduced within the three types of organizations as detailed in the framework [27].

The framework suggests that changes should be specific and relevant to the local context, making evidence more easily understood and interpreted by managers for immediate use. This focus on promoting and rewarding the use of evidence, as well as improving the relevance of evidence, ensures that managers are making informed decisions based on the most current and relevant information available. Additionally, the framework takes into account the interrelated nature of factors relevant to each type of organization, highlighting the need for a holistic approach to improving EIDM in health service management [27].

Another model framework was applied in the University of Babylon to assist in the procurement decisions as highlighted in [17]. Their proposed a framework based on data collection from interview and consequent analysis, as well as, review of literature review. It is applicable in both simple and complex decision probabilities to assist in the provision of accurate results for each criteria as highlighted in Figure 5 [17].

The framework has five constructs with each of them passing through five unique stages. It starts with the initial goods evaluation in stage one followed by development of goods evaluation in stage two [17]. Stage three requires vendor bids evaluation followed by vendor selection in stage four, and finally the supplements in stage five [17].

One of the models applied in a different setting was developed by Van Delden [9].The model as presented in Figure 6 incorporates three different elements, which are the design, development, and implementation. (a) represents the relationship between the main parties that are involved in the development process to enable the functionality of the Decision support framework. Each party has their responsibility within the process expressed. It also identifies all the communication blocks that could have the potential to prevent the development. (b) describes the development process, which is presented as an iterative process as opposed to a waterfall. Finally, (c) places the tasks in their respective order as necessitated in the development process, and it also focuses on iterative processes that arise throughout the framework.

Di Mateo [18] proposed a decision support model for the management of cultural heritage. Their proposed framework aimed at supporting organizations and companies with interest in cultural heritage and museum management to assist in the adoption of scientific policies and criteria in their plans and management of daily operations [18]. Figure 7 is a depiction of their proposed framework.

Another decision support framework applied within the clinic sector is the multi-agent clinical decision support system which uses Case-Based Reasoning (CBR) [28]. The Clinical Decision Support System CDSS is created as an approach towards the improvement of medical decisions by focusing on clinical knowledge, patient information, and related medical information [28]. The approach integrates CBR into CDSS through a connection of the search agent to the decision agent. As highlighted in Figure 8, there is a combination of both CBR and CDSS to develop the ideal tool.

The process of combining CBR into CDSS requires connecting the search agent to the decision agent. The search agent allows finding the cases that are the most similar to the problem. An adaptation agent follows and they determine the differences between the selected cases and the current problem. If it is proven necessary, they set the necessary rules, which makes it possible to apply old solutions to the new problem [28]. An enhancement agent adapts checks and criticizes the results and the execution agent applies the refined solution. In the end, an evaluator is responsible for storing the results into a database and the result is shard with the decision agent [28].

Finally, the application in the field of clinical medicine was explored by [20] in Saudi Arabia and shown in Figure 9. They explored the application and experience of Clinical Decision Support System (CDSS) and its effectiveness within the healthcare sector in Saudi Arabia [20].To be successful, the system required three main areas of focus: input content, integrity of CDSS, and output advice. The input content had to be right, reliable, and updated. For the system to express the right level of integrity, it needed to integrate with Health Information System, clinical workflow, and adopt mechanisms of alerts. Finally, the output advises needed to be simple, speedy, and with references [20]. The CDSS alerts were both active and passive, and they had three main levels, which included critical, moderate, and least important. In KSA, it was implemented as part of the Evidence-Based Medicine for the improvement of patient safety. It offers clinicians with the necessary knowledge of the specific patients or diseases which facilitate taking the decision.

Table 2. Summary of the decision support framework presented.

Table 2. Summary of the decision support framework presented.

Framework Name	Specialty	Country	Source
Environmental Observation Framework (EOF)	Environmental Management in Public Sector	United Kingdom	UK-EOF [26]
Optimal	Forest Management	Czech Republic	Marušák et al. [19]
Evidence-informed decision-making in health service management framework	Health Service Management	Australia	Liang et al. [27]
UOB DSS procurement framework	University setting	Iraq	Abid et al. [17]
Decision Support System Development Framework	Natural Hazard Mitigation	Australia	Newman et al. [9]
DSS framework for cultural heritage	Cultural Heritage Management	Italy	Di Mateo et al. [18]
Multi-agent Clinical Decision Support System using Case-BasedReasoning	Clinical sector	Ukraine	Korablyova et al. [28]
Clinical Decision Support System (CDSS)	Clinical sector	Saudi Arabia	Alqahtani et al. [20]

3. Proposed Framework

4. Methodology

5. Results and Analysis

5.1. Interviews Answers analysis

A. Question one

The first question asked the interviewees, who were decision makers in the organization, about their thoughts regarding the present decision-making processes within their organization. It also required them to express whether they could guarantee the veracity of the decisions. All the interviewees shared their opinions based on what they had experienced within their organizations. For the most part, all the departments represented had some form of a decision-making process, but the differences emerged when describing how it worked, and how veracity could be guaranteed. According to P1, their organization was hierarchical, and the decision-making process required different individuals to participate based on their levels of authority. They also highlighted the importance of the type of decision needed, urgency, or the overall strategy affected.

“As a decision-maker, I am part of the process, and I play my role based on the type of decision being made. While in some cases, and especially when strategy is involved, the decision is largely top-down, there are others where the team at the bottom present options for validation. Therefore, it depends on the type of decision being made, and the reason and urgency involved.”

A similar stance was taken by P2 who also indicated that strategic decisions were made by the top leaders in their organization. P3 stated:

“necessary to identify the authority of the individuals who can work on the decision-making process. Finally, the decision-makers have to seek for the relevant information, data and resources that they intend to use during the process.”

Therefore, all the participants understood what the question required of them, and they shared their opinions based on the operations within their sectors. They also highlighted the need for improvements to ensure validity of the solutions offered during decision making processes.

B. Question Two

The second question investigated into the issues of systems within the organization and what should be used when dealing with decision making. All the respondents had views and opinions regarding potential systems for use, whether they were within their sectors, or they understood their importance based on industry understanding. P3 stated that the BIU, data and statistics sources were critical for the organization when making decisions. Data and statistics were also selected by P1 who stated:

“In my opinion data and statistics allow even a perform unfamiliar with an issue to make a conclusive and informed decision.”

P5 highlighted two important elements: which included an internal system within an organization dedicated to support decision making. They also mentioned the importance of Centers Operation from which all relevant health information can be accessed to inform the basis of decision making for an entity.

He said:

“Firstly, an organization’s internal system that supports decision making…Secondly, Centers Operation which has the access to all the relevant health information within the organization.”

C. Question three

The third question asked the interviewees about the decision criteria that should be taken into account prior to starting the decision-making process. P4 stated that there was a need to understand the type of decision that was required, and in the event that it was a strategic decision for the organization, an informed alternative was necessary. It would be powered by getting the necessary data and exploring potential impact. P3 stated:

“the initial process requires defining the problem and identify how it impacts on the organization.”

For most of the responses, the interviewees highlighted the importance of defining the problem to understand the level of authority required to resolve it and allow the organization to find the necessary resources to support the process. P1 also raised an essential concept by adding that it was necessary to assess the impact that the problem or ultimate decision would have on the organization, which would inform the level of authority that the decision maker required.

“one needs to identify the actual problem. It means that the problem is defined and each of its relevant elements presented. At this stage, the identified problem is classified in line with its impact within the organization.”

D. Question Four

The fourth question requested the interviewees to state the sources that had the biggest impact on decisions. While the sources of the ultimate information to make the decision could be diverse, P1 stated:

“There could be multiple sources, but one of the determinants is the actual problem. Once it is analyzed, one can find the most ideal approach to handle it and find a solution.”

One of the sources that they highlighted as important was industry data from which the organization could benchmark what its peers were doing. Internal sources of information, both digital and non-digital were selected as critical in the decision-making process by P2. Their argument was that most organizations had a many of data about their historical performance and the results of different actions, which they had not taken into perspective when implementing selected decisions. P3 had an extensive list of the vital information that their organization required and the sources that they found essential in the process. He said:

” Customer surveys, market research, financials, and the related reports, opinions of experts in the field, such as consultants, lawyers, and financial advisors…data from external sources, such as government regulatory agencies.”

P5 selected the organizations within the industry that they found critical in the process, and according to them, all the statistics and data collected through customer surveys, BIU and Centers Operation were vital sources for their organization.

E. Question Five

The fifth question asked about the effectiveness of the decision-making process when using digital and non-digital sources. According to the respondents, there was evidence of the fact that they understood how the world was moving away from analogue or non-digital formats to digital formats. Accordingly, a combination of the two sources was selected as the most effective option by most participants. P4 highlighted the importance of considering to use non-digital sources since, according to them, digital sources were often inaccurate.

“A business must utilize both digital and non-digital data sources. The digital sources, however, are not always accurate. In order to help the decision-making process, it is crucial to take into account non-digital sources.”

P5 stated that the use of digital sources gave the decision maker access to a wide range of information, and the process of retrieving non-digital materials was times-taking, which could delay the decision-making process.

He said:

“When coupled with the swiftness of digital technology and authenticity of non-digital materials, a decision-maker has access to some of the most critical information tools necessary.”

F. Question Six

Question six asked about the importance of DMO in the decision decision-making process. P3 stated that they were critical as tools of controlling the decision-making process.

“Limiting access to information, data and potential actions enable organizations control the decision-making process.”

Additionally, they ensured that sensitive data within the organization necessary for the decision-making process was only accessible to authorized parties. P5 stated that DMOs were necessary to ensure that individuals only made the necessary input according to their level of authority in the sense that if a person was only required to save information, they could not retrieve it and edit without getting the proper authority. P4 stated that DMO served two main purposes and said:

“It’s the central unit to guide the decision-making process to the right information, it gives a clear indication of the information's precise source and assure the right access to the data.”

Therefore, the importance of DMO was evidently understood by all the participants, and they highlighted the need for every organization to have such a system within its processes.

G. Question seven

Finally, the last question asked the interviewees to state whether they believed that the addition of Centers Operation, BIU, Statistics, Data, and IDS would improve the decision-making process accuracy. For the most part, all these tools were thought to be important due to their impact on access to data and statistics, which would increase their impact on decision accuracy. According to P3:

“data and statistics form the backbone of any decision.”

P4 highlighted the importance of aligning these sources to ensure that the organization prevented duplicity. Finally, P5 stated that the tools improved the process, and they were well planned and could be easily audited. They also ensured that the decision-making process presented the required relevance to the organization.

“An accurate decision-making process is one that is well planned, and easily audited. When multiple tools are added and they interact with ease, it becomes an ideal tool to promote the framework and its operations.”

Finally, Table 3 depicts the interview questions as well as the interviewees' responses to each question.

Table 3. a summary of each participant response for all interview questions.

Table 3. a summary of each participant response for all interview questions.

6. Discussion and Outcomes

Table 4. A summary of the components discussed.

Table 4. A summary of the components discussed.

6. Conclusions

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