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PubMed2001

What you don't know about making decisions.

Most executives think of decision making as a singular event that occurs at a particular point in time. In reality, though, decision making is a process fraught with power plays, politics, personal nuances, and institutional history. Leaders who recognize this make far better decisions than those who persevere in the fantasy that decisions are events they alone control. That said, some decision-making processes are far more effective than others. Most often, participants use an advocacy process, possibly the least productive way to get things done. They view decision making as a contest, arguing passionately for their preferred solutions, presenting information selectively, withholding relevant conflicting data so they can make a convincing case, and standing firm against opposition. Much more powerful is an inquiry process, in which people consider a variety of options and work together to discover the best solution. Moving from advocacy to inquiry requires careful attention to three critical factors: fostering constructive, rather than personal, conflict; making sure everyone knows that their viewpoints are given serious consideration even if they are not ultimately accepted; and knowing when to bring deliberations to a close. The authors discuss in detail strategies for moving from an advocacy to an inquiry process, as well as for fostering productive conflict, true consideration, and timely closure. And they offer a framework for assessing the effectiveness of your process while you're still in the middle of it. Decision making is a job that lies at the very heart of leadership and one that requires a genius for balance: the ability to embrace the divergence that may characterize early discussions and to forge the unity needed for effective implementation.

Administrative Personnel↗
PubMed2004

How does an Alzheimer's disease patient's role in medical decision making change over time?

As persons with Alzheimer's disease (AD) lose their ability to make decisions, someone else has to make decisions for them. We performed a prospective cohort study of 77 AD patient-caregiver dyads to examine when this transition occurs. When dementia severity surpassed a threshold marked by a Mini-Mental State Examination (MMSE) score less than 20, the level of caregiver-reported patient involvement in the medical decision-making process declined (Moderate [MMSE = 19-12]: Odds Ratio [OR] = 2.35, 95% confidence interval [95% CI] = 1.01-5.49; P =.048; Severe [MMSE < 12]: OR = 29.38, 95% CI = 5.98-144.25, P <.001). Furthermore, older patients (OR = 1.06, 95% CI = 1.00-1.12, P =.049) and mounting caregiver burden (OR = 1.12, 95% CI = 1.04-1.26, P =.003) were significant independent predictors of transitions to the caregiver-dominated medical decision-making process. These results provide clinicians with prognostic information that can help caregivers understand how their role in decision making will change over the course of a patient's dementing illness.

Age Factors↗
PubMed1998

Clinical decision making--what every non-clinician manager should know but was never taught.

The management of a health care system requires making decisions and establishing policies that can affect the process of patient care. Clinicians often complain that these decisions and policies are made by people without clinical training. Clinical knowledge is not a prerequisite for a career in health policy or management. Even graduates of accredited health administration programs are not required to understand the process of clinical decision making or the nature of medical practice. Much of the health services literature advocates a shared decision-making model for clinicians and managers. However, most of the literature focuses on how to involve physicians in management decision making; almost none discusses management involvement in clinical decisions. This paper briefly examines how non-clinician managers can support the clinical decision-making process and then specifies the knowledge and skills required for them to play this role.

Clinical Medicine↗
PubMed1991

Decision making in clinically depressed patients. A transcultural social psychological study.

One of the most important cognitive deficits in depression is said to be the patient's inability to make decisions. A research design involving a cross-cultural comparison between Australian and Japanese normal controls (N = 309 and N = 743, respectively) and clinically depressed patients (N = 59 and N = 45, respectively) was used to examine the influence of culture on illness and decision-making behavior, and whether deficits in decision making may be related to culture. It was found that depression had a greater effect on decision making in Australian patients than in Japanese patients. While many differences were found between Australian and Japanese nondepressed students, few differences were found between Australian and Japanese depressed patients. Thus, there appears to be an important interactional effect of culture and depression on decision making. The theoretical and clinical implications of the results are discussed.

Adolescent↗
PubMedDate not supplied

Diagnostic process and decision making in nursing: a literature review.

In clinical practice professional nurses appear to make different judgments regarding particular nursing situations. The purpose of this literature review is to gain insight into the way nurses make decisions related to nursing diagnoses and interventions. Literature on decision making can be divided into literature that focuses on how decisions are made, ie, information-processing model, and information that focuses on how decisions ought to be made, ie, mathematical models. Most of the literature about decision making in nursing in particular appears to focus on the former, specifically on the stages and strategies in the decision-making process and on factors influencing this process. These factors include the problem task (cues), the decision maker (his or her knowledge, experience, personal variability), and discipline. However, to date, most of the research that has been done with regard to these factors has been restricted to the performance between novice and expert. We conclude that further validation of nursing diagnoses is necessary to ensure accuracy in decision making in nursing.

Clinical Competence↗
PubMedDate not supplied

Ensuring accountability in decision making. A step-by-step approach applies common sense to complex issues.

All institutions must routinely make decisions that may have a profound impact on their organizations and communities. The process used to reach those decisions defines an organization's commitment to its mission, values, and corporate ethics. At Sisters of Mercy Health System in St. Louis (SMHS), a corporate decision-making process was developed over the course of a year and introduced systemwide in 1994. The process establishes a disciplined and accountable technique for evaluating initiatives, discussing options, and arriving at clear, values-based decisions. The process begins with two questions: Is the proposed action compatible with the organization's mission? Will the proposed action advance the mission in any significant manner? Next, a step-by-step approach enables members of the decision-making group to consider the proposed action in light of the SMHS mission and values. Participants explore the implications of the decision from three perspectives: social vision, responsibility, and self-interest. They also consider the potential consequences of the decision on all affected parties, particularly poor and powerless people. SMHS leaders have found the decision-making process brings clarity and comprehension to the task of making decisions.

Decision Making, Organizational↗
PubMed2002

Reproductive decision making in women with multiple sclerosis.

Multiple sclerosis (MS), the most common acquired neurological disorder of young adults, often strikes young women in their childbearing years. Despite the overlap of MS onset with the childbearing years of women, little is known about how women with MS make decisions about pregnancy and childbearing. In an effort to understand the process of decision making in these women, an exploratory descriptive qualitative study was undertaken; 15 pregnant women with MS were interviewed about their decisions to become pregnant and the factors that entered into their decision-making processes. Content analysis was used to identify and describe the fears and concerns of women with MS around the process of making decisions and about how the presence of MS had influenced that process. The unpredictability of MS and the effect that pregnancy might have on MS was a strong theme that emerged from the analysis. Although participants in this study had proceeded to become pregnant despite their fears related to the effect of pregnancy on the course of their MS, they continued to perceive their decision as risky. The diagnosis of MS affected their previous plans for number of children as well as spacing of pregnancies.

Adult↗
PubMedDate not supplied

"Cost-effectiveness" estimates result in flawed decision-making in listing drugs for reimbursement.

BACKGROUND: Facing financial pressures, the provinces and territories have chosen to use "cost-effectiveness" for making decisions about drug listings. This study examines the scientific basis for the procedures used to determine cost-effectiveness in 5 Canadian provinces. METHODS: Questionnaires were mailed to key provincial informants asking about the respondent's expertise and role, the administrative and scientific basis for decision-making, organizational structures and other factors in the scientific evaluation and decision-making process, and the transparency of the process. There were also questions about the data required and received and their importance, the place of cost-effectiveness and other economic impact evaluations, the data sources for them, and the use of follow-up monitoring to evaluate the decisions made. RESULTS: Information required by the provinces for decision-making about cost-effectiveness is not available to them at the time of their decisions about listing new medications. The primary sources of data on both efficacy and cost-effectiveness are pharmaceutical companies. Efficacy information is generated in a scientifically rigorous manner, whereas the effectiveness and cost data are estimates potentially subject to biases and evaluated by judgement (expert opinion) alone. Moreover, there is no collaboration in the assessment process between provinces. The outcomes are large differences between provinces in the decisions made and, hence, in the pharmaceuticals accessible to residents. CONCLUSIONS: Current methods for making decisions about provincial drug listings are based on inadequate data, and the lack of consistency in the provinces' decisions suggest they may be scientifically flawed. We recommend establishing a single national scientific review committee, with re-evaluation of each drug's cost-effectiveness after a suitable period of monitored use.

Canada↗
PubMedDate not supplied

Chinese adolescents' reasoning about democratic and authority-based decision making in peer, family, and school contexts.

This study explored the judgments and reasoning of Chinese adolescents (13-18 years of age) from 3 regions of mainland China (N = 574) regarding procedures for making decisions involving children in peer, family, and school contexts. Participants evaluated 2 democratic decision-making procedures (majority rule and consensus) and decision making by adult authorities for 2 decisions embedded in each social context. Judgments and reasoning about decision-making procedures varied by social context and by the decision under consideration, and evaluations of procedures became more differentiated with increasing age. The findings reveal that concepts of rights, individual autonomy, and democratic norms (majority rule) are salient aspects of Chinese adolescents' social reasoning and are used to evaluate critically existing social practices.

Adolescent↗
PubMed2002

[Making decisions. A conceptual approximation].

Decision making is constant in all aspects of the nursing field, including management, professional development, investigation and assistance. But, What can be stated about the mechanisms and procedures which lead us to adopt a decision? By means of the considerations taken into account, and bearing in mind that in our country there are no research articles which deal with decision making in nursing, the authors make a bibliographical review which contributes to a critical discussion about this topic and which brings to bear elements of reflection for decision making in daily nursing practice. First, the authors deal with the origins and the evolution of decision making models in clinical practice so that they may later analyze decision making in nursing.

Decision Making, Organizational↗
PubMed2006

A comparative study examining the decision-making processes of medical and nursing staff in weaning patients from mechanical ventilation.

A prolonged period of mechanical ventilation is costly for both the patient, in terms of the risk of complications such as ventilator-acquired pneumonia, and to the health service due to the high cost of maintaining a patient in intensive care. The recognition of the role nurses can play in the weaning process and the desire to try and reduce weaning times led to the introduction of nurse-managed weaning on the intensive care unit which is the focus of this study. This means that both doctors and nurses are now responsible for making decisions about weaning. Flexible guidelines for weaning were devised which still require a large element of individual, clinical decision-making during the process. At every stage in the weaning process clinicians are required to make judgments about patient responses, using these judgments as the basis for their decision-making. This study examined the ways doctors and nurses make these decisions. Semi-structured interviews were conducted with doctors and senior nurses. A grounded theory approach was used to analyse the results and the key themes of Treatment, Balance, Making Progress and The Individual were identified which were found to be linked with particular methods of decision-making.

Algorithms↗
PubMedDate not supplied

Exploring decision-making for environmental health services: perspectives from four cities.

Increasing resources are being allocated to environmental health monitoring, especially for developing methods and collecting data to construct environmental health indicators (EHIs). Yet, little research has focused on understanding how communities and service providers make decisions with regard to environmental health priorities and the role of indicators in this process. This paper presents insights regarding local decision-making that arose from a project to test the feasibility of using community-based EHIs to facilitate communication between the providers and the recipients of environmental services in four developing-country cities. The results of the study indicate that decision-making for environmental health services is complex and iterative rather than rational and linear. Contextual and process factors play an important role. These factors include the morale of service providers, the extent of collaboration between service agencies, the priorities of different community groups and relations between service providers and communities. Scientific information, in the form of EHIs, did not appear to be a key element of decision-making in the settings studied. As tools, EHIs are unlikely to become part of the decision-making process unless they are integrated with local agendas and backed by strong local representation.

Cities↗
PubMed2004

Respiratory therapists' attitudes about participative decision making: relationship between managerial decision-making style and job satisfaction.

BACKGROUND: Studies of non-health-care work environments indicate that non-managerial employee job satisfaction is higher in companies that use participative (as opposed to autocratic) decision making. It has not been determined whether managerial decision-making style influences job satisfaction among respiratory therapists (RTs) and which managerial decision-making style RTs prefer. METHODS: We surveyed Nebraska RTs' attitudes regarding their job satisfaction, their perceptions of their managers' decision-making styles (autocratic, consultative, and/or delegative), and which decision-making style they would prefer their managers to use. We sought to determine whether there is a significant correlation between RTs' perceptions of their managers' decision-making styles and the RTs' job satisfaction. The study population was 792 licensed and practicing non-managerial RTs in Nebraska, from which we randomly selected 565 RTs to survey. The self-administered, descriptive survey used 2 Likert scales (one for decision-making style and one for job satisfaction) and inquired about 57 items. The survey was mailed on October 1, 1999. On October 28, 1999, we sent a second mailing to RTs who had not responded. RESULTS: We received 271 responses (response rate 47.9%). The respondents were generally satisfied with their jobs (mean +/- SD Minnesota Satisfaction Questionnaire score 73.46 +/- 11.63). The sub-scale scores ranged from 20 ("very dissatisfied") to 100 ("very satisfied"). The respondents did not want autocratic managerial decision making (mean +/- SD autocratic sub-scale score 4.29 +/- 0.60). Autocratic decision making was associated with lower job satisfaction (r = 0.49), whereas consultative and delegative decision making were associated with higher job satisfaction (r = -0.31 and -0.48, respectively). RTs who worked in departments that had < 25 RT employees reported higher job satisfaction than did RTs in larger departments (p = 0.029). CONCLUSIONS: Our survey data indicate that (1) RTs prefer delegative and consultative managerial decision making, (2) job satisfaction was highest in departments that had < 25 RTs in the department and in which the manager practiced participative decision making. These findings offer guidance for organizing optimal work environments for RTs.

Attitude of Health Personnel↗
PubMed1987

Risk assessment, risk perception and decision making about courses of action involving genetic risk: an overview of concepts and methods.

Developments in medical diagnostics and shifts in the ethics of human reproduction increasingly present prospective parents with deliberate choice problems involving possible child deficiencies. An adequate handling of such problems may be supported by explicit methodologies for judging risks and making decisions under uncertainty. The paper gives an overview of concepts, models and methods concerning risk analysis, risk perception and "good" decision making. Several different (stimulus) definitions of risk are presented, and it is shown that "perceived risk" (a response-defined concept) may be operationally measured at different levels of an organism's activity. Disputes on the meaning of probability statements are related to differences in the available information basis which may result from a combination of frequentistic/nonfrequentistic data about, and external/internal determination of possible consequences. After a listing of various notions of "acceptable risk", three different approaches towards making good decisions are discussed. The paper concludes with a summary and some suggestions for the improvement of genetic counseling procedures.

Decision Making↗
PubMed1999

Decision making related to complementary therapies: a process of regaining control.

The process by which women with breast cancer make decisions related to using complementary therapies was investigated using grounded theory. Open-ended interviews were conducted with 16 women receiving orthodox treatment from across the breast cancer trajectory and who used a wide range of complementary therapies. Constant comparative analysis revealed that decision making regarding complementary therapies involved three interconnected sequential phases: (1) Getting something in place: covering all the bases, (2) hand-picking complementary therapies that fit: getting a personalized regimen in place and (3) living with the security of complementary therapies: fine-tuning a regimen to live with. Factors that influenced the decision-making process, both positively and negatively, were identified. Decision making related to the use of complementary therapies was perceived as a means of regaining control during experiences of uncertainty associated with breast cancer; the outcome of which was the maintenance of hope. Implications for supporting women's decision-making efforts regarding complementary therapies are presented.

Adaptation, Psychological↗