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Decision Making

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Kate Meehan

on 1 June 2015

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Transcript of Decision Making

Is decision making a “political” process?
Difference in decision-making between public and private sector
Decision support system
What is a “quality decision?”
Improving decision making models
Two types of decision making
Routine Problems:
Programmed decision.
Non-routine problems: Crafted decisions.
Three environments in which programmed and crafted decision consider:
Certain Environments.
Uncertain Environments.
Risk Environments.

Problem avoider: non active. participants-missed opportunities
Problem solver : reactive, gather information and respond to problems.
Problem seeker: Proactive participants and are best at decision making as they are aware of barriers and are to cope well.

Shared vs Individual Decision Making
Decision Making
D = Define
E = Establish
C = Consult
I = Identify
D = Develop Action
E = Evaluate
The Decision Process
Factors Influencing Decision Making
Health care system is a complex which requires behavioural and technical skills to deal with multiple ethical, legal, economic, technical and organizational changes (Gue, 2008: 118). In the workplace, managerial decision making according to Gue (2008: 118) has direct effect on individuals and organisational performance.
Economic Factors
Politics and Regulation
Decision Making Models
Shared Decision Making.
Evidence Informed Decision Making.
Economic Decision making.

To help HSMS with:
Demonstrating accountability and transparency.
Effectiveness and efficiency.
External or internal factors.
Sense making.

Improves effectiveness and efficiency through including more perspectives.
Can create a learning environment and empower individuals
Shared Decision Making in a Management Context

Incident Information Management Committee
Root Cause Analysis Focus Groups
General Clinical Training Committee
Medical Workforce Focus Group

Examples of Committees and Focus Groups

Evidence Informed Decision Making:
Source: YouTube. (2014, November 18). NCCMT - Evidence-Informed Decision Making
Figure 5: Decision Making Levels
Source: Williams and Brown (2014, p. 2).
Figure 7:
Shared Decision Making
Harvard Elementary School (n.d. p.1).
Video 2: Evidence Informed Decision Making
Economic Decision Making
The Agency for Clinical Innovation
Evidence Based
Reality is, decision making is a “political” process
Rational decision making is a political process.
A political perspective is taken in rational decision making
Internal and external stakeholders interests need to be considered
Certain stakeholders are chosen to benefit the interests of others ( Lewis and Boldy, 2006: 183)
Therefore managers in a sense are also rational by basing decisions on the relative importance of stakeholders.
Develops a culture decisions being made in the interests of ones own interests and others. (Lewis and Boldy, 2006)
Money, Politics and power are influencing factors in conflicting interests (Palmer and Short, 2010)
co-payment for visiting GP in 2014
(Grattan, 2014)
Comparison in decision-making management between public and private sector
Decision support system
• Decision Support System (DSS) is defined as “…systems which call for, order and promote deliberations and analysis directly relevant to management tasks where complexity and uncertainty make it difficult to arrive at a reasoned response…” (Cropper and Forte, 1997:20).

Have significant organisational impact
Available in a range of database systems
Executive Information Systems that support decisions are
Applications development.

Hospital Decision making systems
The Wand
AIM’ and “Flow Info
Activity Based Management Portal
Provide information such as patient flow, epidemiology, system operations and designs and costs. This also allows hospitals to benchmark with peers

Made with accurate data




A good outcome

What is decision making
Involves a process in weighing out alternatives.
Recognising, analysing, choice of action and implementing action.
Behavioural and Classical theories.
Short term and long term results.
Could be individual or group driven.

Health managers and decision making
Health managers have different responsibilities and duties.
The Health Manager (state) award outlines six categories.
Certain skills and attributes required for each level.
Level one usually involves supporting the department/branch with limited responsibilities.
Level six directly work with CEO, Deputy CEO or Health Executives and have a wider responsibility of managing and delivering policies where needed.

Emotional Intelligence
Emotional Intelligence is vital for health managers. It is the ability to understand, manage and recognise emotions which influence problem solving. Evidence indicates managers with high EI contributes to better teams, conflict resolutions and builds on communication.

Components: Self awareness, Social Awareness, Self regulation and Relationship Management.

Three models: Ability, trait, and mixed models.

Ethical decision making
Vital in decision making.
Considers what needs/ ought to be done based on principle and value.
Four principles: Autonomy, beneficence, non-maleficence and justice.
Virtue ethics.
Clinical ethics consultants or committees to improve quality for ethical decision making.
To improve quality of healthcare, control cost, reduce complaints, and increase trust with health care professions and institutions.

Guo (2008) defined six steps of decision making process, which should be taken by health care managers to arrive at right decision. He used DECIDE model to identify these steps, which include the following:

Personal Traits
There are significant personal traits that influence decision making. For example gender, age, past experience, cognitive biases and emotions.
Gender can influence decision making.
Men and women under low stress levels are pretty much equally good decision-makers.
Men are more prone when stressed.
While in financial decisions women are more confident in investment decisions than men.
Across age there is a significant difference in decision making (Ditrech, 2010).
Older adults in regards ability to make decisions maybe more overconfident.
Older adults prefer fewer options than younger adults.

Past experience
Individuals tend to make decision based on previous experiences.
Individuals are bound to make similar decisions in similar situation (Exforsys, 2011).
Cognitive biases
Cognitive bias as thinking patterns based on generalization and observations, which may lead to inaccurate judgments, memory faults and faulty logic (Exforsys, 2011).
Cognitive biases include belief bias, hindsight bias, omission bias and confirmation bias.
Positive emotions increase creative problem solving and facilitate integration of information (Al Tarawneh,2012: 11).
Negative effect can lead to narrowing of attention and failure for search of new alternatives.

Personal Traits
Policies and Procedures
Organisations formalize policies and procedures with guidance and direction to regulate work and/or to solve issues such as employee-related complaints.
For example: NSW Work Health and Safety: Better Practice Procedures Policy, Complaint Management Policy and NSW Health Code of Conduct Policy.
Organisational Hierarchy
Supervisors on the bottom are responsible to allocate tasks, observe and control operations and do a sort of short-term decisions (Power, 2014).
The top or managerial control level, managerial decisions focus on issues of organisation performance, large allocations of resources, major staff choices and strategic directions on products and markets.

Organisational Politics
Is a competition between interest groups or individuals for power, authority and leadership. Informal behaviour, Influence attempts, power tactics and concealing one’s motives are the means usually used in organisational politics (Sidhu, Ansari, Volberda and Oshri, 2011).
Influence attempts, power tactics and concealing one’s motives are the means usually used in organisational politics.
Decisions in an ideal organisation is subject to rational basis, however politics is non-rational and subject to power interactions between diverse interests.

Economic Factors
It was found economic factors influence organisational decisions.
Economic factors such resource pressures and constraints influenced technical decision making at the organisation level.
Politics and Regulation
A set of groups can and do exercise over decisions (Wiliams and Brown, 2014: 7).
Government, regulatory bodies, legal bodies, the media, members of public and professional representative bodies.

Video 1: Cute baby animals
Source: Youtube (2013 October 29) Cute Baby Animals Compilation
Sense Making
Source: The James Irvine Foundation New Leadership Foundation. (2013, p 1). Sense making
Figure 6: Sense Making
Making sense of complex problems
Can be achieved by sharing ideas or through decision support systems
Source:Executive Development Blog, 2015
Source: Political Power Point, 2015
(Power, 2007)
Source: Decision Support Technologies, 2015
(Power, 2007)
(Baker, 2009)
Advantages of DSS
Develops performance and efficiency of the user.

Decision-making can be made faster.

Saving time and money in making decision.

Improves effective teamwork and communication within groups.

Provides more evidence based for decision-making.
Increases decision-maker satisfaction.

Provides different perspectives to a situation.

(Messum, 2015)

Disadvantages of DSS
Everything is controlled by machines

May reduce skill in staff because they become dependent on the computers.

Overload information associated with reduction in effectiveness.
Shift of responsibility - easy to blame computer.

False sense of being objective - humans still feed information in and decide how exactly to process it.

(Messum, 2015)

What is a quality decision?
The goal of decision-making is “a quality decision”

“A quality decision” should include these characteristics: realistic, feasible, good date, timely, defensible, acceptable and good outcome (Lewis and Boldy, 2006:200)

Source: Decision making process steps management (2015)
Source: Culture tutor, 2015
Figure 8: Which Choice
Figure 9: Politics in decisions
Figure 2: DECIDE
Figure 3 : Matrix Model
Figure 1: DECIDE
Table 1: Private VS Public
Figure 10: Decision Support systems
Figure 11: Decision Proccess
Figure 12: A good decision
Reccomendation #2

Personal traits can assist managers in the decision making process, however, managers should be mindful of bias to these influences.
Recomendations #3
Training in decision making and how to use DSS have to be provided for managers. The trainings should include, conflict resulution, group leadership and group decision making tools
Recommendation #1
Emotional intelligence to be integrated into training modules for all health professionals within the organisation. This is due to the significant impact emotional intelligence can have on the decision making process and an individuals welbeing.
Recommendation #4
Resources within the public health care system are always being stretched, there for it is recommended that one uses evidence and the support from peers to inform ones decisions.
Improving Decision Making Models

Avoiding psychological bias in decision making
The ladder of inference
Decision making under uncertainty
Critical thinking
Linear programming
Reactive decision making
Source: Messum, Lecture week 9, 2015
Critical Thinking Model
"How often do you think about how you think
Critical thinking is discipline skillful using information, experience, observation and data in making decision.
Developing critical thinking skill will give better chance of being "right' and making good decision in life
Source: Critical Thii
What can go wrong?
Politics, power, dominance, group think, predetermined agendas and social pressure.
But wait there is help!
Hoy-Harter Decision making model: Impact of involving certain group members on group dynamics.
Step Ladder technique: Empower and ensure equal involvement.
Evidence to be sourced from a variety of contexts
Ensure evidence is reliable, valid and recent. Use systematic reviews and multiple random control trials.
Economic Decision Making

Cost Benefit Analysis
Net Present Value and Internal Rate of Return
Wheres all the money?
Continuous pressure to perform within a certain
Decision Making Matrix Analysis

When there are to many alternatives to choose from
Ruth's References
Day, G., and Leggat, S. (2015). Leading and Managing in Health Services. Retrieved May 16, 2015, from https://books.google.com.au/books?id=C74sCQAAQBAJ&pg=PA364&dq=emotional+intellige nce+and+decision+making+in+health+management&hl=en&sa=X&ei=V6xYVZv2EKermAXplY HgDQ&ved=0CDgQ6AEwAzgK#v=onepage&q=emotional%20intelligence%20and%20decisio n%20making%20in%20health%20management&f=false
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professional (4th ed.). Leichhardt, NSW: The Federation Press.
Mind Tools. (2015). The FourSquare Protocol: Learning to manage ethical decision making. Retrieved May 23, 2015, from http://www.mindtools.com/pages/article/newTED_83.htm
NSW Health. (2014). Health managers (state) award: Industrial Relations Commission of New South Wales. Retrieved May 15, 2015, from http://www.health.nsw.gov.au/careers/conditions/Awards/hsu_health_managers.pdf
NSW Health. (2012). Corporate governance and accountability compendium for NSW Health. Retrieved May 18, 2015, from http://www.health.nsw.gov.au/policies/manuals/Documents/corporate-governance- compendium-intro.pdf
Schermerhorn, J.R. (2013). Exploring Management (3rd ed.). Retrieved May 17, 2015, from https://books.google.com.au/books?id=qNVP2L6iKi0C&pg=PA88&dq=programmed+and+crafted+ decision&hl=en&sa=X&ei=DtJZVZ_yJubUmgWuzoG4CA&ved=0CCYQ6AEwAg#v=onepage&q=progr ammed%20and%20crafted%20decision&f=false

Wood, J., Zeffane, R., Fromholtz, M., Wiesner, R., Creed, A., Schermerhorn, J., Hunt, J., & Osborn, R. (2010). Organisational behaviour: Core concepts and applications (2nd ed.). Queensland, Australia: John Wiley & Sons Australia.

Ahmed's References
Al-Tarawneh, H. A. (2012). The main factors beyond decision making . Journal of Management Research, 4(1), 1-23. doi: 10.5296/jmr.v4i1.118
Bauer, T., and Erodgan, B. (2012). An introduction to organisational behaviour (pp. 566-617). Retrieved from http://2012books.lardbucket.org/pdfs/an-introduction-to-organizational-behavior-v1.0.pdf
Berggren, J., and Gonzalez, R. (2010).Gender difference in financial decision making. Retrieved from http://www.diva-portal.org/smash/get/diva2:324378/FULLTEXT01.pdf
Castro, M. F., Guccio, C., Pignataro, G., and Rizzo, I. (2014). The effects of reimbursement mechanisms on medical technology diffusion in the hospital sector in the Italian NHS. Health Policy, 115(2), 215-229. doi: http://dx.doi.org/10.1016/j.healthpol.2013.12.004
Dietrich, C. (2010). Decision making: Factors that influence decision making, heuristics used and decision outcomes. Student Pulse, 2(02). Retrieved from http://www.studentpulse.com/articles/180/decision-making-factors-that-influence-decision-making-heuristics-used-and-decision-outcomes
Exforsys.(2011). Factors and components of decision making. Retrieved from http://www.exforsys.com/career-center/decision-making/decision-making-factors-and-components.html
Guo, K. L. (2008). DECIDE: A decision-making model for more effective decision making by health care managers by the health care manager. Lippincott Nursing Center, 27(2), 118-127.doi: 10.1097/01.HCM.0000285046.27290.90
Mind Tools. (2015). Decision matrix analysis. Retrieved from http://www.mindtools.com/pages/article/newTED_03.htm
Power, D. J. (2014).What is the context of decision making? Retrieved May 6, 2015: http://dssresources.com/faq/index.php?action=artikel&id=300
Sidhu, J., Ansari, S., Volberda, H., and Oshri, I. (2011). Managing organisational politics for effective knowledge processes. RSM Insight, 8(4), 12-14. Retrieved from http://www.rsm.nl/fileadmin/Images_NEW/Publications/Insight/RSMInsight08-Organisational-Politics.pdf
Simpson, M. (2014).Gender and decision-making. Retrieved from http://www.mediate.com/articles/SimpsonMbl20141024.cfm
Williams, I., and Brown, H. (2014). Factors influencing decisions of value in health care: A review of the literature. Retrieved from http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/DOV_HSMC_Final_report_July_281.pdf

Eliza's References

Agency for Clinical Innovation. (2013). Understanding the use of health economics an ACI framework. Retrieved 19 May 2015
Harvard Elementary School. (n.d.). Shared Decision-Making Committee (SDMC). Retrieved 20 May 2015 http://www.houstonisd.org/domain/21571
Hill, R., & Mind Tools Team. (2015). The hoy-harter model of decision making. Retrieved 25 May 2015 http://www.mindtools.com/pages/article/hoy-tarter-decision-making-model.htm
Industrial Relations Commission of NSW. (2014). Health managers (state) award. Retrieved 21 May 2015 http://www.health.nsw.gov.au/careers/conditions/Awards/hsu_health_managers.pdf
NSW Health. (2014, February 10). Incident management policy. Retrieved 4 May 2015 http://www0.health.nsw.gov.au/policies/pd/2014/pdf/PD2014_004.pdf

National Collaborating Centre for Methods and Tools. (2012). A Model for Evidence-Informed Decision-Making in Public Health. [fact sheet]. Retrieved 20 April 2015 http://www.nccmt.ca/pubs/FactSheet_EIDM_EN_WEB.pdf.

Rutledge, M. (2009). Sensemaking as a tool in working with complexity. OD Practitioner, 41(2), 19-24. Retrieved 21 May 2015 http://www.revisions.org/pubs/Rutledge_Sensemaking_ODPractioner09.pdf
The James Irvine Foundation New Leadership Foundation. (2013, p 1). Sense making. Retrieved May 21, 2015 NSW Health. (2014, February 10). Incident management policy. Retrieved 4 May 2015 http://www0.health.nsw.gov.au/policies/pd/2014/pdf/PD2014_004.pdf

Sophia's References
Baker, W. (2009). Managerial Decision Making. [Lecture note week 8]
Critical Thinking. (n.d.). Retrieved 2015, May 23rd from http://www.mindtools.com/pages/article/newTED_95.htm
Culture tutor [Image]. Retrieved 2015, May 23rd from http://culturetutor.net/?cat=1
Executive Development Blog. UNC Executive Development: Strategic Planning and Decision Making [Image] (2015, Feb 10th). Retrieved 2015, May 23rd from http://execdev.kenan-flagler.unc.edu/blog/unc-executive-development-strategic-planning-and-decision-making
Decision Making Process Steps in Management. [Image]. Retrieved 2015, May 23rd from http://www.thoughtyoumayask.com/picsbtqq/decision-making-process-steps-in-management
Decision Support Technologies [Image]. Retrieved 2015, May 23rd from http://www.swri.org/4org/d10/isd/decision/default.htm
Grattan, M. (2015). Medicare co-payment: a case study in policy implosion. The Conversation. Retrieved 2015, May 23rd from http://theconversation.com/medicare-co-payment-a-case-study-in-policy-implosion-38311Lewis, J. and Boldy, D. (2006) Decision Making and the Health Service Manager. In M. Harris and Associates Managing Health Services Concepts and Practice Marrickville: Elsevier.
Messum, D. (2015). Managerial Decision Making. [Lecture note week 9].
Nutt, P.C. (2005). Comparing public and private sector decision-making practices. Journal of Public Administration Research and Theory, 16:289–318. doi: 10.1093/jopart/mui041
Palmer, G. and Short, S. D. (2010) Health Care and Public Policy: An Australian Analysis. (3rd Edition) South Yarra: Macmillan.
Political PowerPoint [Image]. Retrieved 2015, May 23rd from http://www.powerpoint.org.cn/ppt/PoliticalPowerpoint/ppt_7684.html
Power, D.J. (2007) A Brief History of Decision Support Systems. DSSResources.COM. Retrieved February 17, 2009 from the World Wide Web: http://DSSResources.COM/history/dsshistory.html, version 4.0.
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