Unit 5 Unit 5

DECISION – MAKING IN DECISION – MAKING IN NURSINGNURSING

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Decision – Making In NursingThe process of selecting one action from alternatives

Decision making is the learned & scientific problem solving process.

Managers spend much time making decisions and solving problems, especially non routine situations

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Decision Making Process

1) Identify the problem:- defining the problem. What is

wrong? Where is improvement needed?

- begins when the nurse manager perceives a gap between what is actually happening and what should be happening.

- The nurse manager can identify the problem by analyzing situation.

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- What is the desirable situation? - What are the presenting symptoms? - What are the discrepancies?- Who is involved? - When? Where ? How?* Develop Feasible hypotheses, and

elimination of hypotheses that fail to conform to the facts.

- Feasible hypotheses should be further tested for causal validity.

- By analyzing available information, manager should begin exploring possible solutions

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2) Explore alternatives:- If situation is not covered by policy,

manager must draw on his education and experience, but it may be inadequate.

- more experienced manager had more alternatives to be suggested for solving a variety of problems.

- Health care is changing rapidly manager should learn how others are solving similar problems.

- This can be done through continuing education, professional meetings, review of the literature, and brainstorming with staff.

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3) Choose most desirable alternative:

- One alternative is not always clearly superior to all others.

- Manager must try to balance multiple factors such as pt safety, staff acceptance, morale, public acceptance, cost, and risk of failure.

* The following questions may be asked:- Will this decision accomplish the

stated objectives? (yes or no) - Dose it maximize effectiveness and

efficiency? use available resources before seeking outside assistance.

- Can the decision be implemented? If not, it will not solve the problem

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4) Implement decision:- The manager will need to

communicate the decision to appropriate staff smoothly to win the cooperation

5) Evaluate results:- Evaluate the results of the chosen

alternative. - Be alert: solutions to old problems

sometimes create new problems, so you need additional decisions.

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Creativity In Decision MakingThe ability to develop and implement new

and better solution

The creativity has four stages.1) Preparation:- Acquiring information to understand the

situation. through observation and extensive use of data collection.

2) Incubation stage: - Is a period for ponderingتأمل the situation.- Repetition of the same thoughts.- No new ideas or interpretations.- Reexamine the situation and review the

data collected.

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3) Illumination (insight):- Is the discovery of solution may be

during performance of another task.4) Verification:- Experimentation of solution (succeeded

or failed).Ethical Decision Making

Ethics:- Moral philosophy.- Science of judging the relationship of

means to ends.- The art of controlling means.- Involves conflict, choice, and

conscience

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**Why ethics became a greater dimension in management decision making?

A . Increasing technology, and regulatory pressures.

B . Competitiveness among health care providers .

C . Nursing shortages, and reduced fiscal resources & spiraling costs of supplies and salaries.

D . The public’s increasing distrust of the health care delivery system and its institution.

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Ethical Dilemmas

Choose decision between two equally desirable or undesirable alternatives

values, beliefs, and personal philosophy play a major role in the ethical decision making.

If no right or wrong answer exists? Or if both answers are right or wrong?

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Characteristics of ethical dilemma:

1 ) problem cannot be solved using only empirical data.

2) problem must be so perplexingمحيرةand making the decision is difficult.

3) The result of the problem must affect more than the immediate situation .

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Ethical Problem Solving And Decision Making.systematic ethical decision making

and problem solving:- reduces personal bias - facilitates better decision - making - managers feel more comfortable about

decisions they have made If problem solving approach is used:- gathering data is adequate- alternatives are analyzed- manager feels that the best possible

decision was made at specific time and available information regardless of the outcome.

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The MORAL Decision - Making Model: Crisham (1985)M.— Massage the dilemma. Collect data about the ethical problem.O.— Outline options. Identify & analyze alternatives and

consequences of each.R.— Review criteria and resolve. Weigh the option's effect in the

decision A. — Affirm position and act. Develop implementation strategy L.— Look back. Evaluate the decision making.

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Ethical Frameworks For Decision Making

Not solve ethical problem, but assist manager in clarifying personal values and beliefs

1) Utilitarianism: - Make a decision based upon providing

the greatest good for the greatest number of people

Ex. : using travel budget money to send many staff to local workshops rather than sending one or two individuals to attend a national conference.

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2) Duty -based reasoning: - some decisions must be made because

there is a duty to do what is right 3) Rights based reasoning:- “Rights are deferent from needs, wants,

or desires”. 4) The intuitionist framework : -decision maker reviews each ethical

problem on a case-by case basis comparing the relative weights of goals duties and rights. determined primarily by intuition.

- What the decision maker feels is right for the particular- situation

- Disadvantages are subjectivity and bias.

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Models For Ethical Relationships:1) 1- The priestly model: The manager is paternalistic and make

decisions without considering other’s values. ‘Autocratic leadership may use the priestly model”

2) The engineering model:Suggests that one person presents facts

to another and sets aside his own ethics to do what the either wants.

“Staff working for line authority may be an example of this model”

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Models For Ethical Relationships.. Cont.

3) The contractual model:Contract that identifies general obligations

and benefits for two or more people.“deals with morals of both parties and is

appropriate for superior-subordinate relationships .

4) The collegial model:Individual's share mutual and reach

decisions through discussion and consensus. (build teams and minimize conflict).

- The result of ethical decision must be ethical & not to be unethical*

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Selec1ing Decision Making Styles1- Continuum of participation:

Members of a group or organization Participate in decision making. The extent of participation depend on organizational philosophy, managerial style.

- Agencies allow greater participation are democratic in nature, & those discourage participation are autocratic

**Tannenbaun and Schmidt: developed the continuum of leadership and participation related to the degree of authority used by the leader and the freedom of subordinates in decisions.

The extreme left characterize the manager who maintains a high degree of control, whereas the right characterize the leader who releases a high degree of control.

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القرار صناعة أساليبالمشكلة ويضع البدائل ويصنع المدير يحدد 1.

القرار وال يأخذ رأي أحد.المدير يحدد المشكلة ويصنع القرار ويحاول 2.

إقناع اآلخرين بتقبل القرار بسهولةيصنع القرار ويتيح الفرصة لآلخرين لألسئلة 3.

واالستيضاحات ولكن دون التأثير على القراريتخذ قرار مؤقت لمعرفة تفاعل اآلخرين ومن 4.

ثم يأخذ القرار الذي يراعي شعورهميحدد المشكلة ويأخذ االقتراحات النابعة من 5.

خبراتهم ثم يختار بديل مناسب من البدائل المشتركة معهم

مثال يضع حدود لنفسه ولآلخرين لصناعة القرار (6.نصف ساعة معنا للقرار)

يسمح لآلخرين بصناعة القرار وربما يساعد أو ال 7.يساعد فيه وفي تلك الحالة تكون سلطته كأي

فرد

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1 2 3 4 5 6 7

Use of authority by manager

Area of freedom for subordinates

ManagerMakes

DecisionAnd

AnnouncesIt

Manager sells

Decision

ManagerPresentsIdeasAndInvitesQuestion

ManagerPresentsTentativeDecisionSubject

ToChange

ManagerPresentsProblem

GetsSuggestion

MakesDecision

ManagerDefinesLimitsAsks

GroupTo makeDecision

ManagerPermits

SubordinatesTo function

WithinLimits

DefinedBy superior

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A manager can be autocratic or democratic in decision making depends on the following factors:

1. How important is the quality of the decision?

2. Does the manager have sufficient information to make a decision? If not, others should be involved in the decision

3. Is there acceptance of the decision from subordinates?

- Subordinates should be included in decision making if they affected with it.

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2- Vroom and yetton normative

mode:They address decision making as a

social process and emphasize how managers do rather than should behave in their normative model.

Identified the 5 decision making methods:

A = autocratic C = Consultative G = Group

I = First variant II = Second variant

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They have identified five decision making methods or styles:

AI- You solve the problem or make the decision alone, using information available to you at that time.

AII- You obtain the necessary information from your subordinates, and make a decision.

- The role of your subordinates in making the decision is providing the necessary information to you, rather than generating or evaluating alternative solutions.

CI- You share the problem with relevant subordinated individually.

- Getting their ideas and suggestions,- Then you make the decision that may or may

not reflect your subordinates’ influence

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CII- You share the problem with your group subordinates

- obtaining their ideas and suggestions. - Then you make the decision that may or

may not reflect your subordinate's influence .

GII- (group decision making) -You share a problem with your

subordinates as a group- Together you generate and evaluate

alternatives & reach agreement (consensus) on a solution. Your role is much like that of chairman.

- Don't try to influence the group to adopt ‘your” solution , & willing to accept and implement group supported solution. مستعد لقبولوتطبيق القرار المتوافق عليه جماعيا

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Vroom's seven rules to determine which style is appropriate in a given situation: ( 3 protect decision quality &4 protect

acceptance 1) The information rule: - quality of the decision is important and

the leader does not have enough information or experience to solve the problem (AI is eliminated )

2)The goal congruence rule. - Quality of the decision is important- The subordinates do not share the

organizational goals to be obtained in solving the problem (GII is eliminated)

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3) The unstructured problem rule:- quality of the decision is important, - leader not have necessary information or

experience to solve the problem by himself- The problem is unstructured, i.e. he does

not know exactly what information is needed and where it is located .

- involvement of subordinate's interaction with full knowledge of the problem to generate a high-quality solution (AI, AII, and CI are eliminated).

4) The acceptance rule.- If the acceptance of the decision by

subordinated is critical to effective implementation

- Not certain that an autocratic decision made by the leader would receive that acceptance.

- (AI and AII are eliminated)

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5) The conflict rule:- If the acceptance of the decision

is criticaland autocratic decision is not

certain to be accepted- subordinates are likely to be in

conflict or disagreement with solution

(AI, AII, and CI are eliminated) G 2 may used because finally you

must solve problem.

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6) The fairness rule:- If the quality of decision is

unimportant - acceptance is critical and not certain

to result from an autocratic decision.(AI, AII, CI, & CII are eliminated)

7) The acceptance priority rule:- If acceptance is critical- Not assured by an autocratic decision- If subordinated can be trusted. (AI. AII. CI, and CII are eliminated)

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Outcomes that influence the effectiveness of decision

1. The quality of the decision .2. Acceptance of the decision by

the subordinates .3. Available time needed to make

the decision

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Managers can diagnose a situation quickly and accurately by answering

following questions 1. Is there a quality requirement?2. Do I have sufficient information to make a

decision?3. Is the problem structured?4. Is acceptance of decision by subordinates

critical?5. If you have to make the decision by yourself,

is It accepted by your subordinates?6. Do subordinates share the organizational

goals to be obtained in solving this problem?

7. Is conflict among subordinates likely in preferred solutions? صراع بين المرؤوسين على الحلول المفضلة

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Individuals as decision makers:

Autocratic manager:- Try to make decision by himself- Fears that others decisions may be

more costly, less effective and affecting his power

Everyone has different decision making style affected by values, life experiences, preferences, risks, and way of thinking

People may perceive the same situation differently

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1- Values and decision making: (decide mode of conduct)

2-Life experience and decision making. 3- perception (Individual preference) and

decision making.4- Individual ways of thinking and decision

making. (decision is a thinking skill, and Individuals think differently)

5- PersonalityGroup factors in decision making:

It is unusual for an individual to do decision making process by himself.

Commitment to the decision is important and increased by participation in the decision making process

Individuals as decision makers: cont…

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The advantages of group participation in decision making:1. increase acceptance and

enhanced cooperation in implementation

2. Broader experiences, wider range of knowledge

3. Time consuming to gather information and analyze it

4. Allows the nurse to express his views and persuade others

5. Sustain friendship

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Disadvantages of group participation in decision making 1. Subordinate may influenced by

his desire for group acceptance or be quite all the time of meeting

2. Few people may be dominated the group

3. Interested in an argument than in determining the best alternatives

4. Consensus may not select the optimal alternative.

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THE END