Generative AI Decision-Making Attributes in Complex Health Services: A Rapid Review

The advent of Generative Artificial Intelligence (Generative AI or GAI) marks a significant inflection point in AI development. Long viewed as the epitome of reasoning and logic, Generative AI incorporates programming rules that are normative. However, it also has a descriptive component based on its programmers' subjective preferences and any discrepancies in the underlying data. Generative AI generates both truth and falsehood, supports both ethical and unethical decisions, and is neither transparent nor accountable. These factors pose clear risks to optimal decision-making in complex health services such as health policy and health regulation. It is important to examine how Generative AI makes decisions both from a rational, normative perspective and from a descriptive point of view to ensure an ethical approach to Generative AI design, engineering, and use. The objective is to provide a rapid review that identifies and maps attributes reported in the literature that influence Generative AI decision-making in complex health services. This review provides a clear, reproducible methodology that is reported in accordance with a recognised framework and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 standards adapted for a rapid review. Inclusion and exclusion criteria were developed, and a database search was undertaken within four search systems: ProQuest, Scopus, Web of Science, and Google Scholar. The results include articles published in 2023 and early 2024. A total of 1,550 articles were identified. After removing duplicates, 1,532 articles remained. Of these, 1,511 articles were excluded based on the selection criteria and a total of 21 articles were selected for analysis. Learning, understanding, and bias were the most frequently mentioned Generative AI attributes. Generative AI brings the promise of advanced automation, but carries significant risk. Learning and pattern recognition are helpful, but the lack of a moral compass, empathy, consideration for privacy, and a propensity for bias and hallucination are detrimental to good decision-making. The results suggest that there is, perhaps, more work to be done before Generative AI can be applied to complex health services.